Lower Quality Of Life Index Research Articles

Urban quality of life amidst COVID-19 pandemic in Indonesia: do economic and geographical factors influence quality of life?

ABSTRACT Urban areas have always been an attraction for the population. As a result, urbanization is constantly happening as more people migrate to cities. This is since urban areas have become a hope for improving the quality of life. This study aims to measure and analyze the Quality of Life (QoL) Index and the influence of economic and geographical factors on the urban QoL during the COVID-19 pandemic. The data used in this study is the Socio-Economic Survey (SUSENAS) in 2020 from the Indonesian Central Statistics Agency. The findings show that larger cities tend to have a good QoL index. Meanwhile, remote cities or island regions have a low QoL, as indicated by a low QoL Index. population density, per capita consumption expenditure, and urban economic growth positively influence the urban QoL.

Quality of life, depression and anxiety in children and adolescents with CKD and their primary caregivers.

Chronic kidney disease (CKD) requires long-lasting treatments and severe changes in the routine of children, which may favor a low quality of life (QoL) and damage to their mental health and that of their primary caregivers (PC). The present study aimed to investigate the presence of anxiety and depression and to analyze the QoL of children and adolescents diagnosed with CKD at stages 3, 4, and 5, and their PC. We carried out an observational case-control study with 29 children and adolescents and their PC as the case group and 53 as the control group. International instruments, validated for the Brazilian population, were used: Child Anxiety Inventory (STAI-C), Pediatric Quality of Life Inventory (PEDSQL), Child Depression Inventory (CDI), Beck Anxiety and Depression Inventory (BAI; BDI), and the WHOQOL-bref. The study identified statistically significant differences in the PEDSQL total score (control group, 72.7 ± 19.5; case group, 63.3 ± 20.6; p = 0.0305) and in the psychosocial (control group, 70.5 ± 20.5 and case group, 61.4 ± 19.7; p = 0.0420) and school health dimensions (control group, 72.9 ± 21.0 and case group, 55.2 ± 19.8; p = 0.0003) and the presence of psychiatric comorbidity (depression and anxiety symptoms) in the case group (p = 0.02). As for PC, the study showed statistical significance for the prevalence of depression (p = 0.01) and anxiety (p = 0.02) symptoms. Patients with CKD have lower QoL indices and more psychiatric comorbidities, and their PC are affected by the disease, with higher indices of depression and anxiety.

Asthma-related disparities in emergency department use and clinical outcomes among Spanish-speaking Hispanic patients

Asthma is the most common chronic respiratory disease in the world, affecting over 270 million people in 2017.1 The impact of asthma morbidity is notable with lower quality of life indices and higher rates of anxiety and depression than those with well controlled or no asthma.2 Health literacy is defined as

Пространственные особенности электорального конформизма в России в 2000-е годы

Introduction. The focus of the article is on identifying spatial patterns of the conformist voting results in the federal elections of Russia in the 2000s. The relevance is due to the fact that against the background of growing social tension in the country there is a territorial and meaningful localization of the protest. Therefore, the analysis of the election results acts as a mechanism for assessing socio-political and protest sentiments in the regions. Methods and materials. The methodological basis of the study was the sociological and rationalinstrumental approach, according to which voters vote based on their social affiliation and assessments of economic well-being. Analysis. The main research methods were statistical analysis methods. Through the use of Pearson’s correlation analysis method, the influence of factors on voting was revealed. Calculations of variation coefficients made it possible to analyze the dynamics of electoral behavior for stability in the regions. Based on calculations of average values of loyalty ratios, regions were grouped according to the specifics of electoral behavior. Results. It was revealed that there is a significant negative correlation between the share of the Russian population, the level of urbanization and the results of conformist voting. In the recent federal elections, the influence of these factors is weakening, which is associated with the process of nationalization of the party system of Russia. The grouping of regions according to the specifics of the voting demonstrated the presence of moderate electoral nonconformism in almost all subjects of Siberia and the Far East, which creates the prerequisites for fixing the “eastern belt” of protest sentiments. A similar specificity was revealed in two capitals, a number of regions with a low quality of life index in the central and northwestern part of Russia, the exclave Kaliningrad region, the economically depressed Kurgan region, as well as in the Volgograd and Kirov regions. The highest level of electoral conformism is recorded mainly in regions with a high degree of authoritarianism regimes. An analysis of the voting dynamics showed that in the regions in which large-scale protests took place in recent years, during the period before them, stable nonconformist sentiments in the elections formed.

English

Inadequate biomedical engineering (BME) training, the gross deficit in the maintenance of biomedical facilities, mismanagement of resources allocated to the hospital biomedical unit by the management coupled with poor maintenance culture, are some of the factors that can aggravate the already high mortality rate, short life expectancy, poor economic growth, and low quality of life index in Africa, South of Sahara, and in Nigeria in particular. This synopsis serves to review the practice of biomedical engineering in Nigeria and also identify relevant factors that palpably influence BME development in Nigeria. Wide gamut of literature survey was carried out with the view to trace the activities of BME from the origin of BME in Nigeria till date. The result shows that the slow rate of BME development in Nigeria could be traced to relatively low allocation in the National budget on health, mismanagement, ignorance of recent advanced technology with poor or lack of personnel and is found to affect technological development of biomedical engineering. This study would serve as a guide to Nigerian government and other relevant stakeholders as a matter of urgency to declare a state of emergency in the health sector and particularly in the field of BME by collaborating with international professional bodies. Key words: Biomedical engineering, biomedical development, healthcare operations, low budget allocation, medical treatment.

Qualidade de vida de idosos inseridos em um programa de atendimento em saúde e associações com as características do paciente, da doença, da terapêutica e suporte social

The increase in life expectancy among individuals over 65 years of age has changed the age pyramid of the Brazilian population. Quality of life (QoL) is an important parameter to assess health status. The aim of the study was to describe the QoL of elderly people enrolled in an elderly care program, showing associations with the characteristics of the patient, disease, therapy, and social support, contributing to improve care for the elderly who receive this service. This was a descriptive, quantitative, cross-sectional, correlational study with 85 individuals aged 60 years or more, who were literate, independent in activities of daily living, without diagnosed cognitive/psychological impairment, and who had been going to the Nossa Senhora do Rosário Social Center for at least one month. To collect the independent variables, an instrument developed by the authors was used; in addition to the Morisk-Green test and Medication Regimen Complexity Index (MRCI). QoL was assessed by WHOQOL-brief. 89.4% were women; 38.8% were 60 to 70 years old; 77.6% had up to 3 comorbidities, the most frequent was hypertension (77.65%); 49.41% used polypharmacy, the MRCI ranged from 2.5 to 48.0 points for one to twelve medications/day; 57.65% acquired their medication through the SUS; 64.80% had medium/low adherence; 43.53% declared having a good perception of health. As for the WHOQOL-brief domains, the highest mean was obtained in the social domain (75.5), followed by the psychological (68.3), physical (67.1), and environmental (64.8) domains. The results of this study highlighted that the female gender, presence of diseases, therapeutic complexity, and perception of poor health are associated with lower quality of life indices in this population.

A autodeterminação de jovens e adultos com deficiência intelectual no rio grande do Sul - Brasil

For decades, emphasis has been placed on investigating the teaching of daily life skills in order to broaden the independence and participation of disabled individuals in society. However, the importance of learning complex skills that help in social insertion and in the labor market, that is, refering to the transition to adult life, is important. The general objective of this study was to evaluate the support intensity of self-determination skills for young people and adults with intellectual disabilities in Rio Grande do Sul - Brazil. Sixty-six young people and adults with a diagnosis of intellectual disability aged 15-58 years old participated in the study. The Support Intensity Scale was applied to assess the support intensity required to perform adaptive behaviors. The scale is divided into three sections, the first one consisting of six parts, namely: domestic life activities; community life; lifelong learning; work\; health and safety, and social aspects. Section two presents protection and advocacy skills, and section three addresses specific needs for medical (3A) and behavioral (3B) support. In order to collect the data, the instrument was applied to the young people with disabilities along with the person in charge or the professional who had known him for more than 3 months. For this study, data on self-determination were analyzed and discussed. The results showed that 39 individuals attended only the special school; 15 had first cycle education; 11 subjects with schooling of the second cycle and one did not report. The length of stay of these individuals in institutions is from 1 to 24 years, and it is possible to indicate that those who remain for a longer period are the individuals with greater cognitive impairment. On the labor market, only three participants reported having participated in a protected workshop, voluntary work. Regarding the data of section two, the participants obtained results that showed an average of 74% of support needed for self-determination activities, the average was 76%, and the calculated mode was the percentage of 97% indicating that an expressive number of participants has high support rates. Our hypothesis is that young people with high levels of support need may have a lower quality of life index. Therefore, working with areas of complex learning could increase the quality of life and develop their full potential.

Sense of smell and quality of life in children with diabetes mellitus

IntroductionDiabetes mellitus is one of the most common chronic systemic diseases seen in children. The increasing prevalence of Type 1 diabetes mellitus (T1DM) among children is alarming. Although olfaction has been found to be altered in some adult T1DM subjects, it is unknown whether this is the case in children and, if so, whether the dysfunction adversely influences their quality of life (QOL). MethodsUsing the Pediatric Smell Wheel® (PSW), we measured the olfactory function of 30 T1DM patients and 30 healthy controls [mean ages = 13.1 & 13.0, respectively]. The Turkish version of the Pediatric Quality of Life Inventory (PedsQL) was also administered. ResultsThe PSW scores were lower in the T1DM patients than in the controls (9.17 vs 10.37; p < 0.0001), although, in both cases, the scores fell within the normal range for individuals of their age (i.e., at or above 80%). Interestingly, such scores were lower in left-handed than in right-handed patients (8.00 vs 9.46; p = 0.001). Lower QOL indices were also found for the T1DM than for the controls for the domains of Emotional Function (p = 0.02), Social Function (p = 0.014), School Function (p = 0.011), and Psychosocial Status (p = 0.002). No significant associations were evident between PSW scores and disease duration and QOL scales. ConclusionsOur study demonstrates, for the first time, that modest decrements in smell function are evident in children with TIDM.

Quality of life in the elderly with and without chronic pain

ABSTRACT BACKGROUND AND OBJECTIVES: In the last decade, the elderly population has grown worldwide, both in developed and developing countries. Together with the aging process, the prevalence of chronic diseases and consequently the presence of pain are common and may have a strong impact on the quality of life of the elderly. The objective of this study was to evaluate the quality of life of elderly patients with and without chronic pain and to compare the quality of life with the number of chronic pathologies, pain intensity and age range METHODS: A quantitative, descriptive cross-sectional study carried out in a city in the West of the state of Santa Catarina with a sample of 385 senior people living in the urban area. The instruments of analysis were: the Mental State Mini Exam; the general data questionnaire adapted from Morais, Rodrigues e Gerhardt; The WHOQOL-OLD questionnaire, and a visual numerical scale. For the intergroup comparison, the Mann-Whitney test was used, and Pearson’s correlation was used in the correlations. RESULTS: It was observed the predominance of pain of moderate intensity. Old people with chronic pain have a lower quality of life index than the group without pain regardless the gender, and those who have chronic pain and age above 71 years have a lower quality of life index. CONCLUSION: The presence of chronic pain, number of diseases, pain intensity, female gender and age group above 71 years negatively influenced the quality of life of the elderly studied.

Spatial distribution of canine zoonotic enteroparasites in Bahía Blanca, Argentina

The objectives of this research were: (1) to determine the occurrence of zoonotic enteroparasites in dog feces from Bahía Blanca, Argentina; (2) to characterize the spatial distribution of the parasites found in association with the quality of life index (QLI) in neighborhoods of Bahía Blanca; and (3) to determine if the presence of a particular parasite genus in a stool sample was facilitated or impeded by the presence of other parasite genera. Samples of dog stools (n=475) were collected between December 2012 and December 2013 in areas with varying QLI. The association between QLI values and the presence of parasites was analyzed using logistic regression. Overall enteroparasite occurrence was 36.6%. Parasitic forms found included nematode larvae, cysts of Blastocystis spp., Giardia spp., and oocysts of Cryptosporidium spp., and eggs of Ancylostoma caninum, Toxocara canis, cestodes and Trichuris spp. For certain enteroparasites, we detected significant associations between their occurrence and QLI. Feces collected in areas with medium and low QLI were 2.46 and 5.43 times more likely, respectively, to contain A. caninum than stools from the high-QLI area. Samples from areas with low QLI were 2.36 times more likely to contain Trichuris spp. than those from the high QLI area. Regarding protozoa, feces from areas with low QLI were 2.4 times more likely to be positive than those from areas with high QLI. We demonstrated that canine zoonotic parasites have a wide distribution in the study area, and that occurrence is higher in neighborhoods with lower QLI.

Quality of life of the patients who had an atherotrombotic stroke in the carotid artery territory

To assess quality of life of patients with first-ever atherothrombotic stroke in the carotid artery territory 2 years after the disease onset. Authors examined 119 patients. Quality of life was measured with the «SF-36 Health Status Survey» using two parameters: level of mental (MH) and physical (PH) health. A control group consisted of 20 sex- and age-matched healthy persons without neurological diseases. After two years, 67% of the patients assessed their health condition as satisfactory. In the patients, a decrease in PH was greater compared to MH than in controls. In post-stroke period, patients for a long time had lower quality of life indices with marked physical impairment. Elimination of or reduction in the focal neurological deficit that led to the decrease in the level of physical wellbeing may be considered as a significant rehabilitation reserve.

HEALTH STATE AND QUALITY OF LIFE IN ELDERLY AND OLD PEOPLE

Objective: to assess the state of health and quality of life (QOL) of elderly and old people living in Gomel region. Material and methods. Questionnaire, a survey study of the quality of life using the questionnaire «SF-36 Health Status Survey», statistical methods. Results. The QOL indices of elderly and old people are significantly reduced by all the scales of the questionnaire «SF-36» except for the scale of social functioning. The respondents with chronic diseases made up 85.6 %, of them 25.8 % had one chronic illness, in other cases - combined pathology. The individuals with chronic illnesses had lower QOL indices by two scales: general health and physical activity. A direct correlation between the age and level of sickliness (r = 0.3, p < 0.05) among elderly and old people. Conclusion. The quality of life of elderly and old people is dependent on their state of health, in the first place, the presence of chronic disease and the level of polymorbidity so in the old age adequate treatment for chronic diseases, timely prevention of exacerbations, complex rehabilitation measures aimed at prevention of disability are very important.

FUNCTIONAL ABILITY AND QUALITY OF LIFE IN PATIENTS WITH RHEUMATOID ARTHRITIS RECEIVING TOCILIZUMAB THERAPY

Rheumatoid arthritis (RA) is a chronic inflammatory joint disease causing joint dysfunction; reduction of quality of life (QoL); loss of work ability, self-care ability, and executing daily routines in most patients 5–10 years after the disease onset. Objective. To study QoL and the functional status (FS) of Russian RA patients receiving tocilizumab (TCZ). Material and Methods. The study involved 42 patients with verified RA diagnosis (moderate or high activity) who had earlier undergone inefficient therapy with basic anti-inflammatory medications. The limitation of the FS of the RA patients was determined quantitatively using the Russian-language version of the HAQ questionnaire. QoL was evaluated using the EuroQol-5D (EQ-5D) Quality of Life questionnaire prior to treatment and after 4, 8, 12, 16, 20, and 24 weeks. Results. TCZ therapy demonstrated a rapid improvement of the FS of RA patients with a 64% decrease in the HAQ index (ΔHAQ=1.12), which corresponded to a 50% improvement of the health status of patients according to the ACR criteria. The median value [25th; 75th percentile] of the EQ-5D index was 0.52 [-0.02; 0.52]; 27.7% patients assessed their QoL as “worse than death”. The index reliably increased by week 8 of therapy; there were no patients with the negative EQ-5D index by week 24. Depending on QoL, all the patients were subdivided into two groups. Group 1 (n=12) comprised the patients with the EQ-5D no higher than 0; in group 2 patients (n=30), it was higher than 0. The groups were comparable in terms of disease duration, age, disease activity indices, and the previous treatment. The low QoL index in all 12 patients in group 1 was attributed to the infeasibility of performing daily activities and the reliably higher pain level (75.0 [61.0; 86.0] and 66.0 [48.0; 71.0] in groups 1 and 2, respectively; p=0.02). Improved QoL and reduced pain level were observed in both groups as early as after the first TCZ infusion. By week 24, the pain level decreased to 26.5 [11.0; 24.0] and 10.0 [2.0; 31.0] in groups 1 and 2, respectively. The EQ-5D index in group 1 became positive by week 8 of therapy. Conclusion. TCZ therapy quickly improves the FS and QoL of RA patients, including those with the most severe condition.

Relationship between exercise test recovery indices and psychological and quality-of-life status in hemodialysis patients: a pilot study

The aim of this study was to correlate the psychological and health-related quality-of-life status of hemodialysis (HD) patients with recovery indices following maximal and submaximal exercise tests. Twenty patients on HD (aged 53.5 ± 12.9 years) and 18 healthy individuals (aged 54.1 ± 10.2 years) underwent a maximal and a submaximal cardiopulmonary test (CPETmax and CPETsubmax). Heart rate recovery (HRrec) 1 minute after exercise and time for VO2 to decrease by half (T1/2VO2) were determined. All subjects also completed 3 questionnaires: (a) the Beck Depression Inventory (BDI), (b) Quality of Life Index (QLI)-Spitzer Index and (c) SF-36 physical and mental component summary scales. HRrec after maximal (p=0.029) and submaximal test (p=0.041) was found to be lower in patients compared with healthy individuals. T1/2VO2 was raised by 29% (p=0.003) in patients compared with controls. Moreover, a significantly higher BDI (by 133.7%), lower SF-36 physical (by 47.8%) and mental (by 42.9%) component summary score and lower QLI (by 32.1%) results were found in HD patients compared with controls. BDI (p=0.045), QLI (P=0.011), SF-36 physical (p=0.017) and mental component scales (p=0.021) were independently associated with HRrec in maximal tests in patients. Similar correlations remained for submaximal tests among HRrec and BDI (p=0.004), QLI (p=0.006), SF-36 physical (p=0.048) but not mental scales (p=0.369) in the patients' group. T1/2VO2 also correlated to BDI (p=0.019), QLI (p=0.005) and SF-36 mental scale (p=0.017) in maximal tests in these patients. In contrast, there was a correlation between HRrec and BDI (p=0.004) in the control group for maximal tests only. In conclusion, in HD patients, recovery indices following maximal and submaximal exercise tests were shown to provide useful indications of the patients' psychological and quality-of-life profiles.

The impact of primary healthcare in reducing inequalities in child health outcomes, Bogotá-Colombia: an ecological analysis.

BackgroundColombia is one of the countries with the widest levels of socioeconomic and health inequalities. Bogotá, its capital, faces serious problems of poverty, social disparities and access to health services. A Primary Health Care (PHC) strategy was implemented in 2004 to improve health care and to address the social determinants of such inequalities. This study aimed to evaluate the contribution of the PHC strategy to reducing inequalities in child health outcomes in Bogotá.MethodsAn ecological analysis with localities as the unit of analysis was carried out. The variable used to capture the socioeconomic status and living standards was the Quality of Life Index (QLI). Concentration curves and concentration indices for four child health outcomes (infant mortality rate (IMR), under-5 mortality rate, prevalence of acute malnutrition in children under-5, and vaccination coverage for diphtheria, pertussis and tetanus) were calculated to measure socioeconomic inequality. Two periods were used to describe possible changes in the magnitude of the inequalities related with the PHC implementation (2003 year before - 2007 year after implementation). The contribution of the PHC intervention was computed by a decomposition analysis carried out on data from 2007.ResultsIn both 2003 and 2007, concentration curves and indexes of IMR, under-5 mortality rate and acute malnutrition showed inequalities to the disadvantage of localities with lower QLI. Diphtheria, pertussis and tetanus (DPT) vaccinations were more prevalent among localities with higher QLI in 2003 but were higher in localities with lower QLI in 2007. The variation of the concentration index between 2003 and 2007 indicated reductions in inequality for all of the indicators in the period after the PHC implementation. In 2007, PHC was associated with a reduction in the effect of the inequality that affected disadvantaged localities in under-5 mortality (24%), IMR (19%) and acute malnutrition (7%). PHC also contributed approximately 20% to inequality in DPT coverage, favoring the poorer localities.ConclusionThe PHC strategy developed in Bogotá appears to be contributing to reductions of the inequality associated with socioeconomic and living conditions in child health outcomes.

Cannabis use amongst patients with inflammatory bowel disease

Experimental evidence suggests the endogenous cannabinoid system may protect against colonic inflammation, leading to the possibility that activation of this system may have a therapeutic role in inflammatory bowel disease (IBD). Medicinal use of cannabis for chronic pain and other symptoms has been reported in a number of medical conditions. We aimed to evaluate cannabis use in patients with IBD. One hundred patients with ulcerative colitis (UC) and 191 patients with Crohn's disease (CD) attending a tertiary-care outpatient clinic completed a questionnaire regarding current and previous cannabis use, socioeconomic factors, disease history and medication use, including complimentary alternative medicines. Quality of life was assessed using the short-inflammatory bowel disease questionnaire. A comparable proportion of UC and CD patients reported lifetime [48/95 (51%) UC vs. 91/189 (48%) CD] or current [11/95 (12%) UC vs. 30/189 (16%) CD] cannabis use. Of lifetime users, 14/43 (33%) UC and 40/80 (50%) CD patients have used it to relieve IBD-related symptoms, including abdominal pain, diarrhoea and reduced appetite. Patients were more likely to use cannabis for symptom relief if they had a history of abdominal surgery [29/48 (60%) vs. 24/74 (32%); P=0.002], chronic analgesic use [29/41 (71%) vs. 25/81 (31%); P<0.001], complimentary alternative medicine use [36/66 (55%) vs. 18/56 (32%); P=0.01] and a lower short inflammatory bowel disease questionnaire score (45.1±2.1 vs. 50.3±1.5; P=0.03). Patients who had used cannabis [60/139 (43%)] were more likely than nonusers [13/133 (10%); P<0.001 vs. users] to express an interest in participating in a hypothetical therapeutic trial of cannabis for IBD. Cannabis use is common amongst patients with IBD for symptom relief, particularly amongst those with a history of abdominal surgery, chronic abdominal pain and/or a low quality of life index. The therapeutic benefits of cannabinoid derivatives in IBD may warrant further exploration.

Ferrans and Powers’ Quality of life index applied in urinary incontinence research – a pilot study

The aim of this study was to explore the usefulness of applying a global, evaluation-based quality of life (QoL) questionnaire in assessing the impact of urinary incontinence (UI) on women's lives. The study population comprised long-term gynaecological cancer survivors (n=160) and controls from the general population (n=493). The presence of UI was assessed by the question 'Do you leak urine?' while UI perceived as a problem was assessed on a five-point scale from 'No problem' to 'A very large problem'. QoL was measured by Ferrans & Powers' QoL index (QLI), generic version II. UI was distributed equally among women with a history of gynaecological cancer and among women from the general population (34%). UI has a negative impact on overall QLI as well as a wide range of items. Approximately 20% of the incontinent women defined UI as no problem, with QLI scores similar to continent women. Only 5% experienced UI as a large/very large problem; with exceptionally low QLI scores. The psychometric testing of QLI (acceptability, internal consistency reliability and known-group validity) supports the use of QLI in UI-studies. The Ferrans & Powers' QLI is considered an acceptable tool for UI research, but further psychometric testing is required.

Coping, quality of life, and hope in adults with primary antibody deficiencies

BackgroundLiving with a chronic disease, such as primary antibody deficiency, will often have consequences for quality of life. Previous quality-of-life studies in primary antibody deficiency patients have been limited to different treatment methods. We wanted to study how adults with primary antibody deficiencies manage their conditions and to identify factors that are conducive to coping, good quality of life and hope.MethodsQuestionnaires were sent to all patients ≥20 years of age with primary antibody deficiencies who were served by Rikshospitalet University Hospital. The questionnaires consisted of several standardized scales: Ferrans and Powers Quality of Life Index (QLI), Short Form-36 (SF-36), Jalowiec Coping Scale (JCS), Nowotny Hope Scale (NHS), and one scale we devised with questions about resources and pressures in the past. Of a total of 91, 55 patients (aged 23–76 years) answered the questionnaires. The questionnaire study were supplemented with selected interviews of ten extreme cases, five with low and five with high quality of life scores.ResultsAmong the 55 patients, low quality of life scores were related to unemployment, infections in more than four organs, more than two additional diseases, or more than two specific occurrences of stress in the last 2–3 months. Persons with selective IgA deficiency had significantly higher QLI scores than those with other antibody deficiencies. An optimistic coping style was most frequent used, and hope values were moderately high. Based on the interviews, the patients could be divided into three groups: 1) low QLI scores, low hope values, and reduced coping, 2) low QLI scores, moderate hope values, and good coping, and 3) high QLI scores, moderate to strong hope values, and good coping. Coping was related to the patients' sense of closeness and competence.ConclusionLow quality of life scores in adults with primary antibody deficiencies were linked to unemployment and disease-related strains. Closeness and competence were preconditions for coping, quality of life and hope. The results are valuable in planning care for this patient group.

Onset of acute myocardial infarction during sleep.

Analysis of the chronology of acute cardiovascular events may provide important pathophysiologic information. There is a circadian pattern in the onset of acute myocardial infarction (AMI) with a mid-morning peak, ascribed to the catecholamine surge that accompanies awakening and assuming the upright posture. However, in up to 27% of patients the onset of AMI occurs during sleep (without apparent precipitating factors). The reasons for this finding are unknown. The aim of the study was to determine why the onset of symptoms of AMI occurs during sleep in some individuals rather than being precipitated by known trigger factors such as physical exertion. Using the database from a large multicenter clinical trial, patients were grouped according to whether or not they were awakened from sleep by the symptoms of AMI. In all, 870 of 3,309 patients (26%) were awakened by AMI. In general, these patients were older and sicker, with poorer left ventricular function, lower quality of life indices, more frequent heart failure, lower ejection fractions, higher incidence of angina, and a greater frequency of atrial arrhythmias. On multivariate analysis, only low ejection fraction and older age were independently associated with awakening by the symptoms of AMI. Patients who are older and sicker are more likely to be awakened from sleep by the onset of symptoms of AMI. Although the reasons are unknown, we speculate that these individuals are less active and therefore less vulnerable to established trigger factors such as vigorous physical exertion.

CHRONICALLY HOSPITALIZED PATIENTS WITH SCHIZOPHRENIA: PSYCHOPATHOLOGIC, COGNITIVE AND FUNCTIONAL ASSESSMENTS

The authors present psychopathological, cognitive, and functional assessments of 43 middle-aged and elderly patients with schizophrenia who have been hospitalized in long-term facilities. These patients were compared to a matched outpatient sample (n=43) from the San Diego VAMC. Inpatients were age>45 and had been hospitalized at least 6 months within the past year in the Chillicothe VAMC inpatient units. Patients also met DSM-IV criteria for schizophrenia or schizoaffective disorder. Assessments were performed using the following instruments: Ham-D, PANSS, MMSE, and Quality of Well Being (QWB) Scale. Scores were compared to outpatients matched on the basis of age and education using t-tests. The mean (x) age of onset of the inpatients was significantly lower than the outpatients (x ± SD=24.5 ± 6.1 vs. 30.4 ± 11.4; P=0.003). The total PANSS scores of the inpatients were significantly higher than the outpatient scores (98.7 ± 26.7 vs. 64.7 ± 16.0; P<0.0001). The positive, negative, and general psychopathology subscales of the PANSS were significantly higher in the inpatients. The MMSE and QWB scores of the inpatient sample were also significantly different from that of the outpatients. For instance, QWB scores in the inpatients were 0.52 ± 0.08 vs. 0.57 ± 0.12 in the outpatients (P=0.01). In addition, MMSE scores in the inpatients were 21.9 ± 7.0 vs. 26.4 ± 3.2 in the outpatients (P=0.0003). There was no significant difference between the Ham-D scores in the two groups. These studies support the hypothesis that the earlier age of onset in inpatients leads to greater disability in later life. In addition, the findings support the premise that chronically hospitalized inpatients exhibit higher levels of psychopathology, greater cognitive impairment, and lower quality of life indices. Obtaining a better understanding of this subset of older individuals with schizophrenia may help investigators better determine which interventions would optimize their treatment. Additional studies are needed to better understand this population of patients. P32