Lower Levels Of Health-related Quality Research Articles

The impact of low vision on activities of daily living, symptoms of depression, feelings of anxiety and social support in community-living older adults seeking vision rehabilitation services.

PurposePrevious studies showed that older persons with vision loss generally reported low levels of health-related quality of life, although study outcomes with respect to feelings of anxiety and social support were inconsistent. The objective of this study was to examine the impact of low vision on health-related quality of life, including feelings of anxiety and social support, among community-living older adults seeking vision rehabilitation services.MethodsDifferences of activities of daily living (Groningen Activity Restriction Scale—GARS), symptoms of depression and feelings of anxiety (Hospital Anxiety and Depression Scales—HADS) and social support (Social Support Scale Interactions—SSL12-I) between 148 older persons ≥57 years with low vision and a reference population (N = 4,792) including eight patient groups with different chronic conditions were tested with Student’s t tests.ResultsOlder persons with vision loss reported poorer levels of functioning with respect to activities of daily living, symptoms of depression and feelings of anxiety as compared to the general older population as well as compared to older patients with different chronic conditions. In contrast, older persons with vision loss reported higher levels of social support.ConclusionsVision loss has a substantial impact on activities of daily living, symptoms of depression and feelings of anxiety. Professionals working at vision rehabilitation services may improve their quality of care as they take such information into account in their intervention work.

Musculoskeletal Pain in the Workforce

To investigate the impact of musculoskeletal pain on health-related quality of life and work productivity losses among US workers. Data from the 2008 US National Health and Wellness Survey were used. Among those currently employed aged 20 to 64 years (N = 30,868), workers with arthritis (n = 2,670), back (n = 4,920), and fibromyalgia (n = 439) pain were compared with workers without those respective musculoskeletal pain conditions. Arthritis, back, and fibromyalgia pain were all associated with significantly lower levels of health-related quality of life, often at clinically meaningful levels. All pain conditions were associated with higher levels of work productivity loss, even after adjusting for demographic and health characteristics. Musculoskeletal pain conditions were highly prevalent and associated with a significant burden. Improved management of these conditions may lead to improved productivity, benefiting both employers and workers alike.

Impact of Chronic Constipation on Health-Related Quality of Life, Work Productivity, and Healthcare Resource Use: An Analysis of the National Health and Wellness Survey

There has been limited research addressing the effects of constipation on work productivity and healthcare resource use. To assess the effect of chronic constipation on health outcomes and healthcare resource use. Using data from the 2007 National Health and Wellness Survey (NHWS), chronic constipation patients (n = 1,430) were propensity score-matched to controls (n = 1,430) on demographic and clinical characteristics. Differences between groups in health-related quality of life (SF-12v2), work productivity and activity impairment, and resource use in the last 6 months were examined. Mediation analyses were conducted in order to determine whether the relationship between constipation and resource use was caused by a reduction in health status. Chronic constipation patients reported significantly lower levels of health-related quality of life (physical component summary score: 39.57 vs. 43.73; mental component summary score: 43.19 vs. 47.86, all P-values < 0.01) and significantly higher levels of loss of work productivity and activity impairment (absenteeism: 9.08% vs. 5.20%; presenteeism: 29.52% vs. 19.09%; overall work impairment: 33.65% vs. 21.56%; activity impairment: 46.58% vs. 33.90%, all P-values < 0.01) compared to the matched controls. Chronic constipation patients also reported significantly more provider (7.73 vs. 5.63) and emergency room visits (0.52 vs. 0.30) in the past 6 months (all P-values < 0.01). Mediation analyses suggested that increased resource use among chronic constipation patients were partially a result of reduced health status. Compared to matched controls, chronic constipation patients reported greater economic and humanistic burden. Alleviating the humanistic burden associated with constipation may have economic benefits.

Quality of life, dyspnea and ventricular function in patients with hypertension

This paper is a report of an investigation of the relationship between health-related quality of life and left ventricular function among patients with hypertension who did not fulfil the criteria for heart failure. Heart failure is a common consequence of hypertension, with Doppler echocardiography being the gold-standard tool to evaluate left ventricular function, mainly hypertension-induced left ventricular damage. Echocardiographic data indicating poorer ventricular function have been related to lower levels of health-related quality of life in patients with systolic and/or diastolic heart failure. However, data are still lacking regarding the correlation between health-related quality of life and left ventricular function and structure in patients with hypertension who do not fulfil the criteria for heart failure. Between September 2005 and February 2007, 98 patients with hypertension without systolic or diastolic heart failure were evaluated. Health-related quality of life was assessed using the Medical Outcomes Study Short Form-36. Left ventricular function was evaluated through Tissue Doppler echocardiography. Statistically significant but weak correlations (varying from r = -0.22 to 0.35) were observed between some of the Short Form-36 domains and echo data. To consider the potential effect of dyspnoea in this relationship, patients were split according to the presence or absence of the symptom. In the subgroup without dyspnoea, similar patterns of correlation were observed (varying from r = 0.26 to 0.32). In the subgroup with dyspnoea, however, more and stronger correlations were observed between echo data and health-related quality of life domains, varying from r = -0.40 to 0.50. Nurses should be aware of the relevance of evaluating the functional echocardiographic data of patients who not fulfil heart failure criteria, but who experience dyspnoea in order to implement appropriate action plans.

1.5 years after: no substantial differences in health-related quality of life by type of coronary revascularisation among German health insurance beneficiaries

Aims: To explore the level of health-related quality of life (HRQL) in usual patients after surgical and percutaneous approaches to coronary revascularisation. Methods: We surveyed all beneficiaries of a large German health insurance, who underwent coronary revascularisation in the year 2005, were younger than 75 years of age, and survived until the time the survey took place (on average 1.5 year after the index-procedure) (n=2.810). We used German validated versions of the Short-Form 36 (SF-36) and the Seattle Angina Questionnaire (SAQ). The eight SF-36 subscales and the five SAQ-subscales are scored from 0 to 100, higher values representing better health. We compared the age- and sex-standardized SF-36-scores with the German reference population and calculated risk-adjusted scores for the SAQ- and SF-36scales (generalized equation modeling). Results: After one reminder answers from 1657 patients were available for analysis. Among the responders 462 patients had coronary artery bypass grafting, 99 patients underwent a percutaneous transluminal coronary angioplasty only, 769 patients had at least one bare metal stent implanted, and 327 patients were treated with drug-eluting stent(s). 1.5 years after the index-procedure, health-related quality of life of the study sample was five to ten points below the German reference population in seven of the eight SF-36 subscales regardless of the type of revascularisation. SF-36- and SAQ-scores by type of revascularisation differed only two to six points. Among others, a history of depression, physical comorbidity, younger age, self-reported complications, and coronary re-interventions lead to lower levels of health-related quality of life. Conclusion: Health-related quality of life in usual patients 1.5 years after coronary revascularisation is still (or again?) limited. There appear no substantial differences by type of revascularisation.

Posttraumatic Stress Disorder and Self-Reported Physical Health Status Among U.S. Military Personnel Serving During the Gulf War Period: A Population-Based Study

The objective of this study was to investigate the relation between posttraumatic stress disorder (PTSD) and perceived physical health. Participants included 3,682 Gulf War veterans and control subjects of the same era who completed a telephone survey about their health status. PTSD was assessed using the PTSD Checklist-Military Version. Veterans screening positive for PTSD reported significantly more physical health symptoms and medical conditions than did veterans without PTSD. They were also more likely to rate their health status as fair or poor and to report lower levels of health-related quality of life. The results of this study are consistent with studies of other combat veterans and provide further support for an association between PTSD and adverse physical health outcomes. Stressful or traumatic life events, such as those encountered during a rapid military deployment and conflict, are associated with a variety of adverse health effects. These health effects may manifest themselves in both psychological and physical outcomes. Health care providers must be attentive to recognize and evaluate both of these dimensions.