Lower Health-related Quality Of Life Research Articles

Matched Comparison Examining the Effect of Obesity on Clinical, Economic, and Humanistic Outcomes in Patients with BipolarI Disorder.

BipolarI disorder (BD-I) is associated with an increased risk of obesity, but few studies have evaluated the real-world clinical, humanistic, and economic effects associated with obesity in people with BD-I. This was a retrospective, cross-sectional analysis of responses to the 2016 and 2020 National Health and Wellness surveys. Respondents (18-64years) with a self-reported physician diagnosis of BD-I were matched to controls without BD-I based on demographic and health characteristics. Respondents were categorized by body mass index as underweight/normal weight (< 25kg/m2), overweight (25 to < 30kg/m2), or obese (≥ 30kg/m2). Multivariable regression models were used to compare obesity-related comorbidities, healthcare resource utilization (HCRU), health-related quality of life (HRQoL), work productivity, and indirect and direct costs. Before matching, the BD-I cohort was younger than the non-BD-I cohort and included more female and white respondents and a greater proportion covered by Medicaid or Medicare. After matching, the BD-I and non-BD-I cohorts had similar characteristics. A total of 5418 respondents (BD-I, n = 1806; matched controls, n = 3612) were analyzed. Obese respondents with BD-I reported the highest adjusted prevalences of high blood pressure (50%), high cholesterol (35%), sleep apnea (27%), osteoarthritis (17%), type2 diabetes (12%), and liver disease (4%). Obesity in respondents with BD-I was associated with the lowest HRQoL scores. Measures of work impairment were highest in respondents with BD-I and obesity, as was HCRU. Respondents with BD-I and obesity had the highest associated total indirect and direct medical costs ($25,849 and $44,482, respectively). Obese respondents with BD-I had greater frequencies of obesity-related comorbidities, higher HCRU, lower HRQoL, greater work impairments, and higher indirect and direct medical costs. These findings highlight the real-world burden of obesity in people with BD-I and the importance of considering treatments that may reduce this burden.

Health-related quality of life in psychiatric outpatients: a cross-sectional study of associations with symptoms, diagnoses, and employment status.

This cross-sectional study aimed to explore health-related quality of life (HRQoL) in a large heterogeneous patient sample seeking outpatient treatment at a specialist mental health clinic. A sample of 1947 patients with common mental disorders, including depressive-, anxiety-, personality-, hyperkinetic- and trauma-related disorders, completed the EuroQoL 5-Dimension 5-Level (EQ-5D-5L) to assess HRQoL. We investigated clinical and sociodemographic factors associated with the EQ-5D index and the EQ Visual Analogue Scale (VAS) using regression analyses. The sample reported lower HRQoL compared with the general population and primary mental health care patients. Sick leave, disability pension, work assessment allowance, and more symptoms of anxiety and depression were associated with lower EQ-5D index and EQ VAS scores. Furthermore, being male, use of pain medication and having disorders related to trauma were associated with reduced EQ-5D index scores, while hyperkinetic disorders were associated with higher EQ-5D index scores. HRQoL of psychiatric outpatients is clearly impaired. This study indicated a significant association between employment status, symptom severity, and HRQoL in treatment-seeking outpatients. The findings highlight the importance of assessing HRQoL as part of routine clinical assessment.

Relative contribution of comorbid diseases to health-related quality of life in patients with Parkinson’s disease

BackgroundMultimorbidity is common in elderly people, and one of the major consequences of multimorbidity is low health-related quality of life (HRQoL). The aim of this study was to investigate the frequency of comorbid diseases in patients with Parkinson’s disease (PD) and to analyze their relative importance in HRQoL. The aim was also to examine agreement between the generic 15D questionnaire and the PD-specific Parkinson’s Disease Questionnaire (PDQ-8) to further validate 15D in the evaluation of HRQoL in patients with PD.MethodsPatients with PD (N = 551) filled a questionnaire on comorbid diseases, and the 15D questionnaire yielding a 15-dimensional health profile and a score representing the overall HRQoL. Self-organizing map was used for an unsupervised pattern recognition of the health profiles. Relative importance analysis was used to evaluate the contribution of 16 comorbid diseases to the 15D score. The agreement between 15D and PDQ-8 questionnaires was studied in a subset of 81 patients that were examined clinically.Results533 patients (96.7%) reported comorbid diseases. The most affected dimensions in the 15D questionnaire were secretion, usual activities, discomfort and symptoms, and sexual activity. Self-organizing map identified three patterns of health profiles that included patients with high, low or transition HRQoL. The transition subgroup was similar to low HRQoL subgroup in non-motor dimensions. Sixteen comorbid diseases explained 33.7% of the variance in the 15D score. Memory deficit, depression, heart failure, and atrial fibrillation had the highest relative importance. The intraclass correlation coefficient between the generic 15D and the PD-specific PDQ-8 was 0.642 suggesting moderate reliability.ConclusionsThe most marked differences in HRQoL were in the dimensions of secretion, usual activities, and sexual activity. Pattern detection of 15D health dimensions enabled the detection of a subgroup with disproportionately poor HRQoL in non-motor dimensions. The comorbid diseases affecting most to HRQoL were memory deficit and depression. The generic 15D questionnaire can be used in the evaluation of HRQoL in PD patients.

Eight-year follow-up of patient-reported outcomes in patients with breast cancer participating in exercise studies during chemotherapy.

Numerous randomized controlled trials (RCTs) have shown beneficial exercise effects on fatigue, anxiety and depression and health-related quality of life (HRQoL) in breast cancer (BC) patients during and shortly after treatment. Here, we investigated the long-term effects of exercise during chemotherapy for BC on these outcomes. We invited participants of two highly comparable RCTs that investigated the effects of exercise (EX) (versus usual care (UC)) during chemotherapy in patients with non-metastatic BC (N = 357) to participate in an 8-year follow-up. In both trials, fatigue, anxiety and depression and HRQoL were assessed using the same questionnaires, at multiple timepoints. Linear mixed-effect models were used to compare study arms over time. In total, 156 participants (EX = 82; UC = 74) completed the follow-up questionnaires. EX reported comparable general (between-group difference 0.73, 95% confidence interval (- 0.35; 1.80), ES = 0.18) and physical fatigue (0.55 (- 0.55; 1.65), ES = 0.13), small but statistically significantly higher levels of anxiety (1.24 (0.47 to 2.00), ES = 0.39) and depression (1.10 (0.34; 1.85), ES = 0.38), significantly lower global HRQoL (- 5.99 (- 10.65; - 1.32), ES = 0.34) and comparable summary HRQoL (- 1.90 (- 4.70; 0.89), ES = 0.16) compared to UC. No long-term beneficial effects of exercise during chemotherapy on BC patients' fatigue, anxiety, depression or HRQoL were observed. The less favourable outcomes for mood and HRQoL that were observed 8years after participation in an exercise intervention may be explained by selective loss-to-follow-up. The results highlight the need to incorporate strategies that promote physical activity maintenance after participation in an exercise programme to also counteract long-term detrimental side effects of cancer treatment.

Family Environment, Social Support, and Health-Related Quality of Life in Adolescents Following Kidney Transplant.

Kidney transplantation is the treatment of choice for pediatric end-stage renal disease. Transplant recipients often have better neurocognitive, academic, and health-related outcomes. While there is some evidence that health-related quality of life (HRQOL) improves following kidney transplant, other studies have found adolescent transplant recipients report lower overall HRQOL than healthy peers. Current research has focused on individual-level factors affecting adjustment to organ transplant, warranting examination of HRQOL from a systems perspective. Family environment and social support contribute to a system of proximal relationships that are crucial in adolescents' development, making them important factors to study in relation to HRQOL post-transplant. The current study utilized archival data of adolescent renal transplant patients who completed surveys about their family environment, social support, and HRQOL during routine transplant clinic visits. Family cohesion, as well as social support from parents, classmates, and people in school, were positively correlated with HRQOL. Social support from people in school uniquely predicted variance in HRQOL, beyond the contribution of overall family environment after controlling for demographic factors. Relative to comparable adolescent samples, transplant recipients reported more optimal overall family environment, greater social support from teachers, and lower social support from close friends. Psychosocial interventions for adolescent kidney transplant recipients may be enhanced by collaborating with school professionals and further bolstering strengths in the family environment. Kidney transplant recipients may benefit from long-term intervention, as decreased HRQOL appears to persist years post-transplant.

Clinical and economic burden of acute exacerbations of idiopathic pulmonary fibrosis: a prospective observational study in Spain (OASIS study)

BackgroundIdiopathic pulmonary fibrosis (IPF) is a fatal progressive lung disease entailing significant impairment in health-related quality of life (HRQoL) and high socioeconomic burden. The course of IPF includes episodes of acute exacerbations (AE-IPF) leading to poor outcomes. This study aimed to compare management, costs and HRQoL of patients with AE-IPF to patients without AE-IPF during one year in Spain.Materials and methodsIn a 12-month, prospective, observational, multicenter study of IPF patients, healthcare resource use was recorded and costs related to AE-IPF were estimated and compared between patients with and without AE-IPF. HRQoL was measured with the St. George’s Respiratory Questionnaire (SGRQ), EuroQoL 5 dimensions 5 levels questionnaire (EQ-5D-5L), EQ-5D visual analogue scale (EQ-VAS) and the Barthel Index.Results204 IPF patients were included: 22 (10.8%) experienced ≥ 1 acute exacerbation, and 182 (89.2%) did not. Patients with exacerbations required more primary care visits, nursing home visits, emergency visits, hospital admissions, pharmacological treatments and transport use (p < 0.05 for all comparisons). Likewise, patients with exacerbations showed higher annual direct health AE-IPF-related costs. In particular, specialized visits, emergency visits, days of hospitalization, tests, palliative care, transport in ambulance and economic aid (p < 0.05 for all comparisons). Exploratory results showed that patients with AE-IPF reported a non-significant but substantial decline of HRQoL compared with patients without AE-IPF, although causality can be inferred.ConclusionWe observed significantly higher resource use and cost consumption and lower HRQoL among patients suffering exacerbations during the study. Thus, preventing or avoiding AE-IPF is key in IPF management.

Gdansk Wound-QoL Questionnaire: Pilot Study on Health-Related Quality of Life of Patients With Chronic Ulcers With Emphasis on Professional Physician-Patient Relations

Introduction: Chronic wounds lower health-related quality of life, as they affect various aspects of life due to pain, odor, tedious treatment, and stigma from society. Implementing proper treatment, where patient is well informed and active is a key for best outcomes. Objective: The aim of the study was to evaluate health-related quality of life among the patients with chronic ulcers, with the use of new scale Gdansk Wound QoL. Methods: We enrolled 108 patients who met the inclusion criteria. Before the education on day 0 patients were asked to fill in Gdansk Wound-QoL questionnaire, that was developed in cooperation between dermatologists, general and plastic surgeons, as well as wound nurses, as well as fill the follow-up Gdansk Would-QoL on day 30, which was also the end of the study. Results: Study participants (n = 108) were on average 76.1 ± 10.8 years and all of whom had a venous ulcer on their lower limbs of average wound area of 10.8 cm2. Quality of life, according to the Gdansk Wound-QoL Questionnaire, increased on average by 36.7% after 30 days trial. Moreover, on the follow-up visit 94.4% of the patients stated that their knowledge on the disease has increased and everyone was satisfied with the course of treatment proposed by the current doctor. Furthermore, 44.4% of the study group increased their activity at the end of the study. Conclusion: This pilot descriptive observational study shows that Gdansk Wound-QoL questionnaire can provide professionals in wound care good feedback on health-related quality of life of patients with chronic wounds. This information has the potential to enhance patients’ well-being and overall comfort”

Hierarchical Regression of Diabetes Self-Management and Health Related Quality of Life among Older Adults Patients with Type 2 Diabetes Mellitus.

The global elderly population is experiencing a rising prevalence of diabetes mellitus (DM). As a chronic and noncommunicable disease, diabetes requires strict daily self-management, significantly affecting the health-related quality of life (HRQOL). We investigated the relationship between diabetes self-management behaviors and HRQOL in a population of older adults diagnosed with type 2 diabetes mellitus (T2DM). This cross-sectional study was conducted between March 2022 and August 2022 at Phramongkutklao Hospital, Bangkok, Thailand. Participants completed questionnaires measuring sociodemographic factors, we utilized the Diabetes Self-Management Questionnaire (DSMQ) and the Diabetes-39 Questionnaire (D-39) to assess self-management behaviors. Hierarchical linear regression analysis was then employed to investigate the association between diabetes self-management and HRQOL. A total of 252 participants with a mean age of 68.96 years (SD = 6.64) were included. Most participants were aged 60-69 years (57.0%), female (59.9%), married (81.0%), had an undergraduate education (56.7%), and had an income lower than or equal to 40,000 baht (76.6%). Three factors were associated with HRQOL: compliance with cardiovascular disease (β = 0.233, P &lt; 0.001), acute pancreatitis (β = 0.132, P &lt; 0.05), and diabetes self-management (β = -0.376, P &lt; 0.001). Our findings from the final Model 3 analysis revealed a statistically significant positive association between cardiovascular disease (CVD) and HRQOL (standardized β = 0.233, P &lt; 0.001). This indicates that individuals with CVD reported lower HRQOL compared to those without the condition. Similarly, a significant positive association emerged between acute pancreatitis (AP) and HRQOL (standardized β = 0.132, P &lt; 0.05), suggesting a negative impact of this acute illness on HRQOL. Conversely, diabetes self-management demonstrated a significant negative association with HRQOL (standardized β = -0.376, P &lt; 0.001). This implies that better self-management practices among diabetic patients were linked to improved HRQOL. These findings highlight the crucial role of understanding patient perspectives on self-management. Healthcare providers and researchers should prioritize investigating these perspectives to develop and implement interventions that deliver effective diabetes self-management education. Such targeted interventions have the potential to significantly enhance the HRQOL of patients living with diabetes.

Depressive symptoms, functional impairment, and health-related quality of life in idiopathic normal pressure hydrocephalus: A population-based study.

Maximising quality of life is a central goal for all healthcare, especially when dealing with dementing disorders. In this study we aimed to compare health-related quality of life (HRQoL), depressive symptoms and functional impairment between individuals with and without idiopathic normal pressure hydrocephalus (iNPH) from the general population. A total of 122 individuals, 30 with iNPH (median age 75 years, 67 females) underwent neurological examinations and computed tomography of the brain with standardised rating of imaging findings and clinical symptoms. The participants completed the Geriatric Depression Scale (GDS-15) and the HRQoL instrument EQ5D-5L. In addition, the modified Rankin Scale (mRS) was used to evaluate functional impairment. Compared with participants without iNPH, those with iNPH reported a higher score on GDS-15 (median 3 vs 1) and mRS (median 2 vs 1) (p < 0.05). Further, those with iNPH rated lower on EQ5D-5L (index 0.79, VAS 70) than those without iNPH (index 0.86, VAS 80) (p < 0.05). In logistic regression models, low HRQoL was associated with more depressive symptoms, a higher degree of iNPH symptoms, and lower functional status. In this population-based sample, those with iNPH had more depressive symptoms, lower functional status, and worse quality of life compared to those without iNPH. The strongest association with low HRQoL was found for depressive symptoms, functional level, and degree of iNPH symptoms. These results underline the value of shunt surgery because of its potential to reduce symptoms and disability in iNPH and therefore improve HRQoL.

Psychometric validation of the Chinese versions of EQ-5D-Y-3L and the experimental EQ-TIPS in children and adolescents with COVID-19.

Respiratory infectious diseases like COVID-19 profoundly impacts the health of children and adolescents, but validated instruments to measure their impacts on health-related quality of life (HRQoL) are lacking. The EQ-5D-Y-3L, widely used for youth HRQoL, now features a Chinese value set. The experimental EQ-TIPS addresses HRQoL assessment for toddlers and infants. This study tested the psychometric properties of both instruments in paediatric COVID-19 patients, and compared the performance of self-complete and proxy EQ-5D-Y-3L. This longitudinal study recruited 861 COVID-19 patients aged 0-18 years and their parental caregivers, with 311 dyads completing the follow-up. Digital administration included the EQ-TIPS, the EQ-5D-Y-3L, and Overall Health Assessment (OHA). Controls comprised 231 healthy children. Analysis encompassed known-group validity, child-parent agreement, and responsiveness to change in disease severity and OHA. COVID-19 children exhibited lower HRQoL than non-infected peers. The EQ-TIPS and the EQ-5D-Y-3L distinguished groups by disease presence, severity and symptoms, showing moderate to good known-group validity (ESs: 0.45-1.39 for EQ-TIPS, 0.44-1.91 for self-complete EQ-5D-Y-3L, and 0.32-1.67 for proxy EQ-5D-Y-3L). Child-parent agreement was moderate to good for EQ-5D-Y-3L (ICC: 0.653-0.823; Gwet's AC1: 0.470-0.738), and responsiveness was good for both EQ-TIPS Level Sum Score (LSS) (ESs: 1.21-1.39) and EQ-5D-Y-3L index scores (ESs: 1.00-1.16). This study demonstrates the reliability, validity, and responsiveness of the experimental EQ-TIPS and the EQ-5D-Y-3L in paediatric COVID-19 patients. It is the first evidence of the EQ-TIPS' responsiveness, supporting its use in assessing the impact of COVID-19 on paediatric HRQoL.

Health utility attributable to oral conditions in Japanese adults.

Utility values enable relative comparisons across various health conditions, providing information for efficient allocation of healthcare resources. This study aimed to (1) quantify the utility values attributable to oral health-related quality of life (OHRQoL) in Japanese adults and (2) develop models for converting the 14-item Oral Health Impact Profile (OHIP-14) scores into EuroQoL 5-dimension 5-level (EQ-5D-5L)-based utility values. This was a cross-sectional study. Data from a large-scale Internet survey of Japanese adults conducted in 2022 (n = 28 405; mean age 48.2 years) were analysed. Multiple linear regression models were fitted to investigate the association between OHIP-14 scores and EQ-5D-5L-based utility values, adjusting for confounders. Conversion models were developed using a random half of the participants, and the observed and predicted utility values in the other half were compared to evaluate the model performance. Among the participants, 55.2% scored 0, 20.9% scored 1-5 and 23.9% scored 6-56 on the OHIP-14, corresponding mean utility values of 0.93, 0.90 and 0.84, respectively. A one-point increase in the OHIP-14 score was associated with a lower utility value (coefficient: -0.0053; 95% confidence interval:health-related quality of life -0.0056, -0.0051). The estimated utility value attributable to OHIP-14 was -23.3 per 1000 individuals, greater than that for other prevalent chronic conditions, including hypertension and diabetes (-2.9 and -7.1 per 1000 individuals, respectively). The conversion model incorporated the OHIP-14 total score, age, sex and self-rated health, predicted utility scores on average and captured differences according to the number of teeth lost. However, there was a discrepancy between predicted and observed utility values in the lower utility value groups. OHRQoL substantially impacted utility values at the population level. The OHIP-14 holds the potential as a valuable tool for predicting average utility values based on oral health conditions; however, the prediction performance was relatively low for individuals with a lower health-related quality of life.

Clustering of Dietary Patterns Associated with Health-Related Quality of Life in Spanish Children and Adolescents.

The aim of the current study was to examine the association between dietary patterns and health-related quality of life (HRQoL) among Spanish children and adolescents. A modified version of the parental version of 10 items of the Screening for and Promotion of Health-Related Quality of Life in Children and Adolescents-a European Public Health perspective (KIDSCREEN-10) was used to assess children's HRQoL in three areas: subjective physical, mental, and social status. To evaluate dietary habits, a food frequency questionnaire was employed. To identify different feeding patterns in the sample of children and adolescents examined, cluster analyses were carried out. In addition, a generalized linear model with a Gaussian distribution was applied to test the associations between the determined clusters and HRQoL. The lowest HRQoL was identified in participants located in the unhealthiest cluster (Cluster 1) (mean [M] = 85.2; 95% confidence interval [CI] 83.7 to 86.7). In comparison with the unhealthiest cluster (Cluster 1), a greater estimated marginal mean of HRQoL was identified for participants in the moderately healthy cluster (Cluster 1) (p = 0.020) and in the healthiest cluster (Cluster 2) (p = 0.044). Based on our findings, dietary habits based on the low consumption of bread, cereals, and dairy products (mainly), together with low intake of fruits and vegetables, are related to lower HRQoL in children and adolescents. These results underscore the importance of promoting balanced and nutrient-rich diets among young populations. Public health initiatives should focus on educating parents, caregivers, and children about the benefits of a varied diet that includes adequate portions of fruits, vegetables, whole grains, and dairy products.

Health-related quality of life and utility values among patients with anxiety and/or depression in a low-income tertiary care setting: a cross-sectional analysis.

To describe the health-related quality of life (HRQoL), estimate the associated health state utility values (HSUVs) and explore factors associated with HRQoL of patients with anxiety and/or depression in a resource-limited hospital setting. A cross-sectional survey involving 462 participants was conducted in a hospital setting. The Amharic version of the EQ-5D-5L assessed HRQoL, while the GAD-7 and PHQ-9 measured severity of anxiety and depression symptoms respectively. HSUVs were analysed based on clinical and demographic profiles; mean differences were compared using t-tests and one-way ANOVA; Scheffe's post hoc comparisons and effect sizes (Cohen's d statistic) were used to assess the magnitude of group differences. Factors associated with HRQoL were explored using regression analysis. The mean HSUV was 0.87 (SD = 0.17) and the EQ VAS was 71.4 (SD = 19.1). Patients with both anxiety and depression scored significantly lower (HSUV = 0.83 [0.16], EQ VAS = 64.4 [17.9]) compared to those with either anxiety only (HSUV = 0.88 [0.17], EQ VAS = 75.3 [17.9]) or depression only (HSUV = 0.89 [0.18], EQ VAS 74.4 [19.7]). Males had slightly higher mean scores than females, while those aged 18-35 years demonstrated the highest scores on both the EQ-5D-5L and EQ VAS. Older age (β=-0.002), higher PHQ-9 scores (β=-0.008) and comorbid hypertension (β=-0.07) associated with lower HSUVs. Lower EQ VAS scores were associated with being female (β=-4.4), having comorbid hypertension (β=-7.4) and higher PHQ-9 scores (β=-0.86), while a positive association was found with having 'more than enough' income (β = 11.8). Older age, severity or co-diagnosis of anxiety or depression and comorbid conditions were associated with lower HRQoL, highlighting the need for better interventions to improve the HRQoL of patients with anxiety and depression in Ethiopia.

The impact of physical activity and exercise interventions on symptoms for women experiencing menopause: overview of reviews

BackgroundWomen experiencing problematic menopausal symptoms report lower health-related quality of life and greater healthcare use than women without symptoms. Not all women want to or are able to take hormone replacement therapy. Strengthening the evidence for menopause symptom-management options, including physical activity, improves agency for women.AimThis overview assesses effectiveness of physical activity and exercise interventions targeting women experiencing menopause symptoms.MethodsMedline, Embase, CINAHL, Scopus, The Cochrane Database of Systematic Reviews and Social Science Citation Index were searched (June 2023) for systematic reviews of physical activity and exercise interventions targeting women experiencing menopause. Reviews were assessed using AMSTAR-2 and a best-evidence approach to synthesis without meta-analysis (SWIM) was adopted. The protocol was registered on PROSPERO (CRD42022298908).ResultsSeventeen reviews included 80 unique relevant primary studies with 8983 participants. There is evidence showing improvement of physical, urogenital, and total symptoms following yoga interventions. Evidence for vasomotor and psychological symptoms was inconclusive. Findings for aerobic exercise were inconclusive although there were some examples of beneficial effects on total and vasomotor symptoms. Evidence was very limited for other types of physical activity and impact on physical, sexual and urogenital symptoms.ConclusionThere is some evidence that yoga, and to lesser extent, aerobic exercise may be beneficial for some menopause symptoms, but there is insufficient evidence to recommend a particular form of exercise. Current reviews categorise women on menopause status; broadening this to include ethnicity, income status, employment and other factors will allow better understanding of context for successful interventions.

Adherence to the Gluten-Free Diet Role as a Mediating and Moderating of the Relationship between Food Insecurity and Health-Related Quality of Life in Adults with Celiac Disease: Cross-Sectional Study.

This cross-sectional study aimed to estimate the relationship between food insecurity (FI) and health-related quality of life (HRQoL) in patients with celiac disease (CD) and assess whether this relationship is mediated or moderated by adherence to the gluten-free diet (GFD). The results of 1162 samples of patients diagnosed with CD showed that 8.3% of individuals who have a combined score of less than 13 exhibited excellent or very good adherence to the GFD. Furthermore, moderate and fair to poor adherence to the GFD was demonstrated, respectively and 71.9% of the patients had poor HRQoL levels. A significant and moderate positive correlation between FI and GFD adherence (r = 0.489) was found, indicating that 24% of the variance in FI is shared with GFD adherence. The patients' gender, marital status, and monthly income made statistically significant contributions to the prediction (p < 0.05). Females had significantly lower HRQoL scores than males (B = -4.619, 95% CL: -6.08, -3.16) after holding all other variables constant. In conclusion, FI is mediated by GFD adherence to HRQoL. Moreover, a significant total effect relation was found between HRQoL and both FI and GFD adherence, suggesting that lowering symptoms and complications associated with CD may reduce the impact of FI on HRQoL.

Characteristics and feedback of adult survivors of childhood cancer seen in Swiss comprehensive follow-up clinics led by general internists: a prospective cohort study

ObjectivesIn our study, we aimed to characterise adult childhood cancer survivors (ACCS), assess their health issues, gauge health-related quality of life (HRQOL) and evaluate visit satisfaction.DesignProspective cohort study using data...

Symptoms of anxiety, depression, and post-traumatic stress disorder 6 weeks and 6 months after ICU: Six out of 10 survivors affected.

Mental health conditions such as depression, anxiety and post-traumatic stress disorder (PTSD) are being increasingly recognised as common adverse outcomes for critical illness survivors. These conditions can have lasting consequences on their wellbeing, ability to return to their pre-illness level of functioning and health-related quality of life. There is a paucity of South African data in terms of the psychological aspects of the post-intensive care unit (ICU) syndrome. To identify and characterise patients who suffered from significant symptoms of mental health disease and poor mental health- related quality of life after ICU admission and who may benefit from appropriate referral, further investigation and medical intervention. Critically ill patients in a multidisciplinary tertiary ICU were prospectively enrolled upon ICU discharge. Survivors were screened for anxiety, depression and post-traumatic stress syndrome at 6 weeks and 6 months after hospital discharge. The Hospital Anxiety and Depression Score (HADS) and the Impact Of Events Scale - Revised (IES-R) were used as screening tools. The mental component summary score (MCS) of the RAND short form-36 was used to determine the effect of psychological symptoms on health-related quality of life (HRQOL). The median age of the 107 ICU survivors was 42 years, and half of them were admitted for complications of COVID-19. Six out of every 10 ICU survivors experienced significant symptoms of anxiety, depression and/or PTSD at follow-up. At the 6-month study visit, 4 out of every 10 patients were experiencing significant psychological symptoms. Those affected had a significantly lower mental HRQOL when compared with those who were unaffected. More than half of those affected had co-occurrence of psychological symptoms. Significant symptoms of anxiety were common, with 5 out of every 10 participants experiencing significant symptoms at either, or both, of the study visits. More than 3 out of 10 of affected patients' symptoms only occurred after the 6-week visit. Associations for significant psychological symptoms comprised female sex, younger age, a diagnosis of trauma and frightening memories of the ICU admission. The burden of mental health disease in ICU survivors is substantial, affecting their HRQOL. Six out of 10 patients experienced symptoms of anxiety, depression and PTSD, and more than half of those affected experienced co-occurrence of the conditions. A third of those affected developed these symptoms only beyond 6 weeks after hospital discharge. A potentially modifiable association with psychological symptoms was frightening memories of the ICU stay.

Wellbeing in Children and Adolescents with Fontan Physiology

To assess health-related quality of life (HRQOL) and global quality of life (QOL) in children and adolescents with Fontan physiology and identify key predictors influencing these outcomes. Cross-sectional analysis of 73 children and adolescents enrolled in the Australia and New Zealand Fontan Registry aged 6-17years, at least 12months post-Fontan operation. Assessments included the Pediatric Quality of Life Inventory (PedsQL) for HRQOL and a developmentally-tailored visual analogue scale (0-10) for global QOL, along with validated sociodemographic, clinical, psychological, relational, and parental measures. Clinical data were provided by the Australia and New Zealand Fontan Registry. Participants (mean age: 11.5±2.6years, 62% male) reported lower overall HRQOL (P<.001), and lower scores across all HRQOL domains (all P<.0001), compared with normative data. Median global QOL score was 7.0 (IQR 5.8-8.0), with most participants (79%) rating their global QOL ≥6. Anxiety and depressive symptoms requiring clinical assessment were reported by 21% and 26% of participants, respectively. Age, sex, and perceived seriousness of congenital heart disease explained 15% of the variation in HRQOL scores, while depressive symptoms and treatment-related anxiety explained an additional 37% (final model: 52% of variance explained). For global QOL, sociodemographic and clinical factors explained 13% of the variance in scores, while depressive symptoms explained a further 25% (final model: 38% of variance explained). Parental factors were not associated with child QOL outcomes. Children and adolescents with Fontan physiology experience lower HRQOL than community-based norms, despite reporting fair overall QOL. Psychological factors predominantly influenced QOL outcomes, indicating strategies to bolster psychological health could improve QOL in this population.

An investigation of the longitudinal trajectory patterns of health-related quality of life among Australians with disabilities: explaining disability types and properties

BackgroundResearch on health-related quality of life (HRQoL) trajectory patterns for people with disabilities (PwD) is scant. Understanding the HRQoL trajectory patterns for PwDs and investigating their relationship with disability types and socioeconomic factors can have important implications for Australia’s welfare policy.MethodsWe analysed data from waves 11 to 21 of the Household, Income and Labour Dynamics in Australia (HILDA) survey of respondents aged 15 + years of the PwDs. The analytic sample consists of 3724 self-reported disabled individuals and 34,539 observations in total. The SF-6D utility score is our HRQoL measure. Group-based trajectory modelling was utilised to identify trajectory groups, and multinomial logistic regression was employed to determine the baseline factors associated with trajectory group membership.ResultsThe study identified four distinct types of HRQoL trajectories (high, moderate improving, moderate deteriorating and low HRQoL trajectories). Psychosocial disability types followed by physical disability types had a high Relative Risk Ratio (RRR) in the low group compared with high trajectory group membership of PwDs (psychosocial: 6.090, physical: 3.524). Similar, results followed for the moderate improving group albeit with lower RRR (psychosocial: 2.868, Physical: 1.820). In the moderate deteriorating group, the disability types were not significant as this group has a similar profile to high group at the baseline. Compared with males, females had a higher RRR in low and moderate versus high improving HRQoL trajectories (low: 1.532, moderate improving: 1.237). Comparing the richest class to the poorest class, socioeconomic factors (income and education) predicted significantly lower exposure for the richer class to the low and medium HRQoL trajectories groups (RRR < 1).ConclusionDifferent forms of disability, demographic and socioeconomic factors have distinct effects on the HRQoL trajectories of disabled individuals. Healthcare and economic resource efficiency might be improved with targeted government policy interventions based on disability trajectories.

Friendship matters—An interview study with adolescents with attention deficit hyperactivity disorder

Attention deficit hyperactivity disorder (ADHD) is a condition diagnosed in 5% of children and adolescents. This neurodevelopmental condition causes impaired academic, social, and occupational functioning. Adolescents with ADHD symptoms have lower health-related quality of life and children with ADHD have been described as having difficulties forming positive friendships. Therefore, the aim was to describe how 15–17-year-old adolescents with ADHD experience friendship with peers. A semi-structured interview study was conducted with twelve adolescents about their experiences of friendships. The adolescents were recruited from a Swedish psychiatry clinic. A qualitative content analysis was used. In the results, three main categories were constructed: "Bonding with Friends" underscores the importance of understanding, shared interests, and adaptability. The "One’s own role" category emphasises the dynamic interplay of self-perception and interpersonal behaviours in interaction with friends. The "How Friendship Matters" category describes the complex nature of friendships, involving both support and conflicts. The adolescents’ relationships improved with age, influenced by self-awareness, ADHD medication and support from adults. In conclusion, friendships play a crucial role in the well-being of the participants, providing vital support when navigating ADHD associated challenges. It is essential that the adolescents themselves, but also adults and healthcare providers, recognise and address their impulsivity issues and need for daily planning. We should assist adolescents in developing effective interaction strategies with friends. The study highlights the significance of friendships and peer support for the adolescents’ health and functioning.