Increase In Quality Of Life Score Research Articles

Efficacy and safety of mirabegron in the treatment of overactive bladder syndrome after radical prostatectomy: a prospective randomized controlled study.

To evaluate the effects of mirabegron in the treatment of overactive bladder syndrome (OAB) after radical prostatectomy (RP). A total of 108 post-operative RP patients were randomly assigned to either the mirabegron (study) or the placebo (control) group. The Overactive Bladder Syndrome Self-Assessment Scale (OABSS) was selected as the primary endpoint, and the International Prostate Symptom Score (IPSS) and Quality of Life (QOL) score were selected as secondary endpoints. Statistical analysis was performed using IBM SPSS Statistics 26, and the treatment effects were compared between the two groups using independent samples t-test. In total, 55 patients were included in the study group and 53 patients in the control group. The mean age was(70.08 ± 7.54)years. There was no statistical difference in the baseline data between the two groups. OABSS scores decreased significantly in the study group compared to the control group during drug treatment (6.67 ± 1.06 vs. 9.14 ± 1.83, p < 0.01) and were better than the control group during the follow-up at week 8 and week 12. In addition, the decrease in IPSS scores (11.29 ± 3.89 and 15.34 ± 3.54, p<0.01) and the increase in QOL scores (2.40 ± 0.81 vs. 3.20 ± 1.00) were statistically significant in the study group. And the patients in the study group had better improvement in voiding symptoms and quality of life than the control group during the follow-up period. Daily administration of 50 mg mirabegron after RP surgery significantly improved the symptoms of OAB after surgery with fewer side effects. Additional randomized controlled trials should be conducted in the future to further evaluate the efficacy and safety of mirabegron.

Effect of Serelys Homme on the Incidence and Severity of Vasomotor Symptoms and Quality-of-Life Impairments in Patients Receiving Hormone Therapy and Radiation for Localized Prostate Cancer: Results of the ESCULAPE Phase 2 Prospective Study

Androgen deprivation therapy (ADT) may cause vasomotor symptoms (VMS) including hot flushes and sweats, which affect quality of life (QoL). Serelys Homme is a nonhormonal and a natural origin product that could affect VMS in men undergoing ADT. We evaluated effectiveness and tolerance of Serelys Homme administration on VMS and QoL of patients undergoing combined ADT and radiation therapy for prostate cancer. Between April 2017 and July 2019, 103 patients were screened, and 53 patients refused to participate in the study. Serelys Homme therapy consisted of a daily administration of 2 tablets for 6 months. Patients were evaluated with 4 questionnaires including the adapted Modified Rankin Scale (adapted-MRS), European Quality of Life 5 Dimensions 3 Level Version (EQ 5D3L), Functional Assessment of Cancer Therapy-Prostate (FACT-P), and Hot Flash Related Daily Interference Scale (HFRDIS) at day 0, day 90 (D90), and day 180 (D180). Statistical evaluation was performed using the Wilcoxon rank sign test. A 2-sided P < .05 was considered statistically significant. Among the 50 patients, 4 withdrew after inclusion. All patients (n=46) received either postoperative or definitive radiation therapy combined with a short (n=15) or long course (n=31) of ADT. Serelys Homme administration significantly decreased the rate of patients who had ≥7 VMS and 3 to 6 VMS per day. The number of patients presenting with moderate or severe VMS was decreased at D90 (P=.005) and at D180 (P=.005). In addition, VMS duration was reduced at D90 (P=.002) and D180 (P < .001). Finally, at D90 and D180, 11.1% and 16.0% of patients, respectively, with initial severe or moderate VMS had a complete response without further symptoms. Among QoL parameters, fatigue decreased significantly. Effectiveness evaluated by doctors was rated as moderate or good to excellent VMS control in 20% and 60% of the patients, respectively. No side effects were recorded in the whole population. This study demonstrated effectiveness and excellent tolerance of Serelys Homme. We observed a significant reduction of the frequency, duration, and intensity of hot flushes and sweats induced by ADT. Serelys Homme increased QoL scores. These encouraging results open the prospect to further studies and Serelys Homme use in patients undergoing ADT for prostate cancer.

Transition Readiness in Adolescents and Young Adults Living With Congenital Adrenal Hyperplasia

ObjectiveCongenital adrenal hyperplasia (CAH) refers to a group of genetic disorders that affect cortisol biosynthesis and the need for glucocorticoid treatment is lifelong. The complexities of CAH can greatly affect teenage life and the transition from pediatric to adult care. The aim was to assess transition readiness and the impact on quality of life (QoL) as well as medication adherence rates in adolescents and young adults with CAH. MethodsProspective assessment of transition readiness was conducted through standardized questionnaires for adolescents and young adults (aged 16-35 years). Four open-ended questions on self-care were summarized in adolescents (aged 18-19 years) and their parents. Transition readiness was assessed using a modified CAH specific questionnaire: “Transition preparation and readiness to transfer from pediatric to adult care” with a cutoff level of >25 defined as good transition readiness. Measurement of QoL was performed using Rand 36. Medication adherence rate was measured using the self-reported questionnaire Adherence Starts with Knowledge. ResultsThirty-eight adolescents and young adults with CAH were included in the study. Transition readiness was classified as good in 26 (68%) of the participants. Good transition readiness was more frequent in participants with good medication adherence rates. A general linear model analysis showed a good transition readiness affected QoL by increasing QoL scores. ConclusionSelf-reported transition readiness was found in the majority of adolescents and young adults with CAH. A good medication adherence rate was associated with a better transition readiness and a good transition readiness was associated with increased QoL scores.

Effect of Total Breast Reconstruction With Autologous Fat Transfer Using an Expansion Device vs Implants on Quality of Life Among Patients With Breast Cancer

There is a need for a new, less invasive breast reconstruction option for patients who undergo mastectomy in their breast cancer treatment. To investigate quality of life (QoL) among patients undergoing a new breast reconstruction technique, autologous fat transfer (AFT), compared with that among patients undergoing implant-based reconstruction (IBR). The BREAST trial was a randomized clinical trial conducted between November 2, 2015, and October 31, 2021, performed in 7 hospitals across the Netherlands. Follow-up was 12 months. Referrals could be obtained from general practitioners and all departments from participating or nonparticipating hospitals. The patients with breast cancer who had undergone mastectomy and were seeking breast reconstruction were screened for eligibility (radiotherapy history and physique) by participating plastic surgeons. Patients receiving postmastectomy radiotherapy were excluded. Breast reconstruction with AFT plus expansion or 2-phased IBR. Randomization was done in a 1:1 ratio. The statistical analysis was performed per protocol. The predefined primary outcome was QoL at 12 months after final surgery. This was measured by the BREAST-Q questionnaire, a validated breast reconstruction surgery questionnaire. Questions on the BREAST-Q questionnaire are scored from 0 to 100, with a higher score indicating greater satisfaction or better QoL (depending on the scale). Secondary outcomes were breast volume and the safety and efficacy of the techniques. A total of 193 female patients (mean [SD] age, 49.2 [10.6] years) 18 years or older who desired breast reconstruction were included, of whom 91 patients in the AFT group (mean [SD] age, 49.3 [10.3] years) and 80 in the IBR group (mean age, 49.1 [11.0] years) received the allocated intervention. In total, 64 women in the AFT group and 68 women in the IBR group completed follow-up. In the IBR group, 18 patients dropped out mainly due to their aversion to implant use while in the AFT group 6 patients ended their treatment prematurely because of the burden (that is, the treatment being too heavy or tiring). The BREAST-Q scores were higher in the AFT group in all 5 domains and significantly higher in 3: satisfaction with breasts (difference, 9.9; P = .002), physical well-being: chest (difference; 7.6; P = .007), and satisfaction with outcome (difference, 7.6; P = .04). Linear mixed-effects regression analysis showed that QoL change over time was dependent on the treatment group in favor of AFT. The mean (SD) breast volume achieved differed between the groups (AFT: 300.3 [111.4] mL; IBR: 384.1 [86.6] mL). No differences in oncological serious adverse events were found. This randomized clinical trial found higher QoL and an increase in QoL scores over time in the AFT group compared with the IBR group. No evidence was found that AFT was unsafe. This is encouraging news since it provides a third, less invasive reconstruction option for patients with breast cancer. ClinicalTrials.gov Identifier: NCT02339779.

Depressive symptoms and quality of life prior to metabolic surgery in Cape Town, South Africa.

BackgroundDepression has been shown to have a negative impact on the outcomes of metabolic surgery and quality of life (QOL). Currently, there are limited data on mental distress and QOL in metabolic surgery candidates in South Africa.AimThis study aimed to determine the prevalence of depressive symptoms at the time of presurgical assessment in participants undergoing metabolic surgery.SettingThe Obesity and Metabolic Surgery Initiative at Tygerberg Hospital.MethodsWe conducted pre-operatively a retrospective cross-sectional study on patients who underwent metabolic surgery from September 2017 to September 2019. Participants were profiled in terms of metabolic parameters, depressive symptoms and QOL.ResultsOf the 157 participants assessed, 88% were female with a body mass index in the super obese range. Twenty-two percent of participants had depressive symptoms. Metabolic surgery candidates with depressive symptoms had a significantly poorer overall QOL score compared with those without depressive symptoms. When controlling for all other variables, an increase in QOL score was shown to decrease the odds of current depressive symptoms, whilst back pain on non-narcotic medication and having had a stroke were found to increase the odds of current depressive symptoms.ConclusionThis study highlights the complex interplay between metabolic, clinical and psychiatric factors in patients undergoing metabolic surgery. The study highlights the vital role of a psychiatrist as part of a multidisciplinary team pre- and post-operatively in the early identification of depressive symptoms. Psychiatrists may have an important role to play as part of the multidisciplinary team in metabolic surgery, including screening for mental health problems pre- and post-operatively, providing psychoeducation and relevant pharmacological treatment and psychotherapy where needed.ContributionThis study expands our limited knowledge of psychiatric comorbidity (in particular depressive symptoms and associated factors) in people undergoing metabolic surgery in low- and middle-income countries.

Effect of RBC Transfusion on Six Minute Walk Test Performance and Quality of Life in Outpatients

Patients with cancer or other diagnoses associated with chronic anemia often receive red blood cell (RBC) transfusion as outpatients for symptoms including fatigue. To determine the effect of RBC transfusion on functional status and quality of life (QoL), we measured 6-minute walk test distance and fatigue-related QoL scores before and after RBC transfusion in outpatients.MethodsThe Red Cells in Outpatients Transfusion Outcomes (RETRO) study was a prospective, observational study of subjects before and after RBC transfusion. Patients were recruited through hospital outpatient infusion units at 4 sites. To account for potential confounding effects of chemotherapy, patients were classified into 2 groups based on cancer treatment (CT) within 4 weeks before or after the study transfusion (CT group) or not (No CT group). Inclusion criteria were age ≥ 50, ambulatory, and chronic anemia with at least one prior RBC within 6 months. Exclusion criteria included active bleed and recent myocardial infarction. Walk test distance, QoL (FACIT-Fatigue Scale), and hemoglobin (Hgb) were measured before and at 5-10 days post-transfusion. Extra RBC transfusions given as part of clinical care and interim Emergency Department (ED) or hospital admissions during the study were recorded. Unadjusted results are expressed as median, interquartile range (IQR) and p values assigned using signed rank test. Regression analyses of change in walk test distance and change in QoL score were performed using backwards elimination to identify significant clinical variables. Minimum clinically important change in walk test distance was 20 meters (m) and in QoL score was 3 points based on literature review.ResultsA total of 221 patients with at least one benign or malignant hematology/oncology diagnosis enrolled and 200 (138 CT, 62 No CT) completed both pre- and post-transfusion walk tests. Mean subject age was 66 and 1 RBC (73%) or 2 RBC (27%) were transfused during the study transfusion episode; 18% received 1-3 additional RBC between walk tests. On average, walk test distance and QoL scores were higher after transfusion. In the No CT group, unadjusted median change in walk test distance was 30 m (IQR 0 to 50; p<0.001). In the CT group, median change in walk test was 16 m (IQR -11 to 45; p<0.001). Median change in QoL score pre- to post-transfusion in the no CT group was 4.0 points (IQR 0 to 11; p<0.001) and 2.5 points (IQR -3 to 7.5; p<0.003) in the CT group.In the regression model of change in walk test distance with RBC, no recent cancer treatment, absence of interim ED visits or hospitalizations, post-transfusion Hgb ≥8 g/dL, and total RBC dose predicted larger increases in walk distance (p<0.05) (Table). Patients with no recent CT had an estimated adjusted change in walk test distance of 24.2 m greater on average than CT patients. Grouped by post-transfusion Hgb, the mean change in walk test distance between patients with post-transfusion Hgb ≥8 and <8 g/dL was 31 m. The total number of RBC transfused between walk tests also predicted greater improvement in walk performance (estimated adjusted mean difference in walk test distance 17.9 m per RBC unit).In the regression model of QoL, baseline Hgb, and Karnofsky score were associated with change in fatigue-related QoL in addition to no CT and lack of interim events (p<0.05). Patients with higher baseline Hgb had larger increase in QoL score (adjusted mean difference 3.8 scale points per g/dL Hgb).The following variables were not significantly associated with change in either primary outcome with transfusion: age, sex, body mass index, number of previous RBC transfusions, and change in Hgb at 1 week.ConclusionsRBC transfusion in outpatients improves walk test performance and fatigue-related QoL. Patients who maintained Hgb 8 g/dL or greater at one week post RBC showed clinically important (>20 m) increases in mean walk test distance. Patients with higher baseline Hgb levels showed relatively larger improvement in QoL scores. For both outcomes, improvement with RBC was most apparent in clinically stable patients not on chemotherapy. The finding that increased RBC dose between walk tests predicted greater increase in walk distance suggests that more RBC transfusion may further improve functional status in some patients. Studies that measure patient-related outcomes, including functional status and QoL, are essential in deciding which oncology patients will benefit the most from RBC transfusion. [Display omitted] DisclosuresCarson:Terumo: Research Funding.

Psychological symptoms and salivary inflammatory biomarkers in patients with dentofacial deformities: a case\u2013control study

Individuals with dentofacial deformities often display a low quality of life (QoL) through biological mechanisms that remain unraveled. In this case–control study, the salivary levels of cytokines, glutamate, and kynurenine metabolites were assessed in patients undergoing orthognathic surgery (OS), while correlating these parameters with QoL and psychological symptoms. Thirty-six patients were enrolled in control (under orthodontic treatment) and test (undergoing OS) groups, matched by age and sex. The QoL was assessed through the World Health Organization Quality of Life BREF (WHOQOL-BREF) and the Orthognathic Quality of Life Questionnaire (OQLQ). The psychological symptoms were evaluated by the Satisfaction with Life Scale, the Rosenberg Self-Esteem Scale (RSES), and the Depression, Anxiety, and Stress Scale-21 (DASS-21). The salivary levels of IL-1β, IL-6, IL-10, glutamate, and kynurenine metabolites were evaluated. The OQLQ demonstrated increased QoL scores in the test group, regarding social aspects, facial esthetics, and function domains, without significant differences in respect to the other surveys. These patients displayed higher IL-1β and glutamate levels; conversely, the kynurenine metabolites were unaltered. The glutamate levels positively correlated with the OQLQ function scores. The data brings novel evidence about the psychobiological features of patients with dentofacial deformities, showing salivary variations of inflammatory biomarkers in these individuals.

Assessment of quality of life among elderly in urban and peri-urban areas, Yangon Region, Myanmar.

BackgroundIn the context of an aging population, quality of life (QOL) is an important consideration for the well-being of the elderly. However, there is limited information on the QOL of the elderly in Myanmar. This study aimed to explore the risk factors for low QOL among the elderly in urban and peri-urban areas of the Yangon Region, Myanmar.MethodsA community-based, cross-sectional study was conducted among the elderly aged 60 years or older in two urban and two peri-urban townships in the Yangon Region from July to September 2019. A multi-stage sampling method was used to recruit study participants using a pre-tested questionnaire. A total of 616 (305 males and 311 females) elderly people were interviewed using a face-to-face interview technique. Multiple linear regression analysis was performed on the four domains (physical health, psychological health, social relationship, and environment) of QOL measured with the WHOQOL-BREF.ResultsIncome level and having intimate friends influenced the QOL scores of the elderly in all domains, while education level and marital status influenced psychological health, social relationship, and environment domains. Social interaction with neighbors increased the QOL scores for physical health, social relationship, and environment domains. Living in peri-urban areas was associated with lower QOL scores for physical health, psychological health, and environment, while participation in group activities increased QOL scores in these domains. Having comorbidities affected the QOL for psychological health and environment domains, while the frequency of going out affected physical health, and the frequency of religious performance affected social relationship.ConclusionResidential location, education level, marital status, income, comorbidities, social interactions with neighbors and friends, participation in group activities, and frequencies of going out and religious activities should be considered in planning and implementing programs for the elderly in Myanmar. Peri-urban development, strengthening healthcare and social security systems, and encouraging social interaction and participation in group activities play critical roles in improving the QOL for elderly residing in Myanmar.

Building Bridges to Housing for homeless adults with intellectual and developmental disabilities: outcomes of a cross-sector intervention.

Adults with intellectual and developmental disabilities (IDD) have high rates of homelessness. This observational study evaluates Bridges to Housing, a cross-sector intervention offering immediate access to housing and supports to this population in Toronto, Canada. Twenty-six participants, enrolled between April 2016 and December 2017, were assessed at baseline, six and 12months post-enrolment. Descriptive statistics and generalized linear modelling evaluated quality of life (QOL) and service needs outcomes. Twenty-one service users and providers participated in semi-structured interviews between August 2017 and June 2018 to elicit their experiences of the intervention, which were analysed thematically. Twelve months post-enrolment, 24 participants were successfully housed and reported increased QOL scores (F(2,43)=13.73, p=<.001) and decreased perceived unmet service needs (Wald χ2 (2)=12.93, p=.002). Individual-, intervention- and system-level characteristics facilitated housing stability in this population. Cross-sector approaches can improve outcomes for homeless adults with IDD and may have an important role in supporting this marginalized population.

Quality of life improvements by durable pulmonary vein isolation in patients with atrial fibrillation.

Successful pulmonary vein isolation (PVI) can improve the quality of life (QOL) of patients with atrial fibrillation (AF). However, the role of durable PVI for such QOL improvement is not known. The aim of this study was to clarify the effectiveness of durable PVI in improving the QOL of patients with AF. We assessed 119 patients who underwent PVI (age 66.4 ± 9.6 years, 104 paroxysmal AF). A scheduled electrophysiological study was performed 6 months after the first PVI session-regardless of recurrence of AF-to assess the durability of PVI and to identify and re-isolate reconnected pulmonary veins. QOL scores were evaluated by an AF-specific QOL questionnaire and checked at baseline, 6 months, and 1 year after the first session. In patients without AF recurrence (nonrecurrence group, n = 93), the scores at 6 months improved compared with those at baseline; conversely, the scores did not improve in patients with AF recurrence (n = 26). Nevertheless, the scores at 1 year improved compared with those at 6 months in both groups. Within the nonrecurrence group, the score difference between 6 months and baseline was higher in the durable PVI group (n = 58) than that in the nondurable PVI group (n = 35). The QOL of AF patients improved by the resumption of sinus rhythm following PVI. Patients with durable PVI had increased QOL scores compared with those with nondurable PVI. The durability of PVI may achieve further improvements in the QOL of patients with AF.

63Effects of exercise-based cardiac rehabilitation and detraining on exercise capacity and cardiac function in patients with atrial fibrillation: a randomized controlled trial with 1-year follow-up

Abstract Introduction We aimed to determine whether maximal exercise capacity, left ventricular function, and quality of life (QoL) scores are sustained in patients with atrial fibrillation (AF) after termination of training following exercise-based cardiac rehabilitation (ECR). Methods In a prospective study, 58 patients with AF (age, 62 ± 7 years) were randomized into an exercise training group for 12 months (ECR, n = 13), a group with 6-month detraining after a 6-month exercise training (DT, n = 15), and a medical treatment only group (MT, n = 30). For exercise training, cycling on a bicycle ergometer was performed in the DT and ECR groups 3 times a week for 6 and 12 months, respectively. Each session started with a 10-minute warm-up at 60%–70% of the maximal heart rate (HRpeak), followed by four 4-minute intervals at 80%–90% of the HRpeak, with 3 minutes of active recovery at 60%–70% of the HRpeak between intervals, ending with a 5-minute cool-down period. Peak exercise oxygen consumption (Vo2), left ventricular function, plasma lipid level, N-terminal pro B-type natriuretic peptide level, and QoL score were measured at baseline, after 6 months of training, and after additional 6 months of continuous training or detraining follow-up assessments. Results Six months of exercise training increased the peak Vo2 (ECR: 28.2 ± 7.0 ml/[kg·min] and DT: 28.0 ± 8.3 ml/[kg·min] vs. MT: 23.0 ± 5.2 ml/[kg·min], p= 0.047) and QoL scores (36-Item Short-form Health Survey) and decreased the total cholesterol level (ECR: 146.8 ± 43.8 mg/dl and DT: 140.6 ± 22.4 vs. MT: 182 ± 44.2 mg/dl, p = 0.008). Detraining resulted in an increase in QoL score and a decrease in total cholesterol level (ECR: 142.8 ± 21.4 mg/dl and DT: 151.8 ± 39.8 vs. MT: 176.8 ± 34.2 mg/dl, p = 0.017). However, the exercise training-induced increase in peak Vo2 reverted to the baseline level after detraining (ECR: 27.1 ± 5.1 ml/kg/min vs. DT: 24.4 ± 7.2 ml/[kg·min] and MT: 21.5 ± 4.86 ml/[kg·min], p = 0.017). The resting left ventricular systolic and diastolic functions were not significantly different, with no inter-group difference after 6 months of training and 6 months of continuous training or detraining. Conclusions As the QoL scores are maintained despite peak Vo2 being lowered by detraining after an exercise training period in patients with AF, physicians should encourage patients’ participation in a continuous exercise program to sustain the improvement in both the QoL score and peak Vo2 with exercise training. Further studies with larger sample sizes are needed to observe the long-term effects of exercise training and detraining.

Quality of life among infertile women with endometriosis undergoing IVF treatment and their pregnancy outcomes

Objective We assessed the quality of life (QoL) and pregnancy outcomes of in vitro fertilization (IVF) treatment among infertile women with endometriosis, as compared to infertile women without endometriosis. Study design Eighty-one (81) endometriosis women (with 142 embryo transfer [ET] cycles) and 605 non-endometriosis women (with 1063 ET cycles) were included. QoL was measured by FertiQoL at the date before ET. Pregnancy outcomes included biochemical pregnancy, ongoing pregnancy and live birth. Generalized estimating equation analyses were performed to assess the association between QoL and IVF pregnancy. Results Endometriosis-affected women had significantly lower QoL, as indicated by mind/body, treatment environment and total treatment scores, and total scores of FertiQoL (p < .05), compared to those without endometriosis. Among non-endometriosis women, QoL scores were significantly associated with successful IVF pregnancy; with one unit increase in QoL scores as measured by emotional domain of FertiQoL, the probabilities of ongoing pregnancy and live birth significantly increased by 2.5% and 2.8%, respectively (p < .05). This association was also observed among endometriosis women but it did not reach statistical significance. Conclusions Lower QoL among women with endometriosis versus non-endometriosis during IVF treatment highlights the importance of developing strategies to improve their QoL, which may enhance following pregnancy rates in this population.

Tai Chi Improves Coronary Heart Disease Risk by Inactivating MAPK/ERK Pathway through Serum miR‐126

Background Tai Chi is effective in preventing heart disease (CHD) risk, but the molecular mechanism remains unclear. Mitogen-activated protein kinase (MAPK) signaling plays a critical role in the pathogenesis of CHD and can be activated by miR-126. Tai Chi may exert its protective function through the miR-126-modulated MAPK pathway. Methods The CHD patients after PCI were randomized into the CG group (CG) (n = 19, normal care) and Tai Chi group (TG) (Tai Chi intervention, n = 17). Epicardial adipose tissue volume (EATV) (one main adverse cardiovascular event of CHD), HR (heart rate), QoL (quality of life) scores, and balance performance were measured in the two groups. The body fat content, abdominal subcutaneous fat, and visceral fat were measured to reflect the improvement of adipose tissue dysfunction. The levels of miR-126 and MAPK-associated molecules were measured in peripheral blood leukocytes. Meanwhile, the effects of miR-126 silence and mimic on MAPK-associated molecules were also explored in cardiac cell H9C2. Results After the 3-month intervention, Tai Chi reduced EATV and HR and increased QoL scores and balance performance, respectively (P < 0.05). The fat percentage, body fat mass, and BMI were also significantly reduced after Tai Chi intervention (P < 0.05). The levels of miR-126, MAPK, JNK, and ERK in the TG group were lower than those in the CG group (P < 0.05). The miR-126 levels had a strong relationship with the values of EATV, HR, and QoL scores (P < 0.05). miR-126 silence or mimic inactivated or activated MAPK-associated molecules in the cardiac cell lines. Conclusions Tai Chi improved CHD risk by inactivating the MAPK/ERK pathway via serum miR-126.

Trajectory of HRQOL scores in pediatric patients receiving proton therapy: results from the Pediatric Proton Consortium Registry (PPCR)

Health-related quality of life (QOL) outcomes are an important metric in understanding the perceived health and emotional well-being of pediatric proton radiotherapy (RT) patients. Here we compare reported QOL outcomes at two time points during radiotherapy to determine the effect RT has on the holistic health of a patient. Pediatric patients (<22 years) treated with RT across multiple institutions were prospectively enrolled on an optional QOL study through the PPCR. Child and proxy answers to the PedsQL v.4.0 are evaluated to generate a total core score (QOL score) ranging from 0-100 (best). QOL scores captured during the first (early) and last (late) week of RT were evaluated. Paired t-tests and Wilcoxon sign-ranked tests were used to assess differences in early and late-RT QOL score within groups, independent t-tests and the Kruskal-Wallis test were used to assess differences between groups. One hundred twenty patients (n=69 (57.5%) CNS, n= 51 (42.5%) non-CNS) enrolled between 9/2015 and 1/2018 comprised the study cohort. Among non-CNS patients, 22 (43.1%) had a head/neck primary tumor. Median age was 10.5 years (<1 to 21.8). Median RT total dose was 54 Gy (21.0-76.0). Mean RT QOL score did not change significantly during RT (early: 74.6; late: 74.8, p=0.87). Children with CNS tumors noted a 3-point increase in QOL scores during RT (p=0.03), whereas QOL among children with non-CNS tumors did not significantly change (p=0.13). Non-CNS primary tumor site had no significant effect on change in QOL score (p=0.31). Patients with KPS=100 at the beginning of RT showed a non-significant decline of 5.0-points, but started higher than patients with a KPS of <100 who remained stable during RT. QOL scores did not differ by anesthesia use for RT (p=0.85), age (p=0.09), or by exposure to concurrent chemotherapy (p=0.34). During RT, children with CNS tumors reported an increase in the QOL score which differed from patients with non-CNS primaries who reported a non-significant decrease in scores. Anesthesia use, age, and concurrent chemotherapy did not significantly effect QOL scores. The PedsQL can be used to monitor the QOL of patients receiving proton radiotherapy. Future efforts to determine if QOL monitoring can lead to improvements in patient’s care and thus treatment experience are warranted.Tabled 1Abstract TU_41_3730; Table 1N(%)Early-RT Score Mean (sd)Late-RT Score Mean (sd)P within groupsP between groups PTumor TypeCNS69 (57.5)76.3 (16.1)79.3 (13.8)0.030.003Non-CNS51 (42.5)72.3 (16.4)68.7 (17.9)0.13AnesthesiaYes47(39.2)72.7 (14.8)72.6 (17.1)0.860.85No70 (58.3)76.0(17.1)76.3 (16.2)0.78Age (years)<10.56175.2 (14.8)73.5 (16.1)0.350.09>10.55974.0 (17.9)76.1 (16.9)0.11ChemotherapyYes79 (65.8)72.2 (16.9)71.3 (17.4)0.960.35No38 (31.7)80.7 (13.1)82.0 (12.0)0.51KPS1003080.8 (15.3)75.8 (15.4)0.070.02<1005870.9 (15.7)72.7 (15.7)0.24 Open table in a new tab

Impact of Ramadan Fasting on Thyroid Status and Quality of Life in Patients with Primary Hypothyroidism: a Prospective Cohort Study from karachi, pakistan

Ramadan is the ninth month in the lunar calendar, during which Muslims fast from predawn to sunset and major changes occur in their dietary, sleep, and physical activity patterns. Most patients with hypothyroidism are unable to comply with the proper timings of levothyroxine (LT4) administration. The objective of the study was to determine the change in thyroid-stimulating hormone (TSH) level and quality of life (QOL) before and after Ramadan in patients with primary hypothyroidism. This prospective cohort study included adult patients on stable doses of LT4 who fasted for at least 20 days during the month of Ramadan in the Islamic year 1437 Hijri (June/July 2016). Baseline characteristics and TSH levels were recorded on all consenting patients within 6 weeks prior to Ramadan. Post-Ramadan TSH was tested within 1 to 2 weeks after Eid-ul-Fitr. During the study period, 64 patients with hypothyroidism were enrolled, of which 58 were female. The mean age of participants was 44.2 ± 13.2 years. Average daily dose of LT4 was 95.3 ± 35.4 μg. On average, patients fasted for 26.5 days and missed a dose of LT4 on 1.27 days. Mean TSH pre-Ramadan was 2.37 ± 1.35 mIU/L, and post-Ramadan, it was 4.69 ± 3.87 mIU/L. Mean difference between TSH pre- and post-Ramadan was 2.32 ± 3.80 mIU/L ( P<.001). However, the difference in TSH was not significantly different between those who were compliant with meals and LT4 interval versus those who were not (compliant, 2.04 mIU/L; noncompliant, 3.15 mIU/L; P = .30). Overall, an increase in QOL scores in the domains of physical health, psychological health, and social relationships was observed after Ramadan. We observed statistically significant changes in TSH concentrations after the month of Ramadan in hypothyroid patients who fasted. The change in TSH was not affected by timing of LT4 intake and interval from meal. AKUH = Aga Khan University Hospital; LT4 = levothyroxine; QOL = quality of life; TSH = thyroid-stimulating hormone.

Effects of Vitamin D Supplementation on Nonspecific Musculoskeletal Pain, Quality of Life, Self-Related Health and Sexual Satisfaction: A Randomized Control Trial

Non-specific musculoskeletal pains (CNMP) are common problem with unknown etiology which has become a major concern because of their negative impact on health. The aim of the present study was to investigate the effect of vitamin D supplementation on pain scores, quality of life, self-rated health and sexual satisfaction among CNMP patients with vitamin D deficiency. In this clinical trial study, sixty-six patients (18–50 years in both sex) with CNMP and vitamin D deficiency were randomly assigned to consume 50000 IU vitamin D, once every week for 8 weeks in the intervention group or placebo in the control condition. Clinical examination, pain scores, quality of life (QoL), self-rated health and sexual satisfaction were measured at the beginning and at the end of study. Patients in the vitamin D group had a significant pain relief after 8 weeks compared to the placebo group (p = 0.04 vs. p = 0.42). Also, they had increased QoL scores and sexual satisfaction compared with placebo (p &lt; 0.0001 and p = 0.01, respectively). We observed a significant effect on improvement of quality of life, sexual satisfaction and pain in patients with CNMP after administration of therapeutic doses of vitamin D. Such findings could be considered to implement informative interventional programs to control CNMP complications and develop practical policies to improve the diet quality among CNMP patients. Further studies are needed to determine whether vitamin D supplementation lead to significant modifications in CNMP complications with consideration of confounding factors in different population.

Home-based cardiac rehabilitation improves quality of life, aerobic capacity, and readmission rates in patients with chronic heart failure.

Background:Exercise tolerance and cardiac output have a major impact on the quality of life (QOL) of patients experiencing heart failure (HF). Home-based cardiac rehabilitation can significantly improve not only exercise tolerance but also peak oxygen uptake ( peak), and the QOL in patients with HF. The aim of this prospective study was to evaluate the beneficial effects of home-based cardiac rehabilitation on the quality of medical care in patients with chronic HF.Methods:This study was a randomized prospective trial. HF patients with a left ventricular ejection fraction (LVEF) of less than 50% were included in this study. We randomly assigned patients to the control group (n = 18) and the interventional group (n = 19). Within the interventional group, we arranged individualized rehabilitation programs, including home-based cardiac rehabilitation, diet education, and management of daily activity over a 3-month period. Information such as general data, laboratory data, Cardiopulmonary Exercise Test (CPET) results, Six-minute Walk Test (6MWT) results, and the scores for the Minnesota Living with Heart Failure Questionnaire (MLHFQ) before and after the intervention, was collected from all patients in this study.Results:Patients enrolled in the home-based cardiac rehabilitation programs displayed statistically significant improvement in peak (18.2 ± 4.1 vs 20.9 ± 6.6 mL/kg/min, P = .02), maximal 6-Minute Walking Distance (6MWD) (421 ± 90 vs 462 ± 74 m, P = .03), anaerobic threshold (12.4 ± 2.5 vs 13.4 ± 2.6 mL/kg/min, P = .005), and QOL. In summary, patients receiving home-based cardiac rehabilitation experienced a 14.2% increase in peak, a 37% increase in QOL score, and an improvement of 41 m on the 6MWD test. The 90-day readmission rate for patients reduced to 5% from 14% after receiving cardiac rehabilitation.Conclusion:Home-based cardiac rehabilitation offered the most improved results in functional capacity, QOL, and a reduced the rate of readmission within 90 days.

Diaphragmatic Breathing Reduces Belching and Proton Pump Inhibitor Refractory Gastroesophageal Reflux Symptoms

In patients with gastroesophageal reflux disease (GERD) and excessive belching, most belches are supragastric, and can induce reflux episodes and worsen GERD. Supragastric belching (SGB) might be reduced with diaphragmatic breathing exercises. We investigated whether diaphragmatic breathing therapy is effective in reducing belching and proton pump inhibitor (PPI)-refractory gastroesophageal reflux symptoms. We performed a prospective study of 36 consecutive patients with GERD refractory to PPI therapy and a belching visual analogue scale (VAS) score of 6 or more, seen at a gastroenterology clinic at a tertiary hospital in Singapore from April 2015 through October 2016. Patients underwent high-resolution manometry and 24-hour pH-impedance studies while they were off PPIs. Fifteen patients were placed on a standardized diaphragmatic breathing exercise protocol (treatment group) and completed questionnaires at baseline, after diaphragmatic breathing therapy, and 4 months after the therapy ended. Twenty-one patients were placed on a waitlist (control subjects), completed the same questionnaires with an additional questionnaire after their waitlist period, and eventually received diaphragmatic breathing therapy. The primary outcome was reduction in belching VAS by 50% or more after treatment. Secondary outcomes included GERD symptoms (evaluated using the reflux disease questionnaire) and quality of life (QoL) scores, determined from the Reflux-Qual Short Form and EuroQoL-VAS. Nine of the 15 patients in the treatment group (60%) and none of the 21 control subjects achieved the primary outcome (P < .001). In the treatment group, the mean belching VAS score decreased from 7.1 ± 1.5 at baseline to 3.5 ± 2.0 after diaphragmatic breathing therapy; in the control group, the mean VAS score was 7.6 ± 1.1 at baseline and 7.4 ± 1.3 after the waitlist period. Eighty percent of patients in the treatment group significantly reduced belching frequency compared with 19% in control subjects (P= .001). Treatment significantly reduced symptoms of GERD (the mean reflux disease questionnaire score decreased by 12.2 in the treatment group and 3.1 in the control group; P= .01). The treatment significantly increased QoL scores (the mean Reflux-Qual Short Form score increased by 15.4 in the treatment group and 5.2 in the control group; P= .04) and mean EuroQoL-VAS scores (15.7 increase in treatment group and 2.4 decrease in the control group). These changes were sustained at 4 months after treatment. In the end, 20 of the 36 patients who received diaphragmatic breathing therapy (55.6%), all with excessive SGB, achieved the primary outcome. In a prospective study, we found a standardized protocol for diaphragmatic breathing to reduce belching and PPI-refractory gastroesophageal reflux symptoms, and increase QoL in patients with PPI-refractory GERD with belching-especially those with excessive SGB.

Effect of Nasal Calcitonin on the Health-Related Quality of Life in Postmenopause Women Affected With Low Bone Density.

Background:Physical activity and mental health could be affected by osteoporosis and various therapeutic options such as calcitonin may influence Quality Of Life (QOL) of these patients with Low Bone Density (LBD).Objectives:This study aimed to evaluate the effect of nasal calcitonin on QOL in post menopause women with LBD.Patients and Methods:This clinical trial study was performed on one hundred and fifteen menopause women with LBD less than 1 SD in Bone Mineral Densitometry (BMD) referred to Baqiyatallah Hospital in Tehran, Iran, during 2009 - 2010. They were assigned to receive 200 IU calcitonin nasal spray along with calcium (1000 mg) and vitamin D (400 IU) for 6 months. Quality of life was assessed by Short-Form 36 (SF-36) questionnaire (Persian-validated version).Results:The mean age (± SD) of the participants was 58.75 ± 8.15 years. Intranasal spray of calcitonin increased QOL scores significantly (88.05 ± 15.63 vs. 92.15 ± 13.22, P value = 0.000). Bone mineral density of spine was increased from 0.834 ± 0.11 to 0.12 ± 0.852 and this difference in BMD of lumbar spine was statistically significant (P value: 0.003) but not significant in femur’s BMD (P value = 0.061). In comparison with BMD indexes, The QOL scores especially Mental Health domain changes had only a significant correlation with the changes of total T score in BMD (P = 0.031, Coefficient Correlation = 0.248).Conclusions:It seems that nasal spray of calcitonin can effectively improve QOL of women with LBD and QOL changes were not influenced by clinical or para-clinical alteration. Mental health domain must be more considered in further studies as a predicting domain for Health-Related Quality of Life (HR-QOL) changes.

Effect of Peripheral and Respiratory Muscle Training on the Functional Capacity of Hemodialysis Patients

Patients on hemodialysis (HD) show changes in muscle structure and function reducing their functional capacity. This study was conduted to assess the effects of respiratory muscle training (RMT) and peripheral muscle training (PMT) during dialysis on functional parameters, inflammatory state, and quality of life (QoL) in patients on HD. Randomized controlled trial included 39 patients on HD, and they were divided into three groups: RMT (n = 11), PMT (n = 14), and controls (C, n = 14). Training was performed during the HD session for 10 weeks. Maximal inspiratory pressure (PImax), maximal expiratory pressure (PEmax), forced vital capacity (FVC), six-minute walk test (6MWT), Kt/Vsp, biochemical parameters, and inflammatory state (i.e., level of high sensitivity C-reactive protein) were evaluated. Variation from baseline was calculated by Analysis of Covariance (ANCOVA). The ΔPImax was 22.5 ± 3.2, 9.1 ± 2.9, and −4.9 ± 2.8 cmH2O in the RMT, PMT and C, respectively (p < 0.001); ΔPEmax was 10.8 ± 6.6, 3.7 ± 5.9, and −15.6 ± 5.9 cmH2O respectively (p = 0.014). The Δ6MWT was significantly greater in RMT and PMT (65.5 ± 9; 30.8 ± 8 m) than in C (−0.5 ± 8.1 m), p < 0.001. Although biochemical parameters decreased after training, Kt/V remained unchanged. CRP decreased only in the RMT and PMT groups. There was a significant increase in QoL scores in the training groups (vs. C) in energy/fatigue (p = 0.002), sleep (p < 0.001), pain (p < 0.001), and list of symptoms/problems (p = 0.014). A short period of RMT or PMT during HD significantly improved functional capacity, with RMT showing greater effect than PMT. Muscle training improved biochemical and inflammatory markers, but a direct cause and effect relationship could not be established by this study.