Worse Health Perception Research Articles

Bordeline personality disorder in primary care: Characteristics and patterns of comorbidity

Background and aims:Borderline personality disorder (BPD) seems to be a prevalent condition in Primary Care (PC) with high rates of comorbidity and health care use. The aim of this study is to describe the characteristics and patterns of comorbidity in patients with suspected BPD.Methods:192 consecutive primary health care patients completed the IPDE screening questionnaire, CAGE and the Prime-MD patient questionnaire, and were interviewed by a general practitioner (GP) using the Prime-MD. Number of visits to the GP (last year), medical illnesses and treatments were also collected. “High Risk” of BPD group (RBPDg) was defined by scoring 4 or higher in the IPDE, and it was compared to patients without psychiatric morbidity and patients with any psychiatric disorder but not BPD's risk.Results:39 (20,3%) patients fulfilled the condition of RBPDg. Compared to the group of patients without psychiatry pathology (n=110) RBPDg had a higher number of visits to their GP (last year) (p<0,001), more somatic complaints (p<0,001), a worse health perception (p<0,001) and higher rates of alcohol abuse or dependence (p=0,016).In the RBPDg we found a high rate of axis I disorders, mainly major depressive disorder (MDD) (40,0%) and generalized anxiety disorder (33,3%). Furthermore, they had a lower level of education (p=0,03) and a higher rate of MDD (p=0,026) than patients with psychiatric pathology but without risk of BPD (n=43).Conclusions:Borderline personality traits or disorder could be present in many depressive patients seen in PC. GP's knowledge about personality disorders needs to be improved

A comparison of health-related quality of life between older adults with heart failure and healthy older adults

Health-related quality of life (HRQOL) in older adults with heart failure may be affected by a variety of variables including aging. It is important to determine the unique impact of heart failure to more effectively improve HRQOL in this population. The purpose of this study was to compare HRQOL and physical, psychologic, clinical, and sociodemographic status in older adults with and without heart failure. The HRQOL of 90 older adults with heart failure and 116 healthy older adults was compared. The factors best associated with HRQOL in each group were determined using multiple regression model. HRQOL was substantially worse among older adults with heart failure than among healthy older adults. Older adults with heart failure had more severe physical and emotional symptoms, poorer functional status, and worse health perceptions. Physical symptom status was the strongest predictor of HRQOL in both groups. In addition, in older adults with heart failure, physical symptom status, age, and anxiety were related to HRQOL. The poor HRQOL seen in patients with heart failure is not just a reflection of aging. Comprehensive interventions targeted toward the factors that specifically negatively impact HRQOL are essential in older adults with heart failure.

Impact of stress urinary incontinence and overactive bladder on micturition patterns and health-related quality of life

We examined the impact of stress urinary incontinence (SUI) and overactive bladder (OAB) on micturition habits and health-related quality of life (QOL). A total of 250 Korean women were included in the study. The Medical Outcomes Study Short Form (SF-36) and the King's Health Questionnaire (KHQ) were used to assess QOL in the patient (SUI, n=158 and OAB, n=92) and control (n=70) groups. A control group was recruited at the Health Promotion Center of our hospital. Each of the dimension scores in the SF-36 represents better health, while that of the KHQ does worse health perception. On the frequency-volume charts, patients with OAB had more nighttime voids than those with SUI (P=0.001). Of the eight domains in the SF-36 questionnaire, four domains were significantly different between the control and OAB groups. Patients with SUI had a significantly lower score on one domain than the controls. Between the SUI and OAB groups, only one domain showed a significant difference. Regarding the KHQ, all domain scores in control subjects were significantly lower than those in the SUI and OAB groups. Between the SUI and OAB groups, the OAB group had higher scores on 'general health perception' and 'sleep/energy disturbances', while the scores of 'physical limitations' and 'severity measures' were higher in the SUI group. Women with OAB have a higher number of nocturic episodes than those with SUI, but the QOL is not less affected by SUI than by OAB. Furthermore, simultaneous disease-specific QOL instruments should be used in the evaluation of urinary incontinence because the generic QOL instrument is not a sensitive tool for measuring QOL in this population.

Quality of Life for Children and Adolescents: Impact of HIV Infection and Antiretroviral Treatment

HIV/AIDS mortality rates in the United States are declining; pediatric HIV has become a chronic disease, with quality of life (QoL) outcomes assuming greater importance. To compare QoL among HIV-infected and uninfected children and to assess the impact of different antiretroviral regimens on QoL among HIV-infected children. Perinatally exposed, HIV-infected (N = 1847) and uninfected (N = 712) children and adolescents were studied. Among infected children, 1283 were available for the antiretroviral regimen analysis. QoL domain scores were assessed for subjects 6 months to 4 years, 5 to 11 years, and 12 to 21 years of age, and the impact of infection status and alternative treatment regimens on QoL domains was evaluated. HIV infection was associated with significantly worse mean adjusted scores for functional status among children 6 months to 4 years of age and health perceptions, physical resilience, physical functioning, and social/role functioning among those 5 to 11 years of age. However, uninfected children 5 to 11 years of age reported significantly worse psychological functioning. HIV-infected children (5-11 years of age) and adolescents (12-21 years of age) receiving no antiretroviral treatment had worse health perceptions. Adolescents receiving no antiretroviral agents also had worse symptoms. When antiretroviral regimens were compared, adolescents receiving protease inhibitor plus nonnucleoside reverse transcriptase inhibitor-containing therapy had worse symptoms, compared with those receiving protease inhibitor-containing therapy; otherwise, no significant differences were found. Generally parents of HIV-infected children 6 months to 4 years and 5 to 11 years of age generally reported lower mean QoL scores than did parents of uninfected children, although worse psychological functioning was reported for uninfected children. HIV-infected adolescents not receiving antiretroviral treatment had worse health perceptions and symptoms. We found no consistent QoL differences among children receiving different antiretroviral regimens.

Lifestyle changes after osteoporotic fractures in elderly women

OBJECTIVE: health promotion and disease prevention activities directed to osteoporosis might help to reduce the rate of osteoporotic fractures among elderly people. METHODS: in order to check whether osteoporotic women modify their habits after the fracture, 518 postmenopausal white Brazilian elderly women were recruited from the outpatient clinic of the Rheumatology Division (122 of them with fracture) and were followed for one year. Questionnaire of evaluation was based on the European Vertebral Osteoporosis Study (EVOS) and inquiries about topics related to falls, bone mass and fracture. Lateral thoracic and lumbar radiographs were taken according to a standard protocol in order to verify vertebral fracture. Bone mineral density was measured using a bone densitometer (Lunar DPX, Madison, WI). Women's behavior was analyzed before and after the fracture. RESULTS: before the fracture, 34% of them had poor health perception, 40.2% walked at least half an hour per day, 14.7% used canes, 56.6% complained of dizziness, 59.6% scattered rugs, 78.9% used public transportation, 21.1% used car, and 36.8% wore leather instead of rubber sole. After the fracture, 66.4% of those women had worse health perception; 69.7% became more sedentary, 27.9% used more canes, 63.4% complained of more dizziness, 38.3% removed rugs, 68.1% changed from public to private car transportation, and 55.7% modified their shoes from leather to rubber sole. Risk factors related to bone mass did not change before and after the fractures. CONCLUSIONS: these findings suggested that women modify only lifestyle habits related to falls but not those related to bone mass after osteoporotic fracture. Further research is needed in order to check which intervention strategies may lead to better results in preventing osteoporotic fractures.

Hypochondriasis, somatization, and perceived health and utilization of health care services.

The authors determined the different effects of hypochondriasis and somatization on health perceptions, health status, and service utilization in a primary care population. The subjects with hypochondriacal responses (HR) on the Illness Attitudes Scales or high somatic concern (HSC) on the Symptom Questionnaire had a worse perception of health and variably used more health services than the control subjects, even though the HR and HSC subjects had the same level of chronic medical disorders. Regression analyses determined that somatization contributed more to negative health perception and service utilization than did hypochondriasis, although an interaction between the two contributed to the use of psychiatric care. The authors discuss the boundary between hypochondriasis and somatization for its implications for research and clinical practice.

Systemic methotrexate therapy versus laparoscopic salpingostomy in patients with tubal pregnancy. Part I. Impact on patients’ health-related quality of life

Objective: To compare patients’ health-related quality of life after systemic methotrexate therapy versus laparoscopic salpingostomy for tubal pregnancy. Design: Multicenter randomized clinical trial. Setting: Departments of obstetrics and gynecology of six Dutch hospitals. Patient(s): Hemodynamically stable patients with a laparoscopically confirmed unruptured tubal pregnancy without signs of active bleeding, who were randomly assigned to undergo either systemic methotrexate therapy or laparoscopic salpingostomy. Intervention(s): Standard health-related quality of life questionnaires administered before and 2 days, 2 weeks, 4 weeks, and 16 weeks after confirmative laparoscopy. Main Outcome Measure(s): Health-related quality of life. Result(s): Health-related quality of life was impaired most severely 2 days after confirmative laparoscopy in both treatment groups and improved during follow-up. Health-related quality of life was impaired more severely after systemic methotrexate therapy than after laparoscopic salpingostomy. Medically treated patients had more limitations in physical functioning, role functioning, and social functioning; had worse health perceptions, less energy, more pain, more physical symptoms, and a worse overall quality of life; and were more depressed than surgically treated patients. Conclusion(s): Systemic methotrexate therapy had a more negative impact on patients’ health-related quality of life than did laparoscopic salpingostomy. This negative impact on patients’ health-related quality of life of systemic methotrexate therapy should be taken into account when deciding on the appropriate therapy for tubal pregnancy.

Do depressed patients in different treatment settings have different levels of well-being and functioning?

Differences in the functioning and well-being of adult patients with current or past depressive disorder who visited clinicians of different specialties in health maintenance organizations, solo practices, or large multispecialty group practices were examined. For patients in different systems, there were no significant differences in functioning and well-being across 12 domains tested. Patients of mental health specialists had worse mental health and more limitations in social activities, whereas patients of medical clinicians had worse physical functioning, more pain, more physical/psychophysiologic symptoms, and worse health perceptions. Thus, each system of care had depressed patients with a similar functioning and well-being "burden" but specialty sectors had patients with slightly different functioning and well-being profiles, probably reflecting patient selection of type of provider.