Health-related Quality Of Life Index Research Articles

#2285 Potentially modifiable factors influencing longitudinal health-related quality of life for those with chronic kidney disease in the NURTuRE-CKD cohort

Abstract Background and Aims Factors affecting poor health-related quality of life (HRQoL) for people with chronic kidney disease (CKD) have been previously described in literature, and worse HRQoL is associated with CKD progression and death. Little emphasis has been placed on which factors may be potentially modifiable, and longitudinal HRQoL outcome analyses in non-dialysis dependent CKD cohorts are few in number. Baseline analysis of the NURTuRE-CKD cohort identified several associations between these factors and HRQoL and these associations can now be examined with longitudinal data. Method The NURTuRE-CKD cohort study recruited 2996 participants with non-dialysis dependent CKD between 2017-2019, collecting biochemical, anthropometric, sociodemographic, medical history and patient reported outcome measure (PROM) data. Face-to-face follow-up repeated these measures. Longitudinal worsening overall HRQoL was the main outcome of interest, represented by mapped EQ-5D-3L index value and visual analogue score (VAS). Multivariable linear mixed effects models were fitted in R using the lmer and lmerTest packages. Models for index value were fit separately for each independent variable of interest and collated, as well as fitting models with all variables of interest. Models were adjusted for available confounders, repeated measures and follow-up time. P-values were adjusted for multiple testing using false discovery rate correction. Results 2054/2996 (68.6%) had complete HRQoL data at follow-up, of whom most had CKD stage G3a-G4 (n = 1597, 77.8%). 1817 (88.5%) were white and 1196 (58.2%) were male. Mean age was 63.7 (SD ±14.5) years and the mean number of comorbidities was 3.7 (SD ±2.2). Median (IQR) time between baseline and follow-up was 518 (410) days. At follow-up, mean mapped EQ-5D-3L index value was 0.72 (SD ±0.3) and mean VAS score was 70.4/100 (SD ±20.6). 1595 (77.7%) reported problems in at least one EQ-5D-5L dimension, with 255 (12.4%) developing issues since baseline. 1203 (58.6%) reported worse HRQoL index values at follow up and 910 (44.3%) reported worse VAS. The dimension with the highest number of newly reported issues at follow-up was ‘usual activities’ with 301 (14.7%). Multivariable linear mixed methods models showed independent associations with worse HRQoL (Figs 1 and 2) for those on ten or more medications (β −0.118, CI −0.137 to −0.100, p < 0.001), current smokers (β −0.036, CI −0.067 to −0.006, p = 0.0.012), obesity (β-0.059, CI −0.080 to-0.039, p < 0.001), haemoglobin of <100g/L (β-0.044, CI −0.073 to-0.016, p = 0.014), hospital anxiety and depression scale scores of 8 or above for anxiety (β-0.146, CI −0.161 to-0.130, p < 0.001) and depression (β-0.202, CI-0.219 to −0.186, p < 0.001), worse health literacy (β −0.099, CI −0.136 to −0.063, p < 0.001), and pain (β −0.148, CI −0.161 to −0.135, p ≤ 0.001), weakness (β −0.106, CI −0.120 to −0.092, p < 0.001) and shortness of breath symptoms (β −0.074, CI −0.087 to −0.060, p < 0.001). Conclusion Potentially modifiable factors influencing longitudinal worsening of HRQoL for people with CKD include polypharmacy, smoking, obesity, anaemia, depression and anxiety, limited health literacy, pain, weakness and shortness of breath symptoms. This highlights the need for high quality randomised controlled trials to test interventions addressing these factors with reported HRQoL outcomes. Further work in this cohort is required, examining a third timepoint for HRQoL and linked clinical outcome data.

Children’s health-related quality of life in early childhood education and care

ABSTRACT Studies focusing on young children’s self-reported health-related quality of life (HRQoL) are scarce. More research is needed on the reliability and validity of the methods as well as how self-reported HRQoL in early childhood is linked to other well-being factors. Using the Kiddy-KINDL questionnaire in interviews with 245 3- to 6-year-old children this study investigated how children view their quality of life in Swedish speaking early childhood education and care in Finland, how reliably it can be assessed, and how it relates to age, gender, parent-reported socioeconomic background, and teacher-reported psychological well-being. The results showed that only the social-emotional scale consisting of eight items was a reliable index of HRQoL. The correlation over time in the 12-week follow-up was significant, but small, which may reflect children’s here and now thinking. Children’s poorer self-reported social-emotional well-being was associated with externalizing problems as reported by the teachers. Older children and children from highly educated families reported better social-emotional well-being.

ESTIMATING THE COSTS, HEALTH-RELATED QUALITY OF LIFE, AND REVISION RISK IN THE YEAR AFTER ELECTIVE PRIMARY AND REVISION HIP ARTHROPLASTY PROCEDURES BY IMPLANT BEARING MATERIALS: AN ANALYSIS OF LINKED DATA FROM THE NATIONAL JOINT REGISTRY (NJR), HOSPITAL EPISODE STATISTICS (HES), AND PATIENT-REPORTED OUTCOME MEASURES (PROMS) FOR ENGLISH PATIENTS

Implants in total hip replacement (THR) are associated with different clinical and cost-effectiveness profiles,. We estimate the costs and outcomes for NHS patients in the year after THR associated with implant bearing materials using linked routinely collected data.We linked NJR primary elective THR patients for osteoarthritis to HES and National PROMs. We estimated health care costs, health-related quality of life indices, and revision risks, in the year after primary and revision THRs overall. We used generalised linear models adjusting for patient and hospital characteristics and estimated 10-year cumulative probability of revision. We imputed utilities using chained equations for half the sample with missing PROMS.We linked 577,973 elective primary THRs and 11,812 subsequent revisions. One year after primary THR, patients with the cemented THRs using cobalt chrome or stainless steel head with HCLPE liner/cup cost the NHS, on average, £13,101 (95%CI £13,080,£13,122), had an average quality-of-life score of 0.788 (95%CI 0.787,0.788), and a 10-year revision probability of 1.9% (95%CI 1.6,2.3). Compared to the reference, patients receiving a cemented THR with delta ceramic head and HCLPE liner/cup, hybrid THR with delta ceramic head and HCLPE liner/cup, and hybrid THR with alumina head and HCLPE liner/cup had lower 1-year costs (-£572 \[95% CI -£775,-£385\], -£346 \[-£501,-£192\], -£371 \[-£574,-£168\] respectively), better quality of life (0.007 \[95% CI 0.003,0.011\], 0.013 \[0.010,0.016\], 0.009 \[0.005,0.013\] respectively), and lower 10-year revision probabilities (1.4% \[1.03,2.0\], 1.5 \[1.3,1.7\], 1.6%\[1.2,2.1\] respectively).Implant bearing materials are associated with varying mean costs and health outcomes after primary THR. Ours is the first study to derive costs and health outcomes from large, linked databases using multiple imputation methods to deal with bias. Our findings are useful for commissioning and procurement decisions and to inform a subsequent cost-effectiveness model with more granular detail on THR implant types.

Evaluation of quality of life scores and family impact scales in pediatric patients with alopecia areata: a cross-sectional cohort study.

There are a limited number of studies evaluating the effects of alopecia areata (AA) on the health-related quality of life (HRQoL) of pediatric patients and their families. This study aimed to assess the HRQoL of pediatric patients with AA and their parents. This single-center cross-sectional cohort study included 72 pediatric patients diagnosed with AA. The study was conducted between December 2020 and December 2021 in the dermatology department of a single tertiary center in Turkey. The HRQoL index of the pediatric patients was assessed with the Children's Dermatology Life Quality Index (CDLQI). At the same time, their parents, who were primarily involved in the disease process, were evaluated using the Dermatological Family Impact Scale (DeFIS). An ordinal logistic regression model was used to detect predictors for CDLQI severity. The mean ± SD CDLQI of the pediatric patients who participated in our study was 8.4 ± 5.3, corresponding to moderate impairment. The highest impairment in CDLQI was observed in the symptoms and feelings domain, while the slightest impairment was observed in the domain of personal relationships (P < 0.001). There was a statistically significant positive correlation between the Severity of Alopecia Tool (SALT) score and all CDLQI domains, and the most substantial relationship was with the leisure domain (r = 0.78, P < 0.001). DeFIS scores of female patients were substantially higher than males (25.3 ± 8.6 vs. 17.6 ± 9, P = 0.001). Our study supports that AA is a disease that significantly impacts the HRQoL of affected children and their families.

The study of associated factors in relation to patient satisfaction during fixed orthodontic treatment from patients’ aspects

ABSTRACT Objective The principal objective of this study is to assess the associated factors of patient’s self-assessment problems to their satisfaction during fixed orthodontic treatment. The secondary objective is to evaluate the oral health-related quality of life index (GOHAI) of patients with a fixed orthodontic appliance. Method Adult patients older than 15 years of age with fixed orthodontic treatment were recruited to fill the questionnaires from validated Chinese version of GOHAI assessment and other parts of questions with patient’s satisfactions for the purpose of this study. Descriptive statistic test was performed between demographic variables of patient’s reported GOHAI assessment and patient’s satisfaction towards fixed orthodontic appliances. Chi-square test or fisher’s exact test was performed to determine associations between scores of GOHAI and patient’s self-reported satisfaction to tooth movement with patient satisfaction towards fixed orthodontic appliance. Result Among 125 volunteers, both males (77.4%) and females (76.6%) were satisfying during fixed orthodontic treatment. In our study, GOHAI total mean scores of 125 patients resulted (43.44) with a minimum of 28 and maximum of 58 points. There was a correlation of treatment duration, awareness of tooth movement improvement, increased frequency of visiting to orthodontic clinic to patient’s satisfaction during their treatment conditions (p < 0.05). Conclusion In this study, patient satisfaction during orthodontic treatment is in relation with ;(1) Duration period of orthodontic treatment, ;(2) Self-awareness of tooth position improvement, ;(3) Frequency of in-between visits, Yet, there is negligible associated between oral health related quality of life assessed by using GOHAI and patients satisfaction during fixed orthodontic treatment.

Evaluation of health-related quality of life in patients receiving outpatient parenteral antimicrobial therapy (OPAT) in a UK setting

ABSTRACT Background Studies assessing the benefits of outpatient parenteral antimicrobial therapy (OPAT) have paid less attention to patient-centered factors such as patients’ experiences and their health-related quality of life (HRQoL). Research design and methods Prospective before-and-after quasi-experimental study enrolled adult patients receiving OPAT at a tertiary hospital in Derbyshire, UK, between October 2022 and October 2023. Consenting patients completed paired EQ-5D-3 L questionnaires before OPAT initiation and upon completion of therapy or 30 days after its commencement (whichever occurred first). Changes and predictors of change in HRQoL indicators and associations with clinical outcomes (treatment failure, adverse events, and 30-day unplanned readmission) were examined. Results Health state index and visual analogue scale (EQ VAS) scores of 162 enrolled patients at baseline were significantly lower than the UK population averages, but the patients experienced significant improvements in both scores and in four EQ-5D dimensions (mobility, self-care, usual activities, and pain/discomfort). Baseline health index and EQ VAS scores were significant independent predictors of positive changes in HRQoL scores. Conclusions OPAT is associated with improved patient-reported quality of life and facilitates early return to work or school. Nevertheless, it is crucial to closely monitor patients with a lower baseline quality of life to optimize their overall OPAT experience.

Health-related quality of life among adults living with chronic non-communicable diseases in the Ho Municipality of Ghana: a health facility-based cross-sectional study

BackgroundMorbidity and mortality rates from chronic non-communicable diseases (CNCDs) are increasing globally. In Ghana, CNCDs account for 43% of all deaths. We examined the Health-Related Quality of Life (HRQoL) and associated factors among adults living with CNCDs in the Ho Municipality.MethodsThis was a health facility-based descriptive cross-sectional study among 432 adults living with cancer, diabetes, chronic kidney disease (CKD), stroke, and hypertension in the Ho Municipality of Ghana. The study adopted the EQ-5D-5L instrument and the Ugandan value set to compute respondents’ HRQoL index. Quantile regression models were used in analysing the data with STATA v17.0 at 95% Confidence Intervals, and statistical significance set at p < 0.05.Results63.7% of our respondents reported having a problem across the five dimensions of the EQ-5D-5L. The most problems were reported in the dimensions “Anxiety/Depression” (94.4%) and “Pain/Discomfort” (91.4%). Divorced/separated respondents (aOR=-0.52, 95% CI=-0.71, -0.33) and those living with comorbidities (aOR=-0.95, 95% CI=-0.15, -0.04,) were less likely to report high index for HRQoL. However, respondents diagnosed with CKD (aOR = 0.26, 95% CI = 0.10, 0.42), diabetes (aOR = 0.28, 95% CI = 0.11, 0.45), hypertension (aOR = 0.35, 95% CI = 0.19, 0.50) and stroke (aOR = 0.26, 95% CI = 0.11, 0.40) were more likely to report higher index than those diagnosed with cancer.ConclusionOur study revealed elevated proportions of reported problems in the “Anxiety/Depression” and “Pain/Discomfort” dimensions, indicating noteworthy concerns in these areas of HRQoL. The prevalent issues reported across HRQoL dimensions are cause for concern, posing potential exacerbation of health conditions. We advocate for collaborative efforts from the Ministry of Health, Ghana Health Service, and relevant stakeholders to scrutinize and implement interventions targeting social and psychological factors. These efforts should specifically address contributors to diminished health-related quality of life, particularly among less educated, divorced, and comorbid individuals.

Comparative Study to Assess the Safety and Effectiveness of Methotrexate and Tofacitinib in Patients Diagnosed with Rheumatoid Arthritis

Introduction: Rheumatoid Arthritis (RA) is an autoimmune disease that causes chronic inflammation of the joints resulting in pain and disability. The prevalence of RA is estimated to be 1% to 2% globally and does not have any ethnic or racial differences. Elevated C-Reactive Protein (CRP) levels in the blood indicate the presence of inflammation and can be used to detect and monitor the disease. Patients with RA tend to have a significant load in association with pain, disability and activity limitation which in turn affects the Health-Related Quality of Life. With a growing rate of RA globally there is a need to assess the safety and effectiveness of drugs and provide a suitable treatment to improve the quality of life of the patients. OBJECTIVES: The goal of the study was to compare the safety and effectiveness of Tofacitinib and Methotrexate in patients diagnosed with Rheumatoid Arthritis. The study also aimed to assess the Health-Related Quality of Life (HRQOL) of patients. Methodology: This was an observational study conducted in selected Orthopaedic clinics in T. Dasarahalli Bengaluru. All the subjects (n=40) meeting the inclusion and exclusion criteria were briefed about the purpose of the study and the informed consent was obtained. The subject’s demographic details and responses were collected. Standard questionnaires, 36-Item Short Form survey (SF-36) to assess the HRQOL and Health Assessment Questionnaire-Disease Index (HAQ-DI) to assess the effectiveness of the drugs were used in all patients. The collected data were entered in Microsoft Excel and appropriate descriptive and statistical analysis was performed. Results: A total of 40 samples were enrolled in the study based on Inclusion and Exclusion criteria. Out of which 50% of the participants were on Methotrexate (MTX) and the other 50% were on Tofacitinib. Majority of the subjects in the study were women (90%) and men (10%) with mean age 51 and 54 respectively. On comparing the effectiveness of both

Body Dissatisfaction, Weight Status and Health-related Quality of Life in Adolescents

Background: Studies on the effect of weight on quality of life provide conflicting results. The purpose of the research was to assess the interconnection between the anthropometric variables and health-related quality of life (HRQoL) in a community-based sample of schoolchildren and to establish the role of body dissatisfaction (BD) in this association. Methods: A number of tenth-year schoolchildren ( n = 413) completed a questionnaire making it possible to describe their sociodemographic and behavioral characteristics and assess body satisfaction and HRQoL (PedsQL 4.0, France). The hypothesis of BD as reflecting the relationship between anthropometric variables and HRQoL was tested using the logistic regression method. Results: No significant correlation was found between BMI and integral HRQoL scores. Waist circumference showed a significant negative correlation with the HRQoL scores in the girls, but not in the boys. The frequency of BD was 60.3% ( n = 249). The relationship between BD and anthropometric variables proved to be differently directed in the boys and the girls. BD had a significant negative correlation with psychosocial and total HRQoL scores in adolescents of both sexes and with the girls’ physical functioning scores. The relationship between HRQoL and anthropometric indices in the girls, after making adjustment for sociodemographic, behavioral variables and BD in multivariate models, was no longer significant. Conclusion: This study has shown that BD is widespread among adolescents and has a significant impact on HRQoL. The impact of actual weight status on girls’ quality of life is entirely mediated by their dissatisfaction with their own bodies, thus justifying the approach to BD as a stand-alone problem having important psychosocial implications and requiring active identification and targeted intervention.

Good subjective health status and health-related quality of life in people with chronic kidney disease: A secondary analysis using the Korea National Health and Nutritional Examination Survey in 2019 and 2020

Purpose: This cross-sectional study aimed to describe subjective health status of people with chronic kidney disease (CKD), identify factors that affect good subjective health status and investigate the relationship between good subjective health status and health-related quality of life (HRQOL) in people with CKD.Methods: This secondary analysis utilized data from the Korean National Health and Nutrition Examination Survey in 2019-2020. Participants (&lt;italic&gt;N&lt;/italic&gt;=295) had an eGFR of ≤59 mL/min/1.73 m&lt;sup&gt;2&lt;/sup&gt;. Descriptive and inferential statistics were used to analyze the data. Univariate and multivariate logistic regression analyses were performed to identify factors affecting good subjective health status and examine the association between good subjective health status and HRQOL.Results: Among all participants, 61.4% had good subjective health status, and the HRQOL index was 0.88 in people with CKD. Household income, activity limitation, stress, and the number of comorbidities in people with CKD were associated with good subjective health status. People with better subjective health status were more likely to be satisfied with self-care, usual activities, and pain/discomfort in HRQOL.Conclusion: Good subjective health status is associated with better HRQOL. Therefore, subjective health status should be assessed early, and a nursing intervention program should be developed considering factors that can improve subjective health status in people with CKD.

Living Long and Well: Cross-Temporal Meta-Analytic Evidence on Elderly Chinese Health-Related Quality of Life

China has been successful in getting her people to live longer. But, merely adding years to life and not life to years poses immense socio-economic challenges. However, not much is known about the effects of government policy and program interventions on changes in how well the elderly live over the years. Accordingly, we cross-temporally meta-analyzed 45 research reports (N = 36,352) that utilized the health-related quality of life (HRQoL) scale (SF-36) from 2000 to 2020. We found that: (1) the bodily pain, general health, vitality, and mental health of the elderly deteriorated over time; however, their physical and emotional roles, as well as their social functioning, improved with time; (2) the rising dependency ratio impoverished the HRQoL of the elderly; (3) the HRQoL indicators of the elderly revealed positive gains under the home-based care model whilst they showed a downward trend under the institutional pension model; (4) the HRQoL indicators of the elderly in economically developed areas produced mixed results; but, they all worsened over the years in economically underdeveloped areas. Thus, more investment efforts from the government and private entities are needed to reduce the dependency ratio and to improve the lives of the elderly under institutional care and/or in economically underdeveloped areas.

Patient-reported health-related quality of life outcomes following mastectomy for breast cancer, with immediate, delayed or no breast reconstruction: Four-year follow-up from a prospective cohort study.

Breast reconstruction (BR) improves women's health-related quality of life (HRQOL) following mastectomy for breast cancer, yet factors contributing to improved HRQOL remain unclear. This study aimed to explore the overall impact of mastectomy with or without BR on participants' perceptions of HRQOL over time in a cohort of women with high-risk breast cancer; to examine differences in mean HRQOL scores between immediate BR, delayed BR and no BR groups; to assess the influence of patient characteristics potentially associated with HRQOL scores; and to determine the feasibility of long-term collection of patient-reported outcome measures in clinical settings. A prospective, longitudinal study of 100 women with high-risk breast cancer who underwent mastectomy with or without breast reconstruction and were likely to require post-mastectomy radiotherapy. Four validated patient-reported questionnaires, comprising 21 outcome measures relating to HRQOL, administered at baseline and up to 4 years post-mastectomy. Demographic, clinical and surgical data extracted from patient medical records. Consistently significant declines in perceptions of future health and arm symptoms, consistently significant improvements in treatment side effects, breast symptoms and fatigue, as well as significant improvements, compared to baseline, in social functioning and financial difficulties at 48 months. No significant differences in mean HRQOL scores between women given a choice of reconstructive options. Similar trajectories of HRQOL scores were found in women with high-risk breast cancer who were offered a choice of BR. Informed choice may be an independent contributing factor in long-term maintenance of most HRQOL indicators at their pre-mastectomy levels.

Subjective Cognitive and Communicative Complaints and Health-Related Quality of Life in Parkinson's Disease with and without Mild Cognitive Impairment

IntroductionMild Cognitive Impairment (MCI) is common in Parkinson's Disease (PD). Few studies have compared the Health-Related Quality of Life (HRQoL) in patients with and without MCI due to PD (PD-MCI), and its correlation to patients’ subjective cognitive and communicative difficulties has not been explored. ObjectiveWe aimed to compare HRQoL in PD-MCI and PD without MCI (PD-nMCI), and explore its possible relationship to subjective cognitive and communicative complaints. MethodsWe included 29 PD-nMCI and 11 PD-MCI patients. The HRQoL was assessed with the Parkinson's Disease Questionnaire-39 (PDQ-39): its Cognition dimension was used as a measure of subjective cognitive complaints, its Communication dimension for subjective communicative complaints, and the summary index (PDQ-39 SI) as an indicator of HRQoL. Non-parametric partial correlations between the Cognition and Communication dimensions, and the adjusted PDQ-39 SI were conducted. ResultsPD-MCI patients had greater subjective cognitive and communicative complaints and worse HRQoL than PD-nMCI patients. In the PD-MCI group, both subjective cognitive and communicative complaints exhibited significant direct correlations with the adjusted HRQoL scores. ConclusionsHRQoL seems to be affected in PD-MCI, and it might be influenced by greater subjective cognitive and communicative complaints. Including patient-reported outcome measures of HRQoL, and providing cognitive and speech rehabilitation, as well as psychotherapeutic strategies to face these deficits can enhance the patient-centred approach in PD.

Influence of polysubstance use on the health-related quality of life among people who inject drugs undergoing opioid agonist treatment following treatment for hepatitis C virus

ABSTRACT Background Treating hepatitis C virus (HCV) in people who inject drugs (PWID) has been associated with increased health-related quality of life (HRQOL). Polysubstance use (PSU) is common among PWID, but no studies have investigated PSU influence on PWID’s HRQOL HCV treatment. Methods Participants included 150 PWID receiving HCV treatment at opioid agonist treatment clinics in Bronx, NY. The EQ-5D-3 L measurement tool assessed five health dimensions producing an index of HRQOL measured at baseline, 4-, 8-, and 12-weeks during treatment and 12- and 24-weeks post-treatment. PSU was determined at baseline. Generalized estimating equations assessed the influence of baseline PSU on changes in mean EQ-5D-3 L index over time. Results Of the 150 participants, 46 (30.7%) reported PSU and mean HRQOL overall was 0.655, indicating moderate HRQOL. Mean HRQOL was lower at all time-points for the PSU group compared to the non-PSU group. Though PSU group showed improvements in mean HRQOL from baseline (0.614) to 4-, 12- and follow-up week 24 (0.765, 0.768, and 0.731, respectively), the mean change of HRQOL scores was not significantly associated with PSU (p-value = .956). Conclusions For individuals with PWID, our study showed no difference in HRQOL between those who did and did not engage in PSU following HCV treatment.

The Non-Paced 3-Minute Sit-to-Stand Test: Feasibility and Clinical Relevance for Pulmonary Rehabilitation Assessment.

Pulmonary rehabilitation (PR) improves health-related quality-of-life (HRQoL) in individuals with chronic obstructive pulmonary disease (COPD), notably by increasing exercise tolerance. Easy-to-implement sit-to-stand tests can facilitate the assessment of exercise tolerance in routine practice. This retrospective study conducted in a real-life setting was designed to describe the non-paced 3-min sit-to-stand test (3-STST) and to evaluate its relationship with HRQoL (VQ11 questionnaire) to identify the determinants of 3-STST performance and to analyze the evolution of 3-STST performance and HRQoL over the course of a community-based PR program. Seventy-one COPD patients (age 69 ± 10 years old; 51% with GOLD spirometric stages III-IV) were included. Mean ± SD 3-STST performance at the initial PR assessment was 43 ± 15 repetitions. This performance was significantly associated with HRQoL and other indicators of clinical severity (lung function, dyspnea, and functional capacities). During the multivariate analysis, younger age, exertional dyspnea with mMRC ≤ 1, and better HRQoL were significantly associated with better 3-STST performance. From the initial to second PR assessment, changes in 3-STST performance were significantly associated with changes in HRQoL. This study provides evidence that the non-paced 3-STST is feasible and might be clinically relevant in the assessment of patients with COPD referred for community-based PR. This test deserves to be prospectively validated.

The influence of transient loss of consciousness in children on the health-related quality of life indicators

Abstract. Any acute, recurrent or inflammatory disease can cause numerous changes in various areas of a child's life from daily duties to emotional and cognitive development, self-esteem, and relationships with other people, as well as can negatively affect his/her contacts with peers, functioning in school or family. The aim of the study was the search for modern scientific achievements in the field of research on the quality of life among children with transient loss of consciousness and their families for a better understanding of the state of the possibilities of using this indicator in the evaluation of the effectiveness of the carried-out treatment and prevention measures. Materials and methods. The following terms were used for the search: «syncope», «epilepsy», «psychogenic transient loss of consciousness», and «quality of life», and «children» in the PubMed Medline and Scopus databases. Only English-language full-text articles published between January 2013 and December 2022 were included in the search. Results. During the past 10 years numerous studies have been published on health-related quality of life in children with epilepsy, and there was only one study among children with vasovagal syncope. Given the typically benign etiology of this disease, children are at high risk of psychological health worsening after experiencing a syncope episode. A diagnosis of epilepsy in early childhood has a profound effect on the child's psychological and physical development. It is important that epilepsy slows down the achievement of children's independence and complicates social relationships and cognitive processes. A number of authors drew attention to the lack of relationship between the quality of life and the frequency of psychogenic non-epileptic seizures in children and proved the key influence of depression and somatoform disorders on the reduction of quality of life. Conclusions. Health-related quality of life study is an important tool for the understanding of disease impact on child’s daily life and family members, which allows you to effectively recognize symptoms for the purpose of their timely correction, and is the final point in assessing the effectiveness of treatment and prevention measures, as well as quality of public health services. The relevance of further quality of life studies in children under the various types of syncope is due to the extremely limited results of observations in this group of patients.

Effects of a Home-Based Physical Activity Program on Blood Biomarkers and Health-Related Quality of Life Indices in Saudi Arabian Type 2 Diabetes Mellitus Patients: A Randomized Controlled Trial.

The purpose of this study was to undertake a randomized control trial examining the effects of a 12-week home-based physical activity program on Saudi Arabian adults with type 2 diabetes. Sixty-four patients with type 2 diabetes mellitus were recruited from the Jazan Diabetes and Endocrinology Center, located in the Jazan region of southwestern Saudi Arabia. Patients were randomly assigned to either control, i.e., usual care (males = 46.9% and females = 53.1%, age = 45.88 ± 8.51 years, mass = 76.30 ± 15.16 kg, stature = 160.59 ± 8.94 cm, body mass index (BMI) = 29.73 ± 6.24 kg/m2, years since diagnosis = 8.12 ± 6.22 years) or a home-based physical activity (males = 50% and females = 50%, age = 42.07 ± 9.72 years, mass = 74.58 ± 13.67 kg, stature = 158.94 ± 9.38 cm, BMI = 29.44 ± 4.38 kg/m2, years since diagnosis = 12.17 ± 8.38 years) trial arms. The home-based physical activity group was required to undertake aerobic training by increasing their habitual step count by 2000 steps per day and performing resistance training 3 times per week for 12 weeks. The primary outcome was hemoglobin A1c (HbA1c), and secondary measures of anthropometrics, blood biomarkers, physical fitness, and patient-reported quality of life outcomes pertinent to type 2 diabetes were measured at timepoints, i.e., baseline, 12 weeks, and 24 weeks (follow-up). Intention-to-treat analyses revealed no significant alterations in the primary outcome (control: baseline = 8.71%, 12-weeks = 8.35%, and follow-up = 8.72%; home-based physical activity: baseline = 8.32%, 12-weeks = 8.06%, and follow-up = 8.39%) between trial arms. However, improvements in psychological wellbeing at follow-up measured using the Patient Health Questionnaire-9 were significantly greater in the home-based physical activity group (baseline = 6.84, 12-weeks = 5.96, and follow-up = 5.00) compared to the control (baseline = 6.81, 12-weeks = 5.73, and follow-up = 8.53). No other statistically significant observations were observed. Home-based physical activity is not effective in mediating improvements in HbA1c levels or secondary hematological, blood pressure, anthropometric, or fitness indices. However, given the link between psychological wellbeing and the etiology/progression of disease activity in type 2 diabetes, home-based physical activity may be effective for tertiary disease management. Future trials should examine the efficacy of relative exercise intensities greater than those in the current study.

Clinical outcome data of anxiety patients treated with cannabis-based medicinal products in the United Kingdom: a cohort study from the UK Medical Cannabis Registry

RationaleCannabis-based medicinal products (CBMPs) have been identified as novel therapeutics for generalised anxiety disorder (GAD) based on pre-clinical models; however, there is a paucity of high-quality evidence on their effectiveness and safety.ObjectivesThis study aimed to evaluate the clinical outcomes of patients with GAD treated with dried flower, oil-based preparations, or a combination of both CBMPs.MethodsA prospective cohort study of patients with GAD (n = 302) enrolled in the UK Medical Cannabis Registry prescribed oil or flower-based CBMPs was performed. Primary outcomes were changes in generalised anxiety disorder-7 (GAD-7) questionnaires at 1, 3, and 6 months compared to baseline. Secondary outcomes were single-item sleep quality scale (SQS) and health-related quality of life index (EQ-5D-5L) questionnaires at the same time points. These changes were assessed by paired t-tests. Adverse events were assessed in line with CTCAE (Common Terminology Criteria for Adverse Events) v4.0.ResultsImprovements in anxiety, sleep quality and quality of life were observed at each time point (p < 0.001). Patients receiving CBMPs had improvements in GAD-7 at all time points (1 month: difference −5.3 (95% CI −4.6 to −6.1), 3 months: difference −5.5 (95% CI −4.7 to −6.4), 6 months: difference −4.5 (95% CI −3.2 to −5.7)). Thirty-nine participants (12.9%) reported 269 adverse events in the follow-up period.ConclusionsPrescription of CBMPs in those with GAD is associated with clinically significant improvements in anxiety with an acceptable safety profile in a real-world setting. Randomised trials are required as a next step to investigate the efficacy of CBMPs.

Gender characteristics of health-related quality of life indicators in children with high normal blood pressure and primary hypertension

Background. The study of health-related quality of life (HRQoL) has great practical importance for patients with hypertension. The aim of the work was to investigate the gender characteristics of HRQoL in children with primary hypertension and high normal blood pressure. Material and methods. One hundred and ninety-nine patients (107 boys and 92 girls) aged 9–17 years were examined. Among them, 81 children had high normal blood pressure, 44 were with stage 1 hypertension, 38 patients had hypertension stage 1 аnd 36 children had normal blood pressure. All patients underwent ambulatory blood pressure monitoring. The Ukrainian version of the PedsQL 4.0 scale was used to assess HRQoL. Results. In girls with high normal blood pressure and in the initial stages of the stable hypertension, a higher frequency of complaints of headache, dizziness, heart pain was found compared to boys, as well as a moderate and significant negative correlation between the frequency of these complaints and HRQoL indicators. The lowest PedsQL indicators were in girls with hypertension stage 2 (total score of the PedsQL 4.0 scale was 67.41 ± 9.94 points). Boys with hypertension stage 2 had normal PedsQL scores. Regardless of gender, psychosocial health indicators were found to be low in children with high normal blood pressure compared to the control group: in girls — 70.68 ± 12.46 points (р &lt; 0.05), in boys — 70.23 ± 13.09 points (p &lt; 0.05). The indicators of social functioning in all children did not differ from the data of the control group. Conclusions. HRQoL indicators in children aged 9–17 years with hypertension and high normal blood pressure depend on the level of blood pressure and have gender characteristics. Girls with hypertension stage 2, except for social functioning data, have worse HRQoL indicators compared to boys with stable hypertension stage 2. Children with high normal blood pressure, regardless of gender, have lower psychosocial health indicators compared to the control group. HRQoL indicators are negatively correlated with complaints of headache (more pronounced in boys), dizziness and heart pain (more pronounced in girls). These data should be taken into account when assessing the state of children with high normal blood pressure and hypertension.

Financial toxicity and quality of life among people with chronic myeloid leukemia on tyrosine kinase inhibitors.

e18918 Background: Costs associated with treatment of Chronic Myeloid Leukemia (CML), along with out of pocket (OOP) expenses related to cancer care, put CML patients at risk for financial toxicity (FT). Although FT is considered a side effect of many cancer treatments, little is known about how FT affects quality of life among CML patients treated with Tyrosine Kinase Inhibitors (TKIs). In this study, we examined the association between FT, demographic factors, and health related quality of life (HRQOL). Methods: A secondary analysis was conducted using data from a parent study examining adherence trajectories in people with CML treated with TKIs. Descriptive, bivariate, and multivariate analyses were used to describe the sample, assess demographic and disease-specific FT correlates, and assess the predictive value of FT on HRQOL. FT was assessed by the Comprehensive Score for Financial Toxicity (COST Facit V2; higher scores were better) along with the Medical Expenditure Panel Survey (MEPS). HRQOL was assessed using the EuroQol 5-Dimension (EQ-5D-5L) single summary index score. Results: Of the 118 participant sample, about half were male (52%), White (57%), married (53%), and currently employed (59%) with a mean age of 49. Most had some college credit (76%). Many reported making financial sacrifices because of cancer costs (42% reduced spending on vacation/leisure activities, 31% delayed large purchases, 24% reduced spending on basics like food and clothing, and 27% used savings set aside for other purposes). Most (62%) reported ever being worried about having to pay large medical bills related to their cancer and 15% reported borrowing money or going into debt to cover cancer care costs. About half (51%) reported never discussing OOP costs for cancer care with their doctor. Overall, participants reported low FT (mean = 25, standard deviation = 11), but approximately 26% of respondents noted FT levels associated with significant financial burden (COST &lt; 17.5). In bivariate analyses, greater FT was associated with Black race, not married/partnered status, unemployed, high school education or less, and lower income. FT was not significantly associated with gender or age. In multivariable models, FT was significantly associated with HRQOL index (β = 0.011, SE = 0.002, P &lt; 0.001) after adjusting for individual characteristics. Age (β = -.003, SE = 0.001, P = 0.01) and education (β = .125, SE = 0.05, P = 0.027) also seemed to be important correlates of HRQOL index. Conclusions: Financial concerns are a common worry for individuals receiving treatment for CML. The association between FT and HRQOL suggests a need for assessing and addressing FT as part of routine care of people with CML who are taking TKIs. Further work is needed to understand the longitudinal experience of FT of people with CML on continuous treatment to help identify individuals who are most in need of intervention across the treatment continuum.