Mean Physical Health Scores Research Articles

Analysis of factors impacting postoperative pain and quality of life in patients with mixed hemorrhoids: A retrospective study.

Hemorrhoids are among the most common and frequently encountered chronic anorectal diseases in anorectal surgery. They are venous clusters formed by congestion, expansion, and flexion of the venous plexus in the lower part of the rectum. Mixed hemorrhoids bleed easily and recurrently, and this can result in severe anemia. Hence, they may have a negative effect on the health of the patient and surgical treatment is required. Milligan-Morgan hemorrhoidectomy has been widely used since 1937 for the treatment of grade III and IV hemorrhoids. However, most patients experience different degrees of postoperative pain that may cause anxiety. To assess the factors influencing pain scores and quality of life (QoL) in patients with mixed hemorrhoids post-surgery. The clinical data of patients with mixed hemorrhoids who underwent Milligan-Morgan hemorrhoidectomy were collected retrospectively. The basic characteristics of the enrolled patients with mixed hemorrhoids were recorded, and based on the Goligher clinical grading system, the hemorrhoids were classified as grades III or IV. The endpoint of this study was the disappearance of pain in all patients. Quantitative data were presented as mean ± SD, such as age, pain score, and QoL score. Student's t-test was used to compare the groups. A total of 164 patients were enrolled. The distribution of the visual analog scale pain scores of all patients at 3, 7, 14 and 28 d after surgery showed that post-surgery pain was significantly reduced with the passage of time. Fourteen days after the operation, the pain had completely disappeared in some patients. Twenty-eight days after the surgery, none of the patients experienced any pain. Comparing the World Health Organization Quality of Life - BREF self-reporting questionnaire scores of patients between 14 and 28 d after surgery, we observed that the quality-of-life scores of the patients post-surgery had significantly improved. There were six items that were compared at 14- and 28-d post-surgery. The mean QoL score 28 d after surgery (4.79 ± 0.46) was higher than that at 14 d post-surgery (3.79 ± 0.57). The mean health condition score 28 d after surgery (4.80 ± 0.41) was also higher than that at 14 d post-surgery (4.01 ± 0.62). The mean physical health score 28 d after surgery (32.10 ± 2.96) was significantly higher than that at 14 d post-surgery (23.41 ± 2.85). The mean psychological health score 28 d after surgery (27.22 ± 1.62) was significantly higher than that at 14 d post-surgery (21.37 ± 1.70). The mean social relations score 28 d after surgery (12.21 ± 1.59) was significantly higher than that at 14 d post-surgery (6.32 ± 1.66). The mean surrounding environment score 28 d after surgery (37.13 ± 2.88) was significantly higher than that at 14 d post-surgery (28.42 ± 2.86). The differences in quality-of-life scores at day 14 and day 28 post-surgery were observed to be statistically significant (P < 0.001). Milligan-Morgan hemorrhoidectomy can significantly improve the postoperative QoL of patients. Age, sex, and the number of surgical resections were important factors influencing Milligan-Morgan hemorrhoidectomy.

Health-related quality of life and hypertension in people with HIV on long-term antiretroviral therapy in Uganda.

The presence of hypertension could reduce the health-related quality of life (HRQoL) of people with HIV (PWH). Yet, literature describing the HRQoL of PWH who have hypertension in Uganda is scarce making the design of locally adapted interventions cumbersome. In our study, we compared HRQoL scores of people with HIV with and without hypertension on long term antiretroviral therapy (ART) in Uganda. We recruited 149 PWH with hypertension and 159 PWH without hypertension in the long-term ART cohort at an urban clinic in Kampala, Uganda. Data on socio-demographics were collected using an interviewer designed questionnaire while data on the World Health Organisation clinical stage viral load and CD4 count as well as ART duration were extracted from clinic electronic database and a generic EuroQol -5D- 5L (EQ-5D- 5L) and Medical Outcome Study (MOS-HIV) questionnaire used to collect HRQoL data. Data were summarized using descriptive statistics while inferential statistics were used to determine associations between key variables and HRQoL. Mann-Whitney U tests were used to compare HRQoL between groups of interest. One hundred ninety (61.7%) participants were female. PWH who had hypertension were older (Mean ± SD: 53.7 ± 8.3 vs 49.9 ± 8.6, p value <0.001) than those without hypertension. Participants with hypertension had lower overall median health utility scores (0.71 (0.33-0.80) vs 0.80 (0.44-0.80), p value = 0.029) and mean physical health score (48.44 ± 10.17 vs 51.44 ± 9.65, p value < 0.001) as opposed to those without hypertension. Hypertension (p value = 0.023), high income status, >70,000 UGX, (p value = 0.044), disclosure of the HIV status of the participants to their partner (p value = 0.026), and current history of smoking (p value = 0.029) were associated with low HRQoL scores. Among people with HIV, those with hypertension had lower HRQoL compared to those without. This calls for inclusion of quality-of-life assessment in the management of PWH who have been diagnosed with hypertension to identify those at risk and plan early interventions.

Career Regret and Health-Related Quality of Life among Medical Students: A Nationwide Cross-Sectional Study in Jordan.

Medical students have a lower quality of life (QoL) when compared to the general population. This lower QoL is associated with multiple factors such as burnout and depressive symptoms. QoL can be reflected in the degree of career satisfaction and career regret. We aim to study the prevalence of career regret in Jordanian medical students and its association with QoL and other related factors. This national cross-sectional study consisted of an anonymous online survey distributed to medical students enrolled in all six Jordanian medical schools over a period of 6 weeks. A validated tool was used to assess QoL and students were asked a series of questions related to their career satisfaction and career regret. A total of 544 medical students completed the survey. The mean age was 21.5 ± 1.63 years (range 17-29), with 45.6% being males. The overall mean physical health score was 45.9 ± 5.17, and the overall mean mental health score (mental component summary (MCS)) was 42.04 ± 5.52. 76.3% of students have regretted studying medicine, citing stress as the main reason. There was a significant relation between the year of study and the percentage of career regret. Additionally, mean MCS was significantly lower in students who were frequently or always thinking about dropping out of medical school. The high percentage of career regret and the low mental QoL in Jordanian students are alarming findings, highlighting an underlying source of psychological distress in Jordanians. This calls for further investigations into the psychological health of medical students, as well as interventions to prevent the development of consequences that can impact both students and their future patients.

Quality of Life After Orthopedic Procedures at Buraydah Central Hospital and King Fahad Specialist Hospital in Qassim Region, Saudi Arabia.

Aim Patients' perspectives on their condition and treatment, their sense of need for healthcare, and their preferences for care and outcomes are all addressed by quality of life metrics. Therefore, it is important to all health professionals and patients involved in orthopedic surgery. This study aimed to evaluate the quality of life after orthopedic procedures and how its results could potentially be used for future improvement. Methods This is a cross-sectional study conducted among patients who underwent orthopedic procedures at Buraydah Central Hospital (BCH) and King Fahad Specialist Hospital (KFSH). A self-administered questionnaire was distributed among the patients using a paper questionnaire. The questionnaire was composed of socio-demographic data (e.g. age, gender, education, etc.) and the 36-Item Short Form Survey (SF-36) to measure patients' quality of life. Results In this study, 215 patients were able to complete the survey (male 82.3% vs female 17.7%). The most common age group was 18 to 30 years old (30.2%) and the most common surgery performed on patients was thigh surgery (19.5%) and hand surgery (13%). The overall mean physical health score after the surgery was 51.1 (SD 11.8) higher than the mental health score (mean 47.7; SD 11.2).Poor quality of life was significantly more common among patients with chronic disease while poor physical functioning and general health subdomains were more associated among patients who underwent hand surgery. Conclusion Patients suffering from chronic diseases tend to exhibit a low quality of life as compared to other patients. The quality of life after the surgery is an important indicator of patient satisfaction which may have a direct impact on the future outlook of a patient. More research is needed to determine the overall quality of life in patients who underwent a surgical procedure in our region.

Study of Insomnia in Chronic Obstructive Pulmonary Disease Patients at a Tertiary Care Centre

Background: Chronic Obstructive Pulmonary Disease (COPD) is a common, preventable and treatable disease that is characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities caused by significant exposure to noxious particles or gases. Aims and Objectives: 1. To estimate the proportion of insomnia in Chronic Obstructive Pulmonary Diseases patients, 2. To study the association of insomnia with severity of Chronic Obstructive Pulmonary Diseases among study participants and 3. Assessment of Quality of Life among study participants. Materials and Methods: This prospective observational study was conducted in Department of Respiratory Medicine in a tertiary care center and medical college. Written informed consent was taken from all the study participants and those who give consent were enrolled in the present study. Total 159 COPD patients were included in the study, after satisfying the eligibility criteria. The COPD patients were enrolled after satisfying the eligibility criteria given GSAQ Questionnaire to find the presence of insomnia, PSQI for quality of sleep and then SF-36 score questionnaire to assess Quality of Life. Study was conducted for duration of 2 years (August 2018 to December 2020). Observation and Results: The most common age group amongst study population was 51 to 60 years (42%) followed by 40 to 50 years (29%) and more than 60 years (29%). There was male predominance (54.5%) in the study population as compared to females (45.5%). The most common occupation amongst study population was farmer (28%) followed by Shopkeeper (23%) and Driver (19%) and most of the study population were obese (65.2%) followed by normal BMI (28.8%) and underweight (6.1%). Most of the study population were Grade 2 dyspnea (36%) followed by Grade 3 (34%) and Grade 4 (16%). Most of the study population were Moderate COPD (45.5%) followed by severe COPD (27.3%) and very severe (21.2%). Comorbidities like Diabetes and Hypertension was observed in 11% and 28% of study population. 29% of study population was ex smokers. 69.57% of ex smokers had more than 20 pack years while 30.43% had less than 20 pack years. The prevalence of insomnia in our study population was 43%. The prevalence of insomnia was most commonly observed in severe COPD (40%) followed by Very severe COPD (35%), Moderate COPD (19%) and mild COPD (6%) and the difference was statistically significant. Mean Physical health score and Mental health score was significantly lower in insomnia patients as compared to non insomnia patients. Mean PSQI was significantly higher in insomniac patients as compared to non insomnia patients. Conclusion: 40% of our patients with COPD experienced poor sleep quality. Presence of insomnia in patients with COPD is also associated with increased day time sleepiness and worse QOL.

Low-risk prostate cancer: evaluation of quality of life after surgical treatment and during active observation

The study objective is to improve results of treatment of patients with low-risk prostate cancer (PC).Materials and methods. In the study, comparative analysis of data from 84 patients with low-risk PC was performed: 40 patients were included in the active observation group (group 1) and 44 patients underwent radical prostatectomy (group 2). For evaluation of functional responses the following questionnaires were used: Short Form 36 Health Quality Survey (SF-36), International Index of Erectile Function (IIEF-5), International Prostate Symptom Score (IPSS), Expanded Prostate Cancer Index Composite (EPIC-26). For control of oncological results, tests for prostate-specific antigen, digital rectal examination, magnetic resonance imaging of the pelvic organs with intravenous contrast, and confirmation biopsy of the prostate were preformed.Results. Mean score for the SF-36 questionnaire in the group 1 (active observation) at the beginning of the study was 63.2 ± 11.5 for mental health (MH) and 57.1 ± 9.8 for physical health (PH), while in the group 2 MH score was 63.1± 6.8, PH score was 56.2 ± 8.6. However, 18 months later in the group 1 mean MH score increased to 68.2 ± 10.1, mean PH score to 62.4 ± 7.8; in the group 2 PH score increased insignificantly to 64.2 ± 7.4 and PH score decreased to 54.8 ± 5.4 (p &lt;0.05). IIEF-5 score in the group 1 decreased from 18.8 ± 4.2 to 18.3 ± 4.0, in the group 2 from 19.1 ± 4.3 to 16.9 ± 4.8 (p &lt;0.05). Mean IPSS score insignificantly increased in the group 1 from 9.1 ± 2.1 to 9.3 ± 2.7, while in the group 2 it decreased from 9.2 ± 2.3 to 8.4 ± 1.5 (p &lt;0.05). For the EPIC-26 questionnaire, mean score for all criteria initially was 56.1 ± 5.1 in the group 1 and 54 ± 4.4 in the group 2 (after prostatectomy), and currently it increased to 65 ± 4.6 in the group 1 and decreased to 49 ± 5.4 in the group 2.Two (5 %) patients from the group 1 underwent surgical treatment due to PC progression. One (2.5 %) patient chose surgical treatment due to cancer-related anxiety. Biochemical recurrence with an increase in prostate-specific antigen of 0.29 ± 0.09 ng/ml was observed in 3 (6,8 %) patients in the group 2.Conclusion. Strategy of active observation is the preferred method of care for patients with low-risk PC allowing to preserve high quality of life while surgical treatment should be performed only if necessary.

Does two-piece PPI provide improvement in patient-partner quality of life?

Objective: The aim of this study is to retrospectively examine patient-partner satisfaction and changes in quality of life due to two-piece penile prosthesis implantation (PPI). There is no data about partner Quality of Life (QoL) related to two-piece PPI in the literature. Material and Methods: SF 36 scale and modified Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS), which were filled before two-piece PPI and at the sixth postoperative month follow-up by male patients (n = 45) and female partners (n = 45), were evaluated. Results: We found patient-partner satisfaction rates as 80% and 86% respectively. The changes in all mean scores of SF 36 (mean total score, mean physical health score and mean mental health score) were statistically significant (p &lt; 0.01). Again, the differences between all mean scores of SF 36 according to the level of patient-partner satisfaction were statistically significant (p &lt; 0.01). Conclusions: Two-piece PPI is an important option for ED treatment. It provides significant improvement in patient-partner QoL with high treatment satisfaction.

Mental health matters: A cross-sectional study of mental health nurses' health-related quality of life and work-related stressors.

Mental health nursing is widely recognized as a stressful occupation; however, little is known about the relationship between work-related stress and health-related quality of life of mental health nurses (MHN). This study aimed to identify MHN health-related quality of life (HR-QoL) and work-related stressors; associations between stressors and HR-QoL; and predictors of HR-QoL. An online cross-sectional survey collected demographic data, work-related stressors and HR-QoL (SF-12v2) of n=498 Australian MHN. Prominent consumer/carer-related stressors were verbal (90%) and physical aggression (85%). Collegial stressors included staff conflict (71%) and bullying (55%), and colleague-perpetrated verbal (34%) and physical aggression (7%). Key organizational stressors included high workloads (74%), lack of organizational support (60%) and lack of adequate resources to perform nursing role (58%). The mean physical health score was 52.62 (SD=8.30), and mental health score was 43.59 (SD=11.34), with mental health substantially lower than national norms (mean difference=10.11). There were statistically significant negative correlations between the number of work-related stressors and HR-QoL. Younger (21-30years) and less experienced (<1-4years) MHN had substantially lower mental health. Higher mental health was predicted with<15 stressors, >4years' experience and working in the community. The poorer mental health of MHN has concerning implications for the well-being, retention and practice of the largest group in the mental health workforce. There is a critical need for organizations to enact effective policy and initiatives to reduce workplace aggression, improve staff psychological and physical safety, and strengthen well-being and resilience. New graduates are a priority group for urgent intervention.

Effect of exercise-based cardiac rehabilitation on clinical outcomes in patients with myocardial infarction in the absence of obstructive coronary artery disease (MINOCA)

BackgroundMyocardial infarction in the absence of obstructive coronary artery disease (MINOCA) is characterized by clinical evidence of myocardial infarction with nonobstructive coronary stenosis on angiography (stenosis < 50%). Studies on the effect that exercise-based cardiac rehabilitation (CR) has on outcomes in MINOCA patients are lacking. Therefore, the purpose of this study was to determine the effect of exercise-based CR on clinical outcomes in patients with MINOCA. MethodsA total of 524 participants with MINOCA were recruited in this prospective cohort study from August 2014 to October 2016 and followed for three years. We randomly divided 524 patients into an exercise-based cardiac rehabilitation group (CR+) and a control group (CR−). The CR+ group followed a home-based exercise-training program three times a week during the three years of moderate continuous training (MCT; 65%–75% of peak heart rate) on a bicycle or treadmill. ResultsAfter one year of follow-up, the Short Form 36 (SF-36) survey showed apparent improvement in the mean physical health score in the CR+ group compared with the CR− group (P < 0.01). During the three-year follow-up, all-cause mortality occurred in 60 individuals, and major adverse cardiovascular events (MACE) happened in 136 individuals. Kaplan-Meier curves indicated a significant reduction in all-cause mortality (log-rank P < 0.05) and MACE (log-rank P < 0.01) in the CR+ group. A multivariate Cox regression analysis indicated that exercise-based CR was associated with a significant reduction in all-cause mortality (hazard ratio [HR] = 0.483; 95% confidence interval [CI], 0.279–0.818; P < 0.01) and MACE (HR = 0.574; 95% CI, 0.403–0.827; P < 0.001). ConclusionsA long-term exercise-based CR program was associated with superior physical health and a significant reduction in all-cause mortality and MACE in patients with MINOCA.

A multicenter, prospective 2-year analysis of the Sidus stem-free shoulder arthroplasty system

BackgroundThe purpose of this multicenter, prospective study was to evaluate the efficacy and safety of a stemless total shoulder arthroplasty compared with a traditional stemmed control.MethodsNinety-five shoulders were selected for participation in this Food and Drug Administration investigational device exemption clinical trial and underwent stemless total shoulder arthroplasty. Subjects returned for follow-up at 6 weeks, 6 months, 12 months, and 2 years postoperatively. Outcome measures included pain; range of motion; American Shoulder and Elbow Surgeons, Western Ontario Osteoarthritis of the Shoulder, and Short Form 12 scores; and radiographic review. Baseline data were compared with 2-year follow-up data to determine the rate of composite clinical success compared with the stemmed control.ResultsAll outcome assessments demonstrated significant improvements (P ≤ .007). The mean American Shoulder and Elbow Surgeons score improved from 20 to 89 (P < .0001), and the mean shoulder pain score decreased from 8.3 ± 1.6 to 0.7 ± 1.5 (P < .0001). The mean Western Ontario Osteoarthritis of the Shoulder score decreased from 1443 ± 256 to 203 ± 267 (P < .0001). On the Short Form 12, the mean physical health score increased from 33 ± 7 to 48 ± 9 (P < .0001) and the mean mental health score increased from 50 ± 13 to 54 ± 8 (P = .007). Mean active forward elevation increased from 97° ± 27° to 143° ± 25° (P < .0001), and mean active external rotation increased from 21° ± 16° to 53° ± 18° (P < .0001). Kaplan-Meier analysis showed an implant survivorship rate of 98% at 2 years. The composite clinical success rate was 87% compared with 85% for the stemmed control.ConclusionsThis study showed that a stemless rough-blasted humeral implant with metaphyseal bone fixation provides good clinical and radiographic outcomes and survivorship at 2 years, with outcomes comparable to a traditional stemmed implant.

Adapting summary scores for the PROMIS-29 v2.0 for use among older adults with multiple chronic conditions.

The patient-reported outcomes measurement information system 29-item profile (PROMIS-29 v2.0) is a widely used health-related quality of life (HRQoL) measure. Summary scores for physical and mental HRQoL have recently been developed for the PROMIS-29 using a general population. Our purpose was to adapt these summary scores to a population of older adults with multiple chronic conditions. We collected the PROMIS-29 v2.0 for 1359 primary care patients age 65+ with at least 2 of 13 chronic conditions. PROMIS-29 has 7 domains, plus a single-item pain intensity scale. We used exploratory factor analysis (EFA), followed by confirmatory factor analysis (CFA), to examine the number of factors that best captured these eight scores. We used previous results from a recent study by Hays et al. (Qual Life Res 27:1885-1891, 2018) to standardize scoring coefficients, normed to the general population. The mean age was 80.7, and 67% of participants were age 80 or older. Our results indicated a 2-factor solution, with these factors representing physical and mental HRQoL, respectively. We call these factors the physical health score (PHS) and the mental health score (MHS). We normed these summary scores to the general US population. The mean MHS for our population of was 50.1, similar to the US population, while the mean PHS was 42.2, almost a full standard deviation below the US population. We describe the adaptation of physical and mental health summary scores of the PROMIS-29 for use with a population of older adults with multiple chronic conditions.

Effect on Quality Of Life of Patients Before and After Functional Endoscopic Sinus Surgery.

Rhinosinusitis is defined as an inflammatory process involving the mucosa of the nose and one or more of the paranasal sinuses. Rhinosinusitis is not associated with increased mortality, but may have an impact on the quality of life (QOL). Current study is aimed at investigating the role of FESS in the enhancement of QOL of the patients with rhinosinusitis. Several instruments have been designed to assess the QOL, among which Glasgow Benefit Inventory (GBI) questionnaire, has been used in this study. This cross sectional study of duration of 1year and 6months was conducted on 30 patients between the age group 18-60years in the Department of Otorhinolaryngology at Safdarjung Hospital in New Delhi. Our results showed that FESS was associated with improved QOL in patients with Chronic Sinusitis. Observations were made on the basis of the GBI questionnaire which is designed to measure outcomes of the surgical procedures in form of 4 different scores. Mean total score before surgery was (-) 65.28 ± 7.39 and after surgery was 21.22 ± 11.24. Mean general Subscale Score before surgery was (-) 60.56 ± 9.14 and after surgery was 25.28 ± 13.40. Mean Social Support Score before surgery was (-) 79.44 ± 14.31 and after surgery was 17.78 ± 16.34. Mean Physical Health score before surgery was (-) 70.00 ± 10.17 and after surgery 10.00 ± 14.25. A statistically significant improvement was observed in all the four scores before and after surgery. The present study demonstrates that radical surgery has led to improvement in the QOL of chronic rhinosinusitis.

Predicting Factors for Patient Reported Satisfaction after Transforaminal Lumbar Interbody Fusion: A Two-Year Follow-Up

Introduction Transforaminal lumbar interbody fusion (TLIF) is an effective treatment of degenerative lumbar spine conditions, to reduce pain and improve function. Understanding predictors of post-operative patient satisfaction is important for better management of patient groups at high risk of dissatisfaction. This study aims to determine the pre-operative predictors of post-operative satisfaction in TLIF surgery. Material and Methods We retrospectively reviewed prospectively collected data on patients who underwent open TLIF for degenerative scoliosis, spondylolisthesis and spinal stenosis from the database of a tertiary hospital between 2008 and 2012 with 2 years follow-up. Clinical outcome was evaluated using Oswestry Disability Index (ODI), North American Spine Society (NASS) Neurogenic Symptom Score (NSS), SF-36 (mean Physical and Mental Health scores), numerical pain rating scale (NPRS) for back and leg pain and two questions from NASS Questionnaire: ((1) Has the surgery met the patient's expectations? (2) How would the patient rate the overall results of treatment?). Paired t-test was used to compare the clinical scores pre-operation and post-operatively at 6 months and 2 years. Univariate and multivariate analyses were conducted to determine significant pre-operative predictors of patient satisfaction at 2 years. Results 217 patients underwent TLIF by a single surgeon during the 5-year period. Mean pre-operative age was 61 and BMI was 25.9. 182 and 35 patients underwent primary TLIF and revision TLIF respectively. 140, 68 and 9 patients underwent single-level, two-level and three-level TLIF respectively. Significant improvement was seen in the post-operative ODI ( p &lt; 0.001), NSS ( p &lt; 0.001), SF-36 (mean physical score; p &lt; 0.001 and mean mental health scores; p &lt; 0.001) and NPRS (back pain; p &lt; 0.001 and leg pain; p &lt; 0.001) scores at 2 years follow-up. 86.8% of patients had their expectations of surgery met and 94.7% of patients were satisfied with the results of treatment at 2 years. Possible indicators identified by univariate analysis for post-operative patient satisfaction ( p &lt; 0.2) were pre-operative scores (NPRS leg pain score, SF-36 Physical Function score, mean Physical Health score and ODI). From multivariate regression model, patients with higher pre-operative NPRS pain score (OR, 1.323; 95% CI, 1.071–1.633; p = 0.009) was more likely to be satisfied at 2 years. Conclusion TLIF surgery provided significant health-related quality of life scores and symptoms improvement in terms of SF-36, ODI, NSS and NPRS (both back pain and leg pain). However, patient reported satisfaction is multi-factorial and their post-operative satisfaction may be largely influenced by expectations of surgery being met and improvement of pain. This highlights the importance of managing patients' expectation pre-operatively as a means of improving post-operative patient satisfaction.

Proportionate universalism in practice? A quasi-experimental study (GoWell) of a UK neighbourhood renewal programme's impact on health inequalities

Recommendations to reduce health inequalities frequently emphasise improvements to socio-environmental determinants of health. Proponents of ‘proportionate universalism’ argue that such improvements should be allocated proportionally to population need. We tested whether city-wide investment in urban renewal in Glasgow (UK) was allocated to ‘need’ and whether this reduced health inequalities. We identified a longitudinal cohort (n = 1006) through data linkage across surveys conducted in 2006 and 2011 in 14 differentially disadvantaged neighbourhoods. Each neighbourhood received renewal investment during that time, allocated on the basis of housing need. We grouped neighbourhoods into those receiving ‘higher’, ‘medium’ or ‘lower’ levels of investment. We compared residents' self-reported physical and mental health between these three groups over time using the SF-12 version 2 instrument. Multiple linear regression adjusted for baseline gender, age, education, household structure, housing tenure, building type, country of birth and clustering. Areas receiving higher investment tended to be most disadvantaged in terms of baseline health, income deprivation and markers of social disadvantage. After five years, mean mental health scores improved in ‘higher investment’ areas relative to ‘lower investment’ areas (b = 4.26; 95% CI = 0.29, 8.22; P = 0.036). Similarly, mean physical health scores declined less in high investment compared to low investment areas (b = 3.86; 95% CI = 1.96, 5.76; P < 0.001). Relative improvements for medium investment (compared to lower investment) areas were not statistically significant. Findings suggest that investment in housing-led renewal was allocated according to population need and this led to modest reductions in area-based inequalities in health after five years. Study limitations include a risk of selection bias. This study demonstrates how non-health interventions can, and we believe should, be evaluated to better understand if and how health inequalities can be reduced through strategies of allocating investment in social determinants of health according to need.

Vascular chronic Q fever: quality of life.

The aim of this study was to evaluate the quality of life in patients with vascular chronic Q fever at time of diagnosis and during follow-up. Based upon the SF-36 questionnaire, the mean physical and mental health of each patient were assessed at 3-month intervals for up to 18 months. A total of 26 patients were included in the study. At time of diagnosis, the mean physical health and mental health score was 50·6 [95% confidence interval (CI) 46·7-54·4] and 44·6 (95% CI 41·6-47·5), respectively. During treatment, the mean physical health score declined significantly by 1·7 points each 3 months (P < 0·001) to 40·8 (95% CI 34·4-45·1). The mean mental health score significantly and steadily increased towards 51·2 (95% CI 46·9-54·3) during follow-up (P = 0·026). A total of 23% of patients were cured after 18 months of follow-up. In conclusion, quality of life at time of diagnosis for patients with vascular chronic Q fever is lower compared to a similar group of patients, matched for age and gender, with an aortic abdominal aneurysmal disease, and physical health decreases further after starting treatment. Considering the low percentage of cure, the current treatment of vascular chronic Q fever patients may require a separate strategy from that of endocarditis in order to increase survival.

A Pilot Study to Assess the Impact of Structured Diet and Exercise Counseling on Obesity and Quality of Life Measures in South Carolina

Purpose: Obesity is a pervasive problem in the U.S., especially in South Carolina, with 33.9% of the population overweight and 32.6% obese. Obesity is associated with a poor quality of life (QOL), as shown by the Medical Outcomes Study Short Form (SF questionnaires). Medicare and Medicaid proposed intensive counseling for all its patients with a body mass index (BMI) over 30kg/m2 in September 2011. Obesity counseling has been used as a Physician Quality Reporting System measure. This study aimed to assess whether structured counseling on healthy diet and exercise choices in patients with a body mass index (BMI) over 25kg/m2 had an impact on their QOL, understanding the benefits of healthy diet and exercise choices (DAEC) and BMI. Methods: In this prospective pilot study, 104 patients were recruited at a gastroenterology center in South Carolina. At the initial consultation, their QOL and knowledge of DAEC were assessed using the SF-12, and a structured ‘diet and exercise' questionnaire (DAEQ). Their BMI was recorded, and categorized according to the World Health Organisation International Classification of Weight According to BMI (Overweight, Obese class I, II or III). They were counseled for 40 minutes on portion sizes, healthy meal choices and the importance of regular exercise. They were shown how to measure serving sizes. Their comprehension was verified by information recall. Written guidelines were supplied, reinforcing this information. These directives were based on guidance from the American Heart Association and Centre for Nutrition Policy and Promotion. The follow-up period was two months, in which patients received two phone calls to monitor their progress, SF-12 and DAEQ scores, and BMI. Results: Obesity class I patients underwent a significant improvement in mean mental health and DAEQ scores. Obesity class II patients experienced significant improvements in mean BMI and mean physical health scores. There were significant improvements in obesity class III patients' mean BMI and mental health scores. Overweight patients demonstrated improvement in all aspects of the SF-12, DAEQ scores, and reduction in BMI. The results before and after structured counseling are summarized in the ‘Summary of Results' table.Table: Table. Summary of resultsConclusion: This study highlights the benefits of regular counseling, even within a short period, as an intervention for obesity management. With further follow-up, there is potential for greater improvement in results. While these results do not evaluate quality of care due to the outcome measures used, there is an opportunity for physicians to motivate patients in clinics to take responsibility for their own physical and mental health, and to prevent future comorbidities through regular counseling and information reinforcement.

Surgery for Outer Ear Canal Exostoses and Osteomata

To analyze the impact of surgery for ear canal exostoses and osteomata on patients' health-related quality of life because the literature suggests that surgery cannot achieve excellent symptom control in all cases and has a considerable complication rate. Retrospective data collection. Germany's largest university clinic for otorhinolaryngology and head and neck surgery. Thirty-nine patients having received surgery for ear canal exostoses and osteomata. Glasgow Benefit Inventory (GBI), a retrospective questionnaire well validated for measuring the effect of otorhinolaryngologic interventions on the health-related quality of life. None. GBI total scores and subscores. Thirty of the 39 patients returned a valid questionnaire (return rate, 76.9%). The mean total GBI score was 14.6 (p < 0.001), suggesting a benefit from the operation. In contrast to the general subscale score (mean, 21.0; p < 0.001), the mean physical health score and the mean social support score were not significantly increased. Of all patients, 83.3% had a total GBI score higher than 0, indicating a benefit from the operation. In 90% of the cases, patients were satisfied with the result of the operation, and 86.7% would again decide in favor of the operation. Most patients preoperatively experienced hearing loss, wax retention and recurrent otitis externa. Postoperatively, 70% of the patients were free of any complaints. The patients not satisfied were the only patients with negative GBI scores in the whole patient collective, and all had had complications from surgery. Surgery for ear canal exostoses and osteomata can significantly improve patients' health-related quality of life and leads to a high rate of patient satisfaction. Postoperative complications are the most important factor for a negative impact on the patient's health-related quality of life. Therefore, in the authors' opinion, only patients with symptoms should have surgery.

Health-related quality of life in adults with transfusion-independent thalassaemia intermedia compared to regularly transfused thalassaemia major: new insights

In patients with β thalassaemia intermedia (TI), the milder anaemia and transfusion independence imply better health-related quality of life (HR-QoL). However, the unbalanced pathophysiology of the disease allows for several serious clinical complications to manifest, which may have a negative impact on HR-QoL. This was a cross-sectional study on adult patients with transfusion- and iron chelation-independent TI and β thalassaemia major (TM) attending the Chronic Care Center, Hazmieh, Lebanon. A total of 80 patients agreed to participate in the study [32 TI (median age 24 yr) and 48 TM (median age 23 yr)]. The RAND SF-36 survey was used to assess HR-QoL. Data on patient demographics, clinical complications and socioeconomic status were collected. Patients with TI and TM were comparable with age and gender, but patients with TM had a significantly longer median duration with a known thalassaemia diagnosis. Patients with TI had a higher proportion of multiple complications. Socioeconomic parameters were comparable, except for patients with TI being more commonly married. The mean Total, Physical Health and Mental Health Scores were significantly lower in patients with TI compared to TM, indicating poorer HR-QoL. There was a statistically significant positive correlation between the duration with a known thalassaemia diagnosis and a higher Mental Health Score (r(s) = 0.73, P = 0.020). The mean Physical Health Score was significantly lower in patients with multiple clinical complications compared to patients with single or no complications (P = 0.012). Associations remained independently significant at multivariate analysis. Patients with transfusion-independent TI have lower HR-QoL compared to TM patients. At a comparable age, the shorter duration since diagnosis and the multiplicity of complications may explain these findings.

Cardiovascular disease and musculoskeletal disorder labels in family practice acted as markers of physical health severity

Objective Family practitioner diagnostic labels applied in consultation provide a signpost for treatment and management. Yet, it is unknown whether each label reflects the health of the respective patient group. Study Design and Setting Consultation records of 7,799 patients aged 50 years and older from six family practices were linked to a cross-sectional baseline health survey. Associations between six mutually exclusive cardiovascular disease and nine mutually exclusive musculoskeletal disorder categories, and physical health severity as measured by the Short Form-12 questionnaire were examined. Results There were 2,447 (31.4%) cardiovascular disease and 3,321 (42.6%) musculoskeletal disorder consulters. The mean physical health scores ranged from 38.38 (95% confidence interval [CI]: 37.8–39.0) for hypertension to the poorest score of health 28.98 (95% CI: 27.5–30.5) for consulters with heart failure, whereas in the musculoskeletal disorder group, scores ranged from 44.85 (95% CI: 42.2–47.5) for soft tissue disorder to 28.79 (95% CI: 26.8–30.8) for consulters with inflammatory polyarthropathy (trend P < 0.001). This trend in the association between diagnostic categories and physical health severity within both spectrums remained after adjustment for confounders. Conclusion Specific diagnostic labels for selected chronic illness indicate the severity of physical health for the corresponding consulting population.

Use of equipment and respite services and caregiver health among Australian families living with Rett syndrome

This study assessed factors that could influence equipment and respite services use among Australian families caring for a girl/woman with Rett syndrome and examined relationships between use of these resources and the health of female caregivers. Data was sourced from questionnaires completed by families ( n = 170) contributing to the Australian Rett Syndrome Database in 2004 and 2006. Regression analysis was used to assess relationships between child factors (age, mobility, clinical severity and behaviour), family factors (accessibility and socio-economic factors) and the use of equipment and respite services in 2004, and relationships between resource use in 2004 and health of female caregivers as measured by the SF-12 in 2006. In 2004, the majority (88.3%) of families used at least one piece of equipment with more equipment use associated with greater mobility restrictions. Home respite services were used by 54.9% of families and overnight respite services by 47.6% of families. Use of more home respite services was associated with severely restricted levels of mobility and mothers having a vocational or university qualification. Use of more overnight respite services was associated with increasing age of the girl/woman with Rett syndrome and mothers being employed while use of less overnight respite services was associated with increasingly difficult behaviours in the girl/woman. In 2006, female caregivers had a mean mental health score of 41.1 (95% CI 38.9–43.3) and no relationships with previous resource use were identified. The mean physical health score of female caregivers was 48.7 (95% CI 46.8–50.5) and lower scores were associated with the use of equipment and overnight respite services. Equipment was a widely used resource whereas respite services, particularly overnight services, were used less widely. Further investigation of the reasons for this and alternative support strategies is indicated.