Impact Quality Of Life Research Articles

Mycobacterium phlei cell wall-nucleic acid complex in the treatment of nonmuscle invasive bladder cancer unresponsive to bacillus Calmette-Guerin

ABSTRACTIntroduction Current guidelines recommend cystectomy in patients with high risk NMIBC who fail to respond to BCG. However due to the significant morbidity and mortality of the procedure, many are not candidates or refuse it. No new treatments for this indication have been approved by the US FDA since 1998.Areas covered A cell wall-nucleic acid complex (MCNA) from M. phlei has been investigated for possible application in patients with BCG refractory NMIBC. The development of this biological from the original studies is reviewed, together with the clinical trials leading to a submission to the FDA. Its efficacy and safety are presented together with comparative analysis of alternative treatments, most of which are used off-label. In addition, new combinations of standard therapies are described as well as single agents exhibiting activity against these tumors.Expert opinion MCNA has shown activity against high risk BCG refractory bladder cancer and offers an alternative to current treatments. The clinical experience remains limited and the optimal therapeutic regimen (dose, frequency) have not been firmly established. Patients and clinicians would welcome the introduction of a compound that may delay or prevent the risks and negative impact in quality of life of cystectomy and urinary diversion.

Capítulo 6. Selección de los candidatos para el ingreso a las clínicas de falla cardiaca

IntroductionCardiac failure units are a good quality care strategy, have high cost-effectiveness standards and impact quality of life, increase survival and reduce rehospitalisation and the costs of a disorder which affects public health. ObjetiveTo formulate strategies towards defining the population who will benefit from follow-up in heart failure clinics. MethodologyNarrative review of the available literature. ConclusionThe population of high risk heart failure patients defined by criteria such as functional class II to persistent IV, 2 or more admissions to hospital due to decompensated heart failure in the past 12 months, de novo heart failure or criteria suggestive of progression of the disease are those who benefit most from follow-up in multidisciplinary programmes.

"We Went in as Strangers, and Left as Friends”: Building Community in the Wahkohtowin Classroom

This paper analyzes interviews with students of an interdisciplinary community-based class in Saskatoon, Saskatchewan. The class— “Wahkohtowin” (“kinship” in Cree)—brought together university students with youth from Oskayak, an Indigenous High School, and members of STR8 UP, a community-based organization for former gang members. The course centred on the theme of “justice,” and students discussed legal and literary texts related to policing, criminal trials, and prison, and shared their own experiences and stories about justice and injustice. The students described the class as a profound experience of “community,” which caused them to reflect critically upon structures that create and reinforce inequality and estrangement and impact quality of life. This paper describes the class within the larger context of community-engaged pedagogy and Indigenous approaches to community engagement. We explore major interview themes centred on the complexities of creating community in the classroom. Participants discussed encountering “strangers”; telling and witnessing traumatic stories; unsettling privilege; and enacting resistance and solidarity. Ultimately, the Wahkohtowin class intervenes in dominant models of engaged pedagogy and community-service learning, disrupting notions of a university-community binary, and creating a space where students began to practice solidarity and imagine a quality of life based on equality and justice for all.

Redefining Borders between Communities and the Classroom: How Community-based Social Activists can Transform Social Work Education

In the context of service restructuring that has gravely impacted quality of life for social workers and the people with whom they work, this paper considers the ways that social work education can better support social justice-based social work practices in urban communities in Canada. The paper’s authors attended a fall 2013 Ryerson University forum that brought together critical social work educators and community-based activist social workers struggling to bring social justice-based practices to their work within restructured social services. Examples of social service restructuring include cuts to services, labour intensification, and increased managerialism, processes known as neoliberalism that have shifted discourses away from quality of life toward a focus on economic markers and efficiencies. The purpose of our forum was to explore ways in which social work curricula and pedagogical practices can be challenged and redefined in order to better support those efforts by social workers to resist such processes and to enhance social worker and client quality of life. Our paper presents the findings of this forum, including the presentation and discussion of a series of recommendations to reconfigure social work education so that it is more congruent with the needs of social justice-based practice in social work.

The Quality of Survival (QoS): A concept framework to assist communication and decision making about cancer care.

78 Background: The past decade has seen the development of transitional, novel cancer therapies that lengthen survival, yet data regarding the quality of that survival are limited or unavailable. Improving patient (pt)/healthcare professional (HCP) communication about issues such as QoS might enhance engagement and inform decision-making about future care. For example, the PROACT study (ECC 2015, abs.1715) has shown how little attention is given to family caregiver impact. Our objective is to develop an inclusive framework that will go beyond existing pt-reported outcomes and quality of life (QoL) constructs, and which HCPs may use to communicate with pts. Methods: An electronic database search to investigate the QoS landscape in cancer was conducted and results were articulated into a visual concept map. Subsequently, 20 US pts with metastatic NSCLC were interviewed about their cancer experiences (a similar melanoma pt survey is ongoing) and this input was integrated into the concept map. Areas explored include: symptoms, disease/treatment communication and education, pt expectations about treatment goals and involvement in decision-making, and impacts of all these on pts, families, and friends. Results: In their interviews, pts reported a host of impacts: physical, psychological/emotional, social/relationship, work, and financial. A QoS concept framework was developed to capture the holistic pt experience throughout the continuum of cancer care (during and post treatment) and consisted of 4 interconnected domains: QoL, survival, side effects and economic impact. The severity and persistence of some of the impacts ultimately affect survival, while others affect the ability to preserve or return to normality. Conclusions: While pt experiences are usually discussed and monitored by HCPs, issues identified as most important to pts and families and their variability over time, are rarely assessed formally during survival. These findings support the development of a pt-centric concept map that defines QoS, provides a comprehensive framework for improving communication between pts and their care teams about long-term QoS in cancer, and potentially enables better treatment decisions.

The Validity of Disease-specific Quality of Life Attributions Among Adults with Multiple Chronic Conditions.

A crucial assumption underlying all disease-specific quality of life (QOL) measures, that patients can validly differentiate a specific disease in the presence of multiple chronic conditions, has not been tested using multiple methods. Our objective was to evaluate the convergent and discriminant validity of QOL attributions to specific diseases among adults with multiple chronic conditions (MCC). Adults age 18 and older (N=4,480) sampled from eight pre-identified condition groups (asthma, COPD, angina/MI with angina, congestive heart failure, diabetes, chronic kidney disease, osteoarthritis, rheumatoid arthritis) completed an Internet survey. Comorbid conditions were determined using a 35-condition checklist. Product-moment correlations were analyzed separately by pre-identified condition group using the multitrait-multimethod of construct validation, where traits were defined by 9-26 conditions and each condition was measured by two methods: disease severity rating and Disease-specific Quality of Life Impact Scale (QDIS) global rating. A third method (symptom or clinical marker) was available for the eight pre-identified conditions. Convergent validity was supported when correlations among different methods of measuring the same condition (trait) were substantial (r≥0.40). Discriminant validity was supported when correlations between the same and different methods of measuring different conditions were significantly lower than corresponding convergent correlations. In support of convergent validity, 22 of 24 convergent correlations were substantial (r=0.38-0.84, median=0.53). In support of discriminant validity, 833 of 924 tests (90.2%) yielded significantly higher convergent than discriminant correlations across the eight pre-identified conditions. Exceptions to this pattern of results were most often observed for comorbid conditions within the same clinical area. Collectively, convergent and discriminant test results support the construct validity of disease-specific QOL impact attributions across MCC within the eight pre-identified conditions. Noteworthy exceptions should be considered when interpreting some specific QOL impact attributions and warrant further study. Pursuit of a summary disease-specific QOL impact score standardized across MCC is recommended.

<b>Impacto da má oclusão na dentição decídua e permanente na qualidade de vida de crianças e adolescentes</b>: revisão de literatura

Uma revisão de literatura foi realizada sobre má oclusão nas diferentes dentições e seu impacto na qualidade de vida de crianças e adolescentes. Pesquisou-se no PUBMED, LILACS e SCIELO, utilizando os descritores malocclusion e quality of life. Foram selecionados 8 artigos sobre má oclusão na dentição decídua e 17 na dentição mista e/ou permanente. Dentre os que avaliaram a dentição decídua, apenas um artigo encontrou impacto negativo na qualidade de vida relacionada à saúde bucal (QVRSB). Quanto aos artigos que avaliaram as dentições mista e/ou permanente, maioria encontrou associação entre má oclusão e pior QVRSB. Conclui-se que a má oclusão só exerce impacto negativo na QVRSB quando presente na dentição mista e/ou permanente, afetando a autoestima dos indivíduos que possuem este agravo.
 
 DOI: 10.18363/rbo.v72i1/2.556

Does Public Spending Improve Citizens’ Quality of Life? An Analysis of Municipalities’ Leisure Supply

This paper offers new evidence regarding the impact of public spending on the supply of leisure services on citizens’ spare-time quality of life. Using data from 103 Italian capital municipalities covering the period 2007–2010, the analysis revealed that public spending on leisure impacted spare-time quality of life in various ways, depending on the category of spending. Spending for tourism essentially followed an upward path, linearly enhancing citizens’ spare-time quality of life. Surprisingly, municipalities’ spending on sport- and culture-related services had a non-linear impact. Hence, spending on sports within a maximum threshold reveals a positive impact on spare-time quality of life, whereas passing over a minimum level of public spending for culture-related projects had a positive effect. This paper provides helpful suggestions for policymakers who approach decisions that address whether it is worth spending on leisure, which is typically a non-basic need but one that must be properly satisfied by municipalities in today’s service-based society.

Circulating microRNA 132-3p and 324-3p Profiles in Patients after Acute Aneurysmal Subarachnoid Hemorrhage

BackgroundAneurysmal subarachnoid hemorrhage (SAH) is a highly morbid and fatal condition with high rate of cognitive impairment and negative impact in quality of life among survivors. Delayed cerebral infarction (DCI) is one the major factors for these negative outcomes. In this study we compared the circulating microRNA profiles of SAH patients and healthy individuals, and the circulating microRNA profiles of SAH patients with and without DCI.MethodsPeripheral blood samples on Day 7 after the onset of SAH were subjected to microarray analysis with Affymetrix miRNA 3.0 array and quantitative PCR analysis. SAH patients with (N = 20) and without DCI (N = 20) and Healthy controls (N = 20) were included for analyses.ResultsWe demonstrated that 99 miRNAs were found to be dysregulated in the SAH patient group with DCI. 81 miRNAs were upregulated and 18 were downregulated. Findings from KEGG pathway analysis showed that miRNAs and target genes for axon guidance and TGF-beta signaling were involved, implying that the resulted differential miRNA expression pattern reflect the results of SAH instead of etiology of the disease. miR-132-3p and miR-324-3p showed distinctive upregulations in qPCR [miR-132: 9.5 fold (95%CI: 2.3 to 16.7) in DCI group and 3.4 fold (95%CI: 1.0 to 5.8) in Non-DCI group; miR-324: 4924 fold (95%CI: 2620 to 7228) in DCI group and 4545 fold (95%CI: 2408 to 6683) in non-DCI group]. However, there were no significant differences in fold changes between SAH patients with and without DCI [fold change ratios (mean+/-SD): 2.7+/-4.2 and 1.1+/-1.1 for miRNA-132 and miRNA-324].ConclusionOur study demonstrated that as compared to healthy control, miR-132 and miR-324 showed a upregulation in both SAH DCI and Non-DCI groups. However, the differences between the SAH DCI and non-DCI groups were not statistically significant.

Impact of Pain and Functional Impairment in US Adult People with Hemophilia (PWH): Patient-Reported Outcomes and Musculoskeletal Evaluation in the Pain, Functional Impairment, and Quality of Life (P-FiQ) Study

Introduction: Pain and functional impairment associated with joint disease are major problems affecting adults with congenital hemophilia. Various standardized and disease-specific patient-reported outcome (PRO) instruments have been used in clinical studies of PWH or other diseases, but the use of these tools in the hemophilia comprehensive care setting for individual patient assessment or overall outcome tracking is limited and inconsistent. P-FiQ was designed to assess the impact of pain on functional impairment and quality of life (QoL) in adult PWH.Objectives: To assess pain and functional impairment in nonbleeding adult PWH through 5 PRO instruments and a clinical joint health evaluation.Methods: Adult males with mild to severe hemophilia and a history of joint pain or bleeding were enrolled from 15 US sites between October 2013 and October 2014. During routine clinical care visits, participants completed a pain history and 5 PROs (EQ-5D-5L with visual analog scale [VAS], Brief Pain Inventory v2 Short Form [BPI], International Physical Activity Questionnaire [IPAQ], SF-36v2, Hemophilia Activities List [HAL]) and underwent a Hemophilia Joint Health Score v2.1 (HJHS) evaluation completed by a trained physical therapist.Results: Overall 381 patients were enrolled, with a median age of 34.0 years. PRO and HJHS summary scores are presented in the table below. On EQ-5D-5L, most participants reported problems with mobility, usual activities, and pain/discomfort. On BPI, median worst pain was 6.0, least pain 1.0, average pain 3.0, and current pain 2.0. Ankles were most frequently reported as the joints with the most pain (37.4%), followed by knees (23.7%) and elbows (18.9%). On IPAQ, approximately half of participants (51.0%) reported no physical activity in the prior week. Median SF-36v2 subscores were lower for the 4 physical health domains than for the 4 mental health domains. Among HAL domains, self-care was the least impacted (median, 100.0) and functions of the legs (median, 66.7) and lying/sitting/kneeling/standing (median, 67.5) were the most impacted. On HJHS, elbow, knee, and ankle scores did not differ appreciably (median, 4.0, 4.0, and 6.0, respectively).TableAssessment ToolMedian (Q1, Q3)RangeEQ-5D-5LVAS Health index80.0 (66.0, 90.0) 0.796 (0.678, 0.861)0 to 100a-0.11 to 1.0aBPIPain severity Pain interference3.3 (1.3, 5.0) 2.7 (0.6, 5.4)0 to 10bIPAQTotal physical activity530.2 (264.0, 1039.5)Metabolic equivalents of task (MET)/minutes per week: Walking = 3.3 METs Moderate activities = 4.0 METs Vigorous activities = 8.0 METsSF-36v2Physical functioning Role physical Bodily pain General health Vitality Social functioning Role emotional Mental health Physical health summary Mental health summary Overall health44.4 (29.7, 52.8) 44.6 (32.4, 56.9) 41.8 (37.2, 51.1) 45.8 (35.3, 52.9) 49.0 (42.7, 55.2) 45.6 (34.9, 56.4) 55.9 (36.4, 55.9) 52.8 (41.6, 58.5) 39.2 (29.5, 49.4) 50.7 (41.4, 55.7) 3.0 (2.0, 4.0)0 to 100a1 to 5aHALUpper extremity activities Basic lower extremity activities Complex lower extremity activities Overall sum score88.9 (73.3, 97.8) 73.3 (46.7, 96.7) 55.6 (30.0, 88.9) 76.6 (58.0, 94.3)0 to 100aHJHSElbow Knee Ankle Global gait Total score4.0 (0.0, 11.0) 4.0 (0.0, 10.0) 6.0 (1.0, 15.0) 3.0 (0.0, 4.0) 19.5 (6.0, 36.0)0 to 40c0 to 124caHigher scores indicate better QoL or functional statusbLower scores indicate less pain severitycLower scores indicate better functionConclusions: Results of this analysis demonstrated challenges of lower extremity pain and functional impairment in US adult PWH. Pain was frequently observed, and it impacted physical function and quality of life across PROs and HJHS. Further analyses are underway to correlate assessments of pain and function across different PROs and with the exam-based HJHS. DisclosuresKempton:CSL Behring: Consultancy; Biogen: Consultancy; Baxter: Consultancy. Recht:Baxalta: Research Funding; Kedrion: Consultancy. Neff:Novo Nordisk: Other: Advisory Board; Kedrion: Other: Advisory Board. Wang:Biogen: Membership on an entity's Board of Directors or advisory committees; CSL Behring: Membership on an entity's Board of Directors or advisory committees; Novo Nordisk: Membership on an entity's Board of Directors or advisory committees; Baxalta: Membership on an entity's Board of Directors or advisory committees. Buckner:Novo Nordisk: Consultancy; Baxalta, Inc. US: Consultancy. Soni:Bayer: Other: member of the Global Emerging HEmophilia Panel (GEHEP); Novo Nordisk: Speakers Bureau. Quon:Bayer: Other: Advisory Board; Grifols: Speakers Bureau; Novo Nordisk: Other: Advisory Board, Speakers Bureau; Biogen: Other: Advisory Board, Speakers Bureau; Baxter: Other: Advisory Board, Speakers Bureau. Witkop:Pfizer: Other: Advisory Board, Research Funding; Baxter Bioscience: Other: Advisory Board; Novo Nordisk: Other: Advisory Board, Speakers Bureau. Boggio:Baxter: Consultancy, Research Funding; OctaPharma: Consultancy, Research Funding; OPKO: Research Funding; CSL Behring: Consultancy, Research Funding; Novo Nordisk: Consultancy, Research Funding; Selexys: Research Funding; Bayer: Consultancy, Research Funding. Cooper:Novo Nordisk: Employment.

The Henri Mondor Procedure of Morbidity and Mortality Reviews (MMR) Meetings: Prospective Registration of Clinical, Dosimetric, and Individual Biological Radiosensitivity Data of Patients With Severe Radiation Toxicity

After radiation therapy (RT), one-fourth of patients can develop radiation-induced toxicities (RIT) that may increase morbidity and impact quality of life. An international interest has arisen in hospitals to integrate morbidity and mortality review (MMR) meetings into their governance processes; moreover, MMR has been identified as an adapted process to increase quality of follow-up after RT. The risk of toxicity and morbidity depends, in part, on the individual radiosensitivity (IRS). For the last, consensual radiobiological parameters to predict IRS are lacking. We aimed to report the first results of patients included in our MMR procedure with clinical evaluation, review of the RT technique and radiobiological assay for IRS determination. Twenty-three patients were prospectively included in our MMR database. Male to female sex ratio: 12/11; age ranges: 38-85y. Type of cancer distribution was: prostate (n=10), breast (n=8), Hodgkin lymphoma (HL; n=2), craniopharyngioma/sarcoma/seminoma (n=3). The total dose delivered was according to the disease (30Gy [HL] to 74Gy [prostate]). Standard fractionation of 1.8-2Gy/fraction was used in 22 patients; MMR procedure was systematic for patients with toxicity grade > 3. The RT technique and dosimetry were reviewed by one physician/physicist not involved in the initial treatment. To establish links between molecular and clinical parameters, we collected fibroblasts from skin biopsies. Fibroblasts were irradiated at 2Gy and observed from 10 min to 24 h post-irradiation to assess the number of radiation-induced micronuclei, δH2AX and pATM nuclear foci that reflects genomic instability and different steps of DSB recognition and repair. We recorded 7 rectitis, 9 skin toxicities, 2 cystitis, and 5 other toxicities. Five out of 7 rectitis received 66Gy post prostatectomy RT (V50 ranges: 45%-75%). For skin toxicity and cystitis, the mean Dmax were in the average standard values without any overdosage or dose heterogeneity. No error was found in the review of treatment planning and positioning control. From IRS assays (n=22), 100% the patients were considered as radiosensitive with significant genomic instability and ATM-dependent DSB repair impairment (Table 1).Poster Viewing Abstracts 2890; Table 1IRS assays (n=22)nResidual MN n (%)Residual gH2AX foci n (%)Early pATM foci n (%)Deduced group of IRSRectitis/Cystitis99 (100)9 (100)7 (78)IISkin toxicity99 (100)9 (100)8 (89)IIOther patients44 (100)4 (100)2 (50)II Open table in a new tab Our procedure has allowed significant staff education for clinical and biological aspects of late RIT. The MMR meetings, allowed clear answers to patients on the relationship between clinical events and their IRS by removing the suspicion of medico-technique error during their irradiation; thus, introduction of the MMR procedure in radiation therapy departments’ organization is highly recommended.

Psychometric evaluation of an online and paper accidental bowel leakage questionnaire: The ICIQ-B questionnaire.

To evaluate the psychometric properties of an online versus paper US-English version of the International Consultation on Incontinence Questionnaire-Bowel (ICIQ-B). The ICIQ-B includes 17 items under 3 domains: bowel pattern (5 items), bowel control (7 items), and quality of life (5 items). We recruited community-dwelling adults seeking treatment for ≥monthly bowel leakage from specialty clinics within a VA medical center and university affiliate. An online versus paper version was evaluated at baseline, 2 weeks later, and 3 months after nonsurgical treatments per usual care. We assessed test-retest reliability (Pearson correlations) at 2 weeks, internal consistency (Cronbach's alpha), and convergent validity (Pearson correlations). Sensitivity to change was the difference between the baseline and post-treatment (3-month) scores. Mean age was 58.0 ± 11.9; 36% Veterans, 52% women. At baseline, 2 weeks, and 3 months, we found no differences in the online vs paper scores for the bowel control and quality of life domains. The ICIQ-B demonstrated fair internal consistency for the bowel pattern domain (Cronbach's α = 0.36-0.54). Internal consistency on the bowel pattern domain was better with the paper version than the online version at 2 weeks (P < 0.05) and 3 months (P < 0.01) with no difference at baseline. All other domains had good internal consistency (Cronbach's α > 0.80), good retest reliability (r ≥ 0.70, P < 0.001), domain-specific convergent validity for stool consistency (P < 0.05), incontinence severity (P ≤ 0.002), and quality of life impact (P < 0.05). After nonsurgical treatments, we found a reasonable response to change (P ≤ 0.05). Online and paper versions had robust psychometric data for use among U.S. men and women, including Veterans. Neurourol. Urodynam. 36:166-170, 2017. © 2015 Wiley Periodicals, Inc.

OP‐7 THERAPEUTIC EFFECTS OF DOMPERIDONE ON ABDOMINAL PAIN‐PREDOMINANT FUNCTIONAL GASTROINTESTINAL DISORDERS

Introduction:The therapeutic effect of domperidone on abdominal pain‐predominant functional gastrointestinal diseases (AP‐FGIDs) was assessed on children in 5–12 year age group at the Gastroenterology Research Laboratory of Faculty of Medicine, University of Kelaniya, Sri Lanka.Methods:Children fulfilling Rome III criteria for AP‐FGIDs were recruited from the out‐patient clinic of the University Paediatric Unit, North Colombo Teaching Hospital, Ragama, Sri Lanka, after obtaining parental consent. They were randomized in to 8 weeks of placebo or Domperidone (Motillium 10 mg, 3 times per day, before meals) groups, using computer generated random numbers. Placebo was a specially prepared dummy tablet without any active ingredients, had the same colour, size, shape and taste of domperidone tablet and were packaged similarly. Primary outcomes defined were cure (abdominal pain less than 25 mm on the visual analogue scale and no impact on daily activities) and improvement (pain relief and sense of improvement recorded on global assessment scale). Secondary outcomes were significant improvement in symptoms, gastric motility, quality of life (QoL) and family impact. Both patients and investigators who assessed primary and secondary outcomes before and after intervention were blind to inventions administered. Symptom severity was recorded on a validated 100 mm visual analogue scale. Translated and validated PedQL Generic Score Scale version 4.0 and Family Impact Module were used. Gastric motility was assessed using a validated ultrasound method.Results:One hundred children were enrolled and 89 completed the trial [Placebo 42 (22 girls), Domperidone 47(33 girls)]. While comparing primary outcomes, domperidone group had significant improvement [37 (78.7%) vs. 25 (59.5%) in placebo group, p = 0.04], while no such difference was observed in cure. When assessing secondary outcomes, domperidone group reported significant reduction in abdominal pain severity (70.84% vs. 48.18% p = 0.03) and improvement in motility index (29.3% vs. 8.6% p = 0.04) after intervention. No such difference was seen in improvement of QoL and family impact (p &gt; 0.05).Conclusions:Domperidone has a favorable therapeutic effect on improvement AP‐FGIDs in children aged 5–12 years. It causes significant reduction in abdominal pain and improvement in motility of the gastric antrum. However, it has no significant effect on improvement of QoL and family impact.

Psychiatric disorders in childhood

Psychiatric disorders in childhood From a clinical perspective, understanding the patient’s illness needs, helps determine our assessment, diagnosis and our treatment plan in the population of child and adolescents. The effective evaluation of different dimensions: Psychosocial Features: expectations, perceptions, and needs; Health Features: reference source, symptoms, quality of life impact; as well as geographic and linguistic diversity, cultural framework, must be also considered. The review of the two main diagnostic and classification systems in the field of psychiatry: the ICD-10 (chapter on mental and behavioral disorders) and the DSM-IV, represents the most important challenge, especially for the diagnostic and assessment in Child & Adolescent Psychiatry. The diagnostic classification should include additional information or dimensions that, while not a part of diagnosis per se, are important for making decisions about patient care, such as associated disability, acuity, exacerbating psychosocial factors, level of social support, and cultural factors. Clinical symptoms based on international classifications, allows identifying clinical entities in the population of children and adolescents, such as, substance use and abuse, emotional disorders especially bipolar disorders, attention deficit disorder and high prevalence of psychiatric comorbidity among themselves, hindering further diagnosis. In this speech, an overview of these conditions, particularly bipolar disorder in children and adolescents and their comorbidity, will be presented.

P061. Clinical characteristics of elderly with headache in an outpatient geriatric setting in Italy.

Background Multiple epidemiological studies show that headache is less prevalent in elderly people. Despite this, there is evidence that headache has a significant impact in elderly quality of life. There are few studies evaluating characteristics of elderly patients with headache. Aim of the present observational study was to evaluate the characteristics of elderly patients reporting headache in an outpatient geriatric service in Italy.

The Impact of Childhood Acute Otitis Media on Parental Quality of Life in a Prospective Observational Cohort Study.

Background and ObjectivesAcute otitis media (AOM) not only affects childhood quality of life (QoL), but can also affect parental QoL. We adapted a previously published questionnaire on the effect of childhood recurrent ear, nose and throat infections on parental QoL for use with AOM and used it in an observational, multicentre, prospective study of children with AOM.MethodsThe AOM-specific parental QoL questionnaire grouped 15 items into emotional, daily disturbance, total and overall parental QoL impact scores. The questionnaire was assessed using item-convergent and item-discriminant validity criteria and internal consistency reliability; and then used with parents of children aged <6 years diagnosed with AOM at 73 practices in Germany, Italy, Spain, Sweden and the UK. Bivariate analyses explored the differences in mean parental QoL impact scores by various characteristics.ResultsThe questionnaire demonstrated good to excellent internal consistency reliability for the various components (Cronbach’s α 0.82–0.97). There were 1419 AOM episodes among 5882 healthy children over 1 year, of which 1063 episodes (74.9 %) among 852 children had a questionnaire. Parents reported interrupted sleep (68.4 %), worry (51.0 %), altered daily schedule (44.6 %) and less leisure time (41.5 %) with a score ≥3 (1 = least to 5 = most impact). Factors that adversely affected parental QoL included: increased parental perception of AOM severity, younger child age and multiple AOM episodes.ConclusionsThe AOM-specific parental QoL questionnaire demonstrated good performance across five European countries. Parental QoL was affected by childhood AOM proportionally to severity, number of episodes and younger child age.Electronic supplementary materialThe online version of this article (doi:10.1007/s40261-015-0319-1) contains supplementary material, which is available to authorized users.

Interpersonal Responses and Pain Management Within the US Military.

Purpose Chronic pain poses a significant problem for the US military. The benefits of self-management treatments for chronic pain are well-documented, but interpersonal responses also influence physical and psychological health and may not be addressed through self-management treatments alone. The current study examines whether perceived interpersonal responses to pain, as measured by the Multidimensional Pain Inventory (MPI), change as a result of participation in an intensive pain management program. It was hypothesized that interpersonal responses to pain would be significantly correlated to psychosocial and physical pain outcomes and that interpersonal responses to pain would change significantly for completers of a functional restoration (FR) program compared to those who were randomized to treatment-as-usual in the military medical system. Methods Forty-four participants were randomly assigned to one of two treatment groups. One treatment group received FR (n=26) and the other group received treatment-as-usual (n=18). Significant other responses to chronic pain were measured by the MPI (Pain 23(4):345-356, 1985). Participants also completed measures of impacted quality of life, reported disability, psychological distress, fear avoidance, pain interference, and physical activity. Results Perceived higher punishing responses from a significant other were significantly related to worse physical health-related quality of life (p=.037), work-related fear avoidance (p=.008), pain interference (p=.026), affective distress (p=.039), and pain while lifting (p=.017). Perceived higher solicitous responses from significant others were significantly associated with lower mental health-related quality of life (p=.011), household activity (p=017), general activity (p=.042), self-reported disability (p=.030), lifting capacity (p=.005), and aerobic capacity (p=.009). Conclusions While findings are preliminary and of limited scope, it appears that the perception of significant others' responses may be impacted by psychosocial and physical pain outcomes and may change after treatment. More work in this area is needed to uncover the benefits one might achieve when a significant other is included within the FR treatment framework.

Development of a Short Version of the Thyroid-Related Patient-Reported Outcome ThyPRO.

Thyroid diseases affect quality of life (QoL). The Thyroid-Related Patient-Reported Outcome (ThyPRO) is an international comprehensive well-validated patient-reported outcome, measuring thyroid-related QoL. The current version is rather long--85 items. The purpose of the present study was to develop an abbreviated version of the ThyPRO, with conserved good measurement properties. A cross-sectional (N = 907) and a longitudinal sample (N = 435) of thyroid patients were analyzed. A graded item response theory (IRT) model was fitted to the cross-sectional data. Short-form scales with three items were aimed for, by selecting items with best fit according to the IRT model, avoiding cross-culturally noninvariant items. Seven scales measuring mental and social well-being and function as well as one overall QoL impact item were analyzed in a bifactor model, to develop a supplementary composite score. Short-form scales were linked to original scales with IRT-based summed-score-linking. Agreement between the short and long form was estimated by agreement plots, intraclass correlations, and mean score levels. Responsiveness was compared by relative validity indices, clinical validity by ability to detect clinically relevant differences, and test-retest reliability by intra-class correlation. One four-item scale was not abbreviated and one two-item scale was omitted from the short-form. For the 11 scales undergoing abbreviation, 10 with three and one with four items were developed. A bifactor model with good overall fit was fitted to the composite score, including the single QoL item. Responsiveness and clinical validity of the short-form scales were preserved, as were test-retest reliability (0.75-0.89). Short- versus long-form intraclass correlations were high (0.89-0.98), and the mean scale levels were similar. A 39-item version of the ThyPRO, with good measurement properties, was developed and is recommended for clinical use.

Modelling of diabetes knowledge, attitudes, self-management, and quality of life: a cross-sectional study with an Australian sample.

BackgroundQuality of life (QoL) is an important aspect of wellbeing for people with chronic conditions like type 2 diabetes, making it a noteworthy outcome. Knowledge about diabetes, attitudes, and self-management of diabetes are key factors that might directly or indirectly impact QoL. However, little is known about the inter-relationships between diabetes knowledge, attitudes, self-management and QoL among people with type 2 diabetes mellitus (T2DM). The aim of this study was to examine a model describing the relationship between diabetes knowledge, attitudes, self-management, and QoL of people with T2DM that is based on previous research linking pairs of these variables.MethodsA cross-sectional study design was employed in this research. A total of 291 participants, 192 males and 99 females, with T2DM, whose mean age was 55.8 (standard deviation = 11.09) completed questionnaires measuring diabetes knowledge (Diabetes Knowledge Scale), attitudes (Diabetes Integration Scale -19), self-management (Summary of Diabetes Self-care Activities Scale), including the aspects of diet, exercise, blood glucose testing, and foot care, and QoL (Diabetes Quality of Life Scale), comprising the aspects of satisfaction and impact on QoL respectively. To examine the model we proposed relating these variables, data were analysed using the path analysis.ResultsIn the final model, diabetes knowledge was a significant predictor for attitudes and self-management in terms of blood glucose testing. Attitudes was a significant predictor for self-management in terms of diet. In addition, self-management in terms of blood glucose testing was a significant predictor of impact of QoL, and self-management in terms of diet was a significant predictor of satisfaction and impact of QoL. Self-management in terms of exercise was a significant predictor of satisfaction in QoL. The final model reflected a good fit (χ2 (14) = 22.52, p = 0.069; CFI = 0.983; GFI = 0.983; RMSEA = 0.046).ConclusionsDiabetes knowledge, attitudes, and self-management are important factors that can impact the QoL among people with type 2 diabetes.

Relación de la universidad con la ciudad. Un estudio de caso

La relación universidad ”“ ciudad es analizada a través de los planteamientos de las partes interesadas de una universidad pública española. El objetivo principal de la investigación que derivo en el presente artículo es, analizar la responsabilidad social universitaria frente a las necesidades y problemáticas de las localidades donde están instalados los campus y ciudades universitarias modernas. Se empleó una metodología de tipo cualitativa mediante un estudio de caso único, considerando como técnica de recolección de la información a la entrevista semi-estructurada. Los resultados evidencian un reconocimiento a la antigüedad de la universidad estudiada, matizado con importantes críticas a su escasa relación con la sociedad local, exigiendo un mayor compromiso e impacto del quehacer universitario frente a las demandas específicas de la ciudad. Además, se observa una mayor presencia del concepto de Edutrópolis, especialmente por el impacto en la calidad de vida de los ciudadanos y el acceso a la vida universitaria que la institución estudiada otorga a los habitantes de la ciudad. El caso estudiado permite concluir que la importancia del entorno universitario dentro de la sociedad del conocimiento del siglo XXI es creciente, especialmente frente a las recientes crisis política y económica en Europa que plantean un cambio social que la universidad debe liderar.