Differences In Health-related Quality Research Articles

Abstract 4128187: Does Health-related Quality of Life Differ by Race over time in Older Patients with Heart Failure from Before to After Heart Transplantation or Long-term Mechanical Circulatory Support?

Background: Minority patients are disproportionately affected by heart failure. Therefore, we aimed to determine the impact of race on health-related quality of life in three groups of older patients (60-80 years) with heart failure who underwent advanced surgical therapies (within race and by surgery group): (1) heart transplantation (HT, with pre-transplant mechanical circulatory support [HT MCS]), (2) HT without pre-transplant MCS (HT Non-MCS), or (3) long-term MCS, if ineligible for HT. Methods: Secondary analyses were conducted using data from the Sustaining Quality of Life of the Aged: Heart Transplant or Mechanical Support study. From 10/1/15 to 12/31/18, 396 patients with heart failure were recruited at 13 U.S. medical centers, of which 305 patients underwent HT (n=161 [68 HT MCS and 93 HT Non-MCS]) or long-term MCS (n=144) and had data through 1 year follow-up. Analysis included non-inferiority testing (Long-term MCS vs HT MCS; Long-term MCS vs HT Non-MCS). To demonstrate non-inferiority, the surgical strategies by race needed to show a difference of at least 5 percentage points, with a 95% lower confidence boundary and a two-tailed p-value<0.05 in health-related quality of life, using the Kansas City Cardiomyopathy-12 Questionnaire Overall Summary Score at baseline and 3-, 6-, and 12 months. Results: The entire cohort was on average 66.2±4.7 years, 78% male, and 84% White. All three surgical groups experienced improved health-related quality of life from before to 1 year follow-up; with the largest gain through 3-months. Using non-inferiority testing, the long-term MCS minority group did not demonstrate non-inferiority when compared to both the HT MCS minority group and HT Non-MCS minority group confidence limits above the non-inferiority margin of -5 (Figure). Also, the White long-term MCS group did not demonstrate non-inferiority when compared to the White HT MCS and White HT Non-MCS groups. Conclusion: Differences in health-related quality of life among groups based on race were not statistically significant. Per non-inferiority testing, HT is superior to long-term MCS for health-related quality of life, regardless of race.

Economic evaluation of fractional flow reserve-guided versus intravascular ultrasound-guided percutaneous coronary intervention

Abstract Background The randomized, controlled FLAVOUR trial demonstrated that the clinical outcomes of the fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) strategy were non-inferior to the intracoronary ultrasound (IVUS)-guided PCI strategy. Purpose This study aimed to compare the difference in economic implications and health-related quality of life between the two strategies. Methods A total of 890 patients with intermediate stenosis in 9 sites in China from the FLAVOUR trial were included. Direct medical costs were calculated using a combination of resource-based and event-based methods. Health utility was defined as quality-adjusted life years and assessed based on the 19-item Seattle Angina Questionnaire. The primary analysis was a cost-utility analysis. Probabilistic sensitivity, one-way sensitivity, and subgroup analyses were performed. Results At two years, the average total cost per patient was Chinese yuan (CNY) 36,287±19,531 in the IVUS-guided group and CNY 29,237±19,239 in the FFR-guided group (ΔIVUS-FFR=CNY 7,050, p<0.001). The difference was driven primarily by the cost of initial admission (ΔIVUS-FFR=CNY 6,284, p<0.001). Quality-adjusted life years gained showed no significant differences between the two groups (FFR vs. IVUS: 1.639±0.086 years vs. 1.638±0.128 years, p=0.872). The probabilistic sensitivity and one-way sensitivity analyses revealed robust results. The subgroup analysis found that the cost reductions attributed to FFR guidance decreased in several subgroups, including patients with diabetes and those with high anatomical complexity. Conclusions In patients with intermediate stenosis, FFR-guided PCI is associated with significant cost savings compared with IVUS-guided PCI at two years and shows no differences in health-related quality of life outcomes.Central Illustration

Patient-reported mental health problems and clinical outcomes in adults with non-dialysis chronic kidney disease.

Mental health affects well-being and physical health. Among adults with chronic kidney disease (CKD), mental health (MH) problems are common and can induce adverse clinical outcomes. We examined the association between patient-reported MH problems and clinical outcomes in adults with non-dialysis CKD. This prospective observational study included 1,879 participants from the KNOW-CKD (KoreaN Cohort Study for Outcomes in Patients With CKD). Patients-reported MH problems were determined using four indicators of the Korea National Health and Nutrition Examination Survey questionnaire. We described the cross-sectional differences in health-related quality of life according to MH problems. We prospectively evaluated the hazard ratio (HR) of all-cause death and end-stage kidney disease (ESKD) according to the MH problems for a median follow-up of 6.4 years. The participants (mean age 53 years; 61.6% male) had patient-reported MH problems of inadequate sleep duration (17.4%), subjective distress (27.3%), depressive symptoms (13.2%), and suicidal ideation (16.8%). In the fully adjusted Cox proportional model, poor MH (≥2 problems) was associated with a high risk of ESKD (HR, 1.46; 95% confidence interval [CI], 1.18-1.08) and death (HR, 1.55; 95% CI, 1.04-2.32) compared with good MH. Furthermore, the single indicator of suicidal ideation was associated with a high risk of ESKD (HR, 1.37; 95% CI, 1.11-1.69) and death (HR, 1.98; 95% CI, 1.34-2.92). Patient-reported MH problems are common in adults with CKD. Poor MH and only suicidal ideation are associated with a high risk of ESKD and early death. Age and sex modify the association between poor MH and adverse clinical outcomes in non-dialysis CKD.

Health-Related Quality of Life in Rugby Athletes: The Role of Dietary Supplements and Their Consumption.

This study investigates dietary supplement use among rugby players and their general health, focusing on prevalence and underlying motivations. Involving 92 athletes, it examines the relationship between supplement usage, motivations, and health outcomes using the 36-item Short Form Health Survey and a 24-item ad hoc questionnaire. Findings reveal a high frequency of supplement usage, motivated by desires to enhance performance, appearance, and mood. Significant differences in health-related quality of life are found between users and non-users, particularly in mental health, social functioning, and emotional stability. Motivations like performance enhancement and body shape manipulation were linked to altered health perceptions, indicating the psychosocial impacts of supplementation. This study emphasizes the need to consider the holistic effects of supplements on athlete well-being, advocating for a balanced approach prioritizing both physical and mental health. It calls for increased awareness among athletes, coaches, and sports professionals about the potential risks and benefits of supplement use and the importance of informed decision-making. Additionally, it highlights the need for further research to understand the mechanisms of supplement use and its impact on athlete health, aiming to enhance sports science and promote overall athlete well-being in competitive environments.

Registry-based study comparing health-related quality of life between patients with primary rectal cancer and locally recurrent rectal cancer

AimNational clinical registries offer the benefits of a comprehensive dataset, particularly when linked with patient-reported outcome (PRO) data. This aim of this study was to utilise UK registry data to assess cross-sectional differences in health-related quality of life (HrQoL) in patients with primary rectal (PRC) and locally recurrent rectal cancer (LRRC). Materials and methodsData were extracted from the COloRECTal cancer Repository (CORECT-R) and the Locally Recurrent Rectal Cancer – Quality of Life (LRRC-QoL) datasets. Propensity score matching was undertaken in a 1:1 ratio using two covariates: age and sex. The primary outcome was the FACT-C Colorectal Cancer Subscale (CCS). Statistical significance was determined using p < 0.05 and clinical significance using effect size (ES) and minimally important clinical difference (MCID). ResultsA matched cohort with 72 patients in each group was identified. Overall FACT-C CCS scores were worse in patients with LRRC from a statistical (11.80 vs 18.03, p < 0.001) and clinically meaningful perspective (ES 1.63, MCID 6.23). Patients with PRC reported better digestion (p < 0.001, ES 0.85), better control over their bowels (p < 0.001, ES 1.03) and increased appetite (p < 0.001, ES 1.74, MCID 2.08). Patients with LRRC reported worse stomach swelling (p < 0,001, ES 0.97) and more diarrhoea (p < 0.001, ES 0.92), however they reported better body image (p < 0.001, ES 0.80). ConclusionPatients with LRRC reported significantly worse overall scores in the FACT-C CCS from both a statistical and clinical perspective, demonstrating the ability of the FACT-C to distinguish between these patient groups and the benefits of the inclusion of PROs within colorectal cancer registries, specifically including patients with advanced/recurrent disease.

Quality of life, capability well-being, financial strain and physical activity in the short- and medium-term COVID-19 post-lockdown phases in the UK: a repeated cross-sectional study.

The COVID-19 lockdowns had negative effects on children's and adults' mental and physical health. There is, however, a paucity of research that explores differences in health-related quality of life (HRQL) and well-being over time after the COVID-19 lockdowns had been lifted. Furlough during lockdowns, increases in unemployment, and the emerging cost-of-living crisis all put pressure on family finances, which could have a detrimental effect on HRQL and well-being. This study, part of the wider Active-6 study, explored how HRQL, capability well-being and family financial strain changed after the lockdowns, the relationship between these outcomes, and whether physical activity had any mediating effect on differences in HRQL and capability well-being. Cross-sectional data were collected in May-December 2021 (Wave 1) and January-July 2022 (Wave 2). Children (aged 10-11) and their parent/carer were recruited from 23 to 27 schools in each wave, respectively, and completed validated questionnaires measuring HRQL (adults - EQ-5D-5L, children - CHU9D), capability well-being (adults - ICECAP-A) and family financial strain (adults - Family Economic Strain Scale, FESS). Children also completed questions on capability well-being. Weekday minutes of moderate-to-vigorous physical activity (MVPA) were measured using accelerometers. Mixed-effects regression models, adjusted for gender, age group (adults only), IMD and highest household education, were used to explore differences in HRQL and capability well-being between waves. In addition, the moderating effect of financial strain and the mediating effect of MVPA on HRQL and capability well-being were explored. Active-6 recruited 393 parent-child pairs in Wave 1 and 436 in Wave 2. There were no differences in HRQL (EQ-5D, CHU9D) and capability well-being (ICECAP-A) scores between waves, but financial strain was worse in Wave 2 compared to Wave 1 (FESS score difference 1.14 adjusted 95% CI 0.15 to 2.12). Increased financial strain was associated with lower (worse) EQ-5D-5L, CHU9D and ICECAP-A scores. There was no evidence of a mediating effect of MVPA. Pre-COVID-19 data on HRQL were not collected, so analysis was limited to post-lockdown only. Participating parents were predominantly female and participation was lower among lower socio-economic groups, limiting our ability to explore inequalities. Intervention planning to increase physical activity and health and well-being during the COVID-19 recovery should consider the financial strain families are experiencing and the negative implications of financial strain on HRQL. There were no differences in HRQL and capability well-being in children and adults after lockdowns lifted in 2021 and a year later in 2022. The results indicate increasing financial strain, which could reflect the UK's 'cost of living crisis'. This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number NIHR131847.

Frailty and Health-Related Quality of Life Among European Older Adults: The Moderating Effect of Human Development Index

ABSTRACT The Human Development Index (HDI) is a proxy for the social and economic level of countries, which is related to the health and well-being of older adults. This study aimed to examine the moderating effect of the HDI on the relationship between frailty and health-related quality of life among European older adults. Participants were 23,972 older adults (53.2% female, M = 74.2 years old, SD = 6.75 years old) from 24 European countries, joining wave 8 (2020) of the Survey of Health, Aging, and Retirement in Europe (SHARE). Multilevel modeling was used to analyze nested data. Significant differences in health-related quality of life among the several European Union countries were observed (intraclass correlation coefficient [ICC] = 0.18, LRT (1) = 5568.07, p < .001). The HDI has been shown to moderate the relationship between frailty and health-related quality of life among older adults, buffering the impact of frailty on the health-related quality of life. Since healthy aging is a priority for the European Union, policies mitigating the impact of HDI on the relationship between frailty and health-related quality of life should be implemented.

Anxiety and disease awareness in individuals with heredity for abdominal aortic aneurysm.

The psychological consequences of being aware of an increased risk of developing abdominal aortic aneurysm as a first-degree relative of a person with abdominal aortic aneurysm are hitherto unexplored. This study investigates the awareness of heritability and anxiety in male and female adult offspring of abdominal aortic aneurysm patients compared to controls. Health-related quality of life among participants with aortic pathology was compared to participants with normal aortic diameters. This was a cross-sectional point prevalence study based on the participants examined in the Detecting Abdominal Aortic Aneurysm in First Degree Relatives Trial (DAAAD; 752 adult offspring, 756 matched controls), 2020-2022. Questionnaires about health-related quality of life and study-specific questions regarding awareness of heritability were collected prior to the aortic ultrasound. Attendance rate was higher among individuals with heredity compared to controls (67% vs. 52%, p < 0.001). Of 1508 adult offspring examined, 65% reported having a close relative with abdominal aortic aneurysm (6% in controls). Female adult offspring reported higher awareness of heritability than controls (38% vs. 12%, p < 0.001), as did males (32% vs. 8%, p < 0.001). A slight majority of participants with awareness reported anxiety (54% of female offspring; 51% of male). There were no measured differences in health-related quality of life between the groups when standard health-related quality of life instruments were used. The higher-than-expected proportion of adult offspring with awareness of heritability and anxiety about such risk indicates that we fail to communicate risk to this group appropriately via the current channels of information within the healthcare system. This calls for the development of dedicated strategies for improved communication of abdominal aortic aneurysm risk to patients and their next of kin.

Sex and gender differences in health-related quality of life in individuals treated with incremental and conventional hemodialysis.

Women treated with hemodialysis report lower health-related quality of life (HRQoL) compared with men. Whether this is related to sex-specific (biological) (e.g. under-dialysis due to body composition differences) or gender-specific (sociocultural) factors (e.g. greater domestic/caregiver responsibilities for women) is unknown. We examined the association between sex assigned at birth, gender score and HRQoL in individuals initiating conventional and incremental hemodialysis. In this prospective multi-center cohort study, incident adult hemodialysis patients were recruited between 1 June 2020 and 30 April 2022 in Alberta, Canada. Sex assigned at birth and gender identity were self-reported. Gender-related characteristics were assessed by self-administered questionnaire to derive a composite measure of gender. The primary outcome was change in Kidney Disease Quality of Life 36 physical (PCS) and mental (MCS) component scores after 3 months of hemodialysis. Sixty participants were enrolled (conventional hemodialysis: 14 female, 19 male; incremental hemodialysis: 12 female, 15 male). PCS improved from baseline with conventional (P=.01) but not incremental (P=.52) hemodialysis in female participants. No difference in MCS was observed by hemodialysis type in female participants. Gender score was not associated with changes in PCS in female participants, irrespective of hemodialysis type. Higher gender score was associated with increased MCS with incremental (P=.04), but not conventional (P=.14), hemodialysis (P=.03 conventional vs incremental) in female participants. No change in PCS or MCS was seen in male participants, irrespective of hemodialysis type or gender score. In this exploratory study, conventional hemodialysis was associated with improved PCS in female participants, while incremental hemodialysis was associated with improved MCS in female participants with more roles and responsibilities traditionally ascribed to women. Large prospective studies are required to further investigate these relationships.

618. A COMPARISON OF HEALTH-RELATED QUALITY OF LIFE AT ONE YEAR FOLLOWING MINIMALLY INVASIVE VERSUS OPEN ESOPHAGECTOMY

Abstract Introduction Minimally invasive esophagectomy (MIE) is being increasingly adopted in the surgical management of esophagogastric cancer. While equivalent clinical and oncological outcomes have been demonstrated in comparison with open resections, differences in health-related quality of life (HR-QOL) between the 2 modalities into survivorship remains unclear. The aim of this study was to determine the differences in HR-QOL between MIE and open esophagectomies (OE) at 1 year post-resection. Methods Consecutive patients undergoing an esophagectomy at a single, U.K based tertiary referral centre for esophagogastric cancer between January 2018 – December 2022 were evaluated. MIE was defined as utilisation of laparoscopic, thoracoscopic or robotic access for at least one phase of an esophagectomy. HR-QOL at 1 year following surgery was measured using the validated European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ-C30) and esophagogastric cancer module (QLQ-OG25) and compared between groups. Results A total of 28 patients undergoing MIE and 25 patients undergoing OE were included. No statistical difference was noted in mean global HR-QOL between the OE and MIE cohorts at 1 year (69.33±19.50 vs 64.88±22.05; p=0.66). No statistically significant intergroup differences between OE versus MIE were observed at 1 year in physical functioning (82.67±16.89 vs 79.05±24.39; p=0.97) or role functioning (73.33±29.27 vs 67.86±32.37; p=0.60) domains. Similarly, no difference was observed in symptoms of nausea/vomiting (10.67±18.17 vs 8.93±14.69; p=0.56), pain (29.33±25.56 vs 26.79±33.44; p=0.26) or fatigue (29.78±25.40 vs 37.70±30.44; p=0.44). Conclusion HR-QOL remains comparable between MIE and OE at 1 year. Patient-reported outcomes must be assessed in the long-term to determine if minimally invasive approaches confer HR-QOL improvements well into survivorship.

Sex differences in health-related quality of life among older Korean adults with type 2 diabetes mellitus: a cross-sectional study

Objectives: This cross-sectional study examined sex differences in Health-Related Quality of Life (HRQoL) among seniors with Type 2 Diabetes Mellitus (T2DM).Methods: Data from the Korea National Health and Nutrition Examination Survey (2008–2020) were analyzed. The EuroQol-5 Dimensions (EQ-5D), a measure of HRQoL, was used. It comprises five dimensions: mobility, self-care, usual activity, pain/discomfort, and anxiety/depression, each with three levels.Results: Analysis of 3,826 older adults with T2DM showed a significant increasing trend in the EQ-5D Index from the 4th survey phase onwards (P for trend &lt; 0.001 for both men and women). Men consistently reported higher EQ-5D levels than women across all survey years. Women’s EQ-5D levels remained lower than men’s, maintaining a decade-old disparity (P &lt; 0.05). Men scored significantly higher (P &lt; 0.05) in most EQ-5D domains, except for self-care and anxiety/depression, resulting in a higher total EQ-5D Index (P = 0.001). Increased comorbidities were strongly associated with lower EQ-5D levels in both sexes. Additionally, there was a negative correlation between the EQ-5D Index and refined grain intake for both sexes (P for trend &lt; 0.001), with high-EQ-5D groups consuming fewer refined grains. Women in the high-EQ-5D group consumed more nuts, vegetables, and meat compared to men (P for trend &lt; 0.05).Conclusions: Our study highlights the sex disparities in HRQoL among older adults with T2DM. The findings suggest the need for tailored treatment guidelines aimed at improving the HRQoL of elderly T2DM patients, with a focus on their sex-specific characteristics. Implementing these tailored guidelines could enhance the HRQoL of older women with T2DM and promote more equitable healthcare outcomes. This underscores the importance of considering sex differences to comprehensively improve the well-being of this population.

Health State Utilities Associated With Treatment Burden in Cystic Fibrosis: A Patient Valuation Study

BACKGROUNDWhile recent advancements in the treatment of cystic fibrosis (CF) have improved survival, reducing high levels of treatment burden remains a priority issue for many people with CF (pwCF). However, economic evaluations of novel interventions may fail to capture their impact on treatment burden due to a lack of suitable outcome measures. This study aimed to estimate health state utilities (HSUs), for changes in treatment burden associated with different CF treatments. RESEARCH QUESTIONWhat value do pwCF place on changes in treatment burden associated with intravenous antibiotic treatment of pulmonary exacerbations, inhaled medicines, and physiotherapy? STUDY DESIGNAND METHODS: Adults attending a specialist CF center were invited to participate in a web-based time trade-off interview. Participants valued their own health, and five health state vignettes describing varying levels of intensity of physiotherapy, inhaled, and IV antibiotic treatment. HSUs for additional instances of each treatment type were estimated using mixed effect linear regression models. RESULTSFifty one people with CF completed the interview (median age, 30 years; range, 19-66); 53% were female; mean FEV(1) % predicted, 65% [SD, 20%]).Mean utility scores for own health were very similar between the EQ-5D index value (0.81, SD 0.20) and the TTO value (0.82, SD 0.20), however limited concordance was observed at the individual level. Adjusted utility decrements associated with treatment burden were -0.037 (SE 0.008) for an additional annual IV antibiotic treatment, -0.029 (SE 0.014) for an additional daily physiotherapy session, and -0.019 (SE 0.013) for an additional daily inhaled medicine. INTERPRETATIONIncreasing treatment burden was associated with decreasing HSU values. The utility decrements associated with treatment burden changes suggest meaningful differences in health-related quality of life (HRQoL) for pwCF. These findings align with existing literature on the impact of treatment burden on HRQoL, and highlight the importance of considering treatment burden in economic evaluations of interventions in CF.

Latent profile analysis for assessing symptom clusters in women with breast cancer.

To identify symptom clusters among breast cancer survivors and investigate differences in health-related quality of life (HRQoL) and distress based on these discerned symptom clusters using latent profile analysis. We enrolled 655 adult breast cancer survivors aged 19 years and older, registered with the Cancer Survivor Integrated Supportive Center from May 2020 to July 2022. The study measured five symptoms-pain, fatigue, insomnia, anxiety, and depression-using a Visual Analogue Scale ranging from 0 to 10 points. Distress was measured using the National Comprehensive Cancer Network Distress Thermometer, with scores ranging from 0 to 10 points. HRQoL was determined using the EuroQol-5 Dimension questionnaire. Data analysis was conducted using the Jamovi and Mplus 8.8 software programs. The Cluster with Few Symptoms (46.8%) was the most common, whereas the Psychological Cluster with a very high degree of depression and anxiety accounted for 20.0%, and the Moderate symptom cluster with symptoms of 3 or more points accounted for 14.4%. Distress scores were relatively high in the Psychological Cluster and the Pain-Fatigue-Insomnia Cluster, and were lowest in the Cluster with Few Symptoms (F = 103.92, p < 0.001). HRQoL scores were highest in the Cluster with Few Symptoms and lowest in the Pain-Fatigue-Insomnia Cluster (F = 177.62, p < 0.001). Approximately half of breast cancer survivors who had completed the major treatment experienced persistent high symptoms such as depression and anxiety or pain, fatigue, and insomnia. These findings provide foundational data for developing tailored intervention strategies and programs based on symptom experiences.

Sex differences in health-related quality of life and psychological distress among colorectal cancer patients: a 2-year longitudinal study.

While sex differences in the incidence and mortality of colorectal cancer (CRC) are well documented, less is known about sex differences in patients' health-related quality of life (HRQoL) and psychological distress. To enhance patient-tailored care, we aimed to longitudinally examine sex differences in HRQoL and psychological distress among CRC patients from diagnosis up until 2-year follow-up. Newly diagnosed CRC patients from four Dutch hospitals were eligible for participation. Patients (N = 334) completed questions on HRQoL (EORTC QLQ-C30) and psychological distress (HADS) before initial treatment (baseline), 4 weeks after surgery, and at 1 and 2 years after diagnosis. Also, HRQoL and psychological distress were assessed in a sex- and age-matched reference population. When directly comparing female (N = 126, 38%) and male (N = 208, 62%) CRC patients, female patients reported significantly worse HRQoL, such as more insomnia at baseline, worse physical and role functioning 4 weeks after surgery, more diarrhea at 1 year, and more pain and constipation at 2-year follow-up. However, a comparison with the reference population revealed larger differences between patients and reference in males than in females. For example, at 1- and 2-year follow-up, male patients reported significantly worse cognitive and social functioning, more insomnia, and more anxiety compared with a reference population. Especially male CRC patients reported worse HRQoL and more psychological distress when compared with a reference population. Knowledge of sex-specific differences in HRQoL and psychological distress among CRC patients may help healthcare providers anticipate and appropriately address patients' unique healthcare needs.

#376 Self-efficacy, social support and hemodiafiltration are independently associated with better Self-Reported Health Status over time

Abstract Background and Aims Patients with kidney disease receiving dialysis are a highly vulnerable population. Psychosocial determinants of Self-Efficacy (SE) and Social Support (SS) have been suggested as potentially important outcomes for people with end stage kidney disease. We investigated whether these variables could explain differences in Health-Related Quality of Life (HRQL) outcome domains over time independently or in interaction with treatment modality of high-flux hemodialysis (HD) versus high-dose hemodiafiltration (HDF). Method HRQL in 1264 participants from the international multi-centre, prospective, randomized, open label, controlled CONVINCE trial were assessed, using screening and quarterly follow-up data up to 24 months. Measures included the MOS Social Support Scale, General Self-Efficacy Scale, and PROMIS short forms for fatigue, physical function, pain interference and intensity, sleep disturbance, anxiety, cognitive function, depression, ability to participate in social roles. SE, SS and interactions with modality were included as independent variables and HRQL domains as dependent variables in a linear mixed effects model with random intercept and slope for SE and SS. Results Participants were 20-92 (M=62.33, SD=13.50) years old, 62.9% were male. Linear mixed effect regression models showed significant main effects for self-efficacy (β = −0.15-1.09, all p &amp;lt; .0001) on all HRQL domains. Significant SE × time interactions were found for all variables (β = −0.02-0.04, all p &amp;lt; .01) but pain intensity. Main effects for SS were found for cognition (β = 0.31, p = .00) and sleep disturbance (β = −0.21, p = .00). A significant SS × time interaction was found for anxiety (β = 0.01, p = .02) and sleep disturbance (β = 0.02, p = .00). Plots for these associations can be found in Figs 1 and 2. Marginal means were plotted and 25%, 50% and 75% quantiles were used to separate the different levels of SE and SS. There were no significant interactions between treatment modality (HDF vs. HD) and SE/SS. Conclusion Our results indicate that higher SE and better SS are independently associated with higher HRQL of dialysis patients over time, showing no significant interactions with HDF. SE had the largest effects on HRQL. This bears the chance to develop targeted psychosocial interventions to improve health outcomes when introducing new therapy options for patients. However, patients achieving higher HRQL over the course of the treatment may also experience higher SE and SS over time. Future research should include longitudinal assessments on these psychosocial determinants to evaluate their effect further.

Health-related quality of life by type of breast surgery in women with primary breast cancer: prospective longitudinal cohort study.

Health-related quality of life and patient-related outcome measures for patients with cancer have gained increased interest over the last decade. However, few prospective studies with longitudinal data evaluated health-related quality of life in patients with breast cancer. This study aimed to investigate how health-related quality of life changed from the time of diagnosis to 1 year after breast cancer surgery for the main surgical techniques. This prospective longitudinal single-centre study included patients with primary breast cancer diagnosed in 2019-2020 who underwent surgery. Patients completed a health-related quality of life questionnaire (Breast-Q) at baseline. One year after surgery, they completed the Breast-Q a second time, the EORTC (European Organization for Research and Treatment of Cancer) quality of life questionnaire-C30 and the quality of life questionnaire-BR23. Analysis of variance and Kruskal-Wallis tests were used to evaluate the differences in health-related quality of life between surgical groups. Analysis of covariance with robust standard errors was used to adjust for confounders. In total, 340 patients were included in the study; 160 patients received oncoplastic partial mastectomy, 112 received partial mastectomy, 42 received mastectomy and 26 had mastectomy with immediate reconstruction. Patients that had partial mastectomy or oncoplastic partial mastectomy were more satisfied with their breasts (P < 0.001), had a better body image (P = 0.006) and higher sexual functioning scores (P = 0.027) than patients who had a mastectomy with/without reconstruction. The oncoplastic and mastectomy with reconstruction groups had more breast symptoms than other groups (P < 0.001), and the mastectomy group had the least symptoms from the chest area. Partial mastectomy and oncoplastic partial mastectomy have the best outcomes in terms of breast satisfaction, body image and sexual functioning. This highlights the importance of preserving the breast when feasible and underscores that breast reconstruction is not equal to breast conservation. Registration number: NCT04227613 (http://www.clinicaltrials.gov).

Sex differences in health-related quality of life and poverty risk among older people living with HIV in Spain: A cross-sectional study.

Current antiretroviral therapies have increased the life expectancy of people living with HIV (PLHIV). There is, however, limited evidence regarding the health-related quality of life (HRQoL) and living conditions of older people living with HIV (OPLHIV) in Spain. We implemented a self-administered online questionnaire to identify sex differences in HRQoL and poverty risk among Spanish OPLHIV (PLHIV ≥50 years). Participants were contacted through non-governmental organisations. We used the standardised WHOQoL-HIV BREF questionnaire and the Europe 2020 guidelines to estimate HRQoL and poverty risk respectively. The statistical analysis included multivariable generalised linear models with potential confounding variables and robust estimates. The study included 247 OPLHIV (192 men and 55 women). On the WHOQoL-HIV BREF questionnaire, men scored higher on 84% of items and in all six domains. Women had significantly lower HRQoL in five domains: physical health (β: -1.5; 95% CI: -2.5, -0.5; p: 0.002), psychological health (β: -1.0; 95% CI: -1.9, -0.1; p: 0.036), level of independence (β: -1.1; 95% CI: -1.9, -0.2; p: 0.019), environmental health (β: -1.1; 95% CI: -1.8, -0.3; p: 0.008), and spirituality/personal beliefs (β: -1.4; 95% CI: -2.5, -0.3; p: 0.012). No statistical differences were found in the domain of social relations. Poverty risk was considerable for both men (30%) and women (53%), but women were significantly more likely to experience it (OR: 2.9; 95% CI: 1.3, 6.5; p: 0.009). The aging of PLHIV is a public health concern. Our findings indicate that HRQoL and poverty risk among Spanish OPLHIV differ significantly by sex. Spain should, therefore, implement specific policies and interventions to address OPLHIV needs. The strategies must place a high priority on the reduction of sex inequalities in HRQoL and the enhancement of the structural conditions in which OPLHIV live.

Bronchoscopy-guided antimicrobial therapy for cystic fibrosis.

Bronchoscopy-guided antimicrobial therapy for cystic fibrosis.

Health-related Quality of Life following Mild (COVID)-19 Illness

Objectives: A cluster analysis was undertaken to help explain reported differences in health-related quality of life among acute respiratory illness (ARI) outpatients. Methods: Symptomatic enrollees (18-87 years) completed the Short Form Health Survey at enrollment and 6-8 weeks later from March 30, 2020 through April 30, 2021. We compared changes in physical health composite score (PCS) and mental health composite score (MCS) across high, medium, and low functioning clusters within COVID-19 cases and non- COVID cases by multivariable regression. Results: Improvements in PCS and MCS among 973 participants were significantly and inversely related to high function at enrollment in both COVID-19 and in non-COVID cases. PCS improvements also were related to more days between surveys and having shortness of breath (SOB) at enrollment in COVID-19 cases, and to younger age and higher educational attainment among non-COVID cases. Improvements in MCS were related to higher educational achievement and older age and inversely related to SOB at enrollment in COVID-19 cases; in non-COVID cases, increases in MCS were significantly related to being male, time between surveys, and inversely related to SOB at enrollment. Conclusion: High functioning COVID-19 cases and non-COVID cases reported smaller improvements in PCS than lower functioning groups. Not experiencing SOB was related to greater improvements in MCS.

Minimal clinically important differences in health-related quality of life after treatment with direct-acting antivirals for chronic hepatitis C: ANRS CO22 HEPATHER cohort (PROQOL-HCV).

Patient Reported Outcomes Quality of Life survey for HCV (PROQOL-HCV) is a specific tool developed to assess health-related quality of life (HRQoL) in patients with chronic hepatitis C receiving direct-acting antivirals (DAA). Thresholds for clinically meaningful changes in PROQOL-HCV scores should be documented to improve the tool's use in clinical practice. This study aimed to estimate the minimal clinically important differences (MCIDs) in PROQOL-HCV scores before and after HCV cure by DAA among participants in the prospective cohort ANRS-CO22 HEPATHER. Data from 460 chronic HCV patients were collected at DAA initiation (baseline) and 24weeks after treatment end. MCIDs were estimated for the six HRQoL dimensions (Physical Health (PH), Emotional Health (EH), Future Uncertainty (FU), Intimate Relationships (IR), Social Health (SH), and Cognitive Functioning (CF)) using two approaches: anchor-based and score distribution-based. Each MCID was estimated for improvement/deterioration both globally and separately for patients with a baseline PRQoL-HCV score ≤ 50 (group1) and patients with a baseline PRQoL-HCV score > 50 (group2). The pooled MCIDs for improvement/deterioration globally, in group1, and in group2, respectively, were as follows: 8.8/-7.6, 9.7/-9.5, and 6.0/-6.9 for PH; 7.1/-4.6, 7.7/-9.6, and 6.6/-6.7 for EH; 6.7/-6.7, 8.2/-8.2, and 6.0/-6.0 for FU; 7.0/-7.0, 5.4/-5.4, and 6.2/-6.2 for IR; 7.7/-7.7, 8.6/-8.6, and 6.5/-6.5 for SH; 7.3/-5.6, 9.1/-8.0, and 6.5/-6.3 for CF. The overall MCID for the PROQOL-HCV scores ranged from 6.7 to 8.8 for improvement and from -7.7 to -4.6 for deterioration. The effect of DAA on PROQOL-HCV scores seemed particularly beneficial for patients with lower baseline scores. This subgroup could be motivated to take DAA if they are informed of the benefits for their HRQoL.