Lower Levels Of Health-related Quality Research Articles

Differential associations between Quantity, content, and context of screen time, and Children's health-related quality of life: A two-wave study

Existing literature suggests that lengthy durations of screen time (ST) are associated with lower levels of health-related quality of life (HRQoL) and other negative outcomes in children. Nonetheless, the current available evidence largely relies on cross-sectional studies. In addition, data on the content and context (parent–child co-use and solitary use) of ST are scarce. We set out to conduct a one-year, two-wave longitudinal study to investigate the association between exposure to different types of ST and HRQoL among primary school children in Hong Kong, from 2021 to 2022. A population representative random sample (N = 1428) participated in the study. Results from pooled ordinary least squares regressions showed children's ST duration was significantly associated with worse HRQoL (β = −1.101, p < 0.0001). However, interactions of ST content and context, including parent–child co-use × TV viewing (β = 1.305, p < 0.0001), parent–child co-use × video gaming (β = 0.280, p < 0.0001), solitary use × video gaming (β = 0.198, p < 0.0001), and solitary use × social media use (β = 0.454, p < 0.0001) were significantly associated with better HRQoL. Our findings suggest that increased overall durations of ST are associated with worse HRQoL in children, but this association is impacted by the types of ST content and context.

Estimating the effects of physical violence and serious injury on health-related quality of life: Evidence from 19 waves of the Household, Income and Labour Dynamics in Australia Survey

ObjectiveThis study aims to investigate the effect of physical violence and serious injury on health-related quality of life in the Australian adult population.MethodsThis study utilised panel data from the Household, Income and Labour Dynamics in Australia (HILDA) Survey. HRQoL was measured through the physical component summary (PCS), mental component summary (MCS), and short-form six-dimension utility index (SF-6D) of the 36-item Short-Form Health Survey (SF-36). Longitudinal fixed-effect regression models were fitted using 19 waves of the HILDA Survey spanning from 2002 to 2020.ResultsThis study found a negative effect of physical violence and serious injury on health-related quality of life. More specifically, Australian adults exposed to physical violence and serious injury exhibited lower levels of health-related quality of life. Who experienced physical violence only had lower MCS (β = −2.786, 95% CI: −3.091, −2.481) and SF-6D (β = −0.0214, 95% CI: −0.0248, −0.0181) scores if switches from not experiencing physical violence and serious injury. Exposed to serious injury had lower PCS (β = −5.103, 95% CI: −5.203, −5.004), MCS (β = −2.363, 95% CI: −2.480, −2.247), and SF-6D (β = −0.0585, 95% CI: −0.0598, −0.0572) score if the adults not experiencing physical violence and serious injury. Further, individuals exposed to both violence and injury had substantially lower PCS (β = -3.60, 95% CI: -4.086, -3.114), MCS (β = −6.027, 95% CI: −6.596, −5.459), and SF-6D (β = −0.0716, 95% CI: −0.0779, −0.0652) scores relative to when the individuals exposed to none.ConclusionOur findings indicate that interventions to improve Australian adults’ quality of life should pay particular attention to those who have experienced physical violence and serious injury. Our findings suggest unmet mental health needs for victims of physical violence and serious injuries, which calls for proactive policy interventions that provide psychological and emotional therapy.

Social Support and Subjective Health in Fibromyalgia: Self-Compassion as a Mediator.

Individuals with fibromyalgia report lower levels of health-related quality of life (HRQL) compared to other chronically ill populations and interpersonal factors (i.e., social support) may influence risk. What is less understood is how intrapersonal factors (i.e., self-compassion) may impact the social support-HRQL linkage. We examined the association between social support and HRQL in a sample of persons with fibromyalgia and tested the potential mediating role of self-compassion. Self-identified adults in the United States with fibromyalgia (N = 508) were recruited from state, regional, and national organizations and support groups and completed an online battery of self-report questionnaires including: Multidimensional Health Profile-Psychosocial Functioning Index, Short-Form 36 Health Survey, and Self-Compassion Scale-Short Form. Individuals with greater subjective social support reported higher levels of self-compassion and, in turn, higher mental HRQL. These findings provide greater information about psychosocial constructs and HRQL and extend our understanding of self-compassion among individuals living with fibromyalgia.

Hemodiafiltration Improves Low Levels of Health-Related Quality Of Life (Qol) and Nutritional Conditions of Hemodialysis Patients.

We compared the effects on the nutritional condition and health-related quality of life (HR-QoL) of the treatment of patients with on-line hemodiafiltration (OL-HDF) and conventional hemodialysis (CHD) using a superflux dialyzer. In total, 47 maintenance (M) HD patients were treated by CHD with a high-flux dialyzer for the first 4 months (1st CHD) and were then switched to predilution OL-HDF for the next 4 months (OL-HDF), after which CHD was resumed for the last 4 months (2nd CHD). We assessed the clinical parameters, fat mass value, muscle mass value, and HR-QoL. In patients with low serum albumin levels, these levels significantly (p < 0.05) increased in the OL-HDF period. Moreover, the fat mass values significantly (p < 0.05) increased in patients with decreased fat mass values in the OL-HDF period. Although there was no significant difference in the patients with higher scores of physical functioning, role physical, vitality, and social functioning, patients with lower scores in the 1st CHD period had significantly increased (p < 0.05) in the OL-HDF period. In this crossover study, we revealed that OL-HDF treatment significantly improved the nutritional conditions and HR-QoL scores compared with the improvement observed after CHD with a superflux dialyzer, especially for maintenance hemodialysis patients with malnutrition and a low QoL.

RISCOP–Cognitive profile in a Portuguese cohort of radiological isolated syndrome patients: A case-control study

IntroductionRadiologically isolated syndrome (RIS) refers to the incidental discovery of white matter lesions suggestive of MS, on brain MRI, in asymptomatic patients. Recent studies suggest similar features of cognitive impairment between RIS and MS patients. Also, lower levels of health-related quality of life (QOL) and fatigue are reported in such patients. Aimscharacterize and compare the cognitive profile of a multicentric Portuguese cohort of RIS patients with a control group. Methodsmulticentric comparative study of a cohort of adult patients with RIS, and age and gender-matched controls followed in the headache outpatient clinic with prior MRI not fulfilling criteria for RIS diagnosis. We conducted interviews with participants, collected clinical data and applied the BICAMS battery and self-reported questionnaires (HADS, MFIS, MSQOL-54). Resultswe evaluated 31 patients with RIS (median age 46 years, IQR [(Dusankova et al., 2012-52], 72% women) and 19 control individuals (median age 32 years, IQR [(O'Jile et al., 2005-48], 71% women). Prevalence of cognitive impairment did not differ between groups (16% of the RIS and 10% of the controls, p=0.579). We found no differences between groups on the BICAMS tests, although the results of the California Verbal Learning Test (CVLT-II) score presented a trend to significance, with a lower value on the RIS group (53.9 vs. 59.3, p=0.066). There were no significant differences regarding fatigue, QOL, anxiety/depression scores. Conclusionthis is the first study on a Portuguese cohort of RIS patients assessing cognitive profile with BICAMS. A non-neglectable part of our cohort presented cognitive impairment. Our findings add to previous studies in suggesting that a more pronounced impairment of verbal memory and learning, evaluated by CVLT-II, may be present in RIS patients compared to controls. BICAMS should be assessed on future studies with larger cohorts.

Effects of Health-Related Quality of Life on Suicidal Ideation and Depression among Older Korean Adults: A Cross-Sectional Study.

Objective The aim of this study was to investigate the prevalence of depression and suicidal ideation among older Korean adults and the predictors of suicidal ideation. Methods We analyzed data from 5,604 Koreans aged 65 or older collected by the Korea National Health and Nutrition Examination Survey in 2012–2016, an annual national, cross-sectional, epidemiologic study of the Korean population. A chi-square test was used to assess differences in socio-demographic characteristics by suicidal ideation. Psychological variables, self-rated physical health, and the five dimensions of the Korean version of the EQ-5D (EuroQoL) were compared between four subgroups categorized according to the presence/absence of suicidal ideation and depression. Multiple logistic regression was used to estimate the predictive power of health-related quality of life variables, as well as physical and psychological factors regarding suicidal ideation. Results Overall, 11.5% of the sample reported suicidal ideation, and 20.0% of the suicidal ideation group were diagnosed with depression. Respondents with suicidal ideation had significantly lower levels of health-related quality of life than those without suicidal ideation. EQ-5D self-control (OR=1.42), anxiety/depression (OR=2.32), depression (OR=2.07), and self-rated physical health (OR=1.36) were found to significantly predict suicidal ideation. Conclusion Suicidal ideation without depression was prevalent among older Koreans. Self-control, anxiety/depression of EQ-5D, selfrated physical health, and depression predicted suicidal ideation. Interventions to screen older Koreans for early detection of suicide risk and prevention strategies should consider evaluating each EQ-5D dimension.

Health-Related Quality of Life Among Patients With Inflammatory Bowel Disease: A Case Control Study.

The aim of this study is to compare health-related quality of life between inflammatory bowel disease patients and age-/gender-matched controls while taking into account comorbid conditions (such as diabetes and heart disease). Data from the 2015 and 2016 National Health Interview Survey were used. Patients with inflammatory bowel disease (n = 951) were age- and gender-matched to noninflammatory bowel disease patients (n = 3,804). Patients with inflammatory bowel disease were more likely to be diagnosed with an airway disease (p < .000), heart disease (p < .000), or stomach cancer (p < .001) than age- and gender-matched individuals without inflammatory bowel disease. Even after controlling for these comorbidities, sociodemographic characteristics as well as health-related behaviors, patients with inflammatory bowel disease had significantly lower health-related quality of life than individuals of the same age and gender. Inflammatory bowel disease appears to be associated with particularly low levels of health-related quality of life. Alcohol consumption, smoking, physical activity, and body mass index may be risk factors for a decreased health-related quality of life.

Unravelling perceived fatigue and activity pacing in maintaining a physically active lifestyle after stroke rehabilitation: a longitudinal cohort study

Purposes To identify fatigue trajectories during/after stroke rehabilitation, to determine characteristics associated with trajectory membership before discharge and to investigate how these trajectories and activity pacing are associated with sustained physical activity after rehabilitation. Methods People after stroke (n = 206) were followed from 3–6 weeks before discharge (T0) to 14 (T1), 33 (T2) and 52 (T3) weeks after discharge from rehabilitation in the ReSpAct study. Latent Class analysis was used to identify trajectories of perceived fatigue. Binomial multivariable logistic regression analyses were performed to determine characteristics associated with trajectory membership (T0). Multilevel regression analyses were used to investigate how perceived fatigue and activity pacing were associated with self-reported physical activity (T0–T3). Results Three fatigue trajectories were identified: high (n = 163), low (n = 41) and recovery (n = 2). Compared with the high fatigue trajectory, people in the low fatigue trajectory were more likely to report higher levels of health-related quality of life (HR-QoL) (OR = 3.07, 95%CI = 1.51–6.26) and physical activity (OR = 1.93, 95%CI = 1.07–3.47). Sustained high levels of physical activity after rehabilitation were significantly associated with low perceived fatigue and high perceived risk of overactivity. Conclusions Three fatigue trajectories after stroke rehabilitation were identified. High levels of HR-QoL and physical activity before discharge identified people in the low fatigue trajectory. A physically active lifestyle after rehabilitation was associated with low perceived fatigue and perceived risk of overactivity. IMPLICATIONS FOR REHABILITATION Since almost 80% of people after stroke in this study perceived severe fatigue up to 1 year after stroke rehabilitation, activities focusing on the management of fatigue symptoms should be integrated in general stroke rehabilitation. In clinical practice, low levels of health-related quality of life and low levels of self-reported physical activity before discharge from stroke rehabilitation should be considered by rehabilitation professionals (e.g., physicians, physiotherapists, and physical activity counsellors) since these characteristics can predict chronic perceived fatigue up to 1 year after stroke rehabilitation. A physical activity counselling programme delivered during and after stroke rehabilitation may be improved by incorporating tailored advice regarding the management of fatigue.

Mental Health, Quality of Life and Violence Exposure in Low-Socioeconomic Status Children and Adolescents of Guatemala.

Growing up in vulnerable conditions has an impact on children and adolescents’ mental health and well-being outcomes. However, this evidence has rarely been obtained in middle and low-income countries like Guatemala, where food insecurity and exposure to violence frequently threaten childhood development. The aim of this study was to analyse the relations that sociodemographic and socioeconomic factors have with psychological adjustment of low-socioeconomic status (SES) Guatemalan children and adolescents, and how these relations were mediated by food insecurity and exposure to violence. A total of 185 participants (50.8% girls; aged between 6 to 17, M = 11.82, SD = 3.7) from three vulnerable schools located in rural and urban areas of Guatemala were assessed. The results indicated that exposure to violence significantly moderates the effect of sociodemographic and socioeconomic variables in measures of depression, anxiety and health-related quality of life. Adolescents more exposed to violence reported higher levels of depression and anxiety, as well as lower levels of health-related quality of life. In contrast, food insecurity did not seem to influence psychological adjustment outcomes in this low-SES sample. These findings highlight the relevance of exposure to violence for mental health and well-being, and is a factor that should be considered when designing public health policies to promote children and adolescents’ welfare.

Patients with Chronic Musculoskeletal Pain of 3-6-Month Duration Already Have Low Levels of Health-Related Quality of Life and Physical Activity.

To determine the level of physical activity and health-related quality of life in patients with chronic musculoskeletal pain of 3-6-month duration who have not been diagnosed or treated before. Low levels of quality of life and physical activity have been reported for patients with musculoskeletal pain with a duration of longer than 6months. This study assessed the levels of quality of life and physical activity at the beginning stage of chronic musculuskeletal pain. Prospective cross-sectional study carried out at a musculoskeletal and sports medicine clinic. Eighty-five consecutive patients with muskuloskeletal (i.e., spine, peripheral joint, muscle, tendon) pain of 3-6-month duration, not diagnosed before, age 14 and older, and from either gender were recruited. Short Form-36 Health Survey and International Physical Activity Questionnaire long were administered during assessments. Scores on subscales of Short Form-36 Health Survey and total scores of International Physical Activity Questionnaire were used as outcome measures. A total of 85 patients with an age range of 15-86 (51.22 ± 15.99) were enrolled. There were 23 male (27.06%) and 62 (72.94%) female subjects. Forty-six (54.11%) patients had three or less painful regions; 39 (45.88%) had more than three painful regions. Majority of the patients had low scores on both Short Form-36 Health Survey subscales and International Physical Activity Questionnaire. Forty-nine patients had low, 32 patients had moderate, and 4 patients had high level of physical activity. Overall, females had lower level of physical activity in all age groups. All patients had less than optimal scores on all subscales of Physical Health and Mental Health scales of the Short Form-36. The female patients had lower scores in role physical and bodily pain subscales of physical health. Patients with musculoskeletal pain duration of 3-6months have low levels of physical activity and health-related quality of life at the time of their first evaluation.

Health-related quality of life and glycaemic control among adults with type 1 and type 2 diabetes \u2013 a nationwide cross-sectional study

BackgroundHealth-related quality of life and glycaemic control are some of the central outcomes in clinical diabetes care and research. The purpose of this study was to describe the health-related quality of life and assess its association with glycaemic control in adults with type 1 and type 2 diabetes in a nationwide setting.MethodsIn this cross-sectional survey, people with type 1 (n = 2479) and type 2 diabetes (n = 2469) were selected at random without replacement from the Swedish National Diabetes Register. Eligibility criteria were being aged 18–80 years with at least one registered test of glycated haemoglobin (HbA1c) the last 12 months. The generic 36-item Short Form version 2 (SF-36v2) was answered by 1373 (55.4%) people with type 1 diabetes and 1353 (54.8%) with type 2 diabetes.ResultsCorrelation analyses showed weak correlations between scores on the SF-36v2 and glycaemic control for both diabetes types. After the participants were divided into three groups based on their levels of HbA1c, multivariate regression analyses adjusted for demographics, other risk factors and diabetes complications showed that among participants with type 1 diabetes, the high-risk group (≥70 mmol/mol/8.6%) had statistically significantly lower means in five out of eight domains of the SF-36v2 and the mental component summary measure, as compared with the well-controlled group (< 52 mmol/mol/6.9%). Among the participants with type 2 diabetes, the high-risk group had the lowest statistically significantly means in seven domains and both summary measures.ConclusionsAmong people with type 1 and type 2 diabetes, adults with high-risk HbA1c levels have lower levels of health-related quality of life in most but not all domains of the SF-36v2. This finding was not explained by demographics, other risk factors, or diabetes complications. The weak individual-level correlations between HRQOL scores and levels of glycaemic control argues for the need to not focus exclusively on either HbA1c levels or HRQOL scores but rather on both because both are important parts of a complex, life-long, challenging condition.

Health-Related Quality of Life and Family Functioning of Parents of Children with Medical Complexity

Children with medical complexity (CMC) have complex chronic conditions, functional limitations, and high resource utilization. When compared to other parents, parents of children with disabilities report low levels of health-related quality of life (HRQOL). We describe the HRQOL of parents of CMC. One hundred seventy parents of CMC (mean age =3.4 years; 57% male) in a Comprehensive Care Program at a tertiary care center completed the PedsQL Family Impact Module (PedsQL FIM™). Scores were low across all sections, with a total average of 52 (SD + 17.7). Parental HRQOL was not associated with the child’s medically complexity, level of parental education, parental medical training, number of children, number of CMC in the home, or advance directive status. Parents of CMC report low HRQOL. Strategies to better support parents of CMC are needed.

Psychological distress and quality of life: rationale and protocol of a prospective cohort study in a rural district in Bangaladesh

IntroductionA significant proportion of the global burden of disease has been attributed to mental and behavioural disorders. People with mental disorders (MDs) have lower levels of health-related quality of life...

Sedentary Behavior and Health-Related Quality of Life across Meeting Physical Activity Guidelines

Sedentary behavior may not differ between individuals meeting and not meeting physical activity guidelines (PAGs); however, sedentary behavior has been associated with lower levels of health-related quality of life (HRQoL). The purpose of this study was to investigate the influence of sedentary behavior on HRQoL across young adults in three physical activity engagement groups (i.e., did not meet aerobic or muscle-strengthening PAGs; met either aerobic PAGs or muscle-strengthening PAGs; and met both aerobic and muscle-strengthening PAGs) using moderation analyses. Participants were 427 young adults (<i>M</i><SUB>age</SUB> = 19.15 ± 0.77) from Southwestern U.S. public university. Participants completed an online survey assessing sedentary behavior, physical activity profile, and HRQOL. On average, participants who did not meet aerobic or muscle-strengthening PAGs reported the lowest physical and psychosocial HRQoL and highest screen-time sedentary behavior, while participants who met both aerobic and muscle-strengthening PAGs reported the highest physical and psychosocial HRQoL and lowest screen-time sedentary behavior. Moderation analyses indicated meeting both aerobic and muscle-strengthening PAGs significantly buffered the negative influence of screen-time sedentary behavior on physical HRQoL. Meanwhile, meeting only one of the PAGs (i.e., aerobic or muscle-strengthening) did not significantly buffer the negative influence of screen-time sedentary behavior on physical HRQoL. Considering the current trends of sedentary behavior, the current study provided support in promoting regularly engaging in both aerobic and muscle-strengthening activity. Moreover, it provided evidence supporting the position that interventions designed to improve HRQoL should include both aerobic and muscle-strengthening activity.

Correlates of well-being among caregivers of long-term community-dwelling stroke survivors.

Although caregiving for stroke survivors is usually long-term, most studies on caregivers have generally involved only the first year following the event. We assessed and compared the long-term level of well-being measures among stroke survivors and their caregivers at more than 1 year following the stroke event and examined the associations between well-being, survivors' characteristics, and caregiver burden. We interviewed a convenience sample of 51 community-dwelling stroke survivors, at least 1 year after the last stroke event, and their primary caregivers. Disability of survivors was assessed using the Barthel index and the modified Rankin Scale; health-related quality of life by the SF-36 questionnaire; and depression and anxiety using the Hospital Anxiety Depression Scale. Caregivers filled the SF-36 questionnaire, Hospital Anxiety Depression Scale questionnaire, and the Zarit Burden Interview, which assesses caregiver burden. Caregivers reported low levels of health-related quality of life and high levels of burden, anxiety, and depression. Caregivers' anxiety level was higher than that of the survivors (7.7±5.1 vs. 5.8±4.5, respectively; P=0.02). Anxiety was the only characteristic of caregivers that was associated with overall caregiver burden. Our study suggests that there is a spillover effect of the disease on stroke patients' primary caregivers. Intervention programs for caregivers should focus on their mental state and address their specific needs.

Health-related Quality of Life among Diabetics visiting RajaRajeswari Medical College and Hospital, Bengaluru

ABSTRACTIntroductionDiabetes mellitus is independently associated with lower levels of health-related quality of life (HRQoL). Quality of life (QoL) is an important aspect in diabetes because poor QoL leads to diminished self-care, which in turn leads to worsened glycemic control, increased risks for complications, and exacerbation of diabetes overwhelming in both the short run and the long run.ObjectiveTo assess the HRQoL among diabetics aged 18 years and above visiting the Medicine Outpatient Department at RajaRajeswari Medical College and Hospital, Bengaluru.Materials and methodsWe conducted a hospital-based study using a generic instrument, Audit of Diabetes Dependent Quality of Life 18 (ADDQoL 18) to measure the QoL of diabetic subjects aged ≥18 years. One hundred and forty diabetics, including 68 males and 72 females, were selected from the Medicine Outpatient Department at RajaRajeswari Medical College and Hospital. Data was analyzed using Statistical Package for the Social Sciences for Windows, version 22.ResultsThe mean age of the participants was 55.7 ±12.5 years. Majority of them (75.7%) were Hindu by religion and most of the study participants (60%) had received formal education. Majority (48.6%) belonged to grade 3 socioeconomic status. Diabetic patients who were employed constituted 52.9%. On the type of diabetes, 91.4% of the participants had type 2 diabetes, while 8.6% had type 1 diabetes. The mean duration of diabetes since diagnosis was 8.2 ±6.5 years.With regard to presence or absence of complications, 38.6% of the participants suffered from complications of diabetes, while 61.4% did not. With regard to treatment, 59.3% of them were consuming only oral hypoglycemic, whereas 40.7% were on insulin. It was observed that diabetes had a negative impact on the present QoL with a mean negative impact of –0.45 and a mean negative average weighted impact of –5.16 on the individual life domains. The negative impact of diabetes on the QoL was greater among those receiving insulin ±oral hypoglycemic agents and among those who had complications. The domains “freedom to eat,” “freedom to drink,” “enjoyment of food,” and “working life” had the greatest negative impact in all patient subgroups. It was observed that male diabetics had a poorer QoL as compared with female diabetics, but this was found to be not statistically significant.ConclusionDiabetes had an adverse effect on the QoL of these study subjects.How to cite this articleKomal SS, Srividya V. Health-related Quality of Life among Diabetics visiting RajaRajeswari Medical College and Hospital, Bengaluru. J Med Sci 2016;2(2):31-35.

A cross-sectional assessment of health-related quality of life among type 2 diabetes patients in Riyadh, Saudi Arabia.

Objective:This study aimed to describe the health-related quality of life profile among type 2 diabetes patients in Riyadh, Saudi Arabia.Method:A cross-sectional study was undertaken using a cohort of 75 patients attending the University Diabetic Centre at King Abdulaziz University Hospital, Riyadh, Saudi Arabia. EuroQoL-5 dimension (EQ-5D) scale was used for the assessment of health-related quality of life. EQ-5D was scored using values derived from the UK general population survey. Inferential statistics were applied to evaluate associations between study variables. The Statistical Package for Social Sciences version 20.0 was used for data analysis; p <0.05 was set as the level of statistical significance.Results:Fifty-eight (77.35%) respondents were male with a mean 12.6 ± 8.4 years of history of diabetes. Thirty-four (45.3%) were categorised into the age group of 45–55 years with a mean age of 54 ± 9.2 years. Forty-four (58.7%) were using oral hypoglycaemic agents and 40 (53.3%) had a university level of education. A moderate level of health-related quality of life (0.70 ± 0.22) was measured in the study cohort. Gender was significantly associated with health-related quality of life scores (p = 0.001). The mean EQ-5D score was lower in females compared to male patients (0.58 ± 0.23 vs 0.74 ± 0.20). There were no statistically significant associations between health-related quality of life scores and age groups, duration of diabetes, marital status, educational level and type of treatment.Conclusion:This study has highlighted that Saudi diabetes patients have low levels of health-related quality of life. Healthcare professionals need to consider this when planning holistic patient treatment approaches.

Health state utility values for diabetic retinopathy: protocol for a systematic review and meta-analysis.

BackgroundPeople with diabetic retinopathy tend to have lower levels of health-related quality of life than individuals with no retinopathy. Strategies for screening and treatment have been shown to be cost-effective. In order to reduce the bias in cost-effectiveness estimates, systematic reviews of health state utility values (HSUVs) are crucial for health technology assessment and the development of decision analytic models. A review and synthesis of HSUVs for the different stages of disease progression in diabetic retinopathy has not previously been conducted.Methods/DesignWe will conduct a systematic review of the available literature that reports HSUVs for people with diabetic retinopathy, in correspondence with current stage of disease progression and/or visual acuity. We will search Medline, EMBASE, Web of Science, Cost-Effectiveness Analysis Registry, Centre for Reviews and Dissemination Database, and EconLit to identify relevant English-language articles. Data will subsequently be synthesized using linear mixed effects modeling meta-regression. Additionally, reported disease severity classifications will be mapped to a four-level grading scale for diabetic retinopathy.DiscussionThe systematic review and meta-analysis will provide important evidence for future model-based economic evaluations of technologies for diabetic retinopathy. The meta-regression will enable the estimation of utility values at different disease stages for patients with particular characteristics and will also highlight where the design of the study and HSUV instrument have influenced the reported utility values. We believe this protocol to be the first of its kind to be published.Systematic review registrationPROSPERO CRD42014012891Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-015-0006-6) contains supplementary material, which is available to authorized users.

P218 Faecal calprotectin testing reduces need for paediatric colonoscopy

evidenced by lower levels of health-related quality of life (HRQOL) especially in children with high levels of abdominal pain. Research examining psychological and social factors related to IBD and associated HRQOL is critical. For children in particular, the family environment might play a crucial role in the their coping with IBD. Dysfunctional levels of overall functioning have been associated with lower HRQOL in chidlren with IBD, yet the impact of specific aspects of family functioning, such as cohesion (i.e., emotional bond or connectiveness), flexibility (i.e., balance between stability and change) and communication patterns (i.e., postive versus negative) is largely unexplored. The purpose of the present study was to investigate the influence of balanced levels of cohesion and flexbility and positive communication on the child’s pain experience and HRQOL. Methods: Thirty children with IBD (14 girls, 16 boys; N = 20 with Crohn’s disease, N = 10 with Ulcerative colitis; Mage = 13.73, SD = 2.30 years) and one parent (25 mothers, 5 fathersMage = 46.73, SD = 6.47 years) completed questionnaires regarding child’s level of pain and interference, HRQOL (i.e., IMPACT) and family functioning (i.e., Faces IV). Results: Linear regression analyses, controlling for child age, indicated that child report of positive communication and balanced level of cohesion and flexibility were positively associated with their HRQOL. Surprisingly, no significant associations were found between child level of pain and family functioning, while the level of interference in daily functioning due to pain was negatively associated with parent report of balanced cohesion and child report of balanced flexibility and positive communication. Conclusions: The current findings indicate that parent-reported cohesion was only associated with pain-related interference, while child-reported aspects of family functioning were related to HRQOL and pain-related interference. Results also suggest that family functioning is primarily associated with HRQOL and interference in daily functioning rather than the level of pain, adding to our understanding of how family functioning relates to children’s coping with IBD and associated pain. In future research, observational assesment of family functioning (e.g., by means of a conflict-discussion task) and parentchild communication patterns when faced with their child in pain (e.g., observation of parent child interaction during an experimental pain task), will contribute to our understanding of how family functioning influences child functioning and pain experiences.

The impact of comorbidity on Health-Related Quality of Life among cancer survivors: analyses of data from the PROFILES registry

The aim of this study was to assess the difference in explained variance of Health-Related Quality of Life (HRQoL) between comorbidity, sociodemographic characteristics and cancer characteristics. This association was assessed among thyroid cancer, colorectal cancer, and (non-)Hodgkin's lymphoma patients. Data from three large population-based surveys on survivors of thyroid cancer, colorectal cancer, and (non-)Hodgkin's lymphoma were used. Cancer-specific HRQoL was assessed with the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30 (QLQ-C30) of which physical function, emotional function, fatigue, and pain were included in the analyses. Comorbidity was assessed using the Self-reported Comorbidity Questionnaire. The association between comorbidity and HRQoL was assessed with multivariate linear regression models. Semi-partial R (2) was reported to assess the amount of variance in HRQoL explained by comorbidity in comparison with sociodemographic and cancer characteristics. In total, 3,792 cancer survivors were included in this analysis. The variance in HRQoL subscales explained by comorbidity was higher compared with sociodemographic and cancer characteristics for physical function (11-17 vs. 2-4 and 1-2%, respectively) and emotional function (7-17 vs. 1-3 and 1-3%, respectively), regardless of cancer type. In addition, comorbidity explained 7-20 and 11-13% of the variance in pain and fatigue, respectively, compared to 0-4% for both sociodemographic and cancer characteristics. Osteoarthritis and back pain were strongly associated with physical function and pain, while depression was strongly associated with emotional function. Depression and back pain were strongly associated with fatigue. This study showed that comorbidity explained more variance in physical and emotional function, pain, and fatigue in comparison with sociodemographic and cancer characteristics in cancer survivors, regardless of cancer type. Our findings emphasize the importance of adjusting for the presence of comorbid diseases when assessing HRQoL in cancer survivors. Cancer survivors suffering from comorbid diseases experience lower levels of health-related quality of life. Clinicians should become more aware of the impact of comorbidity on HRQoL and provide necessary psychological support to assist self-management of comorbid diseases.