Important Determinants Of Quality Of Life Research Articles

Investigation of the Factors Affecting Quality of Life in Patients with Mild to Moderate Alzheimer's Disease in Terms of Patients and Caregivers.

Background and Objectives: As with other chronic diseases with limited medical treatment, the most important goal of Alzheimer’s disease (AD) treatment is to provide a better quality of life (QoL). The purpose of this study was to investigate the factors affecting the QoL of patients with mild to moderate AD in terms of patients and caregivers. Materials and Methods: Seventy-three home-dwelling patients with AD and their caregivers participated in this prospective, cross-sectional study. The patients were asked about their cognition, depression and a self-rating part of a QoL questionnaire. The caregivers were asked about their patients’ sociodemographic information, sleepiness, activities of daily living and a proxy rating part of a QoL questionnaire. Results: The self-rated QoL was higher than that provided by the proxy rating. Cognition (p = 0.02), sleepiness (p < 0.01) and depression (p = 0.03) were correlated with the self-rated QoL, while the patient’s independence level in activities of daily living was correlated with the proxy-rated QoL (p < 0.05). In regard to predicting QoL according to linear regression analysis, the following were statistically significant: depression was for total score, depression and cognition were for the self-rating and instrumental activities of daily living was for the proxy rating (p < 0.01). Conclusions: While individual factors such as psychology are an important determinant of QoL for patients with AD, objective conditions such as the independence of the patient in daily life are important for the caregiver. While evaluating the quality of life of AD patients, it is important to remember that patients and caregivers have different priorities, and the priorities of both should be taken into account when planning a treatment program.

Sleep and quality of life in lung cancer patients and survivors.

Lung cancer patients and survivors are vulnerable to disturbed sleep and impaired quality of life (QOL) across the continuum of illness. Few studies have sought to identify predictors of QOL using well-validated measures of both sleep quality and QOL in this population. The purpose of this study was to examine factors associated with lung cancer that are predictive of QOL in adult lung cancer patients and survivors in the outpatient setting. Cross-sectional data collected exclusively in the outpatient setting from three lung cancer clinics in the Northeastern United States were pooled and analyzed. The pooled sample (N = 103) data included cancer type and stage, body mass index, Pittsburgh Sleep Quality Index, and Functional Assessment of Cancer Treatment-Lung information. Significant correlations between sleep quality, lung cancer symptom severity, and QOL were observed. Sleep quality and lung cancer symptoms were found to be statistically significant predictors of QOL. No significant differences in QOL were found based on cancer type or recruitment source. Demographic factors and cancer stage were also not predictive of overall QOL. Lung cancer symptoms and sleep quality were important determinants of QOL in this pooled sample of lung cancer patients and survivors. Patients and survivors of lung cancer require routine screening for sleep disturbance, lung cancer symptoms, and QOL needs. Nurse practitioners can help improve QOL in this population by screening for and treating sleep disturbance and lung cancer symptoms.

Comparison of the psychosocial impact of acne in adolescents and adults; body satisfaction, self-esteem, and quality of life.

Dermatological diseases, including acne vulgaris, have significant psychosocial effects on patients. To compare body satisfaction, self-esteem, and quality of life (QoL) in adolescents and adults with acne. A total of 192 acne patients (132 female, 60 male; aged 19.42±3.50years) were included in the study. Global Acne Grading System, Rosenberg Self-Esteem Scale (RSES), Turkish Acne Quality of Life Index (TAQoLI), and Body Cathexis Scale (BCS) were used. The patients were divided into two groups: under 20years old (adolescents) and 20years and above (adults). The mean RSES score was found as 19.49±5.11, the mean BCS score was 143.95±20.92 and the mean TAQoLI score was 23.44±10.02. There was no difference between adolescents and adults in terms of the mean value of the RSES score, TAQoLI score, and BCS score (p>0.05). But, the proportion of those whose RSES score is below 15 is higher in patients under 20years of age (28%) than patients aged 20 and over (14%) (p<0.05). Linear regression analysis revealed that the most important determinant of body satisfaction was self-esteem (β=0.287, p<0.05), the most important determinants of self-esteem were body satisfaction (β=0.208, p<0.05), QoL (β=-0.398, p<0.001), and education level (β=0.245, p=0.007) and, one of the most important determinant of QoL was self-esteem (β=-0.403, p<0.001). This study demonstrates that acne vulgaris negatively affects an individual's body satisfaction, self-esteem, and QoL. The psychosocial burden of acne is as significant for adults as for adolescents. Body satisfaction, self-esteem, and QoL are in interaction with each other.

Characterization of symptoms and determinants of disease burden in dementia with Lewy bodies: DEvELOP design and baseline results

BackgroundThe DEmEntia with LEwy bOdies Project (DEvELOP) aims to phenotype patients with dementia with Lewy bodies (DLB) and study the symptoms and biomarkers over time. Here, we describe the design and baseline results of DEvELOP. We investigated the associations between core and suggestive DLB symptoms and different aspects of disease burden, i.e., instrumental activities of daily living (IADL) functioning, quality of life (QoL), and caregiver burden.MethodsWe included 100 DLB patients (69 ± 6 years, 10%F, MMSE 25 ± 3) in the prospective DEvELOP cohort. Patients underwent extensive assessment including MRI, EEG/MEG, 123FP-CIT SPECT, and CSF and blood collection, with annual follow-up. Core (hallucinations, parkinsonism, fluctuations, RBD) and suggestive (autonomous dysfunction, neuropsychiatric symptoms) symptoms were assessed using standardized questionnaires. We used multivariate regression analyses, adjusted for age, sex, and MMSE, to evaluate how symptoms related to the Functional Activities Questionnaire, QoL-AD questionnaire, and Zarit Caregiver Burden Interview.ResultsIn our cohort, RBD was the most frequently reported core feature (75%), while visual hallucinations were least frequently reported (39%) and caused minimal distress. Suggestive clinical features were commonly present, of which orthostatic hypotension was most frequently reported (64%). Ninety-five percent of patients showed EEG/MEG abnormalities, 88% of 123FP-CIT SPECT scans were abnormal, and 53% had a CSF Alzheimer’s disease profile. Presence of fluctuations, lower MMSE, parkinsonism, and apathy were associated with higher IADL dependency. Depression, constipation, and lower IADL were associated with lower QoL-AD. Apathy and higher IADL dependency predisposed for higher caregiver burden.ConclusionBaseline data of our prospective DLB cohort show clinically relevant associations between symptomatology and disease burden. Cognitive and motor symptoms are related to IADL functioning, while negative neuropsychiatric symptoms and functional dependency are important determinants of QoL and caregiver burden. Follow-up is currently ongoing to address specific gaps in DLB research.

Evaluation of Quality of Life among Dental Professionals by Using the WHOQOL-BREF Instrument in Eastern Province of Saudi Arabia.

Objective To evaluate the quality of life (QOL) of dental professionals in the Eastern Province of Saudi Arabia. Methods This cross-sectional study recruited dental professionals (general dentists, specialists, and consultants) from public and private sectors in the Eastern Province of Saudi Arabia. The World Health Organization's QOL Assessment-BREF (WHOQOL-BREF) questionnaire was administered among study participants. The questionnaire addresses four domains of QOL which are physical, psychological, social relationships, and environment. Results There were 313 dental professionals in the study with a mean age of 35.72 (8.58) years. The mean score of QOL in the sample was 63 (13.9) on a 0–100 scale. 75% of the participants rated their QOL as good or very good. Of four domains, the social relationship domain had the highest mean score of QOL (67.04 SD: 23.52) and the physical domain had the lowest score (59.66 SD: 14.69). There were significant differences in the QOL of consultants (66.46 SD: 12.55), specialists (65.42 SD: 12.91), and general dentists (61.06 SD: 14.18) (P 0.010). The participants with medical illness had significantly lower QOL (56.91 SD: 12.83) than those without medical illness (63.67 SD: 13.92) (P 0.01). There were significant differences in the QOL of participants with 0–10 years since graduation (61.97 SD: 14.71), 11–20 years (61.92 SD: 13.56), and more than 20 years (68.53 SD: 10.71) (P 0.009). Conclusion The qualifications, medical illness, and years since graduation were important determinants of QOL among dental professionals. Measures should be taken to improve QOL of dental professionals which can enhance the quality of patient care.

Determinants of quality of life among people living with HIV in the hilly region of Myanmar

The aim of this study was to determine quality of life and its associating factors among people living with HIV (PLHIV) in the hilly region of Myanmar. A cross-sectional study was conducted at the National AIDS Program and Integrated HIV Care Program in Myanmar. A total of 326 PLHIV were recruited, of whom 49.1% had high QOL. Adherence to ART (AOR: 5.18; 95% CI: 2.02–13.31), high social capital (AOR: 3.16; 95% CI: 1.85–5.38), being male (AOR: 2.21; 95% CI: 1.27–3.83), asymptomatic (AOR: 2.18; 95% CI: 1.24–3.83), low self-stigma (AOR: 2.85; 95% CI: 1.61–5.04), and time spent at the clinic less than 30 min (AOR: 2.17; 95% CI: 1.15–4.08) were significant predictors of quality of life (QOL) among PLHIV. This study revealed that social factors such as HIV stigma and gender issues are important determinants of QOL in addition to health service factors and clinical outcomes.

Follow-up after curative treatment for colorectal cancer: longitudinal evaluation of patient initiated follow-up in the first 12\xa0months

PurposeTo compare patient-triggered follow-up (PTFU) for curatively treated colorectal cancer against traditional outpatient follow-up (OPFU).MethodsQuestionnaires were mailed at four time points over one-year post-treatment to two prospectively-recruited cohorts: A, patients entering follow-up and receiving OPFU pre-implementation of PTFU; B, patients entering follow-up (FU) and receiving either OPFU (B1) or PTFU (B2) post-implementation of PTFU. Bi-variate tests were used to compare patient characteristics and outcomes eight months after entering follow-up (generic and cancer-specific quality of life (QoL), satisfaction). Regression analysis explored associations between follow-up model and outcomes. Resource implications and costs of models were compared.ResultsPatients in Cohort B1 were significantly more likely to have received chemotherapy (p < 0.001), radiotherapy (p < 0.05), and reported poorer QoL (p = 0.001). Having a longstanding co-morbid condition was the most important determinant of QoL (p < 0.001); model of care was not significant. Patients were satisfied with their follow-up care regardless of model. Health service costs were higher in PTFU over the first yearConclusionsPTFU is acceptable to patients with colorectal cancer and can be considered to be a realistic alternative to OPFU for clinically suitable patients. The initial costs are higher due to provision of a self-management (SM) programme and remote surveillance. Further research is needed to establish long-term outcomes and costs.

Evaluation of Exercise Performance, Cardiac Function, and Quality of Life in Children After Liver Transplantation.

In children, after having liver transplantation (LT), it is important to assess the quality of life (QOL). Physical fitness is an important determinant of QOL, and because cardiac function can influence exercise performance, it is the purpose of the present study to assess these factors. Children in stable follow-up for more than 6 months post-LT were invited to participate in a case control study. Patients underwent cardiopulmonary exercise testing and echocardiography to assess systolic and diastolic function, and left ventricular wall dimensions. Health-related QOL was evaluated using child- and adolescent-reported PedsQL questionnaire. Twenty-eight of 31 included patients performed a maximal exercise test (15 boys, 11.6 ± 2.9 years, weight, 40.9 ± 13.1 kg; length, 148.6 ± 17.3 cm; body mass index, 17.6 ± 2.3). Liver transplantation patients had lower maximal oxygen consumption (VO2max/kg) (37.5 ± 9.3 mL/kg per minute vs 44.1 ± 8.8 mL/kg per minute), shorter exercise duration (9.3 ± 2.8 minutes vs 13.3 ± 3 minutes) and lower load (71 ± 14 vs 85 ± 20%). They reached the ventilatory anaerobic threshold earlier (81.4 ± 9.5 vs 88.3 ± 11.9%). Echocardiography demonstrated increased interventricular septal wall thickness (interventricular septum in diastole Z value, +0.45 ± 0.49, P < 0.001) and more diastolic dysfunction (lower E', Z value, -0.7 ± 1.02, P = 0.002, higher E/E' Z value, 0.64 ± 1.05. P = 0.005) but no relations with cardiopulmonary exercise testing. Health-related QOL showed lower overall, emotional, psychosocial, and school functioning scores. Children on antihypertensive medication had impaired physical functioning compared with other LT patients. Lower physical fitness level, more deconditioning and lower health-related QOL in children after LT emphasize the importance of exercise stimulation and fitness programs. Patients on antihypertensive medication seem to be the most vulnerable group suffering from decreased physical fitness.

Determinants of quality of life in patients with breast cancer undergoing external beam radiotherapy.

Quality of life (QoL) of patients with breast cancer is not dependent only on the presence of the disease, as there is such a multitude of social and clinical factors [1, 2]. However, data on the determinants of QoL in Polish breast cancer patients during the course of radiotherapy are scarce and based on custom-made questionnaires [3], rather than the EORTC QLQ-C30 or QLQ-BR23, which are the tools of choice for such patients [4, 5]. We evaluated breast cancer patients undergoing radiotherapy for treatment-related determinants of QoL and compared them with the intensity of depressive symptoms. A total of 98 women with breast cancer during the standard course of external beam radiotherapy agreed to complete the validated Polish versions 3.0 of EORTC QLQ-C30, QLQ-BR23 (all global, functional and symptom scales) and – at the same time point – the Beck Depression Inventory (BDI) to evaluate the intensity of depressive symptoms. A control group of 127 healthy women referred to the mammography department for screening purposes was evaluated using the BDI. Median age of the study group was 54 (25–75%: 46.7–60.5) years. Breast conserving therapy (BCT) had been performed in 50% of patients. In the breast cancer group, 65% of subjects had undergone some form of chemotherapy and 51% were undergoing hormone therapy. Cronbach's α values for QLQ-C30, QLQ-BR23 and BDI were 0.91, 0.81 and 0.83 respectively, confirming adequate test performance. Median total radiation dose given to the patients was 34 Gy (25–75%: 18–42 Gy), and only affected intensity of nausea/vomiting and constipation subscales (R = 0.25, p = 0.04; R = 0.27, p = 0.03 respectively) of the QLQ-C30 functional scales. No statistically significant correlations were found between the total dose and QLQ-BR23 scales, but the early reactions (RTOG staged ≥ 2 [6]) significantly worsened arm symptom subscale score assessment in QLQ-BR23. Hormonal therapy was not significantly correlated with any of those three questionnaires’ subscores. Previously received chemotherapy impacted neither QLQ-C30 nor BDI results, but it was associated with body image (BRBI) and systemic therapy side effect scores (BRST) (p = 0.02 and p = 0.005). Type of surgical intervention before radiotherapy impacted the field of global health status, resulting in better overall QoL in patients who had undergone BCT (58% (25–75%: 50–67) vs. 50% (25–75%: 42–58); p = 0.0405). BCT was also associated with lower reported intensity of breast symptoms (p = 0.0338) and better perception of future perspectives (BRFU; p = 0.0328). The level of depressive symptoms measured in controls was significantly lower than in cancer patients (median 5 (25–75%: 1–10) vs. 12 (25–75%: 6–17) points; p < 0.0001). BDI scores were correlated negatively and significantly with all functional scales of QLQ-C30 (Spearman's correlation coefficients ranging from –0.36 to –0.46, all p < 0.05) and QLQ-BR23 subscales: BRBI and BRFU (R = –0.47 and –0.51; p < 0.05). In conclusion, radiotherapy itself has a minor influence on QoL of breast cancer patients, although organ-specific complications may significantly impair physical functioning. Other forms of oncological treatment, such as the type of surgical procedure performed, have a much more profound impact on all fields of QoL. Intensity of depressive symptoms is an important determinant of QoL in cancer patients which mandates routine psychological evaluation.

S144 Quality Of Life In Idiopathic Pulmonary Arterial Hypertension Is Associated With Quadriceps Function And Size

Introduction Despite recent improvements in therapy patients with idiopathic pulmonary arterial hypertension (IPAH) still suffer with significantly reduced quality of life (QOL). Muscle dysfunction and low physical activity are emerging as important complications of the disease. Separately rehabilitation programs have been shown to cause an improvement in both QOL and muscle strength but the direct relationship between these factors has not as yet been documented in this condition. Aims We aimed to define the relationship between QOL and muscle function, size and physical activity in patients with IPAH. Methods In 12 patients with IPAH we measured quadriceps maximal volitional capacity (QMVC), ultrasound cross sectional area of the rectus femoris (USRFCSA), fat free mass index by bioelectrical impedance (FFMI), physical activity using the Sensewear armband (steps per day, total energy expenditure (TEE), and active energy expenditure (AEE)). They were also asked to complete the St. George’s respiratory questionnaire (SGRQ). Correlations were performed with Pearson’s or Spearman’s test. Results In the 12 patients with data so far available in this study QOL measured by the total SGRQ score correlated significantly with QMVC/BMI (r = -0.75, p = 0.005), FFMI (r = -0.71, p = 0.009) and USRFCSA (r = -0.88, p = 0.0002) (Figure 1A). There was no significant correlation between total SGRQ score and Sensewear measured steps per day (r = -0.62, p = 0.08) (Figure 1B) TEE (r = -0.62, p = 0.08) or AEE (rho = -0.41, p > 0.05) in the 9 patients with data available. Furthermore there was no significant correlation between BNP or resting echocardiographic parameters and total SGRQ QOL Discussion We have shown that muscle size and function are directly related to QOL in patients with IPAH. This work suggests that muscle function may be an important determinant of QOL in these patients, making it a potential target for therapeutic intervention. Further data is needed to define the association between physical activity and QOL in patients with IPAH.

Abstract A33: Engaging stakeholders to improve quality of life in Latina breast cancer survivors and their caregivers: Lessons learned from a community-based organization

Abstract Purpose: In the United States, the lifetime risk for cancer among women of Latino origin is 1 in 3. Evidence indicates that Latina breast cancer survivors have lower quality of life (QOL) compared to non-Latina survivors. Similarly, research demonstrates that Latino caregivers experience increased distress and physical symptoms compared to age- and gender-matched controls. Nueva Vida, a community-based organization (CBO) that supports Latinos and Latinas with cancer and their families, designed a multidimensional intervention for Latina breast cancer survivors and their caregivers that is uniquely formatted to reflect the cultural preferences and values of Latina survivors and their spouses. The unique format involves twice monthly sessions in which survivors and caregivers arrive together, separate into survivor and caregiver groups, and discuss collectively at the end of the session. Observations in the literature indicate a critical need for evaluation of patient-caregiver interventions (PCIs) to improve QOL in underserved groups. Funded by the Patient-Centered Outcomes Research Institute, the purpose of this project is to determine whether the PCI improves QOL, communication, and satisfaction with care more than usual care among Latina breast cancer patients and their caregivers. Procedures: In addition to the dyadic component of the PCI, the project is guided by two conceptual models: the Contextual Model of Health-Related QOL, which specifies individual, cultural and contextual influences as important determinants of QOL; and Social Cognitive Theory, which focuses on confidence in ability to engage in communication and coping as a survivor or caregiver. Latina breast cancer survivors will be eligible for the study if they self-identify as Latina, speak English or Spanish, and can identify at least one primary, adult caregiver that speaks English or Spanish. Interventionists at four CBOs with distinct geographic and ethnic populations will receive training on implementing the PCI using psychosocial interventions with Latina breast cancer patients. Participants complete telephone interviews prior to the PCI, immediately after, and six months later. Interviews are conducted using the Patient-Reported Outcomes Measurement Information System (PROMIS), a rigorously tested instrument tailored to an individual's current level on a particular domain, which will allow us to compare our findings to other cancer and non-cancer cohorts and more precisely estimate QOL outcomes. Unpublished data: This study is innovative in the inclusion of an socioeconomically diverse population of cancer survivors and their caregivers. This study is the first evaluation of a cancer PCI developed by a Latina survivor based on empirical and theoretical evidence. Survivors and caregivers who attend Nueva Vida's PCI reported positive changes in: family life (93%), relationship with one another (50%), work (72%), feeling better with self (100%), activity (93%), and their spiritual life (100%). This study will assess the impact of the inclusion of a caregiver as a part of care across geographic and socioeconomic groups. In addition, through a review of organizational records, Nueva Vida identified significant steps CBOs can take to engage in community-based participatory research. Conclusions: If successful the intervention will improve outcomes for Latina survivors and caregivers. The potential impact of our intervention is large: we can quickly share results through outreach to 150+ local and national groups that provide care and support to thousands of Latino families facing cancer. It will also indicate the distinct impacts the patient-caregiver intervention has with different socioeconomic groups. Citation Format: Margaret LG Darling, Maria Gloria Elliott, Claudia Campos, Kristi D. Graves. Engaging stakeholders to improve quality of life in Latina breast cancer survivors and their caregivers: Lessons learned from a community-based organization. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr A33. doi:10.1158/1538-7755.DISP13-A33

Determinants of quality of life in children with cerebral palsy: A comprehensive biopsychosocial approach

This study investigated the determinants of quality of life (QOL) of children with cerebral palsy (CP) considering possible variables comprehensively from a biopsychosocial perspective by adopting the International Classification of Functioning, Disability and Health (ICF) and using a CP-specific QOL questionnaire. A total of 167 children with CP (mean age 9.06 years, SD 2.61 years) and their caregivers participated in this study. Children's QOL was measured by the Cerebral Palsy Quality of Life for Children (CP QOL-Child) - primary caregiver proxy-report form. The potential determinants of QOL were collected based on all ICF dimensions. Results of seven multiple regression models showed that the determinants of QOL in children with CP were multidimensional and biopsychosocial in nature, i.e., encompassing the domains of health condition, body functions and structures, and contextual factors of the ICF. Children's behavioral and emotional problems as well as caregiver's psychological and family-related factors were important determinants of QOL in children with CP. Knowledge of the determinants of QOL could serve as a guide in a holistic approach to evaluation and intervention targeted at these determinants to improve the QOL of children with CP.

Su1316 Beyond Abdominal Pain: Pain Beliefs, Pain Affect, and Distress As Determinants of Quality of Life in Patients With Chronic Pancreatitis

Background: Chronic pancreatitis (CP) is a chronic, gastrointestinal disease whose predominant symptom is pervasive and oftentimes intractable upper abdominal pain. While pain is regarded as a multidimensional experience produced by sensory, affective, and cognitive inputs (Melzack, 2001), little is known about their contribution to pain in CP patients or their association, if any, with health outcomes such as quality of life (QOL). The purpose of this study was to examine how different aspects of pain relate to QOL in CP patients. Subjects: Subjects included 41 CP patients (Male = 58%; M Age = 49 yrs.; Caucasian = 73%) who were referred to a specialty clinic in a tertiary teaching hospital in the southeast part of the US and administered a psychometrically validated test battery that included the Pain Beliefs and Perceptions Inventory, McGill Pain Questionnaire-Short Form, Pain Discomfort Scale (pain affect or emotional unpleasantness of pain), Depression Stress Anxiety Scale, and the EORTCQOLQuestionnaire (QLQC-30). Results: A series of partial correlations (controlling for demographic variables) showed statistically significant relationships between QOL and both the intensity of pain (r = .51, p , . 05) and its emotional unpleasantness (r = -.35, p , . 05). In other words, CP patients who described their pain as more intense and emotionally bothersome reported greater QOL impairment. We also examined the relationship between QOL and 3 discrete types of beliefs that reflect CP patients' own conceptualization of what pain is and what pain means for them. CP patients with greater quality of life impairment tended to blame themselves for pain (r = .36, p , . 05), see pain as more mysterious (r = .37 p , . 05), and characterize the duration of pain as more continuous (r = .37 p , . 05). With respect to non-pain factors, QOL impairment was associated with greater stress (r =. 32, p ,. 05) and depression (r = .35, p ,. 05). A series of hierarchical linear regression was conducted to determine the predictive power of pain and non-pain variables. After controlling for demographic variables, pain intensity (t = -3.51) and perceived self-blame for pain (t = 3.42) were significant predictors of overall QOL. Conclusions: These data are conistent with prior research (Pezzilli et al., 2005) showing that the intensity of pain is an important determinant of QOL in CP patients. Findings dovetail with broader pain research showing that how patients appraise their pain influences their quality of life. Data add to the literature by identifying specific pain-related beliefs of CP patients that are correlated with quality of life impairment. Future research is necessary to determine whether modification of patients' pain beliefs is associated with improvements in CP patients' perception of their quality of life. This study is supported partly by NIH grant DK77738.

Determinants of Change in Stroke-Specific Quality of Life After Distributed Constraint-Induced Therapy

We identified the predictive factors of change in quality of life (QOL) after a distributed form of constraint-induced therapy (dCIT) among stroke survivors. Seventy-four participants were treated with dCIT. We identified eight potential determinants of change: age, gender, side of lesion, time since stroke, cognitive status, motor impairment of the upper extremity, activities of daily living (ADLs), and instrumental ADLs (IADLs). The Stroke-Specific Quality of Life Scale (SS-QOL) was used to assess QOL. Right-sided lesion and onset >17 mo earlier determined greater improvement in the SS-QOL Energy domain. Onset >10 mo earlier, poorer IADL performance, and age >68 yr predicted improvement in the Family Role, Mobility, and Mood domains, respectively. Side of lesion, time since stroke, IADL performance, and age were the most important determinants of QOL in patients receiving stroke motor rehabilitation.

Determinants of quality of life in children with chronic somatic disease: pilot data from the GapS Questionnaire

Quality of life (QoL) is a ubiquitous yet poorly defined concept; the precise determinants of QoL are rarely identified. We used pilot data from the GapS Questionnaire to investigate the most important determinants of QoL in children with chronic somatic illness. We enrolled 92 participants including 60 parents and 32 of their children. The sample comprised rheumatology, diabetes, epilepsy, gastroenterology, cystic fibrosis, and day unit patients. Trained interviewers administered the GapS Questionnaire to parents, and to children if ≥ 10 years. We determined the relative importance of different items for QoL. Child participants had a mean age of 14.7 years. Children identified "having good friendships", "being happy most days", and "getting along with parents" as most important. Parents ranked most highly "being allowed to do all the things you like doing", "getting told you have done a good job at something", and "being physically able to do everything you enjoy doing". Physical health items were not as important as social and psychological determinants of QoL in our pilot sample.

Pain rate and social circumstances rather than cumulative organ damage determine the quality of life in adults with sickle cell disease

Due to the significant morbidity associated with sickle cell disease (SCD), sickle cell patients have a reduced quality of life (QoL). Even though pain is considered an important determinant of QoL in sickle cell patients, factors such as organ damage and socioeconomic circumstances may also be important. Therefore, we determined the contribution of chronic organ damage and sickle cell-related complications to QoL and also analyzed the effect of vaso-occlusive crises and socioeconomic circumstances on QoL. Consecutive adult sickle cell patients were included. QoL was represented in a physical component scale (PCS) and a mental component scale (MCS) and assessed with SF-36 forms. Higher pain rates were related to lower QoL scores. Both occupation and the level of education were significantly related to PCS while no relation with MCS or pain rate was found. Thirty-five percent of the patients were unemployed when compared with 6% of the general population and 16% of immigrants without SCD. Neither genotype nor the presence of chronic organ damage were significantly related to QoL. In conclusion, a reduced QoL was mainly determined by pain rate, occupation, and educational level. Chronic organ damage, although a major factor determining life expectancy in SCD, was not a determinant of QoL.

Quality of Life and Body Image for Bladder Cancer Patients Undergoing Radical Cystectomy and Urinary Diversion—A Prospective Cohort Study With a Systematic Review of Literature

To determine whether health and body image are important determinants of quality of life (QoL) for patients undergoing urinary diversion (UD). Patients with advanced bladder cancer who undergo cystectomy and UD face potential serious morbidity (25%-40%) and a small risk of mortality (0%-4%). The systematic review compares QoL and body image for different types of diversions. One researcher trained in using schedule for evaluation of individual quality of life-direct weighting interviewed 32 consecutive patients undergoing radical cystectomy. The European Organization for Research and Treatment of Cancer QLQ-C30 and the Satisfaction With Life Scale questionnaire were also administered before cystectomy and 9-12 months postcystectomy. All QoL studies reporting on radical cystectomy and UD were reviewed between 1996 and March 2008. Family, relationships, health, and finance were the most important determinants of QoL, whereas body image was not mentioned by anyone. On using European Organization for Research and Treatment of Cancer QLQ-C30 and Satisfaction With Life Scale, it was found that there was no difference in QoL of patients pre- and postcystectomy. In our review of published data, 40 studies were identified reporting on 3645 patients. Only 2 studies reported a better QoL in favor of neobladders, whereas 2 other studies suggest a better body image perception in patients with neobladder. This prospective cohort study suggests that health and body image may not always be important to patients for their QoL. Our systematic review suggests an overall good QoL in most studies irrespective of the type of UD, with no significant differences among the different diversion types.

Erectile function, sexual desire, and psychological well-being in men with epilepsy

Objective The aim of this study was to explore the effects of anxiety, depression, and self-reported quality of life (QOL) on sexual function of men with epilepsy (MWE). Methods Sixty-nine MWE taking one antiepileptic drug and 50 controls were recruited. All completed sexual function questionnaires, the Hospital Anxiety and Depression Scale (HADS), and the World Health Organization Brief Quality of Life Questionnaire (WHOQOL-BREF). Blood was taken to analyze testosterone and dihydroepiandrosterone sulfate levels. Results Compared with controls, MWE reported higher levels of anxiety, depression, and psychological distress; lower overall quality of life and health; and lower levels of sexual desire and erectile function. Seizure frequency did not affect any of these variables, and testosterone levels did not correlate with sexual desire or erectile function. Simple linear regression showed a significant negative correlation between sexual desire and indices of anxiety, depression, and psychological distress. Multiple linear regression using overall QOL as dependent variable showed that anxiety, depression, psychological distress, and the Psychological Well-Being subscale of the WHOQOL-BREF predicted 48% of its variability. Interestingly, sexual function and seizure status did not. Conclusion MWE reported lower levels of sexual desire and were more likely to report erectile dysfunction than controls. But the most important determinant of QOL was psychological status, not seizure frequency or sexual function.

Cognitive Performance and Quality of Life in Bipolar Disorder

In patients with bipolar disorder (BD), quality of life (QOL) scores have been largely attributed to mood symptoms. However, impairments in QOL may occur even in euthymia, and differential factors have been put forward as important determinants of QOL. Our study was designed to assess the role of cognitive performance in self-reported QOL in patients with BD. In this cross-sectional study, we examined the relation between cognitive variables and self-reported QOL in 55 bipolar I euthymic patients and 50 healthy subjects. Participants were administered the World Health Organization Quality of Life Assessment--Abbreviated version and a battery of neuropsychological tests. BD patients showed lower scores in all QOL domains as compared with control subjects. Poorer self-reported QOL correlated significantly with worse cognitive performance, especially on tests of executive functioning and verbal abstraction. A linear regression model revealed that all QOL domains were significantly predicted by cognitive variables, with variances ranging from 12% to 37%, and from 24% to 54% when clinical variables were added to the model. Deficits in executive functioning and verbal abstraction were strong predictors of poor self-reported QOL. Our findings suggest that, along with mood stabilization, adequate cognitive functioning is desirable for achieving better QOL. These findings suggest that cognitive rehabilitation may be an important factor for restoring QOL to baseline levels among BD patients.

The association of dermatologist‐diagnosed and self‐reported skin diseases with skin‐related quality of life in Latino migrant farmworkers

Skin diseases are known to affect the quality of life (QoL), but data to support this are based on clinical samples. Few data document the skin-related QoL in the general population, and whether its association differs with self-reported or dermatologist-diagnosed skin ailments. Farmworkers are at high risk for skin diseases, and are an appropriate population in which to explore these associations. To compare the association between skin-related QoL and workers' self-reports of skin conditions or dermatologist-diagnosed skin diseases over the course of a work season. Three hundred and four Latino farmworkers were recruited from 45 randomly selected residential sites in North Carolina, USA, for longitudinal surveillance. The participants were interviewed up to five times at 3-week intervals and the reported skin problems and Dermatology Life Quality Index (DLQI) were recorded. Nine digital photographs were taken of each participant. A board-certified dermatologist rated each for the presence of specific skin diseases. An impact of skin disease on QoL was reported in 16% of interviews. In multivariate analyses with self-reported skin problems, feet or skin fungus, rash, itching, and poison ivy were predictors of QoL. Dermatologist-diagnosed inflammatory diseases and pigmentary disorders were significant predictors of QoL. The association was stronger for self-reported skin problems than for dermatologist-diagnosed conditions. In a population of farmworkers, skin problems had a clinically significant impact on QoL. Itch-related conditions and cosmetic conditions, such as acne and melasma, were important determinants of QoL. Treatment for these conditions in this population may enhance QoL.