Medical Outcomes Study Short Form Research Articles

Patient-Reported Outcomes Predict Mortality in Lupus.

Physician-assessed disease activity and damage predict mortality in systemic lupus erythematosus (SLE). Patient-reported outcomes (PROs) are known predictors of mortality in other chronic diseases, but this relationship has not been well examined in SLE. The aim of the present study was to assess whether PROs predict mortality in SLE. Data were derived from the University of California at San Francisco Lupus Outcomes Study (n = 728). PROs (Medical Outcomes Study Short Form 36 [SF-36] subscales), self-rated health, and depression (Center for Epidemiologic Studies Depression scale [CES-D]) from 2007 (baseline data [T0]) were used to predict mortality (censored 2015). Univariate Cox regression analyses were completed for each PRO as a predictor of mortality, and multivariate Cox regression with covariates for each PRO separately. Covariates were age, sex, race/ethnicity, poverty, disease duration, disease activity (Systemic Lupus Activity Questionnaire), and damage (Brief Index of Lupus Damage). The mean ± SD age of patients was 50.6 ± 12.6 years. Ninety-two percent of patients were women and 68.5% were white. There were 71 deaths (9.1%). In univariate analyses, both the SF-36 physical component subscale score and self-rated health were associated with mortality, and the SF-36 mental health subscale and CES-D scores were not associated with mortality. In multivariate analyses, lower scores of SF-36 physical function at T0 independently predicted mortality after controlling for all other covariates (hazard ratio 0.97 [95% confidence interval 0.94-0.99]; P < 0.01). Patient-reported physical function independently predicted mortality in SLE, even after accounting for demographics (including poverty) and disease (duration, activity, and damage). Because PROs are easy to assess, they may be used to triage, track, and guide early interventions for those at high risk of mortality in SLE.

Racial and ethnic disparities in neurocognitive, emotional, and quality-of-life outcomes in survivors of childhood cancer: A report from the Childhood Cancer Survivor Study.

Survivors of childhood cancer are at risk of neurocognitive impairment, emotional distress, and poor health-related quality of life (HRQOL); however, the effect of race/ethnicity is understudied. The objective of this study was to identify race/ethnicity-based disparities in neurocognitive, emotional, and HRQOL outcomes among survivors of childhood cancer. Self-reported measures of neurocognitive function, emotional distress (the Brief Symptom Inventory-18), and HRQOL (the Medical Outcomes Study Short Form-36 health survey) were compared between minority (Hispanic, n=821; non-Hispanic black [NHB], n=600) and non-Hispanic white (NHW) (n=12,287) survivors from the Childhood Cancer Survivor Study (median age, 30.9years; range, 16.0-54.1years). By using a sample of 3055 siblings, the magnitude of same-race/same-ethnicity survivor-sibling differences was compared between racial/ethnic groups, adjusting for demographic and treatment characteristics and current socioeconomic status (SES). No clear pattern of disparity in neurocognitive outcomes by race/ethnicity was observed. The magnitude of the survivor-sibling difference in the mean score for depression was greater in Hispanics than in NHWs (3.59 vs 1.09; P=.004). NHBs and Hispanics had greater survivor-sibling differences in HRQOL than NHWs for mental health (NHBs: -5.78 vs -0.69; P=.001; Hispanics: -3.87 vs -0.69; P=.03), and social function (NHBs: -7.11 vs -1.47; P<.001; Hispanics: -5.33 vs -1.47; P=.001). NHBs had greater survivor-sibling differences in physical subscale scores for HRQOL than NHWs. In general, the findings were not attenuated by current SES. Although no pattern of disparity in neurocognitive outcomes was observed, differences across many HRQOL outcomes among minorities compared with NHWs, not attenuated by current SES, were identified. This suggests that further research into environmental and sociocultural factors during and immediately after treatment is needed.

Estimating Health Utility in Patients Presenting for Spine Surgery Using Patient-reported Outcomes Measurement Information System (PROMIS) Health Domains.

Prospective cohort study. To evaluate whether Patient-Reported Outcomes Measurement Information System (PROMIS) health domains can effectively estimate health utility index values for patients presenting for spine surgery. Stable estimates of health utility are required to determine cost-effectiveness of spine surgery. There are no established methods to estimate health utility using PROMIS. We enrolled 439 patients with spine disease (mean age, 54 ± 18 yrs) presenting for surgery and assessed their health using the Medical Outcomes Study Short Form-12, version 2 (SF-12v2) and PROMIS domains. Standard health utility values were estimated from the SF-12v2. Participants were randomly assigned to derivation or validation cohort. In the derivation cohort, health utility values were estimated as a function of PROMIS domains using regression models. Model fit statistics determined the most parsimonious health utility estimation equation (HEE). In the validation cohort, values were calculated using the HEE. Estimated health utility values were correlated with SF-12v2-derived health utility values. Mean preoperative health utility was 0.492 ± 0.008 and was similar between the two cohorts. All PROMIS health domains were significantly associated with health utility except Anxiety (P = 0.830) and Sleep Disturbance (P = 0.818). The final HEE was:Health Utility (est) = 0.70742 - 0.00471 × Pain + 0.00647 × Physical function - 0.00316 × Fatigue - 0.00214 × Depression + 0.00317 × Satisfaction with Participation in Social Roles.The estimation model accounted for 74% of observed variation in health utility. In the validation sample, mean health utility was 0.5033 ± 0.1684 and estimated health utility was 0.4966 ± 0.1342 (P = 0.401). These measures were strongly correlated (rho = 0.834). Our results indicate that PROMIS provides a reasonable estimate of health utility in adults presenting for lumbar or cervical spine surgery. 1.

The Longitudinal Course of Fatigue in Antineutrophil Cytoplasmic Antibody-associated Vasculitis.

Fatigue is common and burdensome in antineutrophil cytoplasmic antibody-associated vasculitis (AAV). This study aimed to understand how fatigue changes over time following treatment initiation and to determine whether individuals with the poorest prognosis can be robustly identified. One hundred forty-nine patients with AAV and new-onset disease recruited to 2 clinical trials (RITUXVAS and MYCYC) were followed for 18 months. Fatigue was measured at baseline and 6-month intervals using the vitality domain of the Medical Outcomes Study Short Form-36 quality of life questionnaire and compared to a cohort of 470 controls. Group-based trajectory modeling (GBTM) determined trajectories of the symptom to which baseline characteristics and ongoing fatigue scores were compared. Fatigue levels at diagnosis were worse in patients than controls [median (interquartile range; IQR) 30 (10-48) vs 70 (55-80); p < 0.001], with 46% of patients reporting severe fatigue. Fatigue improved after 6 months of treatment but remained worse than in controls (p < 0.001). GBTM revealed varied trajectories of fatigue: low fatigue stable (n = 23), moderate baseline fatigue improvers (n = 29), high baseline fatigue improvers (n = 61), and stable baseline high fatigue (n = 37). Participants who followed stable high fatigue trajectories had lower vasculitis activity compared to improvers, but no other demographic or clinical variables differed. This study longitudinally measured fatigue levels in patients with AAV. Although most patients improved following treatment, an important subgroup of patients reported persistently high levels of fatigue that did not change. Few clinical or laboratory markers distinguished these patients, suggesting alternative interventions specific for fatigue are required. [clinicaltrialsregister.eu, RITUXVAS EudraCT number: 2005-003610-15; MYCYC EudraCT number: 2006-001663-33].

Quality of Life of Myasthenia Gravis Patients in Regard to Epidemiological and Clinical Characteristics of the Disease.

Myasthenia gravis (MG) affects overall quality of life (QoL). The aim of the research was to evaluate QoL in patients suffering from MG in regard to epidemiological and clinical factors of the disease. The study included 70 patients. The severity of clinical manifestation was estimated using quantitative MG score and MG composite score. Patients were classified by using Myasthenia Gravis Foundation of America Classification. The Questionnaire of Life Quality Specific for Myasthenia Gravis-15 items (MGQOL15) is developed for QoL assessment in patients suffering from MG. In addition to the MGQOL15 revised version (MGQOL15r), a 36-item health survey of the Medical Outcomes Study Short Form (SF36) questionnaire, the Hamilton scales for the assessment of anxiety (HAM-A), and depression (HAM-D) were also used. MGQOL15r scores are negatively correlated with SF36 scores and positively correlated with scores on HAM-A and HAM-D scales (P<0.001). Patients with longer disease duration and severe clinical manifestation often manifest anxiety, depression, and have poorer QoL (P<0.05). In relation to the presence of the anti-nAchR antibody, statistically significant differences were found in relation to the summed scores on scales for assessing QoL, as well as on a HAM-A scale (P<0.05). Physical workers and unemployed patients had worse scores in relation to retired and administrators/intellectual workers on all scales (P<0.001). MGQOL15r is a life quality assessment questionnaire that could be used in routine practice in patients with MG. It is much simpler for use in these patients than SF36 and provides relevant data.

Health-Related Quality of Life of Hypertension Patients: A Population-Based Cross-Sectional Study in Chongqing, China.

Purpose: Hypertension is a major risk factor for cardiovascular diseases and stroke, and it requires lifelong medication. This study aimed to investigate the factors impacting on Health-Related Quality of Life (HRQoL) among hypertensive patients in Chongqing, China, and to provide evidence-based strategies to improve their HRQoL. Methods: This cross-sectional survey was conducted in Chongqing, China. Of 600 randomly selected patients, 586 patients agreed to participate and 567 patients completed the survey. A SF-36 (Medical Outcomes Study (MOS) Short Form Health Survey questionnaire) that included eight domains: physical functioning, role limitations due to physical problems, body pain, general health, vitality, social function, role limitations due to emotional problems, and mental health was used to measure HRQoL. Linear regressions were used; each domain of HRQoL was measured in the stratification of sex. Results: Self-perceived relatively low economic burden caused by hypertension and regular physical activity had a positive impact on HRQoL (p < 0.05) for both men and women. For women, younger age was associated with higher scores of measuring physical functioning and body pain. Living with more than three family members had a positive impact on domains, including physical functioning. Emotional self-regulation had a positive association with women’s mental health. Alcohol use for men was associated with higher scores in physical and mental health measures, and emotional self-regulation showed some positive impact on general health. Conclusion: Perceived economic burden caused by hypertension was the most common factor impacting on patients’ HRQoL. Female patients were more susceptible when compared to male patients. Health intervention strategies need to be further explored and adapted to the context of improving HRQoL for patients who suffer from hypertension and other chronic non-communicable diseases.

Postoperatif tibia plato kırıklı hastalarda Tıbbi Sonuç Çalışması Kısa Form 36 (SF-36) ile konvansiyonel objektif sonuç ölçekleri arasındaki ilişki.

Objective: Patient-based outcome measures are actively utilized within the subjective health status and functional status of life. The aim of this study was to evaluate the correlation between existing Knee Society Score(KSS), Knee injury and Osteoarthritis Outcome Score (KOOS), Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and the Medical Outcomes Study Short Form-36 (SF-36) and to evaluate their correlation with each other as well as to evaluate their measurement capabilities.Materials and Methods: In the study, we have retrospectively evaluated 43 healthy knees and 43 operated knees of a total of 43 patients with Schatzker type 2 and type 3 tibial plateau fractures that were treated surgically between July 2010 and March 2016 in our clinic. Patients were evaluated weekly with SF-36 General Physical Functional Score and also with the WOMAC, KSS and KOOS scoring systems, which are scoring systems that are used to address specifically the problems with the knee joint. Result and Conclusion: The KSS Functional Score and the KOOS Daily Functional Score were found to be reliable for the functional evaluation of the knee joint. We believe that the numerical scoring system used by WOMAC Functional Scoring causes distraction and we believe that the measurement effectiveness is reduced as a result. As a result of this study, we think that we need to be very careful when selecting and using evaluation scales where the responses are first matched to numerical values.

Foot Function Index: A Promising Questionnaire for Individuals With Charcot-Marie-Tooth Disease Type 1A

ObjectiveTo evaluate in a preliminary methodologic study, the Foot Function Index (FFI), a 3-subscale (pain, disability, and activity restriction) foot disability assessment questionnaire, in patients with Charcot-Marie-Tooth disease type 1A (CMT1A). DesignMonocentric exploratory cross-sectional study with 2 identical evaluations by the same physical medicine and rehabilitation physician at 14-day intervals (test-retest) according to international guidelines for validating health-related patient-reported outcomes, the Consensus-based Standards for the Selection of Health Measurement Instruments Criteria. SettingPhysical medicine and rehabilitation and neurology departments in a French academic hospital. ParticipantsPatients with CMT1A confirmed by molecular biology (N=26). InterventionThe FFI and a health-related quality-of-life questionnaire (Medical Outcomes Study Short Form 36 [SF-36] with mental and physical composite scores) combined with quantitative walk analysis by instrumental gait analysis and evaluation of isokinetic quadriceps and hamstrings peak torque by isokinetic dynamometer. Main Outcome MeasuresFFI score and its dimensions. ResultsAcceptability was satisfactory, with less than 5% missing data and good distribution of results. Internal consistency was very satisfactory, with Cronbach α of 0.95. Reproducibility was very satisfactory, with Lin concordance coefficient 0.82. External consistency was satisfactory, with expected correlation coefficients: the FFI was significantly correlated with the SF-36 physical composite score and gait parameters (cadence) (r=-0.58 and r=-0.52; P<.005) but not with peak torque or SF-36 mental composite score. ConclusionsThis study confirms the very good metrologic properties of the FFI in patients with CMT1A. The FFI could be a promising questionnaire to assess foot-related disability in a neurologic disease. Complementary studies are still needed to confirm these promising preliminary results.

Physical Activity, Self-efficacy and Health-related Quality of Life among Adults with Visual Impairments

Purpose The purpose of this study was to examine the relations between self-efficacy for exercise, physical activity, and health-related quality of life (HRQoL) in adults with visual impairments. Materials and Methods Adults with visual impairments were invited via email through two visual impairment organizations in the United States to complete four questionnaires: (a) the international physical activity questionnaire-short form, (b) the self-efficacy to exercise behaviors scale, (c) the medical outcomes study short form health survey, and (d) a demographic questionnaire. One hundred fifty-nine participants (Mage = 44.77) provided complete surveys for analyses. Data were analyzed using three components: (a) a descriptive analysis, (b) a confirmatory factor analysis, and (c) a test of a hypothesized structural model. Results Both self-efficacy and HRQoL were tenable among this population with two item removals. Self-efficacy had a direct association (β = 0.26), and an indirect association (β = 0.17) with HRQoL which was mediated by participants’ moderate-to-vigorous physical activity (MVPA). MVPA was positively associated with psychological health (β = 0.17), but not with physical health. Conclusions The findings of this study suggest that self-efficacy can both directly and indirectly, through MVPA, influence HRQoL among adults with visual impairments. This study supports the utilization of self-efficacy based interventions to promote physical activity and thus impact HRQoL among adults with visual impairments. IMPLICATIONS FOR REHABILITATION Adults with visual impairments tend to report lower health-related quality of life than peers without visual impairments. In this study, physical activity shows promise as an effective means to improving psychological health-related quality of life for adults with visual impairments. In this study, self-efficacy directly and indirectly, through physical activity, influences health-related quality of life for adults with visual impairments. Results support the utilization of self-efficacy based physical activity interventions to enhance physical activity and health-related quality of life among adults with visual impairments.

Risque suicidaire et dépression : diagnostic en porte-à-porte auprès d’étudiants français vivant en résidence universitaire

Feeling of unease is frequently reported among French students in survey from mutual insurance institutions. However, these studies have not investigated psychological clinical issues of this feeling. The present study aimed to state about psychological distress, major depression or suicidal risk prevalence among French students. We used a diagnostic methodology based on validated tools set including MH-5 (Mental Health Inventory from Medical Outcome Study Short Form; Ware & Sherbourne, 1992), MINI-A, MINI-C (Mini International Neuropsychiatric Interview; Sheehan & Lecrubier, 1992) and BDI-II (Beck Depression Inventory; Beck, Steer, & Brown, 1996). We targeted students living in university students’ residences because of their higher risk of psychological fragility due to the distance with their families and some socio-economic difficulties. A total of 1324 students (53.55% females; Mean Age=21.1), recruited by door-to-door method, participated in structured clinical interviews. We observed that 20.99% were diagnosed with a psychological distress state, 5.1% in major depression and 5.14% were currently at-risk of suicide. The higher at-risk students were females, studying languages or humanities for the first year at university. However, only 2.7% of them used psychological health care. We discuss the benefits of our diagnostic method to avoid “false positive” cases. Our study then emphasizes the pressing need to understand why only few French students seek psychological health care and how they could be promoted.

Dissociation Between Clinical Benefit and Persistent Urate Lowering in Patients with Chronic Refractory Gout Treated with Pegloticase.

To assess clinical benefit in patients with chronic refractory gout who did not meet the protocol-defined criteria of responders to pegloticase. This analysis used results from 2 randomized controlled trials (ClinicalTrials.gov: NCT00325195, NCT01356498) to assess the clinical efficacy in responders and nonresponders to treatment (8 mg of pegloticase every 2 weeks). Serum urate was measured before each infusion and the following were recorded: assessment of gout flares, tophus reduction, patient's global assessment (PtGA), tender and swollen joints (TJC and SJC), pain using a 100-mm visual analog scale, and a variety of patient-reported outcomes [Medical Outcomes Study Short Form-36 questionnaire physical component summary score and arthritis-specific health index (ASHI) score]. The analysis included 36 persistent urate responders, 49 nonresponders, and 43 patients who received placebo. Results for both responders and nonresponders indicated significant reduction in tophi and improvements from baseline in PtGA, TJC, SJC, pain, and ASHI. No significant improvements were observed in the patients who received placebo. Chronic refractory gout patients not achieving protocol-defined persistent urate lowering still achieve significant clinical benefits with pegloticase treatment, suggesting that transient reduction in serum urate may result in sustained clinical benefit.

Association Between Comorbidities and Quality of Life in Psoriatic Arthritis: Results from a Multicentric Cross-sectional Study.

In psoriatic arthritis (PsA), comorbidities add to the burden of disease, which may lead to poorer quality of life. The purpose of this study was to evaluate the relationship between comorbidities and quality of life (QOL). Patients from a multicentric, cross-sectional study on comorbidities in PsA were included in the analysis. Data on comorbidities were collected and were subsequently used to compute the modified Rheumatic Disease Comorbidity Index (mRDCI). The Medical Outcomes Study Short Form-36 questionnaire physical (PCS) and mental component summary (MCS) scales were used to assess QOL. In total, 124 recruited patients fulfilled the ClASsification for Psoriatic ARthritis criteria (CASPAR): 62.1% were male; mean age and mean disease duration were 52.6 ± 12.6 years and 11.3 ± 9.6 years, respectively. The number of comorbid conditions was 2.0 ± 1.3, with 30.6% of the sample having currently or a history of 3 or more comorbidities. In the multivariate linear regression analysis, only anxiety remained significantly related to mental health (p < 0.0001). Anxiety alone accounted for 28.7% of the variance in MCS scores. Moreover, MCS was also significantly associated with the mRDCI score, which explained 4.9% of the variance in MCS [β = -1.56 (standard error 0.64), R2 = 0.049, p = 0.0167]. In contrast, PCS was not significantly associated either with type or number of comorbidities. In this study, the type of comorbidity appeared to have a greater effect than the number of comorbidities. Indeed, anxiety in PsA was independently associated with QOL and would thus be an important factor to take into account in daily clinical practice.

Indicators of Quality of Life and Functional Status of Patients with Arterial Hypertension and Gout

The objective: to evaluate the quality of life (QOL) and functional status of patients with arterial hypertension (AH) and gout, to determine the factors influencing the QOL in this category of patients.Materials and methods. The study included 61 patients with AH, mean age (SD) of 54,25±10,29 years, which were divided into 2 groups: group 1 (n=36, main) –patients with AH and gout, group 2 (n=25, comparison) – patients with AH. The control group included 10 patients. The QOL was evaluated using the Short Form Medical Outcomes Study (SF-36) questionnaire, the Health Assessment Questionnaire (HAQ-DI) and the 10-point Patient Global Assessment (PGA).Results. Patients with AH and gout were more likely to have lowered their physical health indicators and the role-emotional. The average value of the HAQ-DI questionnaire was significantly lower in the main group, and on the PGA scale, in the main and comparison group.Conclusion. QOL of patients with AH and gout has been reduced to a greater extent in comparison with patients without gout due to chronic pain syndrome, functional constraints, psychological problems. Factors affecting the lung in this category of patients are the clinical manifestations of AH and gout: age, number of exacerbations of AH per year, total cardiovascular risk (TCVR), total number of affected joints, severity of gout, comorbidity.

COMPARISON OF THE PREVALENCE AND DYNAMICS OF ANXIETY, DEPRESSION AND QUALITY OF LIFE IN PATIENTS WITH CHRONIC RHEUMATIC HEART DISEASE

The objective. The assessment of the severity, prevalence and five-year dynamics of anxiety and depression in those studied with rheumatic heart disease.Materials and methods. The study included 168 patients with rheumatic heart disease: mean age 58,69±0,47 years; 141 women (83,93%) and 27 men (16,07%). To assess anxiety and depression, the following scales were used: HADS (hospital anxiety and depression scale), CES-D (depression scale of the epidemiological research center), and STAI (Spielberger anxiety scale). Quality of life was assessed using total scale SF-36 (Short Form Medical Outcomes Study), KCCQ (Kansas questionnaire for patients with cardiomyopathy), and MHFLQ (Minnesota questionnaire for the quality of life of patients with CHF).Results. Initially, patients with rheumatic heart disease had mild depression and anxiety, except for the high level of state anxiety according to STAI — 48.00 ± 0.95. More pronounced depressive disorders were revealed in patients with CHF NYHA III and IV. According to CES-D — 17,58±1,27 for FC I and 23,4±0,75 for FC IV, for HADS — 7,00±0,64 for FC I and 13,6±0,78 for FC IV. Anxiety disorders, on the contrary, were less with III and IV FC CHF: 8,5±0,49 with FC I and 8,2±1,02 with FC IV in HADS. According to STAI state anxiety — 47,58±1,22 (FC I) and 42,8±1,76 (FC IV), for trait anxiety — 42,67±1,08 (FC I) and 40,4±1,85 (FC IV). For the five-year period there was no negative and positive dynamics according to the questionnaires of anxiety and depression. The only exception was the increase in anxiety according to HADS by 0.66 points. In terms of quality of life, there was a decrease in physical health according to SF-36 by 1.78, and in overall summary score according to KCCQ by 1.55 and MHFLQ by — 3.99.Conclusions. In patients with rheumatic heart disease, the severity of anxiety and depression is insignificant and does not increase during five years of observation. Indicators of depression are more pronounced in the group with CHF NYHA III and IV, and anxiety indicators in patients with CHF NYHA I and II. An increase in depression rates in subjects with rheumatic heart disease is associated with a deterioration in the quality of life. With an improvement in the quality of life values, depressive symptoms decrease, and anxiety rates increase.

Posttraumatic stress and health-related quality of life in parents of children with cardiac rhythm devices.

Studies have shown a high prevalence of post-traumatic stress disorders (PTSD) among parents of children with life-threatening diseases. However, it is yet unknown whether parents of children with cardiac rhythm device develop posttraumatic stress symptoms or even PTSD. This cross-sectional investigation is part of a comprehensive single-center study of long-term medical and psychosocial outcomes in pediatric patients with pacemaker (PM) and implantable cardioverter defibrillator (ICD). 69 patients (78%) were included in the study, with the participation of 69 mothers and 57 fathers. Parents completed the Posttraumatic Diagnostic Scale and Medical Outcomes Study Short Form-36 item questionnaire. Child's medical data was collected retrospectively from patients' hospital records. At assessment, the patients (39% females) were on average 11.2years old. The predominant device type was PM in 56 cases (81%). The mean time since device implantation was 6.3years (SD = 4.3). Full heart-disease related PTSD was diagnosed in one mother and no father, while partial heart-disease-related PTSD was diagnosed in 3 mothers (4%) and 2 fathers (4%). Parental HRQoL-especially regarding the mental health dimension-was affected in both parents. In both parents, total PTSD symptom severity scores were a significant predictor for mental health summary scores after controlling for child age at implantation, presence of other non-cardiac disease in the child, parental age, and presence of own chronic disease. Special attention should be given to parental PTSD symptoms in the clinical follow-up of PM and ICD patients as some parents might probably benefit from psychological support.

Total Knee Arthroplasty: Fitness, Heart Disease Risk, and Quality of Life.

Total knee arthroplasty (TKA) may decrease coronary heart disease (CHD) risk in patients with advanced osteoarthritis by reducing pain and allowing for a more active lifestyle. We examined cardiovascular fitness, CHD risk factors, and quality of life in patients for 1 year after TKA compared with matched controls who did not undergo surgery. A total of 14 patients, 7 surgery patients and 7 matched controls, were tested for measurements of body composition, knee range of motion, resting blood pressure, strength testing, a maximal exercise test, quality-of-life questionnaires (Medical Outcomes Study Short Form-36 and Knee Osteoarthritis Outcome Score [KOOS]), and activity monitoring, fasting blood glucose, and lipids at 0, 3, 6, and 12 months after surgery or baseline testing. Comparison between the two groups was analyzed. Twelve months after surgery, patients with TKA had significantly (p < 0.05) lower pain scores, increased fat free mass, lower resting mean arterial pressure, and improved scores on the KOOS for pain, symptoms, activities of daily living, and quality of life. Initially, total cholesterol, high-density lipoprotein cholesterol, triglycerides, and body fat percentage were reduced in the TKA group but returned to baseline at 12 months. The results of this study indicate that there are immediate and long-term improvements in pain and quality of life in patients with TKA, but physical function, exercise capacity, leg strength, and some lipid profiles may take longer than 12 months to improve. This is a level II, prospective, Therapeutic study, comparative study.

Effects of solution-focused approach combined with tinnitus therapeutic instrument on negative emotions and quality of life among sudden hearing loss patients with tinnitus

Objective To explore the effects of solution-focused approach combined with tinnitus therapeutic instrument on negative emotions and quality of life among sudden hearing loss patients with tinnitus. Methods From February 2016 to December 2018, we selected 160 sudden hearing loss patients with tinnitus in Liuzhou Worker's Hospital by purposive sampling as subjects. All of the patients were randomly divided into observation group and control group, with 80 cases in each group. The control group received routine treatment and nursing intervention. Apart from that, observation group received the intervention of solution-focused approach combined with tinnitus therapeutic instrument. The intervention effects were assessed with the Tinnitus Handicap Inventory (THI) , the Medical Outcomes Study Short Form-36 (SF-36) , Self-Rating Anxiety Scale (SAS) and self-Rating Depression Scale (SDS) . Results After intervention, the total score and dimension scores of THI, scores of SAS and SDS of observation group were lower than those of control group with statistical differences (P<0.01) . Besides, the total score and dimensional scores of SF-36 of observation group were higher than those of control group after intervention with statistical differences (P<0.01) . Conclusions Solution-focused approach combined with tinnitus therapeutic instrument helps to relieve negative emotions of patients and improve tinnitus as well as quality of life of patients. Key words: Quality of life; Hearing loss, sudden; Solution-focused approach; Tinnitus therapeutic instrument; Tinnitus; Negative emotions

Impact of Sleep and Dialysis Mode on Quality of Life in a Mexican Population.

Health-related quality of life (HR-QOL) is reduced with end-stage renal disease (ESRD) but little is known about the impact of sleep disorders, dialysis modality and demographic factors on HR-QOL of Mexican patients with ESRD. 121 adults with ESRD were enrolled from 4 dialysis units in the state of Guanajuato, Mexico, stratified by unit and dialysis modality (hemodialysis [HD], continuous ambulatory peritoneal dialysis [CAPD] and automated peritoneal dialysis [APD]). Analysis included clinical information and data from the Sleep Heart Health Study Sleep Habits Questionnaire, the Medical Outcomes Study (MOS) short form (SF-36) HR-QOL measure and Epworth Sleepiness Scale. Overall, sleep symptoms and disorders were common (e.g., 37.2% insomnia). SF-36 scores were worse versus US and Mexican norms. HD patients reported better, while CAPD patients poorer HR-QOL for Vitality. With multivariate modelling dialysis modality, sleep disorders as a group and lower income were significantly associated with poorer overall SF-36 and mental health HR-QOL. Overall and Mental Composite Summary models showed HR-QOL was significantly better for both APD and HD with small to moderate effect sizes. Cost-effectiveness analysis demonstrated an advantage for APD. Mexican ESRD patients have reduced HR-QOL, and sleep disorders may be an important driver of this finding. APD should be the preferred mode of dialysis in Mexico.

Post-traumatic stress disorder in living donors after pediatric liver transplantation: A cross-sectional investigation study.

Liver transplantation can lead to post-traumatic stress disorder (PTSD) in recipients, but the risk factors associated with PTSD in living donors are unknown. To investigate this progression in pediatric living donors, a cross-sectional investigation was carried out.All participants completed 2 questionnaires: a PTSD self-rating scale (PTSD-SS) and a validated Chinese version of the Medical Outcomes Study Short Form-36 (SF-36). Clinical and demographic data were collected from medical records and self-report questionnaires. Univariate analysis was conducted to identify statistical differences.The prevalence of full PTSD (all symptom clusters) and partial PTSD (2 out of 3 symptom clusters) was 12.1% and 31.1%, respectively. Those with an educational status of elementary school (P = .001), who were donors to their children (P = .008), who were in the first 6 months after transplant (P < .001), or were involved in transplants where the recipients had severe complications (P = .02) were more likely to have higher PTSD-SS scores than other groups. The non-PTSD group had a higher health-related quality-of-life score compared with the full and partial PTSD groups in the domains of physical function, role-physical, bodily pain, general health, vitality, social functioning, role-emotional, and mental health. In addition, the occurrence of PTSD was related to a poorer quality of life.The occurrence of PTSD was common in living donors after pediatric liver transplantation. Those with a lower educational status, who were donors to their children, were in the first 6 months after transplant, or were involved in transplants where the recipients had severe complications were most likely to experience PTSD. Post-traumatic stress symptom severity was significantly associated with a poorer quality of life after transplant.

Diffuse Idiopathic Skeletal Hyperostosis in Smokers and Restrictive Spirometry Pattern: An Analysis of the COPDGene Cohort.

Diffuse idiopathic skeletal hyperostosis (DISH) is a condition characterized by bony proliferation at sites of tendinous and ligamentous insertions in the spine. Spinal mobility is reduced in DISH and may affect movement in the thorax, potentially leading to restrictive pulmonary function. This study investigated whether DISH is associated with restrictive spirometric pattern (RSP) in former and current smokers. Participants (n = 1784) with complete postbronchodilator spirometry who did not meet spirometric criteria for chronic obstructive pulmonary disease (COPD) at time of enrollment in the COPDGene study were included in this study. Subjects were classified as RSP if they had forced expiratory volume in 1 s(FEV1) to forced vital capacity (FVC) ratio > 0.7 with an FVC < 80%. Computed tomography (CT) scans were scored for the presence of DISH in accordance with the Resnick criteria. Chest CT measures of interstitial and alveolar lung disease, clinical symptoms, health surveys, and 6-min walking distance were recorded. Uni- and multivariable analyses were performed to test the association of DISH with RSP. DISH was present in 236 subjects (13.2%). RSP was twice as common in participants with DISH (n = 90/236, 38.1%) compared to those without DISH (n = 301/1548, 19.4%; p < 0.001). In multivariable analysis, DISH was significantly associated with RSP (OR 1.78; 95% CI 1.22-2.60; p = 0.003) after adjusting for potential confounders. The RSP group with and without DISH had significantly worse spirometry, dyspnea, St. George's Respiratory Questionnaire score, BODE index (Body mass index, airflow Obstruction, Dyspnea and Exercise capacity), and Medical Outcomes Study Short Form-36 questionnaire score. In heavy smokers with an FEV1/FVC ratio > 0.70, DISH is associated with RSP after adjustment for intrinsic and extrinsic causes of restrictive lung function. (Clinical trial registration number: NCT00608764.).