Improvement In General Health Research Articles

Multilevel percutaneous kyphoplasty in painful osteolytic vertebral metastases: a study of the efficacy and safety.

Purpose: The spine is the most common skeletal site for metastatic tumors. In the treatment of vertebral metastases, the absolutely safe number of levels that can be treated via percutaneous kyphoplasty (PKP) during one procedure remains controversial. Thus, the present study aimed to evaluate the safety and efficacy of multilevel (>3) PKP for painful osteolytic vertebral metastases.Patients and methods: We retrospectively analyzed the data from 176 patients who received PKP for painful osteolytic spinal metastases. Group A (n=104) received PKP at a maximum of three vertebral levels per procedure, while group B (n=72) received PKP at more than three levels during one operation. Surgical efficacy was assessed via a comparison of the VAS, Oswestry Disability Index (ODI), and general health (GH) and mental health (MH) scores of the Short Form-36 Health Survey before and after PKP. The complications were observed to evaluate the safety.Results: Both groups had significantly improved VAS, ODI, GH and MH scores after PKP (P<0.05). One week after surgery, group A had significantly less pain (VAS 3.41±0.1) than group B (VAS 3.74±0.13) (P<0.05). At 3 and 6 months postoperatively, the GH score was more significantly improved in group A than group B (P<0.05). There were no significant differences between the two groups in the ODI, MH score, and complications (P>0.05).Conclusion: Multilevel PKP is safe and results in effective pain relief, and improvement of spinal mobility and GH in patients with osteolytic vertebral metastases. However, patients who undergo PKP at more than three levels have slightly worse short-term pain relief (less than 1 week postoperatively) and improvement of GH in the long-term (more than 3 months postoperatively) compared with patients who undergo PKP at less than three levels.

Clinical outcome following duraplasty in type 1 Arnold Chiari malformation

Background: Few authors support the use of duraplasty and few authors have reported a higher rate of complications associated with the same. The objective of the present endeavor was to study clinical outcome following duraplasty in type 1 Arnold Chiari malformation.Methods: Retrospectively, 24 cases and prospectively 18 cases diagnosed and operated for Chiari malformation type I were included. Patients with Chiari type II, III, and IV were excluded. A questionnaire was used to assess the improvement in neck pain and disability due to it, head pain and disability due to it and improvement in general health before and one year after surgery. The results of the questionnaire of both groups were analyzed and compared.Results: The most common age group of presentation was 2nd decade (35.71%) followed by 3rd decade (26.19%). The male to female ratio was 1.2:1. The most common presenting complaint was sensory disturbances (66.66%) followed by neck pain in 14 patients (33.33%). The most common sign was limb weakness in 21 patients (50%). 24 patients were operated with foramen magnum decompression with duraplasty and 18 patients were operated without duraplasty. There were more complications in the duraplasty group. Patients showed an overall clinical improvement of 83.33% in the duraplasty group compared to a lower overall clinical improvement rate of 55.50% in the no duraplasty group. Specific symptoms like neck pain showed similar rate of improvement of (88.89%) in the duraplasty group compared to no duraplasty group (80%).Conclusions: Foramen magnum decompression with duraplasty is superior to foramen magnum decompression without duraplasty although slightly higher rate of complication is seen with duraplasty.

Ectoine lozenges in the treatment of acute viral pharyngitis: a prospective, active-controlled clinical study

PurposeAcute pharyngitis is an uncomfortable disorder mostly caused by viruses and for which antibiotics are unwarranted. This study compared lozenges containing ectoine, a natural extremolyte, with hyaluronic acid lozenges and hypertonic saline gargle for symptomatic treatment of acute viral pharyngitis.MethodsThis prospective, controlled clinical study, recruited 90 patients with moderate-to-severe pharyngitis symptoms who chose to use either ectoine (n = 35), hyaluronic acid (n = 35), or saline gargle (n = 20). Patients applied their 7-day treatment from the inclusion visit (V1) until the end-of-study visit (V2). Patients’ pharyngitis symptoms, general health, general treatment effectiveness and tolerability, and patient compliance were assessed by investigators and patients.ResultsThe sum score for three primary symptoms (pain on swallowing, urge to cough, and hoarseness) decreased by 79.5% (ectoine), 72.2% (hyaluronic acid), and 44.8% (saline gargle). Both lozenges were significantly superior to saline gargle (P < 0.05). Regarding general health improvement, ectoine was significantly superior to saline gargle (72.5% vs. 45.2%, P < 0.05), but hyaluronic acid (63.3%) was not. At V2, 65.7% of patients receiving ectoine reported “very good” general health vs. 48.6% of those receiving hyaluronic acid and 20.0% using saline gargle. Ectoine was significantly superior (P < 0.05) to both hyaluronic acid and saline gargle in terms of tolerability and patient compliance. No patients taking ectoine reported unpleasant sensations while applying their treatment, whereas almost half of patients using hyaluronic acid lozenges and saline gargle did.ConclusionTreatment with ectoine lozenges significantly relieves moderate-to-severe symptoms of acute viral pharyngitis and is more effective and tolerable than treatments with hyaluronic acid lozenges and hypertonic saline gargle.

Responsiveness and minimal clinically important difference for the EQ-5D in chronic rhinosinusitis.

The 5-dimensional EuroQol questionnaire (EQ-5D) is validated to measure general health-related quality of life (QOL). Our objective was to determine the responsiveness and minimal clinically important difference (MCID) of the EQ-5D health utility value (EQ-5D HUV) and visual analog scale (EQ-5D VAS) in chronic rhinosinusitis (CRS). 203 adults undergoing medical management for CRS were prospectively recruited. General health-related QOL (using EQ-5D HUV and EQ-5D VAS) and CRS-specific QOL (using the 22-item Sinonasal Outcome Test [SNOT-22]) were measured at enrollment and a subsequent follow-up time point 2-12 months later. At follow-up, participants also rated change in general health as Much worse, A little worse, About the same, A little better or Much better compared to enrollment. The EQ-5D HUV and EQ-5D VAS MCIDs were calculated using distribution-based, anchor-based, and receiver operator characteristic (ROC) curve-based methods. Change in SNOT-22 score was correlated with EQ-5D HUV and EQ-5D VAS change. Using the different methods of calculating MCID, we find the EQ-5D HUV MCID to be 0.04 and EQ-5D VAS MCID to be 8.0. The calculated EQ-5D MCIDs had approximately a sensitivity of 40-50% and specificity of 80% in detecting patients experiencing noticeable improvement in general health. The EQ-5D responds well to changing CRS symptomatology. We propose MCIDs for EQ-5D HUV of 0.04 and EQ-5D VAS of 8 in CRS patients, which although specific, are not sensitive for detecting patients experiencing improvement in general health.

Healthcare Providers Underestimate Patients' Glucocorticoid Use in Crohn's Disease.

One of the therapy goals for Crohn's disease (CD) is glucocorticoid-free remission. Studies have shown care setting-specific variations in inflammatory bowel disease (IBD) management. The principal objective of this study was to assess concordance between patient-reported and physician-reported outcomes in two different care settings (IBD centers and community practices). Data of overall and long-term (≥ 3months) glucocorticoid, immunosuppressant, and biologics use in participants ≥ 18years old with a confirmed diagnosis of CD were collected. HCPs were grouped by IBD centers and community practices. Quality of life (using EuroQol 5D [EQ-5D]) and work/activity days lost were assessed. Agreement between patients' and HCPs' responses to survey questions was tested using kappa statistics. Data from 812 patients were examined. Significantly more patients versus HCPs reported oral glucocorticoid use (25.9% vs. 20.8%, κ = 0.735, P < 0.0001). Long-term use of oral glucocorticoids was similar for patients versus HCPs (67.7% vs. 63.8%, κ = 0.598, P = 0.53). Immunosuppressant use was 52.4% vs. 51.1% (κ = 0.784) and biologics use was 49.5% vs. 47.0% (κ = 0.909) for patients vs. HCPs. Patients and HCPs reported greater rates of symptom improvement with vs without biologic therapy (patients: 33.3% vs 16.8%; HCPs: 29.3% vs 13.5%, both P < 0.001). Patients with versus without routine follow-up were less likely to be treated with long-term glucocorticoid monotherapy (10.3% vs. 20.7%, P < 0.01) and had fewer lost work/activity days (5vs. 8days, P < 0.05). Patients reported more oral glucocorticoid use than physicians thought. Routine follow-up and higher rates of biologic use are associated with improvement in disease symptoms and general health among patients with CD.

Targeted therapy of underlying conditions improves quality of life in patients with persistent atrial fibrillation: results of the RACE 3 study

Atrial fibrillation (AF) reduces quality of life (QoL). We aim to evaluate effects of targeted therapy of underlying conditions on QoL in patients with AF and heart failure (HF). The Routine versus Aggressive risk factor driven upstream rhythm Control for prevention of Early atrial fibrillation in heart failure (RACE 3) study randomized patients with early persistent AF and HF to targeted or conventional therapy. Both groups received guideline-driven treatment. The targeted group received four additional therapies: mineralocorticoid receptor antagonists; statins; angiotensin converting enzyme inhibitors and/or receptor blockers; and cardiac rehabilitation including physical activity, dietary restrictions, and counselling. Quality of life was analysed in 230 patients at baseline and 1 year with available Medical Outcomes Study Short-Form Health Survey (SF-36), University of Toronto AF Severity Scale (AFSS) questionnaires, and European Heart Rhythm Association (EHRA) class. Improvements in SF-36 subscales were larger in the targeted group for physical functioning (Δ12 ± 19 vs. Δ6 ± 22, P = 0.007), physical role limitations (Δ32 ± 41 vs. Δ17 ± 45, P = 0.018), and general health (Δ8 ± 16 vs. Δ0 ± 17, P < 0.001). Dyspnoea at rest improved more (Δ-0.8 ± 1.3 vs. Δ-0.4 ± 1.2, P = 0.018) and EHRA class was lower at 1-year follow-up in the targeted group. Patients with AF at 1 year, improvement in physical functioning (Δ9 ± 9 vs. Δ-3 ± 16, P = 0.001), general health (Δ7 ± 16 vs. Δ-7 ± 19, P = 0.004), and social functioning (Δ6 ± 23 vs. Δ-4 ± 16, P = 0.041) were larger in the targeted group. A strategy aiming to treat underlying conditions improved QoL more compared with conventional therapy in patients with early persistent AF and HF. Its benefit was even observed in patients in AF at 1 year. Clinicaltrials.gov NCT00877643.

Effect of Yoga on Immune Parameters, Cognitive Functions, and Quality of Life among HIV-Positive Children/Adolescents: A Pilot Study.

Context:HIV/AIDS individuals have problems relating to immune system, quality of life (QOL), and cognitive functions (CFs). Yoga is found to be useful in similar conditions. Hardly, any work is reported on yoga for HIV-positive adults/adolescents. Hence, this study is important.Aim:The aim of the study is to determine the effect of yoga on immune parameters, CFs, and QOL of HIV-positive children/adolescents.Settings and Design:Single-group, pre–post study with 4-month yoga intervention.Methods:The study had 18 children from an HIV/AIDS rehabilitation center for children/adolescents. CD4, CD8, CD4/CD8 ratio, and viral loads were studied. CF tests included six letter cancellation test, symbol digit modalities test, digit-span forward backward test, and Stroop tests. QOL was assessed using PedsQL-QOL and fatigue questionnaire. Depression was assessed using CDI2-SR.Statistical Analysis Used:t-test and Wilcoxon signed-rank tests, as applicable.Results:The study included 18 children/adolescents. There was improvement in general health of the participants. There was statistically significant increase in CD4 cells counts (p = 0.039) and significant decrease in viral load (p = 0.041). CD4/CD8 ratio moved to normal range. QOL significantly improved. CFs had mixed results with improved psychomotor performance (PP) and reduced executive functions.Conclusions:There was improvement in general health and immune parameters. While depression increased, QOL improved. CFs showed mixed results with improved PP and reduced executive functions.

Management of Type 1 diabetes mellitus with autologous mesenchymal stem cells

Type 1 diabetes mellitus (DM) is one of the most common chronic metabolic disorders among children. The condition is associated with dysregulation of the immune system resulting in loss of self-tolerance and destruction of pancreatic β-cells by autoreactive T-lymphocytes. Regulation of β-cell homeostasis is vital to maintain optimum blood glucose control as well as prevent the development of complications. Exogenous insulin and oral hypoglycemic agents do not achieve this, as they do not address the core pathology of type 1 DM. This report describes a case of a 17-year-old female patient with fluctuating blood glucose levels and high glycosylated hemoglobin, unresponsive to conventional therapy. After undergoing two sessions of cell-based therapy, within a year, optimum control of blood glucose was achieved along with negative anti-insulin antibodies. The patient was able to discontinue insulin and has not experienced any adverse effects till date. Improvement in general health was noticed, and the patient is now free from any symptoms associated with her former diabetic status. Mesenchymal stem cells (MSCs) possess immunomodulatory and pro-angiogenic properties, which may aid in arresting β-cell destruction. In addition, MSCs may preserve residual β-cell mass and facilitate endogenous β-cell regeneration. These cells are capable of differentiating into glucose-responsive insulin-producing cells, making them ideal candidates in treatment of and prevention of complications in T1DM.

A Randomized Clinical Trial of Elemental Zinc Add-on Therapy on Clinical Outcomes of Patients with Chronic Rhinosinusitis with Nasal Polyposis (CRSwNP).

Recent studies suggest a relationship between zinc deficiency and inflammation. In the present study, we studied the effect of oral zinc supplementation on clinical improvement of chronic rhinosinusitis with nasal polyposis. In this single-blind randomized controlled trial, 44 patients with chronic rhinosinusitis with polyposis referring to ENT clinic of the Loghman Hakim hospital during 2013-2014 were randomly allocated in two groups. The treatment group (n = 28) was treated with a four-drug fixed-dose regimen (FD_FDR) consisting of oral dexamethasone (0.02 mg/kg), fluticasone nasal spray, fexophenadine 60 mg daily, montelukast 10 mg daily plus 220mg zinc sulfate capsules containing 55 mg elemental zinc, b.d., and the control group (n = 16) received the FD_FDR without supplemental zinc, for six weeks. After sixth week, two groups were compared regarding clinical outcomes based on theSNOT20 (Sinonasal outcome test) questionnaire, the general health questionnaire (SF12), the Lund-Mackay, and the Lund-Kennedy scoring systems. In the treatment group, serum zinc levels were significantly increased compared to those at the baseline (1.33 fold-increase; p = 0.0002). Within groups analysis revealed a significant reduction (p < 0.01) in LM and LK in both treatment (55% LM; 50% LK) and control groups (45% LM; 53% LK). Incontrast, between groups analysis revealed no significant differences in the LM and LK. The treatment group showed a mild superiority in general health improvement compared to that of the control group. Add-on therapy with supplemental zinc sulfate was not associated with significant improvement in patients with chronic rhinosinusitis with nasal polyposis (CRSwNP). The advantage of zinc supplementation on the general health improvement of the patients with CRSwNP requires further assessments.

Brain repair and general health improvement through human neurophysiology and repair physiology

Brain repair and general health improvement through human neurophysiology and repair physiology

Change in patients' self-reported quality of life before and after dental implantation

Background/Aim: The loss of teeth and its consequences for health, as well as the psychological discomfort it entails, have a negative impact on both self-reported health state and quality of life (QoL). Dental implantation aims to increase patients' health and satisfaction and to improve all aspects of QoL. The purpose of this cross-sectional correlational study was to compare the patients' QoL before and after dental implantation. Material and Methods : The study comprised 62 patients aged between 24 and 77, including 28 (45.16%) women and 34 (54.84%) men, who reported to a private dental clinic in Szczecin, Poland to replace missing teeth with implants. The survey was carried out twice: prior to the treatment, when the decision to use implants had been made, and three months after implantation, during the first check-up. QoL was measured using the 36-Item Short Form Health Survey (SF-36), and sociodemographic data were collected using a questionnaire of the author. Results: There were statistically significant differences between the assessment of health and QoL before and after implantation treatment. Both the patients' health and comfort of life improved after therapy. Conclusions: Replacement of missing teeth with dental implants brought overall improvement in patients' QoL, social comfort, and general health. Dental implantation should be recommended in the early phase of edentulism, after tooth loss.

Efficacy and safety of neuroprotection in patients with primary open-angle glaucoma

To study the effect of 'Cytoflavin' drug on the stabilization of glaucomatous optic neuropathy in patients with POAG. The study included 103 patients with initial or developed POAG. Patients were randomized into two groups using random numbers: the control group patients (n=50) receiving standard conservative treatment, and the main group (n=53), where patients received the combined drug with metabolic action 'Cytoflavin'. In addition to standard ophthalmological studies, all patients underwent biological, electrophysiological, perimetric, structural topographic, laboratory and sociological examinations before and after the treatment. By the end of the 3rd month of the treatment, the patients of the main group showed positive dynamics of the amplitude and phase characteristics of bioelectric activity of the retina, improvement in the total sensitivity of the retina for central field of view. Cytoflavin contributed to reducing the rate of progression of glaucoma according to optical coherence tomography: stabilization of the thickness of the nerve fiber layer, reduction of the rate of global and focal loss of retinal ganglion cells. In patients of the main group, by the end of the 3rd month, the severity of oxidative stress has significantly reduced and the antioxidant defense improved. On the background of stabilized glaucomatous process, a subjective improvement in general and psycho-emotional health, increased confidence in the success of the therapy and thus the improved the quality of life was observed in comorbid patients of the main group. Cytoflavin acts on the mechanisms that enhance the protection of the retina against the effects of reperfusion injury and oxidative stress, contributes to the metabolic adaptation of neurons and leads to a more favorable variant of POAG.

MOral Health in India: Current Scenario and Future Perspectives.

Oral diseases affect half of the world's population and found to be the most common and preventable noncommunicable diseases worldwide. The World Health Organization Oral Health Programme work plan 2018–2020 is to prevent the burden of oral diseases using digital technology. With 5 billion mobile phone subscribers in the world, covering over 85% of the world's population, the utilization of technology-based interventions for oral health promotion is no different. In India, numerous medical applications such as eRaktkosh and mDiabetes have been developed for the improvement of general health, whereas few initiatives such as mCessation and National Quitline services for oral health have been undertaken. Digitalization and oral health forms a crucial component in the future of oral health, which should be utilized in ensuring oral health for all.

Total serum IgE levels among adults patients with intermittent and persistent allergic asthmas

Background: Obesity with knee osteoarthritis (OA) is related to chronic pain causing physical inactivity that leads to decreased cardiorespiratory endurance and quality of life. Aquatic and land-based exercises are effective in improving physical activity. The aim of this study is to compare between aquatic and land-based exercise to improve cardiorespiratory endurance and quality of life in obese patients with knee osteoarthritis.Methods: A single-blind, randomized, controlled trial was conducted on thirty-three obese patients with knee OA who visited Obesity Clinic of Medical Rehabilitation Cipto Mangunkusumo Hospital, from October 2016 to January 2017, subjects were divided into aquatic or land-based exercise group. Aerobic and knee-strengthening exercises were given. Cardiorespiratory endurance was assessed using the Borg Scale, whereas both the BORG CR-10 and SF-36 questionnaires were used to assess quality of life.Results: After intervention, there were significant improvements in the land-based exercise group in the rating of perceived exertion (p=0.02), role limitations due to physical health (p=0.024), role limitations due to emotional problems (p=0.041), energy/fatigue (p=0.016), and the decline in pain (p=0.049) parameters. While in the aquatic exercise, there were significant improvements in leg fatigue (p=0.016), energy/fatigue (p=0.025), emotional well-being (p&lt;0.001), and general health (p=0.045) parameters. Despite this, there were no significant differences between two groups regarding cardiorespiratory endurance and quality of life.Conclusion: This study found that patients could start aquatic exercise to reduce leg fatigue and enhance general health and energy. After that, exercise could be continued in land-based settings to improve cardiorespiratory endurance and quality of life.

Aquatic versus land-based exercise for cardiorespiratory endurance and quality of life in obese patients with knee osteoarthritis: a randomized controlled trial

Background: Obesity with knee osteoarthritis (OA) is related to chronic pain causing physical inactivity that leads to decreased cardiorespiratory endurance and quality of life. Aquatic and land-based exercises are effective in improving physical activity. The aim of this study is to compare between aquatic and land-based exercise to improve cardiorespiratory endurance and quality of life in obese patients with knee osteoarthritis.Methods: A single-blind, randomized, controlled trial was conducted on thirty three obese patients with knee OA who visited Obesity Clinic of Medical Rehabilitation Cipto Mangunkusumo Hospital, from October 2016 to January 2017, subjects were divided into aquatic or land-based exercise group. Aerobic and knee-strengthening exercises were given. Cardiorespiratory endurance was assessed using the Borg Scale, whereas both the BORG CR-10 and SF-36 questionnaires were used to assess quality of life.Results: After intervention, there were significant improvements in the land-based exercise group in the rating of perceived exertion (p=0.02), role limitations due to physical health (p=0.024), role limitations due to emotional problems (p=0.041), energy/fatigue (p=0.016), and the decline in pain (p=0.049) parameters. While in the aquatic exercise, there were significant improvements in leg fatigue (p=0.016), energy/fatigue (p=0.025), emotional well-being (p&lt;0.001), and general health (p=0.045) parameters. Despite this, there were no significant differences between two groups regarding cardiorespiratory endurance and quality of life.Conclusion: This study found that patients could start aquatic exercise to reduce leg fatigue and enhanced general health and energy. After that, exercise could be continued in land-based settings to improve cardiorespiratory endurance and quality of life.

Cancer survivors\u2019 needs during various treatment phases after multimodal treatment for colon cancer - is there a role for eHealth?

BackgroundMore colon cancer patients are expected to fully recover after treatment due to earlier detection of cancer and improvements in general health- and cancer care. The objective of this study was to gather participants’ experiences with full recovery in the different treatment phases of multimodal treatment and to identify their needs during these phases. The second aim was to propose and evaluate possible solutions for unmet needs by the introduction of eHealth.MethodsA qualitative study based on two focus group discussions with 22 participants was performed. The validated Supportive Care Needs Survey and the Cancer Treatment Survey were used to form the topic list. The verbatim transcripts were analyzed with Atlas.ti. 7th version comprising open, axial and selective coding. The guidelines of the consolidated criteria for reporting qualitative research (COREQ) were used.ResultsExperiences with the treatment for colon cancer were in general positive. Most important unmet needs were ‘receiving information about the total duration of side effects’, ‘receiving information about the minimum amount of chemo needed to overall survival’ and ‘receiving a longer aftercare period(with additional attention for psychological guidance)’. More provision of information online, a chat function with the oncological nurse specialist via a website, and access to scientific articles regarding the optimal dose of chemotherapy were often mentioned as worthwhile additions to the current health care for colon cancer.ConclusionsMany of the unmet needs of colon cancer survivors occur during the adjuvant treatment phase and thereafter. To further optimize recovery and cancer care, it is necessary to have more focus on these unmet needs. More attention for identifying patients’ problems and side-effects during chemotherapy; and identifying patients’ supportive care needs after finishing chemotherapy are necessary. For some of these needs, eHealth in the form of blended care will be a possible solution.

The Assessment of Health-Related Quality of Life in Relapsed or Refractory Myeloma Patients Receiving Lenalidomide and Low Dose Dexamethasone: A Result of Hola Study

IntroductionMultiple myeloma is still considered an incurable disorder. Nevertheless, many patients now live beyond five years with improvements in treatment. As a result, the management of heath related quality of life (QoL) has emerged as an important issue in myeloma patients. Lenalidomide has been widely used for relapsed or refractory myeloma. As lenalidomide is an oral agent, lenalidomide-based treatment for multiple myeloma is mostly out-patient based. Thus, patients receiving lenalidomide should spend most of their time managing symptoms at home with unclear impact on their life quality. To date there are limited data about longitudinal QoL and psychosocial effects of patients receiving lenalidomide treatment.MethodsThe study population was relapsed or refractory myeloma patients who would be treated with lenalidomide and low-dose dexamethasone as a clinical practice. The length of a cycle was 28 days and the treatment consisted of lenalidomide 25mg per day (D1-21) and dexamethasone 40mg once a week (D1, 8, 15, and 22). The objective of the study was to assess serial changes of QoL and psychosocial problems in relapsed or refractory myeloma patients receiving lenalidomide. After obtaining informed consent, we assessed the baseline QoL using the EORTC QLQ C30 and myeloma-specific questionnaires. We also assessed distress, psychosocial problems, sleep, depression, pain and social support using distress scales, Pittsburgh sleep quality index, geriatric depression scales, and brief pain inventory. Distress was assessed every visit at outpatient clinic. The follow-up assessment of QoL and psychosocial problems was performed before the 4th and 12th cycle. When a patient progressed during treatment, the final assessment was done at the end of treatment.ResultsA total of 140 myeloma patients were enrolled between March 2013 and April 2017. The median age was 67 years (range: 45-81 years), and male was dominant (n = 92, 66%). The median time from diagnosis to enrollment was 2.8 years (range: 0.4 - 14.1 years), and the median number of previous treatments was three (range: 1 - 8). All patients were previously treated with bortezomib-containing treatment including bortezomib/dexamethasone, bortezomib/thalidomide/dexamethasone and bortezomib/melphalan/prednisone. Patients received lenalidomide and dexamethasone for their relapsed disease (n = 98, 70%) or refractory disease to previous treatments (n = 42, 30%). The baseline evaluation showed the presence of psychosocial problems including depression (n = 51, 36%), distress with problems (n = 42, 30%) and suffering from insufficient support (n = 29, 21%). During treatment, 58 patients withdrew from the study due to disease progression. The serial assessment of QoL showed the improvement of general health in tandem with the response to lenalidomide/dexamethasone treatment. The physical, role and emotional functioning were also improved compared to baseline values at the time of enrollment. As might be expected, the QoL items reflecting the general health and physical/role functioning showed higher values in patients responding to treatment than patients who failed to respond to lenalidomide/dexamethasone. However, some aspects of QoL, notably cognitive and social functioning, were not improved during treatment in responders and non-responders. The serial monitoring of distress level also showed no significant change regardless of response to lenalidomide. Although the difference was not statistically significant, patients reported their physical symptoms such as fatigue, constipation, dyspepsia and neuropathy were improved during treatment. However, the majority of patients experienced insomnia and financial difficulties.ConclusionsThe health-related QoL of myeloma patients such as global health and functioning improved as patients were treated with lenalidomide and low-dose dexamethasone. However, a substantial number of patients continued to suffer from sleep disturbance and physical symptoms such as neuropathy. Accordingly, distress level of patients was not changed even though patients achieved complete response to lenalidomide. The discordant results suggest that physicians should pay close attention to the various aspects of QoL and psychosocial problems, managing appropriately those facets that are not improved in association with response to treatment. DisclosuresNo relevant conflicts of interest to declare.

1356. Improvement in Quality of Life for Adults With Acute Bacterial Skin and Skin Structure Infections Following Treatment With Omadacycline or Linezolid

BackgroundThe appearance of multidrug-resistant Gram-positive bacteria is a major challenge in clinical care. Omadacycline is the first aminomethylcycline antibiotic (semisynthetic compounds related to tetracyclines) in late-stage clinical development for acute bacterial skin and skin structure infections (ABSSSI), and demonstrates potent in vitro activity against many pathogens.MethodsSeven hundred thirty-five patients were enrolled in the OASIS-2 randomized controlled trial comparing omadacycline and linezolid for the treatment of adult subjects with ABSSSI known or suspected to be due to a Gram-positive pathogen, with 368 and 367 enrolled in each group, respectively. Subjects completed the 36-Item Short Form Health Survey Version 2 (SF-36v2), a validated questionnaire on physical and mental health, at both screening and post-treatment evaluation. Results of the SF-36v2 were analyzed in accordance with established norm-based standards for the survey (Ware 2000) for the intention-to-treat population.ResultsSubjects who received omadacycline experienced a 3.25 point mean improvement in overall physical health (P < 0.001, Figure 1) and reported significant improvements across all but one component parameter of overall physical and mental health, including physical functioning, bodily pain, role physical, vitality, role emotional, mental health, and social functioning (Figure 2). In contrast, while overall physical health improved for subjects who received linezolid, the improvement in vitality, role emotional, mental health, and general health was not significant (Figure 2). Although omadacycline achieved greater increase from baseline than linezolid across all domains analyzed, the difference in scores was not statistically significant at the P < 0.05 level (Figure 1).Figure 1.Figure 2.ConclusionOmadacycline provides significant improvement in the physical component of quality of life over baseline for adult subjects with ABSSSI known or suspected to be due to a Gram-positive pathogen. Although the OASIS-2 trial was neither designed nor powered to measure differences in quality of life following treatment, trends identified in this analysis merit further investigation.

The role of knowledge in internet-based cognitive behavioural therapy for adolescent depression: Results from a randomised controlled study

Background and objectivesClients' knowledge about their condition and treatment is considered crucial for general health improvement, and knowledge acquisition is an essential part in internet-based cognitive behavioural therapy (ICBT). Yet, little is known about the role of knowledge and how it influences treatment outcome. This study aimed to examine if explicit knowledge increased following ICBT for adolescent depression, if knowledge gain would be associated with symptom reduction, and if pre-existing knowledge predicted changes in depressive symptoms. MethodsSeventy-one adolescents were randomised to a therapist-supported ICBT or a attention control condition. A measure of depression (BDI-II) and a knowledge test dealing with depression, comorbid anxiety, and its CBT-treatment were administered before and after treatment. ResultsSignificant improvements in knowledge were observed following ICBT compared to the attention control (between-group Cohen's d = 1.25, 95% CI [0.67–1.79]). On average, participants in the treatment group answered 1.4 more questions correctly at post treatment compared to the control group. No relation between change in knowledge and change in depressive symptoms could be observed. Knowledge scores at baseline were high for both groups, with participants answering approximately 75% of the questions correct. A higher level of initial knowledge level predicted poorer treatment response (Parson's r = −0.38, p = .048). ConclusionsThe findings indicate that knowledge about basic concepts and principles about depression, anxiety, and CBT increases following ICBT. This increase in knowledge was not related to change in depressive symptoms, indicating that knowledge is a different construct. The results also suggest that clients who are more knowledgeable prior to treatment might benefit less from ICBT. In sum, the results highlight the need to further examine the role of knowledge in ICBT.

The complex relationship between diet, quality of life and life expectancy: a narrative review of potential determinants based on data from Italy.

The increasing life expectancy at birth and the improvement of general health observed worldwide over the previous years are likely due to many factors. In this regard, the Organisation for Economic Cooperation and Development (OECD) has highlighted the favourable situation of the Italian population, which is amongst the most privileged in the world. In Italy, the national healthcare system is easily accessible to the whole population without direct costs, and alcohol abuse and cigarette smoke are less widespread compared to neighbouring countries. Moreover, the population still largely follows a dietary pattern characterised by the consumption of foods rich in protective compounds (plant foods and their components, such as fibre, polyphenols and polyunsaturated fatty acids). According to recent data, a significant consumption of these foods, which are key components of the Mediterranean model, is likely to play a more important role compared to the limited consumption of nutrients considered less favourable (essentially, saturated fat and sugar). Based on these assumptions, it can be inferred that the adoption of coercive legislative interventions-which have been introduced in other western countries to improve diet quality-may not be an optimal strategy in a country like Italy. Such an intervention would contend with psychological and social aspects (namely with the belief that participating in decision-making is an essential right) and with broader indications emerging in the research within this field (the effectiveness of a nudge approach as opposed to constraining interventions). These factors may limit any expected positive impact on health within this context. LEVEL OF EVIDENCE: Level V, narrative review.