Greater Health-related Quality Of Life Impairment Research Articles

Health-related quality of life in non-alcoholic fatty liver disease: A cross-cultural study between Spain and the United Kingdom.

It is unclear what biopsychosocial factors influence the impact of NAFLD on health-related quality of life (HRQoL), and if these factors are equally important predictors between different nationalities. HRQoL (CLDQ) was measured in both Southern European (Spain, n = 513) and Northern European (United Kingdom -UK-, n = 224) cohorts of patients with NAFLD in this cross-sectional study. For each cohort, participant data were recorded on histological grade of steatohepatitis, stage of fibrosis and biopsychosocial variables. Regression analysis was used to explore which of these variables predicted HRQoL. Moderated mediation models were conducted using SPSS PROCESS v3.5 macro. Participants with severe fibrosis reported more fatigue, systemic symptoms and worry, and lower HRQoL than those with none/mild fibrosis, regardless of place of origin. In addition, body mass index (BMI) and gender were found to be significant predictors of HRQoL in both Spanish and UK participants. Female gender was associated with worse emotional function, higher BMI and more fatigue, which predicted lower participants' HRQoL. UK participants showed more systemic symptoms and worry than Spanish participants, regardless of liver severity. The negative effects of gender on HRQoL through emotional function, BMI and fatigue were reported to a greater degree in UK than in Spanish participants. UK participants showed a greater impairment in HRQoL as compared to Spanish participants. Higher fibrosis stage predicted lower HRQoL, mainly in the Spanish cohort. Factors such as female gender or higher BMI contributed to the impact on HRQoL in both cohorts of patients and should be considered in future multinational intervention studies in NAFLD.

Correlation between TSH levels and quality of life among subjects with well-controlled primary hypothyroidism.

It has been suggested that increasing levothyroxine dose to lower TSH levels within the normal laboratory range might be a therapeutic option for patients with apparently well-controlled primary hypothyroidism who are dissatisfied with their treatment and complain of physical or psychological symptoms. This study assessed whether there is a relationship between TSH levels and health-related quality of life (HRQoL) among subjects with adequately treated hypothyroidism. HRQoL was measured with the specific thyroid disease ThyPRO-39 questionnaire in 218 consecutive patients with primary hypothyroidism of any cause attending an Endocrinology Department in a single center. Patients had TSH values within the normal laboratory range on a blood test performed not before than 6 weeks prior to study participation, but they were not aware of their lab results. The association between TSH values and the different ThyPRO-39 scales was analyzed by means of multiple regression models, both linear and additive, in which, in addition to TSH, a wide set of clinical and sociodemographic variables potentially related to HRQoL were also considered. TSH levels and the use of anxiolytic and antidepressant drugs were the only variables that showed a positive linear correlation with the ThyPRO-39 composite scale in the multivariate regression analysis, indicating greater impairment in HRQoL with increasing TSH values. TSH was also independently correlated to scores of scales dealing on tiredness and emotional susceptibility. In patients with primary hypothyroidism, higher TSH values, even within the normal reference range, are associated with greater deterioration of HRQoL.

Health-Related Quality of Life Impairments and Benefits 15-19 Years after Lung or Heart Transplant

Growing numbers of patients are entering the very late term period (15+ yrs) of survivorship after cardiothoracic transplant (CTx). Their health-related quality of life (HRQOL) is unknown. We examined (a) degree of late-term HRQOL impairment in multiple domains, (b) HRQOL benefit in areas of personal growth and life satisfaction, and (c) demographic, psychosocial, and clinical correlates of HRQOL. Among 178 lung and 126 heart recipients from a single-site prospective study during the first 2 yrs post-CTx, we recontacted survivors 15-19 yrs post-CTx. We used validated scales to assess HRQOL impairments (SF-36) and benefits (personal growth from transplant experience [Post-Traumatic Growth Inventory]; having new life goals [Life Engagement Scale]; global life satisfaction rating). We examined HRQOL outcomes' associations with other patient characteristics using multivariable regression. Of 82 survivors, 64 (84%) were assessed (n=29 lung, 35 heart recipients; M±SD=16±1 y post-CTx, range 15-19; 61% male; age 66±11). They were impaired in physical functional HRQOL domains, relative to norms (Fig 1). Mean mental health and social functioning were similar to or better than norms. Personal growth, and life engagement and satisfaction averaged higher than the scales' midpoints (p<.05) and exceeded norms. More concurrent dyspnea symptoms, poorer family caregiver support, and low feelings of self-efficacy were associated (p<.05) with greater HRQOL impairment and less HRQOL benefit. Other factors (eg, demographics, lung v heart transplant, chronic graft rejection) did not predict these outcomes. Despite physical functional HRQOL impairments in the late years after CTx, mental and social HRQOL is strikingly high and other HRQOL benefits are prominent. Because patients with more dyspnea and poorer psychosocial resources appear at risk for more HRQOL impairment and less HRQOL benefit, interventions targeting such individuals may help to maximize their HRQOL.

PGI50 THE RELATIONSHIP BETWEEN DISEASE SEVERITY AND HEALTH-RELATED QUALITY OF LIFE IN PATIENTS WITH ULCERATIVE COLITIS IN JAPAN

Patients with ulcerative colitis (UC) experience abdominal pain and bloody diarrhea during the active phase of their disease, and their health-related quality of life (HRQOL) is often disrupted. Understanding patient's HRQOL along with disease severity is an important guide to select their treatment options for both patients and physicians. The aim of this study is to assess the relationship between disease severity and HRQOL in patients with UC in Japan. We conducted a multi-center, cross-sectional study in patients with UC. Patients with a variety of disease severity were recruited during their routine visits. Patients' disease severities were evaluated by their physicians using the Partial Mayo Score (pMayo). Patients were requested to fill in the Inflammatory Bowel Disease Questionnaire (IBDQ), EQ-5D, and the Work Productivity and Activity Impairment (WPAI), to assess their HRQOL and impairment in their daily work and activity. A total of 319 out-patients were enrolled from 12 health facilities. The mean age was 46 years old and 54% of patients were male. Of these, 60% of patients were in remission, 23% had a mild disease, and 18% had a moderate-to-severe disease based on the pMayo. The mean IBDQ scores were 190.5, 165.8 and 149.7 in remission, mild, and moderate-to-severe disease, respectively and these scores were statistically significant (P<0.001). The mean EQ-5D scores were also significantly lower in patients with moderate-to-severe symptoms than those in remission (mean=0.93, 0.86 and 0.79 in remission, mild and moderate-to-severe, respectively, p<0.001). A similar finding was observed with WPAI scores, where patients with moderate-to-severe disease symptoms had the largest impairment in both work and daily activity. The study demonstrated that UC disease severity is associated with patients' HRQOL. The more severe a level of disease the patients had, the greater impairment in HRQOL and work productivity patients experienced.

History of Hepatic Encephalopathy Is Associated With Symptoms of Depression in Liver Transplant Candidates

Introduction: Hepatic encephalopathy (HE) can manifest as a variety of neuropsychiatric symptoms with the potential to lead to inappropriate psychoactive drug therapy. Despite HE, patients with cirrhosis have good insight into their health related quality of life (HRQOL). We aimed to further characterize the relationship between HE and depressive symptoms in liver transplant (LT) candidates using dynamic computerized adaptive testing (CAT) to offer an individualized, tailored assessment of HRQOL. Methods: LT candidates at a single U.S. tertiary care academic medical center completed the Patient-Reported Outcomes Measurement Information System computerized adaptive testing (PROMIS-CAT) assessment via iPad. Nine health domains were assessed (physical function, cognitive function, anxiety, depression/sadness, fatigue, pain interference, sleep disturbance, social roles, and instrumental support) with scores calibrated to the general population median of 50. General linear regression modeling was used to assess the significance of differences in mean PROMIS domain scores for patients with history of HE versus those without history of HE. Results: One hundred and nine LT candidates (mean age 55.6 +/- 8.6 years, 73% male, mean Model for End Stage Liver Disease score 16.3 +/- 6.3) were enrolled. 77.7% were Child-Pugh Class B or C. Leading etiologies of liver disease included chronic hepatitis C (34.8%), nonalcoholic steatohepatitis (25.7%) and alcoholic liver disease (21.1%). 92.6% had decompensated liver disease. 62.4% of patients had a history of HE. Patients with HE reported significantly higher levels of depression/sadness (52.4 vs. 48.0, p = 0.012), fatigue (58.7 vs. 52.8, p = 0.001), pain interference (58.0 vs. 53.7, p = 0.039), and sleep disturbance (56.3 vs. 51.7, p = 0.013) compared to those without history of HE. These values were similar when compared to all candidates diagnosed with depression and/or anxiety (depression/sadness 52.2, fatigue 56.8, pain interference 56.3 and sleep disturbance 54.4). Conclusion: LT candidates with history of HE have significantly higher levels of depressive symptoms compared to those without HE as measured by individualized, dynamic CAT. PROMIS-CAT may be considered as a standard part of the assessment of LT candidates to identify which candidates may benefit most from HE-directed therapy to improve depressive symptoms prior to initiation of antidepressant medications. This may ultimately improve HRQOL in this highly compromised patient population.Figure: PROMIS CAT results stratified by hepatic decompensating event: In general, decompensated cirrhosis was associated with greater impairment in HRQOL. Hepatic encephalopathy was the strongest independent predictor of lower HRQOL.

Impact of osteoporosis and bone fracture on health-related quality of life in postmenopausal women

Background Osteoporosis is responsible for fragility fractures, which are associated with decreased physical and social function. The GINERISK study was a cross-sectional epidemiological study conducted in 4157 Spanish postmenopausal women initially diagnosed with osteoporosis according to WHO criteria within the last 2 years.Aim The aim of the study was to explore the impact of osteoporosis on health-related quality of life (HRQoL).Method Menopause-specific and generic HRQoL were assessed, respectively, with the specific Cervantes Scale and the generic SF-12v2 Health Survey. The impact of osteoporosis on HRQoL was ultimately evaluated in 3328 (80.1%) women who had measurements for both bone mineral densitometry (BMD) and HRQoL.Results Menopause-specific or generic HRQoL, respectively, were worse in women with current osteoporosis and prior osteoporotic bone fracture (BF) in comparison with current osteoporosis without BF or whose T-score had increased above −2.5 on the BMD after receiving osteoporosis drug therapy. Impaired HRQoL was found both in Spanish postmenopausal female populations and the Spanish general female population. Women with osteoporosis with BF had physical and mental summary component scores in the 20th and 30th percentiles, respectively, of the Spanish general population. Higher risk for cardiovascular death was also associated with greater HRQoL impairment. The use of selective estrogen receptor modulators in women with a BMD T-score ≤ −2.5 was associated with lower impact of osteoporosis on HRQoL, particularly in the domains of physical health and sexuality.Conclusion The HRQoL analysis results in this study demonstrated a loss of quality of life in postmenopausal women with osteoporosis and confirmed that this loss is greater in women with prior osteoporotic fracture.

Humanistic and economic burden of generalized anxiety disorder in North America and Europe

To review the humanistic and economic burden of generalized anxiety disorder (GAD). MEDLINE, EMBASE and the Cochrane Library, limited to articles published in English, between 1987 and 2010, in North America, Europe and Australia. The key focus was humanistic or functional outcomes, cost of illness and economic outcomes. Ninety articles fitting criteria on (a) GAD study population, (b) United States, Europe or Australia, and (c) humanistic burden or economic burden were reviewed. Methods and findings were summarized by two researchers; inconsistencies were resolved by a third reviewer. GAD was associated with increased impairments in psychosocial functioning, role functioning, work productivity and health-related quality of life (HRQL). The HRQL impairments were comparable with those associated with depression or panic disorder. Patients with GAD and co-morbid depression reported significantly greater impairment in HRQL than did those with either disorder alone. GAD patients had significantly higher median medical costs than primary care patients without GAD (US $2375 versus $1448). The mean annual medical cost of GAD was $2138 higher than for other anxiety disorders (mean $6475). Finally, GAD was frequently under-recognized in primary care, and available studies reported that only 20% to 32% of patients were adequately treated. The review was limited to pharmacologic treatments for GAD and to publications in English. GAD is associated with significant burden on patient functioning and well-being, leading to increased health care utilization and medical costs. Patients with GAD are often suboptimally treated, which adds to the HRQL burden of this disorder.

Online version of the food allergy quality of life questionnaire–adult form: validity, feasibility and cross‐cultural comparison

Food-allergic reactions occur in 3-4% of the adult population in Western countries. It has been shown that food allergy may impair health-related quality of life (HRQL). Food allergy quality of life questionnaires (FAQLQs) have been developed and validated, including an adult form (FAQLQ-AF). These questionnaires may be particularly useful for cross-cultural comparisons. The aims of this study were to translate the FAQLQ-AF from Dutch into English and validate an online version in the United States. Additionally, HRQL of American and Dutch food-allergic adults was compared. The Dutch FAQLQ-AF was translated into English as set out by the World Health Organization and converted to an electronic online format. Participants (food allergic American adults) were recruited through the 'Food Allergy and Anaphylaxis Network' website and completed the questionnaire online. Construct validity, internal consistency, discriminative ability and feasibility were analysed. A cross-cultural comparison was made using the Dutch FAQLQ-AF scores. Data from 180 American participants were analysed. The online FAQLQ-AF had a good construct validity (correlation with FAIM: ρ=0.72; P<0.001), internal consistency (Cronbach's α=0.95) and was discriminative for 'anaphylaxis' vs. 'no anaphylaxis' and 'number of food allergies'. The most striking finding was a significantly greater impairment in HRQL in the American participants, as compared with their Dutch counterparts (the total FAQLQ-AF scores were 4.3 vs. 3.5, respectively; P<0.001, where 1 signifies no impairment and 7 signifies extreme impairment in HRQL). The online American FAQLQ-AF is a valid instrument to measure HRQL in food-allergic patients in the United States. Additionally, HRQL of American food-allergic adults may be more impaired than Dutch food-allergic adults. The FAQLQ-AF can now be used to determine the HRQL in American food-allergic adults and can assist clinicians in optimizing management strategies for food-allergic patients.

Evaluating quality of life in patients with asthma and rhinitis: English adaptation of the rhinasthma questionnaire

Separate health-related quality of life (HRQL) instruments exist for asthma and rhinitis. The Rhinasthma questionnaire, originally developed in Italian, is a unique measure designed for use where both conditions coexist. We sought to assess the performance and validity of a new adaptation of the Rhinasthma questionnaire for use in English-speaking populations. We analyzed cross-sectional data from an ongoing study of adults with asthma and rhinitis (n = 450), asthma alone (n = 75), or rhinitis alone (n = 20). Subjects were administered an English translation of the original 30-item Rhinasthma questionnaire. Health status measures simultaneously assessed include the Short Form (SF)-12, EuroQol (EQ)-5D, and Marks Asthma Quality-of-Life. Variable cluster analysis of the original 30-item instrument identified 5 discrete item clusters corresponding to the following domains: nasal (5 items), eye (4 items), respiratory (5 items), activity restriction (9 items), and treatment burden (5 items). Two other items were removed because of poor item-cluster correlations. Subjects with concomitant asthma and rhinitis had greater HRQL impairment, as measured by the Rhinasthma, than subjects with either asthma or rhinitis alone. The Rhinasthma correlated significantly (P < .05) with the SF-12, EQ-5D, and Marks Asthma Quality-of-Life in the anticipated direction consistent with the underlying constructs. In multiple logistic regression, poorer Rhinasthma HRQL was associated with significantly (P < .05) increased odds of both asthma- and rhinitis-related disability even after taking into account physical health status as measured by the SF-12. The 28-item English adaptation of Rhinasthma performs well in assessing HRQL in patients with asthma, rhinitis, or both conditions combined.

Factors Contributing to Weight Misperception in Obese Children Presenting for Intervention

To assess weight stigma, self-perception of weight status, and factors contributing to accurate self-perception of weight status in obese youth presenting for treatment at a hospital-based multidisciplinary weight management program. Participants (N = 97; mean age = 8.56 +/- 1.66 years) used a figural rating scale to assess weight stigma and their current and ideal body type, and Sizing Me Up, a measure of obesity-specific health-related quality of life (HRQOL). The majority endorsed negative/stereotypical attributes toward an obese body type, chose an average or underweight figure as their ideal, and 39% misperceived their weight status. Older child age and greater HRQOL impairment were significant predictors (P < .01) of correct self-perception. Pediatricians may find that talking with the elementary school-aged patient and family about whether weight/size affects their day-to-day life will prove to be a salient and neutral opening to discussing the child's obesity and need for intervention.

Fatigue and Health-Related Quality of Life (HRQL) in Chronic Hepatitis C Virus Infection

In addition to chronic hepatitis, many individuals infected with hepatitis C virus (HCV) suffer from fatigue, which may compromise their health-related quality of life (HRQL). To assess systematically health-related quality of life (HRQL) in patients with chronic hepatitis C and to determine if any clinical, biochemical, virologic, demographic, and histologic features are associated with HRQL status. In this cross-sectional observational study, one hundred thirty patients with chronic HCV infection (HCV RNA positive by PCR) and 61 healthy controls were enrolled from a tertiary care teaching medical center. All patients and controls completed one generic HRQL questionnaire (MOS SF-36) and one liver-disease specific instrument (Chronic Liver Disease Questionnaire, CLDQ). Ninety-five HCV patients and all the controls also completed a fatigue questionnaire (Chronic Fatigue Screener, CFS) and had immunologic markers determined (Cryoglobulin, Soluble IL-2 receptors, Rheumatoid Factor). We compared the HRQL of HCV-infected patients to the controls and, using data from other studies, to the general population, patients with diabetes, and patients with chronic low back pain. Patients with chronic HCV had greater HRQL impairment than healthy controls and those with type II diabetes. Fatigue was the most important symptom with negative impact on HRQL. Sixty-one percent of HCV-infected patients reported fatigue-related loss of activity. Additionally, other factors associated with HRQL were gender and histologic cirrhosis. Chronic HCV infection has a profound negative impact on patients' HRQL. Disabling fatigue is the most important factor that contributes to loss of well-being in this relatively young group of patients.

Depression and altered quality of life in women with epilepsy of childbearing age.

To calculate the prevalence of depression in a referral population of women of childbearing age, to define the factors associated with depression, and to assess health-related quality of life (HRQOL) in the same population. The 642 consecutive women with epilepsy aged 18-55 years were enrolled by 40 neurologists over an 8-month period and asked to give details on selected demographic and clinical features regarding the disease, any associated clinical condition, and any drug treatment. Depression was diagnosed by using the Hamilton depression scale and HRQOL was measured through the SF-36 form. Demographic, clinical, and therapeutic risk factors for depression were searched for within the study population. Depression (any severity) was present at interview in 242 women, giving a prevalence rate of 37.7%[95% confidence interval (CI), 33.9-41.6]. Mild depression was reported by 18.5% of women, moderate depression by 8.6%, major depression by 10.3%, and severe depression by 0.3%. Factors found to be independently associated with depression (any severity) included treatment of associated conditions [relative risk (RR), 1.5; 95% CI, 1.2-1.8), concurrent disability (RR, 1.3; 95% CI, 1.0-1.6), seizures in the preceding 6 months (RR, 1.4; 95% CI, 1.1-1.7), and being unemployed or a housewife (RR, 1.3; 95% CI, 1.0-1.5). Factors associated with moderate to severe depression included treatment for associated conditions (RR, 2.0; 95% CI, 1.4-2.7), seizures in the preceding 6 months (RR, 1.7; 95% CI, 1.2-2.5), and being unemployed or a housewife (RR, 1.6; 95% CI, 1.1-2.2). Compared with normal women of similar age, patients with epilepsy tended to present lower scores for each HRQOL domain (mostly Role Physical, General Health, Social Functioning, and Role Emotional). However, when the analysis was limited to nondepressed women with epilepsy, any difference disappeared. Women with epilepsy of childbearing age are at high risk of depression. Factors associated with depression include lack of occupation, the presence of an underlying disabling condition (with treatment), and the severity of epilepsy. Compared with the general population, depressed women have greater impairment of HRQOL with epilepsy, which reflects the physical, social, and emotional implications of the disease.