Lower Physical Component Summary Scores Research Articles

Prediction based on preoperative opioid use of clinical outcomes after transforaminal lumbar interbody fusions

OBJECTIVE Opioid analgesics have become some of the most prescribed drugs in the world, despite the lack of long-term studies evaluating the benefits of opioid medications versus their risks associated with chronic use. In addition, long-term opioid use may be associated with worse long-term clinical outcomes. The primary objective of this study was to evaluate whether preoperative opioid use predicted inferior clinical outcomes among patients undergoing transforaminal lumbar interbody fusion (TLIF) for symptomatic lumbar degenerative disc disease. METHODS The authors of this observational study prospectively enrolled 93 patients who underwent 1-level to 2-level TLIFs in 2011-2014; the patient cohort was divided into 2 groups according to preoperative opioid use or no such use. Visual analog scale (VAS) scores for low-back pain and leg pain, Oswestry Disability Index scores, and the scores of the mental component summary (MCS) and physical component summary (PCS) on the 36-Item Short Form Health Survey were used to assess pain, disability, and health-related quality of life outcomes, respectively. The clinical scores for the 2 groups were determined preoperatively and at a 12-month follow-up examination. RESULTS In total, 60 (64.5%) patients took prescribed opioid medications preoperatively. Compared with those not taking opioids preoperatively, these patients had significantly higher VAS scores for low-back pain (p = 0.016), greater disability (p = 0.013), and lower PCS scores (p = 0.03) at the 12-month follow-up. The postoperative MCS scores were also significantly lower (p = 0.035) in the opioid-use group, but these lower scores were due to significantly lower baseline MCS scores in this group. A linear regression analysis did not detect opioid dose-related effects on leg and back pain, disability, and MCS and PCS scores, suggesting that poorer outcomes are not significantly correlated with higher opioid doses taken by the patients. CONCLUSIONS The use of opioid medications to control pain before patients underwent lumbar fusion for degenerative lumbar conditions was associated with less favorable clinical outcomes postoperatively. This is the first study that has demonstrated this association in a homogeneous cohort of patients undergoing TLIF; this association should be studied further to evaluate the conclusions of the present study. Clinical trial registration no.: NCT01406405 ( clinicaltrials.gov ).

Health-related quality of life of among elders in rural China: the effect of widowhood.

Purpose China has an enormous and rapidly growing population of widowed elders. Little is known about how losing a spouse affects elders’ health-related quality of life (QOL), especially in the rural areas where most Chinese elders live. This article analyzes QOL data collected in 2014 among rural Chinese elders to address this question.MethodsSF12 questionnaires and information about individual and household characteristics were collected from 3053 elders aged 60 and above in rural China. We compared the physical component summary (PCS) and mental component summary (MCS) scores between 1925 married elders and 1060 widowed elders in a bivariate model stratifying by gender and age group and in a general factorial ANOVA multivariate analysis that examined and controlled for other predictors of PCS and MCS scores including education, chronic disease, and family and household factors.ResultsWidowed male and female elders’ physical health and mental health were in decline with age. Widowed men had lower PCS and MCS scores than married men. Widowed women also had lower PCS scores, but differences in MCS scores did not reach statistical significance. In multivariate analysis, widowhood was associated with lower PCS and MCS scores overall. Support from children was associated with better QOL and, based on interaction analysis, appeared to mitigate negative effects of widowhood.ConclusionsWidowed rural elders in China have lower physical and mental quality of life than their married counterparts. These elders rely on their children for care, and a supportive family is associated with better QOL.

Quality of Life and Mortality of Long-Term Colorectal Cancer Survivors in the Seattle Colorectal Cancer Family Registry.

Background and AimBecause most colorectal cancer patients survive beyond five years, understanding quality of life among these long-term survivors is essential to providing comprehensive survivor care. We sought to identify personal characteristics associated with reported quality of life in colorectal cancer survivors, and sub-groups of survivors potentially vulnerable to very low quality of life.MethodsWe assessed quality of life using the Veterans RAND 12-item Health Survey within a population-based sample of 1,021 colorectal cancer survivors in the Seattle Colorectal Cancer Family Registry, approximately 5 years post-diagnosis. In this case-only study, mean physical component summary scores and mental component summary scores were examined with linear regression. To identify survivors with substantially reduced ability to complete daily tasks, logistic regression was used to estimate odds ratios for “very low” summary scores, defined as a score in the lowest decile of the reference US population. All cases were followed for vital status following QoL assessment, and mortality was analyzed with Cox proportional hazards regression.ResultsLower mean physical component summary score was associated with older age, female sex, obesity, smoking, and diabetes or other co-morbidity; lower mean mental component summary score was associated with younger age and female sex. Higher odds of very low physical component summary score was associated with older age, obesity, less education, smoking, co-morbidities, and later stage at diagnosis; smoking was associated with higher odds of very low mental component summary score. A very low physical component score was associated with higher risk of mortality (hazard ratio (95% confidence interval): 3.97 (2.95–5.34)).ConclusionsOur results suggest that identifiable sub-groups of survivors are vulnerable to very low physical components of quality of life, decrements that may represent meaningful impairment in completing everyday tasks and are associated with higher risk of death.

Depression treatment and health-related quality of life among adults with diabetes and depression.

Previous findings regarding depression treatment and its consequences on health-related quality of life (HRQoL) of adults with diabetes were inconsistent and targeted certain groups of population. Therefore, there is a critical need to conduct a population-based study that focuses on a general population with diabetes and depression. The primary aim of this study was to examine the physical and mental HRQoL associated with depression treatment during the follow-up year. We adopted a longitudinal design using multiple panels (2005-2011) of the Medical Expenditure Panel Survey to create a baseline year and follow-up year. We included adults with diabetes and depression. We categorized the baseline depression treatment into: (1) antidepressant use only; (2) psychotherapy with or without antidepressants; and (3) no treatment. HRQOL was measured using SF-12 version 2 physical component summary (PCS) and SF-12 mental component summary (MCS) scores during both baseline year and follow-up year. Ordinary least squares (OLS) were used to estimate the association between depression treatment and the HRQoL measures. The OLS regression controlled for predisposing, enabling, need, external environment factors, personal health practices, and baseline HRQoL measures. After controlling for all the independent variables and the baseline PCS, individuals who received psychotherapy with or without antidepressants had higher PCS scores as compared to those without any treatment for depression (beta=1.28, p<0.001). Individuals who reported using only antidepressants had lower PCS scores (beta=-0.54, p<0.001) as compared to those without depression treatment. On the contrary, individuals who reported receiving psychotherapy with or without antidepressants had lower MCS scores as compared to those without depression treatment (beta=-1.43, p<0.001). Those using only antidepressants had higher MCS scores as compared to those without depression treatment (beta=0.56, p<0.001). The associations between depression treatment and the HRQoL varied by the type of depression treatment and the component of the HRQoL measures.

Do knee osteoarthritis and fat-free mass interact in their impact on health-related quality of life in men? Results from a population-based cohort.

To investigate whether obesity and other risk factors interact with knee osteoarthritis (OA) in its adverse impact on health-related quality of life (HRQOL). In 1,262 participants of the Netherlands Epidemiology of Obesity Study, a population-based cohort (age 45-65 years, 53% women, and median body mass index [BMI] 27 kg/m(2) ), knee OA was defined following modified American College of Rheumatology criteria. BMI and fat-free mass (as proxy for muscle mass) were assessed by bioelectrical impedance analysis, and comorbidities by self-report. HRQOL was assessed using the Short Form 36 physical component summary (PCS) score. Linear regression analyses were performed to examine associations between knee OA and PCS score, adjusting for age and sex and stratified for BMI, fat-free mass, and comorbidities. Knee OA (prevalence 16%) was associated with a 7.2-points lower PCS score (95% confidence interval -9.5, -4.8). PCS score was also negatively associated with obesity and comorbidities; however, no interaction with knee OA was seen. Low fat-free mass was associated with a lower PCS score and interacted with knee OA in men. Interaction between concurring OA and low fat-free mass attributed to 64% of the decrease in PCS score, as compared with men without OA and with high fat-free mass. Knee OA was associated with a lower HRQOL, as were its risk factors, obesity, comorbidities, and low fat-free mass. In men, fat-free mass interacted with knee OA, leading to an additional decrease of HRQOL in the case of concurrence. Especially in the former, improvement of fat-free mass may improve HRQOL in knee OA patients.

Health-related quality of life in persons with apparent treatment-resistant hypertension on at least four antihypertensives.

Little is known about the impact of treatment-resistant hypertension (TRH) on health-related quality of life (HrQoL). We aimed to compare HrQoL measures in adults with apparent TRH (aTRH) and non-resistant hypertension among nationally representative US Medical Expenditure Panel Survey data pooled from 2000 to 2011. Cohorts compared were adults with aTRH (⩾2 unique fills from ⩾4 antihypertensive classes during a year) versus non-resistant hypertension (those with hypertension not meeting the aTRH definition). Key outcomes were cohort differences in SF-12v2 physical component summary (PCS) and mental component summary (MCS) scores and disease-state utility using the SF-6D. Of 57 150 adults with hypertension, 2501 (4.4%) met criteria for aTRH. Persons with aTRH, compared with non-resistant hypertension, were older (mean, 68 vs 61 years), had a higher BMI (30.9 vs 29.7 kg m(-)(2)) and were more likely to be Black (20% vs 14%), but less likely to be female (46% vs 54%). Persons with aTRH, compared with non-resistant hypertension, had lower mean PCS scores (35.8 vs 43.2; P<0.0001), and utility (0.68 vs 0.74; P<0.0001), but similar MCS scores (49.1 vs 50.4). In multivariable-adjusted analyses, aTRH was associated with a 2.37 (95% CI 1.71 to 3.02) lower PCS score and 0.02 (95% CI 0.01 to 0.03) lower utility, compared with non-resistant hypertension. In conclusion, aTRH was associated with substantially lower HrQoL in physical functioning and health utility, but not in mental functioning, compared with non-resistant hypertension. The multivariable-adjusted reduction in physical functioning was similar in magnitude to previous observations comparing hypertension with no hypertension.

Health Status and Risk Factors among Adolescent Survivors One Month after the 2014 Ludian Earthquake.

Background: An earthquake struck Ludian in Yunnan Province (China) on 3 August 2014, resulting in 3143 injuries, 617 deaths, and 112 missing persons. Our study aimed at estimating the health status and associated determinants among adolescent survivors after the Ludian earthquake. Methods: A cross-sectional survey of 845 was conducted at the Ludian No. 1 Middle School. Descriptive statistics, t-tests, ANOVA and stepwise linear regression analysis were used for data analysis. Results: The mean scores on the physical component summary (PCS) and mental component summary (MCS) were 46.23 (SD = 7.10) and 36.34 (SD = 7.09), respectively. Lower PCS scores in the aftermath of an earthquake were associated with being trapped or in danger, being female, being an ethnic minority, injury to self and house damage, while lower MSC scores were associated with fear during the earthquake, Han ethnicity, death in the family, not being involved in the rescue and low household income. Conclusions: In our study, significant associations between demographic, socio-economic, and trauma-related experiences variables and overall physical and mental health of adolescent survivors were presented. The results of this study help expand our knowledge of health status among adolescent survivors after the Ludian earthquake.

PDB86 - Depression Treatment and Health-Related quality of Life among adults with Diabetes and depression

Previous findings regarding depression treatment and its consequences on health-related quality of life (HRQoL) of adults with diabetes were inconsistent and targeted certain groups of population. Therefore, there is a critical need to conduct a population-based study that focuses on a general population with diabetes and depression. The primary aim of this study was to examine the physical and mental HRQoL associated with depression treatment during the follow-up year. We adopted a longitudinal design using multiple panels (2005–2011) of the Medical Expenditure Panel Survey to create a baseline year and follow-up year. We included adults with diabetes and depression. We categorized the baseline depression treatment into: (1) antidepressant use only; (2) psychotherapy with or without antidepressants; and (3) no treatment. HRQOL was measured using SF-12 version 2 physical component summary (PCS) and SF-12 mental component summary (MCS) scores during both baseline year and follow-up year. Ordinary least squares (OLS) were used to estimate the association between depression treatment and the HRQoL measures. The OLS regression controlled for predisposing, enabling, need, external environment factors, personal health practices, and baseline HRQoL measures. After controlling for all the independent variables and the baseline PCS, individuals who received psychotherapy with or without antidepressants had higher PCS scores as compared to those without any treatment for depression (beta = 1.28, p < 0.001). Individuals who reported using only antidepressants had lower PCS scores (beta = −0.54, p < 0.001) as compared to those without depression treatment. On the contrary, individuals who reported receiving psychotherapy with or without antidepressants had lower MCS scores as compared to those without depression treatment (beta = −1.43, p < 0.001). Those using only antidepressants had higher MCS scores as compared to those without depression treatment (beta = 0.56, p < 0.001). The associations between depression treatment and the HRQoL varied by the type of depression treatment and the component of the HRQoL measures.

The impact of pain on health-related quality of life 3 months after stroke

Background:Pain is common in stroke; however, its impacts on health-related quality of life (HRQoL) are unclear due to the limitations of previous studies.Objectives:The current study aims to examine and compare the demographic and clinical characteristics of Chinese stroke patients with and without pain and explore the correlations between poststroke pain and HRQoL.Method:Four hundreds and forty-one participants recruited in an acute stroke unit in a regional hospital. They were assessed 3 months after the index stroke with the following instruments. HRQoL was measured using the Short Form-12 (SF-12). The Chinese version of the Faces Pain Rating Scale-Revised (FPS-R) was used to determine the presence and intensity of pain. The demographic and clinical characteristics of patients were obtained using Barthel Index (BI), Fatigue Severity Scale (FSS), Geriatric Depression Scale (GDS), Anxiety subscale of the Hospital Anxiety and Depression Scale (HADSA), Instrumental Activities of Daily Living (IADL), Mini Mental State Examination (MMSE), Modified Rankin Scale (MRS), and National Institutes of Health Stroke Scale (NIHSS).Results:Of all participants screened, 167 reported pain and 69 had novel pain. The pain group had significantly lower physical component summary (PCS) scores after adjusting for sex, education, DSM-IV depression and BI, GDS, HADSA, and FSS scores. The FPS score was negatively correlated with a lower PCS score in patients with pain and with novel pain.Conclusion:The presence and intensity of pain have significant negative effects on HRQoL in stroke survivors. Interventions for pain could make a valuable contribution to improving HRQoL in stroke survivors.

How much do cancer-related symptoms contribute to health-related quality of life in lung and colorectal cancer patients? A report from the Cancer Care Outcomes Research and Surveillance (CanCORS) Consortium.

The objective of this study was to examine associations of symptoms with physical and mental health-related quality of life (HRQOL) in patients with colorectal cancer (CRC) and in patients with lung cancer. Patients with newly diagnosed CRC (n = 3040) or lung cancer (n = 2297) who were participating in the Cancer Care Outcomes Research and Surveillance Consortium study completed surveys on general HRQOL and symptoms. HRQOL was measured by using physical component summary (PCS) and mental component summary (MCS) scores on the Medical Outcomes Study 12-item short-form heath survey. Nonspecific cancer symptoms were measured using items from the European Organization for Research and Treatment of Cancer core quality-of-life questionnaire. Cancer type-specific modules developed by the European Organization for Research and Treatment of Cancer were used to assess CRC-specific and lung cancer-specific symptoms. For both cancer types, linear regression models that were controlled for demographic and clinical information were used to examine correlations of nonspecific and cancer-specific symptoms with PCS and MCS scores. PCS scores for patients with CRC and lung cancer were below the general population norm of 50 (43 and 37, respectively), and MCS scores were at the population norm. For the CRC sample, in the model that included both symptom indices, an increase in nonspecific symptoms was more strongly associated with lower PCS and MCS scores than an increase in CRC-specific symptoms (PCS, standardized coefficient [β] = -0.41 vs -0.09; MCS, β = -0.38 vs -0.08). In a similar model for lung cancer, increases in lung cancer-specific symptoms were more strongly associated with lower PCS scores (β = -0.34 vs -0.20), whereas nonspecific symptoms were more strongly associated with lower MCS scores (β = -0.34 vs -0.14). Symptoms were associated with HRQOL impairments in recently diagnosed patients. Additional supportive care implemented early in cancer care, regardless of cancer stage, may provide symptom relief and improve HRQOL.

Health-related quality of life in women referred for bone density assessment: relationships with bone mineral density, fracture and co-morbidity.

To identify variables that might influence health-related quality of life (HRQoL) in patients with and without a history of fracture, attending bone mineral density (BMD) assessment prior to diagnosis of osteoporosis. This cross-sectional study included 312 newly referred postmenopausal women attending for a DXA scan, without a diagnosis of osteoporosis. Data were obtained from the medical history and the General Practitioner's letter. HRQoL, using SF36 was scored using published algorithms with reference to an age-related population from England. Regression analyses were used to determine relationships between HRQoL and BMD, age, fracture status and co-morbidities. For all patients, the age-related physical component summary (PCS) and mental component summary (MCS) scores were 46 ± 10 and 47 ± 10, respectively. Controlling for confounding variables, low BMD at the femoral neck was associated with worse PCS scores (p = 0.010) and MCS scores (p = 0.034) in patients without fracture. In patients with a history of fracture, this relationship was less evident, and younger age (p < 0.00), increasing BMI (p = 0.016) and number of co-morbidities (p = 0.042) were associated with reductions in PCS scores. Patients referred for BMD assessment before a diagnosis of osteoporosis had reduced PCS scores. In patients without fracture, low BMD contributed to this reduction in health-related quality of life. Low PCS scores in patients with fracture were seen only in younger subjects with osteoporosis.

Abstract 5045: Genetic and social determinants of quality of life in lung cancer patients

Abstract Patient reported health-related quality of life (QOL) has been recognized as a major component of the overall well-being of cancer patients, with links to prognosis and other endpoints. We aimed to identify determinants of baseline QOL by investigating the relationship between patient characteristics, genetic factors, and baseline QOL in lung cancer patients. We included 7,135 newly diagnosed and previously untreated lung cancer patients. Patient reported data from the SF-12 questionnaire was used to calculate baseline Physical Component Summary (PCS) and Mental Component Summary (MCS), with lower scores indicating a worse quality of life. We observed that the mean PCS (38.82) and MCS (46.22) scores were reduced in the lung cancer population when compared to the general population which was normalized to 50. We observed a significant trend for decreasing mean PCS and MCS from never, former, to current smokers (PCS Ptrend&amp;lt;0.0001; MCS Ptrend&amp;lt;0.0001) and a similar significant increasing trend of mean PCS/MCS was seen for education from no high school through college (PCS Ptrend&amp;lt;0.0001; MCS Ptrend&amp;lt;0.0001). When compared to never smokers, current smokers were at an increased risk of reporting a poor PCS (OR: 1.51, 95%CI: 1.18-1.94, P=1.0x10-3). Compared to individuals with less than a high school degree, those with a high school (OR: 0.76, 95%CI: 0.61-0.94, P=1.0x10-2) or college degree (OR: 0.48, 95%CI: 0.38-0.62, P&amp;lt;0.001) had a decreased risk of a poor PCS. A similar relationship was seen for MCS. As cancer stage increased the mean PCS and MCS score decreased (PCS Ptrend&amp;lt;0.0001; MCS Ptrend&amp;lt;0.0001). Further, we analyzed 218 single nucleotide polymorphisms (SNPs) in the p38 MAPK signaling pathway, a key mediator of response to cellular and environmental stress, as genetic determinants of QOL in a subset of the study population (N=588). Using the median PCS/MCS score as the cut-off, twenty SNPs were statistically significantly associated with PCS and 26 SNPs were associated with MCS (P&amp;lt;0.05). In the PCS analysis, there was a 3.47-fold (95%CI, 1.75-6.88, P=3.5x10-4) increased risk of reporting a low PCS score in individuals with at least one variant of MAP2K6: rs12600726. At least one variant allele of rs7207011 in MAP2K4 was associated with a lower score for both PCS and MCS (PCS: OR=0.10, 95%CI, 0.01-0.87, P=3.7x10-2; MCS: OR=0.09, 95%CI, 0.01-0.80, P=3.0x10-2). A gene-based analysis identified MEF2D and MAP3K5 as a significant contributor to PCS, but not MCS. Furthermore, MAP2K6 was identified as a significant contributor to both PCS and MCS. Validation for these results is underway. Taken together these findings suggest that multiple factors can contribute to QOL in lung cancer patients. Citation Format: Jeanne A. Pierzynski, Michelle Hildebrandt, Yuanqing Ye, Alma Rodriguez, Xifeng Wu. Genetic and social determinants of quality of life in lung cancer patients. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 5045. doi:10.1158/1538-7445.AM2014-5045

The health-related quality of life of Chinese patients with lower urinary tract symptoms in primary care

The aim of this study was to evaluate the health-related quality of life (HRQOL) of Chinese primary care patients with lower urinary tract symptoms (LUTS). Five hundred and nineteen primary care subjects with LUTS completed a structured questionnaire containing the International Prostate Symptom Score, the adapted Incontinence Impact Questionnaire-7, the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form, the Chinese (HK) SF-12 Health Survey Version 2 (SF-12 v2) and the Depression, Anxiety and Stress Scale-21. LUTS patients had poorer HRQOL for the General Health and the Vitality domains and lower Physical Component Summary scores, but better HRQOL for the Role Emotion domain than the adjusted Hong Kong population norms. Clinical factors associated with poorer HRQOL measured by the SF-12 v2 included having more severe LUTS and having more severe depressive, anxiety and stress symptoms. Socio-demographic factors associated with poorer SF-12 v2 were consistent with those found in the general populations. Clinical and socio-demographic factors associated with poorer HRQOL assessed by condition-specific measures included having more severe LUTS (excluding intermittency and straining), the presence of mixed urinary incontinence, having more severe anxiety and stress symptoms, younger age, being not married, being in employment and having a lower household income. LUTS had substantial negative impact on patients' overall health perception and global well-being in Chinese population. A decline in HRQOL might be a key determinant for Chinese patients with LUTS to seek treatment. Patients with nocturia, frequency, urgency or mixed urinary incontinence and younger patients deserve more treatment attention because they appear to have poorer HRQOL.

Internet-based survey of factors associated with subjective feeling of insomnia, depression, and low health-related quality of life among Japanese adults with sleep difficulty.

This study was conducted to determine what symptom components or conditions of insomnia are related to subjective feelings of insomnia, low health-related quality of life (HRQOL), or depression. Data from 7,027 Japanese adults obtained using an Internet-based questionnaire survey was analyzed to examine associations between demographic variables and each sleep difficulty symptom item on the Pittsburgh Sleep Quality Index (PSQI) with the presence/absence of subjective insomnia and scores on the Short Form-8 (SF-8) and Center for Epidemiologic Studies Depression Scale (CES-D). Prevalence of subjective insomnia was 12.2% (n = 860). Discriminant function analysis revealed that item scores for sleep quality, sleep latency, and sleep medication use on the PSQI and CES-D showed relatively high discriminant function coefficients for identifying positivity for the subjective feeling of insomnia. Among respondents with subjective insomnia, a low SF-8 physical component summary score was associated with higher age, depressive state, and PSQI items for sleep difficulty and daytime dysfunction, whereas a low SF-8 mental component summary score was associated with depressive state, PSQI sleep latency, sleeping medication use, and daytime dysfunction. Depressive state was significantly associated with sleep latency, sleeping medication use, and daytime dysfunction. Among insomnia symptom components, disturbed sleep quality and sleep onset insomnia may be specifically associated with subjective feelings of the disorder. The existence of a depressive state could be significantly associated with not only subjective insomnia but also mental and physical QOL. Our results also suggest that different components of sleep difficulty, as measured by the PSQI, might be associated with mental and physical QOL and depressive status.

Multicountry Burden of Chronic Hepatitis C Viral Infection among Those Aware of Their Diagnosis: A Patient Survey

BackgroundThe World Health Organization has called for global and regional assessments of the burden of hepatitis C (HCV) along with country-specific patient profiles to better inform healthcare policy. The present investigated the characteristics and burden of patients reporting a diagnosis of HCV infection in the US, France, Germany, Italy, Spain, the UK, urban China, and Japan using a consistent methodology of patient-reported surveys.MethodsThe 2010 5EU (N = 57,805), 2009 US (N = 75,000), 2008/2009 Japan (N = 37,683), and 2009/2010 urban China (N = 33,261) waves of the National Health and Wellness Survey were used as the data source. Within each country, patients with a self-reported diagnosis of HCV were compared with those who did not report a diagnosis of HCV on sociodemographics, health behaviors, comorbidities, and health outcomes (e.g., Short Form-12v2). The effect of HCV was examined using regression analysis applying sampling weights.ResultsThe prevalence of HCV ranged from 0.26% (China) to 1.42% (Italy). Patients in Japan and Italy (61.60 and 61.02 years, respectively) were the oldest, while patients in the US were the most likely to be obese (39.31%) and have concomitant anxiety (38.43%) and depression (46.05%) compared with other countries. Pooling countries and adjusting for sociodemographics, health behaviors, and comorbidities, HCV was associated with significantly lower physical component summary scores (b = −2.51) and health utilities (b = −0.04) and greater overall work impairment (b = 8.79), physician visits (b = 2.91), and emergency department visits (b = 0.30) (all p<.05). The effects on health status were strongest in the US and UK while the effects on healthcare resource use were strongest in Japan.ConclusionsHCV was associated with a significant humanistic and economic burden. These results suggest that the manifestation of the HCV burden, and the profile of the patients themselves, varied dramatically by country. Successful disease management should be cognizant of region-specific unmet needs.

243 * QUALITY OF LIFE AS AN INTEGRAL ASPECT OF TRANSAPICAL TRANSCATHETER AORTIC VALVE IMPLANTATION OUTCOME

Objectives: Transapical transcatheter aortic valve implantation (TA-TAVI) has been shown to be an effective and safe alternative procedure in selected high-risk patients with aortic stenosis. However, as elderly patients with multiple co-existing disorders are treated, quality of life (QoL) becomes a fundamental aspect of outcome. We therefore assessed not only clinical parameters such as morbidity and mortality but also focused on subjective improvement of life quality after TA-TAVI procedures. Furthermore, efficiency of TA-TAVI therapy was evaluated by comparison with surgical aortic valve replacement (AVR) and patients with chronic diseases in terms of these aspects. Methods: Between June 2008 to October 2011, 60 consecutive TA-TAVI patients (age 78.8 ± 6.3 years; 66.7% women, log EuroSCORE 22.1% ± 16.7%; Edwards Sapien XT) were included in the study. Complication rates were evaluated according to VARC criteria. Forty-four patients could be asked about life quality six months after the procedure, using the SF-36 survey to assess quality of life. Response rate was 95.7%. Norm based Physical Component Summary (PCS) and Mental Component Summary (MCS) scores were calculated. Comparison of data of, for example, patients with chronic disease was assessed with two tailed t-test. Kaplan-Meier analysis was utilized for survival statistics. Results: Thirty-day mortality was 5%, and overall 1-year survival rate was 78.3%; 3.4% of patients had a stroke, and 8.5% required pacemaker implantation. Results of the SF-36 demonstrated relatively low PCS (36.47 ± 10.47) and MCS (44.63 ± 11.4) scores. However, in 79.6% of patients, postoperative QoL was rated improved or at least unchanged. Compared with results of surgical AVR, quality of life after TA-TAVI was shown to be significantly lower, with values close to patients with life-limiting diseases like cancer. Conclusions: In conclusion, self-assessment by the SF-36 survey is an effective instrument with which to evaluate disease-related life quality. For evaluation of TA-TAVI efficiency, QoL should be analysed in addition to clinical parameters. Due to considerably impaired QoL PCS and MCS scores, careful psychological supervision of TA-TAVI patients has to be considered in the pre- and postoperative course.

Gender differences in health-related quality of life in patients with bipolar disorder

Health-related quality of life (HRQOL) is a widely accepted measure of illness state that is related to morbidity and mortality. Findings from various populations show that women report lower HRQOL than men. We analyzed baseline HRQOL data for gender differences from a multisite, randomized controlled study for adults with bipolar disorder. HRQOL was assessed using the 12-item Short Form (SF-12) physical component summary (PCS) and mental component summary (MCS) health scales. Multivariate linear and bivariate regression models examined differences in self-reported data on demographics, depressive symptoms (nine-item Patient Health Questionnaire), bipolar disorder symptoms (Internal State Scale), and medical comorbidities. Out of 384 enrolled (mean age = 42 years), 256 were women (66.7 %). After controlling for sociodemographic characteristics and clinical factors, women had lower SF-12 PCS scores than men [β = -1.78, standard error (SE) = 0.87, p < 0.05], indicating worse physical health, but there were no gender differences in MCS scores. After controlling for patient factors including medical and behavioral comorbidities, the association between gender and PCS score was no longer significant. Of the medical comorbidities, pain was associated with lower PCS scores (β = -4.90, SE = 0.86, p < 0.0001). Worse physical HRQOL experienced by women with bipolar disorder may be explained by medical comorbidity, particularly pain, suggesting the importance of gender-tailored interventions addressing physical health conditions.

Association of obstructive sleep apnea severity with exercise capacity and health-related quality of life

Background:Current research is inconclusive as to whether obstructive sleep apnea severity directly limits exercise capacity and lowers health-related quality of life (HRQoL).Aims:The aim of this study was to evaluate the association of obstructive sleep apnea severity with determinants of exercise capacity and HRQoL.Subjects and Methods:Subjects were evaluated by home somnography and classified as no obstructive sleep apnea (n = 43) or as having mild (n = 27), moderate or severe obstructive sleep apnea (n = 21). Exercise capacity was assessed by a ramping cycle ergometer test, and HRQoL was assessed with the SF-36 questionnaire.Results:Greater obstructive sleep apnea severity was associated with older age, higher body weight, higher body mass index, lower peak aerobic capacity, a higher percentage of peak aerobic capacity at a submaximal exercise intensity of 55 watts, and lower physical component summary score from the SF-36. None of these variables were statistically different among obstructive sleep apnea severity groups after controlling for age and body weight. Obstructive sleep apnea severity was not associated with any cardiorespiratory fitness or HRQoL parameter.Conclusions:Obstructive sleep apnea severity has no independent association with exercise capacity or HRQoL.

Health‐related quality of life and associated factors in patients with primary lymphedema

Primary lymphedema requires continuous conservative treatment during the patient's life, which may affect their health-related quality of life (HRQOL). Physical and psychosocial characteristics related to lymphedema are associated with their HRQOL. This study aimed to assess HRQOL in those patients undergoing conservative treatment and to determine the factors associated with their HRQOL. This was a cross-sectional, observational study that included 83 patients with primary lymphedema at an outpatient clinic for lymphedema. HRQOL was assessed with the Medical Outcomes Study 36-Item Short Form Survey (SF-36) and EuroQol 5-Dimension (EQ-5D). Lymphedema status/complications and psychosocial status were evaluated by medical records, physical assessment, and self-administrative questionnaires. The general health perception score in the SF-36 was lower than the age- and sex-stratified national norms (P = 0.001). In the EQ-5D, the proportions of patients with some/moderate or severe problems were 42.2% for pain/discomfort, 21.7% for usual activities, and 20.5% for anxiety/depression. By multiple regression analyses, a lower physical component summary score in the SF-36 was associated with a higher lymphedema stage (P = 0.021), cellulitis within 30 days (P = 0.003), exercise (P = 0.010), and more substance use coping (P = 0.012). A lower mental component summary score was associated with skin lesions over edematous limbs (P = 0.008), less humor coping (P = 0.005), and more self-blame coping (P = 0.014). Patients with primary lymphedema have problems in health perception, discomfort, usual activities, and anxiety/depression. Preventing cellulitis and skin lesions and humor coping may be able to improve HRQOL.

PIN47 The Humanistic and Economic Burden of Hepatitis C Across the United States, Europe, and Asia

PIN47 The Humanistic and Economic Burden of Hepatitis C Across the United States, Europe, and Asia