Chronic Disease Population Research Articles

In Vitro Cell Study of Possible Anti-inflammatory and Pain Relief Mechanism of Far-infrared Ray-emitting Ceramic Material

Inflammation and pain are the major chronic symptoms in geriatric medicine. This study examines the possible mechanism of a far-infrared ray-emitting ceramic material (bioceramic) on these symptoms using cell models. Effective doses of lipopolysaccharides (LPS) were added to induce acute episodes of inflammation in murine macrophage (RAW 264.7) and human chondrosarcoma (SW1353) cells. The inducible nitric oxide synthetase (iNOS), cyclo-oxygenase-2 (COX-2), and prostaglandin E2 (PGE2) levels were determined for the cell lines. Biocermic treatment was found to have significant inhibitory effects on COX-2 and PGE2 and a probable effect on iNOS in the cell models of LPS-mediated inflammation. Bioceramic treatment may be an alternative method for palliative pain control to reduce chemical drug dependence for the protection of renal functions in the chronic pain disease population.

Restless Legs Syndrome in Liver Transplant Recipients

Background: The prevalence of restless legs syndrome (RLS) is approximately 10% in general population. This condition is more prevalent in certain diseases and we previously reported the prevalence of RLS in chronic liver disease population to be 62%. Objectives: Our aim was to assess the self-reported prevalence of RLS using an RLS symptom specific questionnaire in liver transplant patients. Methods: Subjects were a convenience sample in transplant clinic. They completed a validated survey for core RLS symptoms and if positive went on to completed a telephone survey using the validated International RLS Severity Scale Questionnaire (IRLS) and the Johns Hopkins RLS QoL survey to measure the effect of RLS symptoms on daily activities. Results: 40 patients surveyed, RLS was found in 16 subjects (40%) with moderate severity {17 (SD + 7.2, high score 31)}. Hepatitis C as indication for liver transplant was more likely associated with RLS (p = 0.05). Calcium channel blockers were protective (p = 0.032) while antidopaminergic agent use was statistically significant for RLS symptom (p = 0.005). On multiple linear regression analysis, diabetes (p = 0.024) and use of antidepressants/antihistamines (p = 0.049) were associated with RLS. Quality of Life (QoL) surveys specific to RLS suggested RLS symptoms resulted in significantly diminished QoL, with an average QoL score of 80 (SD + 11.7). Conclusion: There was a very high prevalence of RLS in our liver transplant patients with majority experiencing moderate or severe symptoms. The explanation for this higher prevalence is likely due to combination of comorbidites as well as medications that can trigger RLS.

Self-Care and Chronic Disease

Chronic diseases are the leading cause of death and disability worldwide. They account for almost 60% of all deaths and 43% of the global burden of disease [1]. This is expected to markedly increase with chronic disease contributing 73% of all deaths and 60% of the global burden of disease by 2020 [1]. The most prevalent chronic diseases—cardiovascular diseases, cancer, and type 2 diabetes—are linked by common and preventable biological risk factors (i.e., high blood pressure, dyslipidemia, and obesity) as well as major behavioral risk factors including unhealthy diet, physical inactivity, and tobacco use. Patient centered care, which includes self-care or self-management, is a fundamental concern for nursing and essential to the prevention and management of chronic diseases [2]. In fact, leading agencies across the globe currently emphasize the importance of patients' self-management of chronic illness symptoms and treatment. This is an international problem requiring international collaboration to address the needs of this at-risk group [3]. In this issue, the international community of nurse scientists and clinicians has contributed to an increased understanding of the multidimensional influences on self-care in chronic disease by describing predictors of self-care and related outcomes and effective strategies to help people with chronic illness improve their health and quality of life. In addition the ongoing gaps in the science of self-care are highlighted. We are pleased to include the findings of studies from nurse scientists in Australia, Brazil, Iran, Republic of Korea, Portugal, and the United States in the three most common chronic disease populations—cardiovascular disease, cancer, and type 2 diabetes. Topics covered in this special issue include predictors of self-care in Brazilian patients with heart failure following six months of home visits; the influence of health literacy on heart failure knowledge and self-care in the USA; a supportive educational program that improved self-care among Iranian adults with chronic heart failure; and the cross-cultural adaptation and psychometric testing of the Brazilian version of the Self-Care of Heart Failure Index version 6.2. As heart failure reaches epidemic proportions in all parts of the world [4], these papers add to our understanding of the influences of heart failure self-care and help to advance the science by addressing the need for culturally appropriate measurement and interventions. The importance of providing holistic nursing care to Portuguese patients with cancer is highlighted by S. M. O. Pinto et al. In this study, authors described the importance of religious beliefs, optimism, and being well-informed as contributing to quality of life among patients undergoing chemotherapy and the essential role of nurses throughout the process. Another global chronic disease on the rise is diabetes. The number of adults with diabetes is expected to increase from 366 million in 2011 to 552 million by 2030 [5]. A. Thomas and A. Ashcroft address an important and understudied population, individuals who undergo acculturation from traditional to modern life style with resulting increased risk for type 2 diabetes. As the global population becomes increasingly mobile, understanding increased risk from changes in lifestyle behaviors like physical activity and dietary choices is increasingly important for all nurses. Finally, despite the advances in nursing research of self-care and chronic disease over the past few decades, the literature reviews in this special edition remind us that there is still a great deal of conceptual and psychometric work to be done. Self-care in chronic disease is complex and there are significant limitations in the science including issues with precise yet pragmatic measurement of multiple chronic conditions, the need for rigorous scientific methodology, and, most importantly, addressing health equity issues by ensuring adequate representation of diverse populations in our research. This special edition reminds us that the global nursing community shares common concerns and challenges as well as overarching, common goals. As the number of individuals with chronic diseases like cardiovascular disease, cancer, and diabetes continues to increase, it is imperative that we as nurse scientists and nurse clinicians collaborate to improve the health and quality of life of patients with chronic disease worldwide. Victoria Vaughan Dickson Robyn A. Clark Eneida Rejane Rabelo-Silva Harleah G. Buck

Personality traits, quality of life and perceived health in adolescents with congenital heart disease

This study investigated how the Big Five personality traits were related to quality of life and perceived health in adolescents with congenital heart disease (CHD). Adolescents with CHD were selected from the database of paediatric and congenital cardiology of the University Hospitals Leuven. A total of 366 adolescents (15–20 years) participated; 364 were matched on sex and age with community controls. Adolescents’ personality was assessed using the Quick Big Five, quality of life was measured using a Linear Analogue Scale and several domains of perceived health were assessed using the Paediatric Quality of Life Inventory. Adolescents with CHD displayed similar Big Five levels as controls, except for a lower score on Extraversion. Whereas disease-specific domains of perceived health were mainly related to Emotional Stability, several traits contributed to patients’ quality of life and generic perceived health. Hence, the present findings demonstrate that the Big Five is a valuable framework for examining linkages between personality and disease adaptation in chronic disease populations. Moreover, these findings underscore the importance of examining patients’ personality to shed light on their daily functioning. Future research should explore potential mechanisms detailing how personality influences disease adaptation over time in these patients.

Prognostic Impact of the Addition of Ventilatory Efficiency to the Seattle Heart Failure Model in Patients With Heart Failure

BackgroundThe Seattle Heart Failure Model (SHFM) is a multivariable model with proven prognostic value. Cardiopulmonary exercise testing (CPX) and neurohormonal markers (eg, B-type natriuretic peptide [BNP]) are also well accepted assessment techniques in the HF population and have both demonstrated robust prognostic value. The purpose of this investigation was to assess the combined prognostic value of the SHFM and CPX. Methods and ResultsThis study included all 453 patients enrolled in the Multicenter In-Sync Randomized Clinical Evaluation (MIRACLE) trial. Baseline SHFM and CPX were used. Both peak oxygen consumption (VO2) and ventilatory efficiency (VE/VCO2) were determined. In a univariate Cox proportional model analysis, SHFM and log-transformed peak VE/VCO2 were stronger predictors of 6-month mortality (both P < .001) than log-transformed BNP (P = .013) or peak VO2 (P = .066). In a multivariable Cox proportional hazards model, neither peak VO2 nor BNP were independent predictors when added to the SHFM (P > .1). Conversely, peak VE/VCO2 was a strong independent predictor when added to the SHFM, with an increase in the Cox proportional hazards model Wald χ2 from 22.7 for SHFM alone to 33.8 with inclusion of log-transformed peak VE/VCO2 (P < .0001) and significant changes in the net reclassification improvement and integrated discrimination index (both P < .002). ConclusionsThese results indicate that the SHFM and peak VE/VCO2 work synergistically to improve prognostic resolution. Further investigation is needed to continue to optimize multivariable prognostic models in patients with HF, a chronic disease population that continues to suffer from a high adverse event rate despite advances in medical care.

Validity of activity monitors in health and chronic disease: a systematic review

The assessment of physical activity in healthy populations and in those with chronic diseases is challenging. The aim of this systematic review was to identify whether available activity monitors (AM) have been appropriately validated for use in assessing physical activity in these groups. Following a systematic literature search we found 134 papers meeting the inclusion criteria; 40 conducted in a field setting (validation against doubly labelled water), 86 in a laboratory setting (validation against a metabolic cart, metabolic chamber) and 8 in a field and laboratory setting. Correlation coefficients between AM outcomes and energy expenditure (EE) by the criterion method (doubly labelled water and metabolic cart/chamber) and percentage mean differences between EE estimation from the monitor and EE measurement by the criterion method were extracted. Random-effects meta-analyses were performed to pool the results across studies where possible. Types of devices were compared using meta-regression analyses. Most validation studies had been performed in healthy adults (n = 118), with few carried out in patients with chronic diseases (n = 16). For total EE, correlation coefficients were statistically significantly lower in uniaxial compared to multisensor devices. For active EE, correlations were slightly but not significantly lower in uniaxial compared to triaxial and multisensor devices. Uniaxial devices tended to underestimate TEE (−12.07 (95%CI; -18.28 to −5.85) %) compared to triaxial (−6.85 (95%CI; -18.20 to 4.49) %, p = 0.37) and were statistically significantly less accurate than multisensor devices (−3.64 (95%CI; -8.97 to 1.70) %, p<0.001). TEE was underestimated during slow walking speeds in 69% of the lab validation studies compared to 37%, 30% and 37% of the studies during intermediate, fast walking speed and running, respectively. The high level of heterogeneity in the validation studies is only partly explained by the type of activity monitor and the activity monitor outcome. Triaxial and multisensor devices tend to be more valid monitors. Since activity monitors are less accurate at slow walking speeds and information about validated activity monitors in chronic disease populations is lacking, proper validation studies in these populations are needed prior to their inclusion in clinical trials.

Treatment for Pulmonary Hypertension of Left Heart Disease

Pulmonary hypertension (PH) secondary to left heart disease is a largely underestimated target of therapy. Except for a specific focus on PH consequences in patients with advanced heart failure (HF) receiving a left ventricular mechanical assist device or candidates for transplantation, prevention and treatment of initial subclinical forms of PH are not considered a priority in the management of this chronic disease population. Nonetheless, there is recent growing evidence supporting a clinical and prognostic role of PH in the elderly and in HF with preserved ejection fraction (pEF). Studies have defined PH-HFpEF as a new entity typically defining the evolving nature of disease. Although the prevalence of PH in these populations is not well-defined, the potential for effective pharmacological approaches that might impact the natural history of the disease starting from earlier stages is promising. However, it should be recognized that pharmacological studies performed to date with traditional pulmonary vasodilators in cohorts with HF and left-sided PH have not been positive, primarily because of concomitant systemic hypotension and hepatic side effects. This evidence along with the lack of studies specifically performed in the elderly and HFpEF often lead Guidelines to give neutral recommendations or even arbitrary assumptions. Recent availability of selective well-tolerated pulmonary vasodilators, such as phosphodiesterase type 5 (PDE5) inhibitors, however, seem to offer a solid background for treating left-sided PH at both early and later stages of the disease process.

Benefits of remote real-time side-effect monitoring systems for patients receiving cancer treatment.

In Australia, the incidence of cancer diagnoses is rising along with an aging population. Cancer treatments, such as chemotherapy, are increasingly being provided in the ambulatory care setting. Cancer treatments are commonly associated with distressing and serious side-effects and patients often struggle to manage these themselves without specialized real-time support. Unlike chronic disease populations, few systems for the remote real-time monitoring of cancer patients have been reported. However, several prototype systems have been developed and have received favorable reports. This review aimed to identify and detail systems that reported statistical analyses of changes in patient clinical outcomes, health care system usage or health economic analyses. Five papers were identified that met these criteria. There was wide variation in the design of the monitoring systems in terms of data input method, clinician alerting and response, groups of patients targeted and clinical outcomes measured. The majority of studies had significant methodological weaknesses. These included no control group comparisons, small sample sizes, poor documentation of clinical interventions or measures of adherence to the monitoring systems. In spite of the limitations, promising results emerged in terms of improved clinical outcomes (e.g. pain, depression, fatigue). Health care system usage was assessed in two papers with inconsistent results. No studies included health economic analyses. The diversity in systems described, outcomes measured and methodological issues all limited between-study comparisons. Given the acceptability of remote monitoring and the promising outcomes from the few studies analyzing patient or health care system outcomes, future research is needed to rigorously trial these systems to enable greater patient support and safety in the ambulatory setting.

A collaborative engagement of advance care planning within a diverse chronic disease population

Patients living with Chronic Kidney Disease (CKD) have a high symptom burden associated with multi-co morbidities including diabetes and cardiovascular disease. The annual mortality rate of CKD patients is 25%,...

PMO-170 Prevalence of hepatitis E in New York among HIV negative chronic liver disease population “is it an innocent bystander”

IntroductionHepatitis E is essentially an oral fecal infection with high prevalence in developing countries. There is limited data available on its prevalence in Urban US. The study evaluates the prevalence...

Reducing Chronic Obstructive Pulmonary Disease Readmissions

Exacerbation and frequent rehospitalization in chronic obstructive pulmonary disease exacts a heavy toll on the US health care system. To address these issues, new initiatives have been proposed that are largely based on financial penalties to promote patient education and postdischarge care. However, as laudable as these goals are, improving outcomes in the chronic obstructive pulmonary disease population is more confounding than it may first appear. Chronic hypoxia, cognitive dysfunction, poor nutrition, and economic disadvantage are just a few of the challenges that require creative solutions and ongoing support. Case managers need to utilize all the potential products and services that can assist in improving outcomes for these patients. Durable medical equipment providers are often viewed as purveyors of medical equipment that offer little in the form of clinical support. However, in many cases these providers represent an overlooked resource that provides individualized, highly structured patient education and ongoing support programs. The challenge is in identifying those durable medical equipment providers that offer patients contemporary technology, and have both the resources and the commitment to provide patient support that is amenable to the goals of the hospital. This article reviews many of the confounding issues that contribute to the frequent rehospitalization of chronic obstructive pulmonary disease patients. Recommendations to improve patient education and oxygen therapy outcomes are provided along with suggestions to aid in the vetting of durable medical equipment providers. Acute care hospitals, long-term acute care hospitals, extended care facilities, integrated delivery systems. 1. An understanding of the complex variables that play in the management of chronic obstructive pulmonary disease will help the case manager to plan an effective course of care. 2. Case managers need to ensure that patients receive long-term oxygen technology that supports their lifestyle, promotes compliance, and ultimately achieves the desired outcomes. 3. Case managers must advocate for coordinated, ongoing patient education and stress the need for continuing reinforcement. 4. Case managers must ensure that patients under their care be matched with durable medical equipment providers that provide the technology and support that favors positive clinical outcomes.

The chronic bronchitis phenotype in subjects with and without COPD: the PLATINO study

Little information exists regarding the epidemiology of the chronic bronchitis phenotype in unselected chronic obstructive pulmonary disease (COPD) populations. We examined the prevalence of the chronic bronchitis phenotype in COPD and non-COPD subjects from the PLATINO study, and investigated how it is associated with important outcomes. Post-bronchodilator forced expiratory volume in 1 s/forced vital capacity <0.70 was used to define COPD. Chronic bronchitis was defined as phlegm on most days, at least 3 months per year for ≥ 2 yrs. We also analysed another definition: cough and phlegm on most days, at least 3 months per year for ≥ 2 yrs. Spirometry was performed in 5,314 subjects (759 with and 4,554 without COPD). The proportion of subjects with and without COPD with chronic bronchitis defined as phlegm on most days, at least 3 months per year for ≥ 2 yrs was 14.4 and 6.2%, respectively. Using the other definition the prevalence was lower: 7.4% with and 2.5% without COPD. Among subjects with COPD, those with chronic bronchitis had worse lung function and general health status, and had more respiratory symptoms, physical activity limitation and exacerbations. Our study helps to understand the prevalence of the chronic bronchitis phenotype in an unselected COPD population at a particular time-point and suggests that chronic bronchitis in COPD is possibly associated with worse outcomes.

Abrupt withdrawal of inhaled corticosteroids does not result in spirometric deterioration in chronic obstructive pulmonary disease: Effect of phenotyping?

BACKGROUND AND OBJECTIVE:Some studies show a decline of FEV1 only one month after withdrawal of inhaled corticosteroids (ICS), while others show no decline. We speculate that the presence of an asthma phenotype in the Chronic Obstructive Pulmonary Disease (COPD) population, and that its exclusion may result in no spirometric deterioration.METHODS:We performed a prospective clinical observation study on 32 patients who fulfilled the Global Initiative for Chronic Obstructive lung disease definition of COPD (Grade II-IV). They were divided into two phenotypic groups. 1. Irreversible asthma (A and B) (n = 13): A. Asthma: Bronchial biopsy shows diffuse thickening of basement membrane (≥ 6.6 μm). B. Airflow limitation (AFL) likely to be asthma: KCO > 80% predicted if the patient refused biopsy. 2. COPD (A and B) (n = 19): A. COPD: hypercapneic respiratory failure with raised bicarbonate, panlobular emphysema with multiple bullas, or bronchial biopsy showing squamous metaplasia and epithelial/subepithelial inflammation without thickening of the basement membrane. B. AFL likely to be COPD: KCO < 80% predicted.RESULTS:The asthma phenotype was significantly younger, had a strong association with hypertrophy of nasal turbinates, and registered a significant improvement of FEV1 (350 ml) vs a decline of - 26.5 ml in the COPD phenotype following therapy with budesonide/formoterol for one year. Withdrawal of budesonide for 4 weeks in the COPD phenotype resulted in FEV1 + 1.33% (SD ± 5.71) and FVC + 1.24% (SD ± 5.32); a change of <12% in all patients.CONCLUSIONS:We recorded no spirometric deterioration after exclusion of the asthma phenotype from a COPD group.

Innovation in Health Care: Time for a Gut Check

O the past several decades, advances in science and technology have yielded great strides in our ability to reat major medical conditions such as heart disease and cancer. he genesis of many of these technologies has been innovative iopharmaceutical, medical device, and diagnostic start-up ompanies often formed by physicians and researchers within cademic medical institutions and hospitals. These start-up companies often have taken on venture captal funding to complete product development and clinical rials. As a reward for successful clinical trials, these companies ere historically able to raise additional capital through muliple investment rounds and sometimes through an initial pubic offering of their stock to public investors. Indeed, there are several very successful examples of new herapies that followed this playbook in the area of gastroenerology including treatments for morbid obesity, hepatic enephalopathy, hepatitis C, reflux disease, and Barrett’s esophaus, all developed by small companies that effectively developed nd launched these products with the backing of high-risk nvestment capital and in concert with thought-leading physiians and inventors. Over the past 30 years, this ecosystem of physician, acaemia, start-up, and venture capital fostered a very successful ilieu for the advancement of innovation in health care and as yielded many new drugs and devices in use today by phyicians. Indeed, it has been shown previously that contrary to opular belief, venture capital returns from health care start-up nvestments actually have exceeded the returns from informaion technology and Internet investments since 2000 by a very ide margin.1 Today, however, we are at serious risk of dismantling this medical innovation ecosystem. There are 3 major reasons for this looming crisis in financing innovation in health care.

Abstract 17062: Adequacy of Primary Care Screening of Women with Adult Congenital Heart Disease

Introduction: Adults with congenital heart disease (ACHD) face non-cardiac healthcare challenges as the population ages. The 2008 ACC/AHA guidelines called for every ACHD patient to have a primary care physician and receive preventive screening, often underemphasized in chronic disease populations. Hypothesis: We assessed the hypothesis that women with ACHD have lower compliance rates for preventive screening compared with control subjects seen in a cardiac practice and with norms in the US population. Methods: IRB approved retrospective review of females over age 18 years seen in a cardiac care center in 2009-2011. Data on history, Pap smears, mammograms, colonoscopy, and bone densitometry were obtained from medical records. Adequacy of screening was defined according to US guidelines (as of November 2009). Results: We reviewed data of 164 women with ACHD, with 89 women meeting criteria with adequate data, and compared with 39 age-matched control subjects. Women with ACHD had lower rates of preventive screening compared with controls (p &lt; 0.001 for comparison across 4 screening categories, see Table 1). Compliance rates of both groups with colonoscopies were better than nationwide statistics, surpassing the Healthy People 2010 target. Women with ACHD had low screening rates for cervical cancer, breast cancer, and osteoporosis, below national averages. Follow-up for abnormal results was adequate, with lowest rates of follow up for colonoscopies. Individuals with “moderate” ACHD per Bethesda conference guidelines had the lowest rates of adequate screening (37%) compared with simple (50%) or complex (47%) disease patients. Conclusions: Women with ACHD need increased primary care screening with Pap smears, mammograms, and DEXA scans. Primary care physicians, cardiologists, and gynecologists should collaborate to ensure appropriate health maintenance screening for this growing and aging patient population.

The effect of spontaneous breathing on systemic interleukin-6 during ventilator weaning

During the weaning process, spontaneous breathing trials (SBTs) involve cardiopulmonary stress for ventilated patients. As interleukin (IL)-6 is a major modulator of the stress response, we hypothesised that systemic IL-6 increases during a SBT and that this increase is more evident in SBT failure. 49 SBTs of 30-min duration were performed on different mechanically ventilated patients, and classified as SBT failure or success. Blood samples were drawn before and at the end of the SBT. An additional sample was drawn 24 h later in a subset of patients (n = 39). Serum IL-6 levels and other inflammatory mediators commonly associated with stress were determined. IL-6 levels increased from mechanical ventilation to spontaneous breathing in all patients (p = 0.02) and in the chronic obstructive pulmonary disease (COPD) population (p = 0.05) with SBT failure compared with success, but not in non-COPD patients (p = 0.12). After 24 h of SBT stress, IL-6 levels decreased in patients with SBT failure (under mechanical ventilation at that point) (p = 0.02) and those with weaning success (p = 0.04). No changes were observed in the remaining inflammatory mediators. Systemic IL-6 increases during a 30-min, failed SBT, especially in COPD patients. Future studies may corroborate the different IL-6 responses among different populations who initiate weaning, together with the potential clinical implications.

Urotensin II Levels Are an Important Marker for the Severity of Portal Hypertension in Children

Urotensin II (U-II), a somatostatin-like cyclic peptide, was recently identified as the most potent human vasoconstrictor peptide; however, the contribution of U-II-mediated alterations in peripheral vascular tone in disease states such as chronic liver disease and portal hypertension is poorly characterised. There are no data examining U-II in chronic liver disease in children. In this study, we aimed to determine whether U-II levels in healthy children are ontogenically regulated and we explored the effect of chronic liver disease on peripheral circulating U-II levels. U-II levels from healthy controls (n = 129) were compared with a healthy adult population (n = 80) in addition to a well-characterised cohort of children with chronic liver disease (n = 20). U-II was measured by radioimmunoassay. There was no correlation between U-II and age in healthy children (r2 = 0, P = 0.8). U-II levels were similar between the paediatric and the adult control populations (1.35 ± 0.96 vs 1.25 ± 0.78, P = 0.8). U-II was significantly elevated in children with liver disease compared with controls (1.35 ± 0.96 pmol/L vs 3.56 ± 2.21 pmol/L; P < 0.001). In addition, U-II levels positively correlated with severity of liver disease as determined by Child-Pugh score (P < 0.05) and paediatric end-stage liver disease score (P < 0.001). Levels of U-II also correlated with long-term clinical outcome. These data suggest that U-II is an important marker of severity of portal hypertension in children. It is independent of age and may be a potential therapeutic target in the chronic liver disease population.

Chronic Obstructive Pulmonary Disease Patient Well-Being and Its Relationship with Clinical and Patient-Reported Outcomes: A Real-Life Observational Study

Background: Quality of life is an umbrella concept that refers to all aspects of a person’s life, including health status and well-being. While health status measure focuses on the impact of the disease on physical functioning, well-being represents the self-representation of the emotional states related to the disease itself. Objectives: The objective of this study was to evaluate the psychological well-being and its determining factors in a real-life chronic obstructive pulmonary disease (COPD) population and to evaluate if patients with a different well-being differ in illness perception, health status and alexithymia. Methods: Psychological well-being (Psychological General Well-Being Index), health status (SF-36), illness perception (Illness Perception Questionnaire), alexithymia (Toronto Alexithymia Scale), as well as clinical parameters were assessed in COPD out-patients. Results: One hundred and sixty-four patients, with a mean forced expiratory volume in 1 s of 58.5%, were recruited. Forty percent of them had a moderately/severely impaired well-being, not correlated with forced expiratory volume in 1 s and the Charlson index value but significantly with the Medical Research Council score (p = 0.0001) that appeared to be the dominant factor. Patients with impaired well-being showed a different illness perception in terms of correct identification of symptoms, disease consequences, emotional representation and confidence in treatment compared with those having a positive well-being. The latter presented a lower alexithymia prevalence and a better health status. Conclusions: In order to minimize the disease-negative effects on patients’ lives, assessment of well-being and its determining factors, as well as planning specific behavioural, educational and therapeutic interventions seem to be relevant and useful.

The Relationship of Physical Activity and Aerobic Fitness with Health-Related Quality of Life and Executive Function in Celiac Disease Patients

Celiac Disease (CD) is a multisystem disorder that is caused by gluten and affects approximately 1% of the United States population. Approximately 10% of CD patients have neurological complications, such as ataxia, brain atrophy, dementia, epileptic seizures, peripheral neuropathy, and cognitive impairment. CD patients have also been found to have lower health-related quality of life (HRQL) than the general population. Given the established relationships of physical activity and aerobic fitness with HRQL and executive function in other chronic disease populations and in older adults, it seems likely that these same relationships may exist for CD patients. However, these relationships have not been investigated. Therefore, the purpose of this study was to determine if both physical activity (number of vigorous bouts of physical activity/week; MET hours/week) and aerobic fitness were positive predictors of HRQL and executive function in CD patients. The relationship of functional fitness with those same outcome variables was also explored given the established positive relationship between functional fitness and HRQL. Separate canonical correlations were used for the HRQL composite and the executive function composite with the physical activity measures, aerobic fitness, and functional fitness. Canonical correlations for the HRQL composite with number of vigorous bouts of physical activity/week, MET hours/week, aerobic fitness, or functional fitness were not statically significant. However, canonical correlations for the executive function composite with number of vigorous bouts of physical activity/week (Rc = .55; p=0.02) and functional fitness (Rc = .57; p=0.01) were statistically significant. The results do not support positive relationships for any of the predictor variables with HRQL, and this may be due to our high functioning CD sample, which scored higher than normative scores on measures of HRQL. However, these findings do support a positive relationship for number of vigorous bouts of physical activity/week and functional fitness with executive function.

Effects of an osteoarthritis self‐management programme

The aim of this study was to assess the effectiveness of a self-management programme among osteoarthritis knee sufferers. Osteoarthritis of the knee is a major cause of loss of function and is common in the older people. A self-management programme is an effective way to increase arthritis self-efficacy, and helps with mastering self-management practices. This study was carried out from January 2008 to December 2008 and included 205 participants, with 114 in the intervention group and 91 in the control group. The 4-week trial was followed by an 8-week follow-up assessment. The outcome measures included assessments of arthritis self-efficacy, pain beliefs, unplanned medical consultations, pain days and disability days using the Mann-Whitney U-test and Friedman test. At post-intervention, significant differences were found in pain beliefs (P<0·001) and pain days (P<0·004). At 8-week follow-up, there was a significant improvement in arthritis self-efficacy: pain and other symptoms subscales (P<0·001 and 0·049, respectively), pain beliefs (P<0·001) and number of unplanned medical consultations (P<0·010). The study supports the hypothesis that a self-management programme enhances arthritis-related self-efficacy and pain beliefs. A decrease in the number of unplanned medical consultations, pain days and disability days suggests that the programme might help reduce healthcare costs. This programme has introduced a significant result about self-efficacy and self-management to a chronic disease population in Taiwan. In short, there were great beneficial effects on self-management among persons who are affected by knee osteoarthritis.