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PubMed2004

Physical and mental health in young adults operated on for idiopathic scoliosis.

In this study, physical and mental health were investigated in 30 young adults who were operated on for idiopathic scoliosis, 2-3 years after surgery, and the results compared to an age- and sex-matched control group of 40 individuals. We used the short form of the 36 health survey (SF-36 version 1.2), which is a 36-item questionnaire measuring health functioning on eight scales: physical functioning, role limitations due to physical functioning, bodily pain, general health perceptions, vitality, social functioning, emotional role limitation, and general mental health. The patient scores indicated lower than the controls in physical health but higher in mental health. Otherwise, there were no significant differences between the two groups. Overall, this study showed that young adults operated on for idiopathic scoliosis were satisfied, and that their mental health was even better than the normal group, but their physical health was somewhat poorer. Thus, the surgical procedure was well tolerated and had not traumatized the patient.

Adolescent↗
PubMed2006

A nonrandomised controlled trial of endovenous laser therapy and surgery in the treatment of varicose veins.

Endovenous laser therapy (EVLT) is a minimally invasive treatment for varicose veins. This study compares early quality-of-life (QoL) outcomes following EVLT and surgery. Two nonrandomized groups were studied: an EVLT group with 70 patients, median age 49 (interquartile range [IQR] 35-58) years, and a surgery group with 62 patients, median age 49 (IQR 35-61) years. Patients were assessed prior to and at 1, 6, and 12 weeks following the procedure using the Short Form 36 (SF-36), the Aberdeen Varicose Veins Questionnaire (AVVQ), and the Venous Clinical Severity Score (VCSS). Follow-up at 1, 6, and 12 weeks was 100%, 77%, and 70% following EVLT and 100%, 85%, and 47% following surgery. SF-36 scores were significantly better in the EVLT group at 1 week (Physical Functioning, Role Physical, Bodily Pain, Vitality, and Social Functioning domains) and at 6 weeks (Physical Functioning and Role Physical). At 12 weeks, no significant differences were evident between the groups. AVVQ scores were significantly better in the EVLT group at 6 and 12 weeks. VCSS scores were significantly improved in both groups at 12 weeks. EVLT and surgery provide similar QoL improvements in patients with varicose veins. EVLT, however, removes the QoL limitations experienced by patients in the early postoperative period.

Activities of Daily Living↗
PubMed1990

Measuring quality of life in cardiac spouses.

The purpose of this study was to develop an objective instrument to measure changes in quality of life of spouses of post-myocardial infarction (MI) patients, and to determine its responsiveness and validity. A 70-item list of potential areas of concern was compiled; the 25 most frequent and important concerns comprised the framework of the final questionnaire. The questions on the Quality of Life Questionnaire for Cardiac Spouses (QL-SP) were categorized into the Emotional Function Dimension (EFD), and the Physical and Social Function Dimension (PSFD). Subjects (n = 39) completed the QL-SP and a battery of established questionnaires at home, 1-2 weeks post-hospital discharge for the patient, and 8 weeks later. Scores on the QL-SP between visits were improved for both the EFD (t = 5.56, p less than 0.001), and the PSFD (t = 6.11, p less than 0.001). The agreement between predicted and observed relationships between the dimension changes and other index changes, as measured statistically by a kappa with Cicchetti weights, was significant (kappa w = 0.43, p = 0.0012). The QL-SP appears to be responsive and valid, and may be useful in evaluating clinical and research intervention strategies.

Activities of Daily Living↗
PubMed1996

A comparison of health-related quality of life in patients with epilepsy, diabetes and multiple sclerosis.

The purpose of this investigation was to compare self-reported health-related quality of life (HRQOL) in epilepsy compared to another neurological condition or a non-neurological chronic illness. Patients with epilepsy (N = 271), multiple sclerosis (N = 85) and diabetes (N = 555) completed a generic measure of HRQOL (RAND 36-Item Health Survey 1.0 (SF-36)), and the eight SF-36 scale scores were compared across groups, adjusting for differences in sociodemographic characteristics and co-morbid medical conditions. Patients with multiple sclerosis reported significantly worse HRQOL compared to both the epilepsy and diabetes groups (who did not differ from one another) on the Physical Functioning, Role Limitations-Physical, Energy, and Social Function scales. Patients with epilepsy and multiple sclerosis did not differ from one another but reported significantly lower HRQOL scores than the diabetes group on the Emotional Well-Being and Role Limitations-Emotional scales. However, the epilepsy group reported better health perceptions compared to the diabetes and multiple sclerosis patients. Generic measures of HRQOL appear useful in identifying some effects of neurological disease, but disease-targeted supplements may be required to more clearly identify the impact of epilepsy on quality of life.

Adult↗
PubMed2005

Knee arthrodesis using an intramedullary nail.

Fifteen knee arthrodeses using an intramedullary nail were performed in 15 patients. Indications included 11 failed total knee arthroplasties (10 of 11 septic). A retrospective review revealed 100% fusion rate. Complications included 4 cases of painful hardware, 1 trochanteric bursitis, and 1 deep infection. Ten patients were available for assessment at 7 years follow-up. Average leg length discrepancy was 3.7 cm. Anatomic axis averaged 1.3 degrees valgus. Flexion angle averaged 3.5 degrees . Compared with age-matched controls, our patients fared significantly worse in physical functioning, physical role, bodily pain, vitality, and social functioning. Arthrodesis of the knee with an intramedullary nail provides a reliable means of fusion with reasonable alignment. These patients have high rates of pain and diminished functional status.

Adult↗
PubMed2005

Health-related quality of life after thoracoscopic sympathectomy for palmar hyperhidrosis.

BACKGROUND: Palmar hyperhidrosis is a benign functional disorder regarded as a psychological and social handicap. Improvement of the quality of life is a major goal of treatment. However, little attention has been given to quality of life after thoracoscopic sympathectomy, which is the first line of treatment for palmar hyperhidrosis. This study investigated the impact of thoracoscopic sympathectomy on subjective health-related quality of life (HRQoL) and psychological properties. METHODS: Forty patients who underwent thoracoscopic sympathectomy were followed up for 6 months. The HRQoL measures were the Medical Outcomes Study Short Form 36 (SF-36), the Spielberger State Trait Anxiety Inventory (STAI), and the Zung Self-Rating Depression Scale (SDS). Patients were administered these questionnaires before procedure and then again at 1, 3, and 6 months after sympathectomy. RESULTS: A comparison between the current sample and Japanese normative data for the SF-36 showed mild impairment of HRQoL before sympathectomy. However, it also showed significant improvement of the social functioning domain after sympathectomy. While there was worsening of the bodily pain and role physical domains 1 month after sympathectomy, both domains recovered in 3 months. The results of STAI showed significant improvement of both trait and state anxiety after sympathectomy. However, the results of SDS showed patients remained neurotic. CONCLUSIONS: This study is the first to show the pattern of impairment in health status and therapeutic impact in palmar hyperhidrosis patients. Hyperhidrosis is associated with impaired HRQoL. It was also demonstrated that thoracoscopic sympathectomy is safe, minimally invasive, and improves HRQoL, even if compensatory hyperhidrosis occurs.

Adolescent↗
PubMedDate not supplied

Neuropeptides and the social brain: potential rodent models of autism.

Conducting basic scientific research on a complex psychiatric disorder, such as autism, is a challenging prospect. It is difficult to dissociate the fundamental neurological and psychological processes that are disturbed in autism and, therefore, it is a challenge to discover accurate and reliable animal models of the disease. Because of their role in animal models of social processing and social bonding, the neuropeptides oxytocin and vasopressin are strong candidates for dysregulation in autism. In this review, we discuss the current animal models which have investigated oxytocin and vasopressin systems in the brain and their effects on social behavior. For example, mice lacking the oxytocin gene have profound deficits in social processing and social recognition, as do rats lacking vasopressin or mice lacking the vasopressin V1a receptor (V1aR). In another rodent model, monogamous prairie voles are highly social and form strong pair bonds with their mates. Pair bonds can be facilitated or disrupted by perturbing the oxytocin and vasopressin systems. Non-monogamous vole species that do not pair bond have different oxytocin and V1aR distribution patterns in the brain than monogamous vole species. Potential ties from these rodent models to the human autistic condition are then discussed. Given the hallmark disturbances in social function, the study of animal models of social behavior may provide novel therapeutic targets for the treatment of autism.

Animals↗
PubMed2004

Modulation of involuntary and voluntary behavior following emotional stimuli in healthy subjects.

INTRODUCTION: Alterations of behavior control are core symptoms of various psychiatric disorders. Patients present with changes in complex behavior patterns and basic motor functions. Little is known about emotional modulation of voluntary behavior. Therefore, a paradigm was developed to study simultaneously influence of emotions on voluntary and involuntary movements. METHOD: Healthy volunteers (n=30) documented aspects of their mood and personality including depression, anxiety, and impulsivity. Individuals were instructed to view color slides of different emotional content and switch off the slide after by pressing a button, which was placed in a standardized distance from the resting point. The startle reflex was elicited while looking at the slides and quantified by EMG. Kinematic measures of hand movements by infrared detection were used to analyze the patterns of voluntary movements. RESULTS: This study confirmed previous findings about the modulation of the startle reflex by emotional stimuli which may reflect activity of the amygdala and subcortical stimulus processing. Voluntary movements, which may result from cortical processing of stimuli, were not influenced by the emotional context. In individuals with higher impulsivity scores, the startle reflex amplitudes were lower and relative time to peak velocity of the movement smaller. CONCLUSION: Voluntary movements were not modulated by emotional stimuli, but time to peak velocity was shorter in individuals with greater impulsivity. The ability to generate adequate behavior as a key function of the brain is relevant for social functioning and activities of daily living. The studied paradigm could be useful to assess impulsivity and behavior control in psychiatric disorders.

Adult↗
PubMed2001

Measurement of outcome.

The outcomes of treatment of oesophageal cancer include traditional biological and physical measures, such as mortality and morbidity data, disease free and overall survival, clinical and pathological response rates and symptom control. Such factors are essential and should be recorded prospectively for clinical audit. Using this type of information alone to evaluate effectiveness of treatment is inadequate, however, because the diagnosis and treatment of oesophageal cancer has a major impact on functional well-being (including psycho-social function), general health perceptions and overall quality of life (QL)/satisfaction with health and health care. These aspects of patients' well-being need to be considered, in addition to standard outcomes in the evaluation of treatment of oesophageal cancer. Recent needs to judge the economic efficiency of health care by comparing health outcomes with costs may also be part of treatment appraisal. This article reviews surgical, oncological, patient-based and economic outcomes in oesophageal cancer.

Adenocarcinoma↗
PubMedDate not supplied

SF-36 health status of workers compensation cases with spinal disorders.

BACKGROUND CONTEXT: Poorer outcomes of treatment are reported in patients with spinal disorders who receive workers compensation. The reason for their suboptimal outcomes is unclear. No study has examined the relationship between workers compensation and the Short Form Health Survey (SF-36) health status of patients with spinal disorders. PURPOSE: To compare the self-perceived health status of spinal disorder patients receiving workers compensation with those not receiving workers compensation. STUDY DESIGN/SETTING: A cross-sectional study on 18,389 patients who were evaluated in the 28 centers comprising the National Spine Network. PATIENT SAMPLE: The study data were derived from patients when first evaluated for back or neck pain between January 1998 and April 2000. OUTCOME MEASURES: The outcome measures used were the eight individual and two component scores of the SF-36. METHODS: All first-visit patients enrolled in the National Spine Network from January 1998 to April 2000 were reviewed. Eight individual scores and two component scores of the SF-36 were compared. RESULTS: Of the 18,389 patients, 1,535 (8%) were receiving workers compensation. Bivariate analyses showed all eight individual scores, and two summary scores of the SF-36 were significantly lower (p<.0001) in patients receiving workers compensation. After controlling for confounding covariates, workers compensation status was a significant predictor of lower SF-36 scores for General Health (p<.0001), Physical Functioning (p<.0001), Role Physical (p<.01), Social Functioning (p<.05), and Mental Health (p<.05). CONCLUSIONS: Workers compensation status is associated with poorer physical and mental health of patients with spinal disorders. Because the workers compensation group is younger, has a shorter duration of symptoms, and fewer comorbid medical problems, the lower SF-36 scores most likely reflect psychological factors and not ill health per se. The lower SF-36 scores may also reflect premorbid personality differences in the workers compensation patients, compared with those not receiving workers compensation. SF-36 is a validated tool that can be used to objectively identify the patient at risk for delayed recovery. Future treatment protocols should pay special attention to improve the health-related quality of life, especially general health and physical functioning of spinal patients receiving workers compensation.

Adult↗
PubMed2004

Perceived stress, internal resources, and social support as determinants of mental health among young adults.

BACKGROUND: Mental health is a central determinant of quality of life. While psychiatric morbidity of populations has been studied extensively, the role of perceived stress, social support, and internal resources as determinant of health is still poorly understood. METHODS: We surveyed 2000 randomly selected university students. Perceived stress was measured by the Brief Encounter Psychosocial Instrument, social support by the Duke-UNC Functional Social Support Questionnaire, internal resources (mastery and self-esteem) by a brief version of the Pearlin coping questionnaire. Linear regression models were used to explore the relationships between these variables and mental health, based on the SF-12 health survey. RESULTS: After two reminders, 1257 students answered the questionnaire. In bivariate analysis, mental health was negatively associated with stress and positively associated with internal resources and social support (all p-values < 0.001). In multiple regression analysis, internal resources were positively associated with mental health, and buffered the negative impact of stress on mental health. Internal resources and stress mediated the positive impact of social support on mental health. CONCLUSIONS: Our data confirm that perceived stress is an important risk factor for low mental health and suggest that mastery and self-esteem are important protective factors of mental health among young adults.

Adaptation, Psychological↗
PubMed2003

Quality-of-life in patients with paroxysmal atrial fibrillation after catheter ablation: results of long-term follow-up.

Paroxysmal atrial fibrillation (PAF) significantly impairs patients' quality-of-life (QOL). The effect on QOL of recently developed ablation techniques with curative intention has not been studied. Thirty patients (21 men, age 54.1 +/- 9.5 years) with PAF (duration 5.6 +/- 5.2 years) who failed antiarrhythmic (3.8 +/- 1.2 trials) drug therapy underwent catheter ablation. The follow-up time was 33.9 +/- 11 months. QOL was assessed preablation, 3, 6, 9, 12, 24, and 36 months after catheter ablation. The Medical Outcomes Survey Short-Form (SF-36), scored on a 0-100 scale for each of eight domains: bodily pain, general health, mental health, physical functioning, role-emotional, role-physical, social functioning, and vitality, was used. Simultaneously, patients filled out a symptom-specific checklist (SSC) with seven clinical items scored 1-4 (1 best): dyspnea, nausea, palpitations, anxiety, syncope, presyncope, and NYHA classification. Patients with successful catheter ablation had a significant benefit in seven of eight subscales while patients with recurrence had an impact on QOL in two of eight subscales. Using SSC, a successful ablation influenced scores in all seven items while patients with recurrence had a significant change of clinical symptoms in only one item, anxiety. The subscales of the study group compared to a healthy population show higher scores after 24 months of follow-up. Patients with PAF experience a significant improvement in QOL after a successful catheter ablation. In contrast, in patients with recurrence of PAF the QOL showed improvement to a lesser extent and patients experienced ongoing symptoms.

Atrial Fibrillation↗
PubMedDate not supplied

Quality of life 12 months after coronary artery bypass graft surgery.

OBJECTIVE: The primary purpose of this study was to assess the relationship between preoperative risk factors, postoperative chronic pain, sleep, and gender on perceptions of quality of life (QoL) in a sample of 123 coronary artery bypass graft (CABG) surgery patients 12 months after surgery. A secondary purpose was to determine whether there is concordance between spousal and patient reporting of QoL after CABG surgery. DESIGN: A cross-sectional comparative study. SETTING: The study setting included patients living in the community, who had had CABG surgery 12 months earlier at The Alfred hospital, a major metropolitan public acute care center, in Melbourne, Australia. PARTICIPANTS: Study participants were 123 adult patients (mean age = 64 years) who had undergone CABG surgery and had participated in a recent clinical trial. These patients were followed up to 12 months. The patient's spouse or next of kin (NoK) was asked questions about their perception of change in the patient's QoL. INSTRUMENTS: Results were assessed using The Medical Outcome Study Short Form-36 (SF-36) questionnaire and additional questions given at 12 months after CABG surgery. The Cleveland Clinic Clinical Severity Score (CSS) was used preoperatively as a tool to predict QoL outcome. RESULTS: Significant improvements in QoL, as measured by the SF-36, were seen in physical functioning (P <.0001), bodily pain (P =.024), social functioning (P =.011), and role limitations resulting from emotional status (P =.003). Other significant associations (P =.002) were found between poor QoL and patients who reported severe pain or poor quality sleep. Low-risk patients, as identified by the preoperative CSS, were more likely to have improved QoL at 12 months. Alteration in QoL was reported equally by patients and their spouses or NoK. Short-term memory impairment was reported by 41% of spouses or NoK. CONCLUSIONS: CABG surgery results in improved QoL for the majority of patients with extensive coronary artery disease. Nevertheless, some patients continue to have severe pain, sleep disturbances, and altered relationship with their spouse or NoK 12 months after surgery.

Activities of Daily Living↗
PubMed1998

Loss of social behaviors by myxococcus xanthus during evolution in an unstructured habitat.

Social behaviors are often targets of natural selection among higher organisms, but quantifying the effects of such selection is difficult. We have used the bacterium Myxococcus xanthus as a model system for studying the evolution of social interactions. Changes in the social behaviors of 12 M. xanthus populations were quantified after 1,000 generations of evolution in a liquid habitat, in which interactions among individuals were continually hindered by shaking and low cell densities. Derived lineages were compared with their ancestors with respect to maximum growth rate, motility rates on hard and soft agar, fruiting body formation ability, and sporulation frequency during starvation. Improved performance in the liquid selective regime among evolved lines was usually associated with significant reductions in all of the major social behaviors of M. xanthus. Maintenance of functional social behaviors is apparently detrimental to fitness under asocial growth conditions.

Journal Article↗
PubMed1989

The social environment and the adaptation of mothers of physically handicapped children.

Evaluated relationships between social environmental characteristics and adaptation in 50 mothers of congenitally physically handicapped 6- to 11-year-old children. Mothers reported on utilitarian resources, child adjustment, psychosocial family resources, service utilization, and three dimensions of adaptation. Analyses of the concurrent correlational design indicated significant proportions of the variance in mental and social functioning were explained by features of the social environment. Mother's physical health could not be significantly predicted. Consistently strong contributions were made by psychosocial family resources in all adaptation domains.

Adaptation, Psychological↗
PubMed2003

Quality of life in adults with end-stage renal disease since childhood is only partially impaired.

BACKGROUND: Little is known about the quality of life of adults with end-stage renal disease (ESRD) since childhood. In a long-term follow-up study, we assessed quality of life in these patients and compared their outcomes with those in the general population and in dialysis patients with adult-onset of ESRD. METHODS: All Dutch adult patients with onset of ESRD at age 0-14 years between 1972 and 1992 were asked to complete the RAND-36 questionnaire. We obtained clinical information by reviewing all available medical charts, and by current history. Patient scores were compared with those of age-matched healthy controls and with those of patients with adult onset of dialysis, of whom data were derived from a national study on the adequacy of dialysis (NECOSAD-2). RESULTS: We obtained a complete RAND-36 score in 131 of 187 surviving patients. Clinical characteristics of participants and non-participants were similar. Compared with the general population, we found a higher prevalence of impaired quality of life in dialysis patients in the following domains: physical functioning, role limitations due to physical health, social functioning (SF), general health perception (GH) and physical component summary. In other domains, impaired quality of life was equally or less prevalent (mental component summary). In transplanted patients, only impaired GH and SF were more prevalent. In dialysis patients with adult ESRD onset, impaired quality of life was more prevalent than in the general population in all domains, except in emotional role limitations. CONCLUSIONS: Dialysis patients with paediatric ESRD have an impaired physical quality of life, but in contrast to dialysis patients with adult ESRD onset, they have a normal mental quality of life.

Activities of Daily Living↗
PubMed2003

fMRI study of recognition of facial expressions in high-functioning autistic patients.

Autistic disorder is associated with deficits in social function. The disorder may be related to dysfunction in the brain regions that are involved in the process of recognising facial expressions of other persons. Using fMRI, we investigated whether autistic patients with relatively high IQ would have different brain activation on the tasks of recognition of facial expressions (i.e. faces expressing disgust, fear, and happiness) compared with normal control subjects. In disgust and fear recognition tasks, there were different patterns of brain activation in the cortico-limbic neural circuits qbetween autistic and normal groups. Patients with autistic disorder may have difficulty in grasping facially expressed qemotions in others, and thereby cannot manipulate the interpersonally derived information.

Adolescent↗
PubMed2000

Long-term health-related quality of life in survivors of sepsis. Short Form 36: a valid and reliable measure of health-related quality of life.

OBJECTIVE: To describe the long-term health-related quality of life (HRQL) of survivors of sepsis and to evaluate the reliability and validity of the medical outcomes study Short Form-36 (SF-36) in this population. STUDY DESIGN: Cross-sectional survey. SETTING: University intensive care unit. PATIENTS: Surviving patients over the age of 17 yrs who met the criteria for the Society of Critical Care Medicine/American College of Chest Physicians definition of sepsis identified through a review of patients admitted to the intensive care unit from 1994 to 1998. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Baseline demographics and clinical characteristics were abstracted from the medical chart. After hospital discharge, the SF-36 and Patrick's Perceived Quality of Life scale were administered by telephone. The SF-36 was readministered 2 wks later. We screened the charts of 109 patients; 78 had a diagnosis of sepsis. Of these, 31 had died, 3 had severe communication problems, 9 refused to participate, and 5 patients could not be located. A total of 30 patients completed the first interview; 26 completed the second. Compared with established norms for the U.S. general population, survivors of sepsis scored significantly lower on the physical functioning, role physical, general health, vitality, and social functioning domains, as well as on the Physical Health Summary Scale. Mean scores on the Mental Health Summary Scale were very similar between the survivors of sepsis and U.S. norms. The SF-36 demonstrated high internal consistency (Cronbach's alpha ranged from 0.65 to 0.94) and excellent test-retest stability (intraclass correlation coefficient ranged from 0.75 to 0.97). Both the Physical Health Summary Scale and the Mental Health Summary Scale correlated well with overall Perceived Quality of Life scores (Pearson correlation coefficients 0.45 and 0.56, respectively). CONCLUSIONS: The long-term HRQL of survivors of sepsis is significantly lower than that of the general U.S. population. The SF-36 demonstrated good reliability and validity when used to measure HRQL in survivors of sepsis.

Activities of Daily Living↗