Medical Outcomes Study Short-Form Health Research Articles

Comparison of the Effects of Body Mechanics Education Methods on Pain, Disability, and Quality of Life: A Randomized Controlled Study

BackgroundEducating patients undergoing surgery for LDH is important to maintain the proper performance of body mechanics. PurposeThe study compared the effects of standard, brochure-based, and video-based education on postoperative pain, disability, and the quality of life in patients undergoing surgery for lumbar disc herniation. DesignThis was a randomized controlled study. SettingsThe study was conducted in the Department of Neurosurgery of a training and research hospital in Turkey. Participants/SubjectsSixty patients (n = 20 control, n = 20 video, n = 20 brochure) undergoing surgery for LDH who volunteered to participate. MethodsThe study was carried out between 15 January and 30 July 2017. The data were collected preoperatively and postoperatively using the Patients’ Characteristics Form, Oswestry Disability Index (ODI), Short-Form McGill Pain Questionnaire (SF-MPQ), Physical Functioning and Bodily Pain subscales of the Medical Outcomes Study Short-Form 36-Item Health Survey (SF-36) and the Survey of Patient Satisfaction with Clinical Education and Materials. ResultsAll three groups were similar in terms of socio-demographic and clinical characteristics. Preoperative scores obtained from the ODI, SF-MPQ, and the two subscales of the SF-36 were not significantly different. However, there was a statistically significant difference between the video group (81.5 ± 24.3) and the control group (67.7 ± 18.6) in terms of the Physical Functioning subscale of the SF-36 in the postoperative period (p< .05). ConclusionsPreoperative education on body mechanics increases the physical functioning of patients with LDH and facilitates the integration of information into their daily activities.

High mobility group box 1 and a network of other biomolecules influence fatigue in patients with Crohn’s disease

BackgroundFatigue is common in patients with chronic inflammatory and autoimmune diseases, often with a severe impact on the patient’s daily life. From a biological point of view, fatigue can be regarded as an element of the sickness behavior response, a coordinated set of responses induced by pathogens to enhance survival during an infection and immunological danger. The mechanisms are not fully understood but involve activation of the innate immune system, with pro-inflammatory cytokines, in particular interleukin (IL)-1β, acting on cerebral neurons. These mechanisms are also active during chronic inflammatory conditions. High mobility group box 1 (HMGB1) protein has interleukin-1 like properties and is a strong inducer of innate immune responses. Its role in generation of fatigue is not clarified. Emerging evidence indicates that also other biomolecules may influence sickness behavior. We aimed to elucidate how HMGB1 influences fatigue in patients with Crohn’s disease, and how the protein interacts with other candidate biomarkers of fatigue.MethodsIn 56 patients with newly diagnosed Crohn’s disease, fatigue was evaluated using three different fatigue instruments: the fatigue visual analog scale (fVAS), Fatigue Severity Scale (FSS), and the vitality subscale of Medical Outcomes Study Short-Form Health Survey (SF-36vs). The biochemical markers IL-1 receptor antagonist (RA), soluble IL-1 receptor type 2 (sIL-RII), heat shock protein 90 alpha (HSP90α), HMGB1, anti-fully reduced (fr)HMGB1 antibodies (abs), hemopexin (HPX), and pigment epithelium-derived factor (PEDF) were measured in plasma. Multivariable regression and principal component analyses (PCA) were applied.ResultsMultivariable regression analyses revealed significant contributions to fatigue severity for HMGB1 in the FSS model, HSP90α in the fVAS model and IL-1RA in the SF-36vs model. Depression and pain scores contributed to all three models. In PCA, two components described 53.3% of the variation. The “inflammation and cellular stress dimension” was dominated by IL-1RA, sIL-1RII, HSP90α, HPX, and PEDF scores, where the “HMGB1 dimension” was dominated by HMGB1, anti-frHMGB1 abs, and fVAS scores.ConclusionThis study supports the hypothesis that HMGB1 and a network of other biomolecules influence fatigue severity in chronic inflammatory conditions. The well-known association with depression and pain is also acknowledged.

Efficacy and Safety of Sacubitril/Valsartan Compared With ACEI/ARB on Health-Related Quality of Life in Heart Failure Patients: A Meta-Analysis.

Data on the effects of sacubitril/valsartan compared with angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB) on health-related quality of life (HRQoL) are limited. To evaluate the comparative effects between sacubitril/valsartan and ACEI/ARB on HRQoL, a systematic review and meta-analysis were performed. PubMed, EMBASE, Web of Science, and ClinicalTrials.gov were searched from inception to March 2, 2022 for randomized controlled trials that compared the HRQoL scores, including Kansas City Cardiomyopathy Questionnaire (KCCQ), Minnesota Living with Heart Failure Questionnaire (MLHFQ), or Medical Outcomes Study Short-Form Health Survey 12 or 36 (SF-12/36), between sacubitril/valsartan and ACEI/ARB. After screening, studies that met the inclusion criteria were eventually included and analyzed. A total of 8 studies with 17 390 patients (8693 patients used sacubitril/valsartan, and 8697 patients used ACEI/ARB) were included in this study. Five of these studies used KCCQ, 1 used SF-12/36, 1 used MLHFQ, and 1 used both KCCQ and SF-12/36. The KCCQ overall summary score and its subscales were significantly higher in sacubitril/valsartan compared with ACEI/ARB in heart failure patients with reduced ejection fraction, but were similar in heart failure patients with preserved ejection fraction. Sacubitril/valsartan conferred similar HRQoL scores in MLHFQ and SF-12/36 to ACEI/ARB. The most frequently reported adverse event for sacubitril/valsartan is hypotension and the risk is higher than for ACEI/ARB. Sacubitril/valsartan may have the potential to improve HRQoL in heart failure patients with reduced ejection fraction compared with ACEI/ARB. Hypotension is the most common adverse event with sacubitril/valsartan compared with ACEI/ARB. The results of this study may contribute to the rational use of sacubitril/valsartan.

Physical, social, mental and spiritual functioning of COVID-19 intensive care unit-survivors and their family members one year after intensive care unit-discharge: A prospective cohort study

ObjectiveTo describe the long-term functioning of patients who survived a COVID-19-related admission to the intensive care unit and their family members, in the physical, social, mental and spiritual domain. DesignA single-centre, prospective cohort study with a mixed-methods design. SettingThe intensive care unit of the University Medical Center Groningen in the Netherlands. Main outcome measuresTo study functioning 12 months after intensive care discharge several measurements were used, including a standardised list of physical problems, the Clinical Frailty Scale, the Medical Outcomes Study Short-Form General Health Survey, the McMaster Family Assessment Device, the Hospital Anxiety and Depression Scale, and the Spiritual Needs Questionnaire, as well as open questions and interviews with survivors and their family members. ResultsA total of 56 survivors (77%) returned the 12-month questionnaire, whose median age was 62 (inter-quartile range [IQR]: 55.0–68.0). Moreover, 67 family members (66%) returned the 12-month questionnaire, whose median age was 58 (IQR: 43–66). At least one physical problem was reported by 93% of the survivors, with 22% reporting changes in their work-status. Both survivors (84%) and their family members (85%) reported at least one spiritual need. The need to feel connected with family was the strongest. The main theme was ‘returning to normal’ in the interviews with survivors and ‘if the patient is well, I am well’ in the interviews with family members. ConclusionsOne year after discharge, both COVID-19 intensive care survivors and their family members positively evaluate their health-status. Survivors experience physical impairments, and their family members’ well-being is strongly impacted by the health of the survivor.

Metabolic Syndrome and Health-Related Quality of Life among Patients with Liver Transplantation

Background: The purpose of this study was to determine whether metabolic syndrome (MetS) and MetS management behaviors would be significantly associated with health-related quality of life (HRQOL) among patients with liver transplantation.Methods: Ninety-four patients who underwent liver transplantation were recruited at an outpatient clinic from a university hospital in Seoul. MetS was defined according to the National Cholesterol Education Program-Adult Treatment Panel III. MetS management behaviors were measured by using the Evaluation Tool of a Lifestyle Habit for MetS Modification. HRQOL was measured by using the Medical Outcomes Study Short-Form Health Survey-36 II and analyzed by categorizing physical and mental quality of life (QOL). Results: The means of physical and mental QOLs were 82.3 and 82.8 scores, respectively. MetS prevalence was 72.3% and a mean of MetS management behaviors was 97.0. MetS prevalence was not significantly associated with either physical or mental QOLs. A total score of the MetS management behaviors was significantly associated with physical (&lt;i&gt;β&lt;/i&gt;=0.42, &lt;i&gt;P&lt;/I&gt;=0.008) and mental QOLs (&lt;i&gt;β&lt;/i&gt;=0.44, &lt;i&gt;P&lt;/I&gt;=0.001). Of the MetS management behaviors, diet control and drinking &amp; smoking control were significantly associated with physical QOL (&lt;i&gt;P&lt;/I&gt;&lt;0.05 for all). Physical activity, diet control, and drinking &amp; smoking control were significantly associated with mental QOL (&lt;i&gt;P&lt;/I&gt;&lt;0.05 for all).Conclusions: MetS prevalence may not associate with HRQOL directly but MetS management behaviors may associate with HRQOL among patients with liver transplantation. Therefore, nursing strategies for promoting MetS management behaviors should be enhanced to improve their HRQOL levels in outpatient clinics and community settings.

Problematic substance use in midwives registered with the United Kingdom’s Nursing and Midwifery Council: A pragmatic mixed methods study

ObjectiveUse a pragmatic mixed methods approach to provide a rich understanding of the perceptions of Problematic Substance Use (PSU) and the influences of PSU on the mental and physical health of midwives registered with the Nursing and Midwifery Council (NMC). DesignA confidential and anonymous self-administered online survey was employed to encourage wider participation. SettingUnited Kingdom ParticipantsMidwives (n=623) registered with the NMC MeasurementsOpen text responses were invited throughout the survey. Along with the collection of brief demographic data, PSU was also measured using the Tobacco, Alcohol, Prescription Medications, and Substance Use/Misuse (TAPS) Tool whilst mental and physical health was measured via version 2 of the Medical Outcomes Study Short-Form 12-Item Health Survey. All qualitative open text responses were analysed inductively using reflexive thematic analysis. Multiple regression was used to test whether health outcomes in the sample as a whole were predicted by PSU and Mann-Whitney U tests to compare the health dimensions between participants who met the criteria for PSU and those who did not. FindingsPSU significantly predicted poorer general health, physical functioning, and mental functioning. Additionally, those who met criteria for PSU experienced significantly poorer general, mental, and physical health than those who did not. The influence of PSU was captured via 3 themes and 10 subthemes. Though the signs and symptoms of PSU identified remained broadly consistent, approaches to management did not. Many midwives were conflicted in how they might seek support without facing professional, personal and practical reprisal. Key conclusions and implications for practicePSU in midwifery populations poses professional, personal, and occupational risks. Congruence between policies and approaches to identification and management may reduce risk overall. Future interventions including educational and practitioner health programmes could also be usefully co-created with midwives, policy, and decision makers to reduce stigmatising attitudes and encourage greater awareness, compassion and help seeking to appropriate sources.

MEASUREMENT OF PATIENT-REPORTED OUTCOMES AT APPROXIMATELY ONE MONTH FOLLOWING A HOSPITAL OR ED DISCHARGE FOR COVID-19

TYPE: Abstract TOPIC: Chest Infections PURPOSE: To collect data for prolonged morbidity in COVID-19 infections using validated questionnaires. METHODS: An IRB-approved telephone survey was administered to 54 patients who were discharged from the hospital or ED for COVID-19 approximately one month earlier. PRO included the Modified Medical Research Council questionnaire (MRC, 0-4 scale), Short Fatigue Questionnaire (SFQ), Patient Health Questionnaire for Depression and Anxiety (PHQ– 4), the Cognitive Change Questionnaire (CCQ8), and the Medical Outcomes Study Short-Form General Health Survey (SF-20). Published thresholds for abnormality in these outcomes were utilized. RESULTS: Age was 50 ± 16 years; 54% were female, 81% were hospitalized while 19% were treated only in the ED. Higher dyspnea ratings (MRC >2) were present in 37%. Elevations in PRO at 32 ± 10 days were: PHQ anxiety (28%) and depression (19%), SFQ fatigue (57%), CCQ8 (19%). Mean ± SD values for the SF-20 health measures were as follows (range = 0 to 100, higher scores = greater functioning): Physical Functioning 69 ± 25, Role Functioning 53 ± 45, Social Functioning, 53 ± 41, Mental Health 71 ± 19, Health Perceptions 50 ± 30, Pain 61 ± 29. These scores were all lower (worse) compared to a cohort of Canadians (age range = 66-70) living at home (Carver et al., Age and Ageing, 1999; 28:169-174). CONCLUSIONS: Substantial abnormality in PRO remains at approximately one month after COVID-19 infection. CLINICAL IMPLICATIONS: Patients who have recovered from COVID-19 require follow-up care to address prolonged morbidity, and further analysis is needed to determine causation. DISCLOSURE: Nothing to declare. KEYWORD: COVID-19

Post-COVID-19 Condition and Health Status

Background: Observational studies of the long-term effects of COVID-19 infection generally focus on individual symptoms rather than health status. Objective: Longitudinal assessment of general health status following COVID-19 infection. Design: Observational study, with data collected from two telephone surveys at 32 ± 10 and 89 ± 25 days after discharge from the hospital or emergency department (ED) for a COVID-19 infection. Medicaid or no insurance was our marker of low socioeconomic status (SES). Acute disease severity was determined by summing 10 severity markers (yes-no) from the health encounter. Baseline comorbidity was a modified Charlson Index. Participants: 40 patients. Mean age was 54 ± 15 years, 50% were female, and 40% had low socioeconomic status. Main Measures: (1) the 20-item Medical Outcomes Study Short-Form General Health Survey (SF-20); (2) Dyspnea (modified Medical Research Council); (3) Psychological symptoms (Patient Health Questionnaire for Anxiety and Depression); (4) Cognitive function (Cognitive Change Questionnaire); (5) Fatigue (Short Fatigue Questionnaire); (6) A 10-item review of systems (ROS) questionnaire. Key Results: Percentages with abnormal symptoms at the first and second surveys were (respectively): Dyspnea (40, 33), Fatigue (53, 50), Anxiety (33, 18), Depression (20, 10), PHQ-4 Composite (25, 13), and Cognitive (18, 10). Mean scores on the SF-20 subscales, Physical Functioning, Role Functioning, Social Functioning, Health Perception, Mental Health, and Pain were numerically lower than means from a published study of elderly outpatients. With the exception of Pain, all SF-20 subscale scores improved significantly by the second survey. In multivariable analyses, dyspnea was predictive of impairment in all SF-20 subscales at the second survey. Conclusions: COVID-19 infection causes persistent abnormality across multiple patient-reported outcome areas, including health status. The persistence of impairment in each health status component is influenced by baseline dyspnea.

Effect of male infertility on quality of life

Background Infertility is a condition with psychological, economic, medical implications, resulting in trauma and stress, particularly in a social setup, with a strong emphasis on child bearing. Objective To evaluate the effect of infertility on quality of life (QOL) and to determine what variables predict QOL in infertile men in Upper Egypt. Patients and methods This is a case–control study that included 200 married men, comprising 100 infertile men and 100 fertile men with at least one living child. Assessment of QOL was done using the 36-item Medical Outcomes Study Short-Form Health Survey. Results Compared with fertile controls, infertile men had lower scores in the following variables: role limitations owing to emotional health, energy/fatigue, emotional well-being, social functioning, and general health (P Conclusions Infertile men had lower QOL than controls, which confirms the need for psychological support for those men.

A Preliminary Investigation of Psychoneurological Symptoms in Low-Income Mothers.

Exposure to chronic stressors may contribute to the development of psychoneurological symptoms (i.e., fatigue, cognitive dysfunction, sleep disturbance, depressed mood, and pain) that can compromise maternal function. In two studies of low-income mothers, we investigated the presence of psychoneurological symptoms and explored associations between mothers' stressors and psychoneurological symptoms as well as between symptoms and function. We also considered the possible mediating role of the symptoms between stressors and function. We conducted secondary analyses of psychoneurological symptoms in two studies of low-income mothers of infants and toddlers in the United States. Study 1 sampled Latina women with limited English proficiency, whereas Study 2 was conducted with English-speaking women from diverse backgrounds. In both studies, symptoms were measured using items from the Center for Epidemiological Studies Depression Scale and the Medical Outcomes Study Short-Form Health Survey. Maternal function was measured through self-report and researcher observation. In Study 2, stressors were measured using the Everyday Stressors Index. Multiple linear regressions were used to investigate associations while controlling for relevant covariates. In both studies, mothers endorsed a wide range of psychoneurological symptoms. In Study 1, psychoneurological symptoms had significant negative associations with role function, social function, and developmental stimulation. In Study 2, psychoneurological symptoms had significant negative associations with role function, social function, and physical function. Using Aroian test for mediation, we found that psychoneurological symptoms mediated all significant relationships between stressors and maternal functions in Study 2. In two samples of low-income mothers, psychoneurological symptoms were prevalent and associated with chronic stressors and with maternal function and may mediate the association between those two factors. These findings extend prior research on depressive symptoms in mothers by investigating pain as an additional key symptom. The studies advance symptom science by highlighting psychoneurological symptoms in a heterogeneous sample without known health conditions.

The Role of Patient-reported Outcomes and Medication Adherence Assessment in Patient-focused Drug Development for Solid Organ Transplantation.

The Role of Patient-reported Outcomes and Medication Adherence Assessment in Patient-focused Drug Development for Solid Organ Transplantation.

Estimating and characterizing the burden of multimorbidity in the community: A comprehensive multistep analysis of two large nationwide representative surveys in France.

BackgroundGiven the increasing burden of chronic conditions, multimorbidity is now a priority for healthcare and public health systems worldwide. Appropriate methodological approaches for assessing the phenomenon have not yet been established, resulting in inconsistent and incomplete descriptions. We aimed to estimate and characterize the burden of multimorbidity in the adult population in France in terms of number and type of conditions, type of underlying mechanisms, and analysis of the joint effects for identifying combinations with the most deleterious interaction effects on health status.Methods and findingsWe used a multistep approach to analyze cross-sectional and longitudinal data from 2 large nationwide representative surveys: 2010/2014 waves of the Health, Health Care, and Insurance Survey (ESPS 2010–2014) and Disability Healthcare Household Survey 2008 (HSM 2008), that collected similar data on 61 chronic or recurrent conditions. Adults aged ≥25 years in either ESPS 2010 (14,875) or HSM 2008 (23,348) were considered (participation rates were 65% and 62%, respectively). Longitudinal analyses included 7,438 participants of ESPS 2010 with follow-up for mortality (97%) of whom 3,798 were reinterviewed in 2014 (52%). Mortality, activity limitation, self-reported health, difficulties in activities/instrumental activities of daily living, and Medical Outcomes Study Short-Form 12-Item Health Survey were the health status measures. Multiple regression models were used to estimate the impact of chronic or recurrent conditions and multimorbid associations (dyads, triads, and tetrads) on health status. Etiological pathways explaining associations were investigated, and joint effects and interactions between conditions on health status measures were evaluated using both additive and multiplicative scales.Forty-eight chronic or recurrent conditions had an independent impact on mortality, activity limitations, or perceived heath. Multimorbidity prevalence varied between 30% (1-year time frame) and 39% (lifetime frame), and more markedly according to sex (higher in women), age (with greatest increases in middle-aged), and socioeconomic status (higher in less educated and low-income individuals and manual workers). We identified various multimorbid combinations, mostly involving vasculometabolic and musculoskeletal conditions and mental disorders, which could be explained by direct causation, shared or associated risk factors, or less frequently, confounding or chance. Combinations with the highest health impacts included diseases with complications but also associations of conditions affecting systems involved in locomotion and sensorial functions (impact on activity limitations), and associations including mental disorders (impact on perceived health). The interaction effects of the associated conditions varied on a continuum from subadditive and additive (associations involving cardiometabolic conditions, low back pain, osteoporosis, injury sequelae, depression, and anxiety) to multiplicative and supermultiplicative (associations involving obesity, chronic obstructive pulmonary disease, migraine, and certain osteoarticular pathologies). Study limitations included self-reported information on chronic conditions and the insufficient power of some analyses.ConclusionsMultimorbidity assessments should move beyond simply counting conditions and take into account the variable impacts on health status, etiological pathways, and joint effects of associated conditions. In particular, the multimorbid combinations with substantial health impacts or shared risk factors deserve closer attention. Our findings also suggest that multimorbidity assessment and management may be beneficial already in midlife and probably earlier in disadvantaged groups.

Five-year outcomes from a prospective comparative effectiveness study evaluating external-beam radiotherapy with or without low-dose-rate brachytherapy boost for localized prostate cancer.

To inform patients who are in the process of selecting prostate cancer treatment, the authors compared disease-specific function after external-beam radiotherapy (EBRT) alone versus EBRT plus a low-dose-rate (LDR) brachytherapy boost (EBRT-LDR). For this prospective study, men who had localized prostate cancer in 2011 and 2012 were enrolled. Assessments at baseline, 0.5, 1, 3, and 5 years included the patient-reported Expanded Prostate Index Composite, the 36-item Medical Outcomes Study Short-Form Health Survey, and treatment-related regret. Regression models were adjusted for baseline function and for patient and treatment characteristics. The minimum clinically important difference in scores on the Expanded Prostate Index Composite 26-item instrument was from 5 to 7 for urinary irritation and from 4 to 6 for bowel function. Six-hundred ninety-five men met inclusion criteria and received either EBRT (n = 583) or EBRT-LDR (n = 112). Patients in the EBRT-LDR group were younger (median age, 66 years [interquartile range [IQR], 60-71 years] vs 69 years [IQR, 64-74 years]; P < .001), were less likely to receive pelvic radiotherapy (10% vs 18%; P = .040), and had higher baseline 36-item Medical Outcomes Study Short-Form Health Survey physical function scores (median score, 95 [IQR, 86-100] vs 90 [IQR, 70-100]; P < .001). Over a 3-year period, compared with EBRT, EBRT-LDR was associated with worse urinary irritative scores (adjusted mean difference at 3 years, -5.4; 95% CI, -9.3, -1.6) and bowel function scores (-4.1; 95% CI, -7.6, -0.5). The differences were no longer clinically meaningful at 5 years (difference in urinary irritative scores: -4.5; 95% CI, -8.4, -0.5; difference in bowel function scores: -2.1; 95% CI, -5.7, -1.4). However, men who received EBRT-LDR were more likely to report moderate or big problems with urinary function bother (adjusted odds ratio, 3.5; 95% CI, 1.5-8.2) and frequent urination (adjusted odds ratio, 2.6; 95% CI, 1.2-5.6) through 5 years. There were no differences in survival or treatment-related regret between treatment groups. Compared with EBRT alone, EBRT-LDR was associated with clinically meaningful worse urinary irritative and bowel function over 3 years after treatment and more urinary bother at 5 years. In men with prostate cancer who received external-beam radiation therapy (EBRT) with or without a brachytherapy boost (EBRT-LDR), EBRT-LDR was associated with clinically worse urinary irritation and bowel function through 3 years but resolved after 5 years. Men who received EBRT-LDR continued to report moderate-to-big problems with urinary function bother and frequent urination through 5 years. There was no difference in treatment-related regret or survival between patients who received EBRT and those who received EBRT-LDR. These intermediate-term estimates of function may facilitate counseling for men who are selecting treatment.

Physical Activity and Quality of Life in Hemodialysis Patients and Healthy Controls: A Cross-Sectional Study.

Hemodialysis (HD) patients have lower functional abilities compared to healthy people, and this is associated with lower physical activity in everyday life. This may affect their quality of life, but research on this topic is limited. Therefore, the present study aimed to determine the relationship between habitual physical activity and quality of life in HD patients and healthy controls. Ninety-three HD patients and 140 controls participated in the study. Quality of life was assessed using a 36-item medical outcomes study short-form health survey (SF-36). Human Activity Profile (HAP) was used to assess habitual physical activity. The adjusted activity score (AAS) from HAP, age, gender, fat tissue index (FTI), lean tissue index (LTI), and Davies comorbidity score were analyzed as possible predictors of the Physical Component Summary (PCS) of the SF-36. Three sequential linear models were used to model PCS. In Model 1, PCS was regressed by gender and age; in Model 2 the LTI, FTI, and Davies comorbidity scores were added. Model 3 also included AAS. After controlling for age and gender (ModelHD 1: p = 0.056), LTI, FTI, and Davies comorbidity score effects (ModelHD 2: p = 0.181), the AAS accounted for 32% of the variation in PCS of HD patients (ModelHD 3: p < 0.001). Consequently, the PCS of HD patients would increase by 0.431 points if the AAS increased by one point. However, in healthy controls, AAS had a lower impact than in the HD sample (B = 0.359 vs. 0.431), while the corresponding effects of age and gender (ModelH 1: p < 0.001), LTI, FTI, and Davies comorbidity score (ModelH 2: p < 0.001) were adjusted for. The proportion of variation in PCS attributed to AAS was 14.9% (ModelH 3: p < 0.001). The current study results showed that physical activity in everyday life as measured by the HAP questionnaire is associated to a higher degree with the quality of life of HD patients than in healthy subjects. Routine physical activity programs are therefore highly justified, and the nephrology community should play a leading role in this effort.

Quality of life in nursing home non-demented residents in Tunisia

Admission to nursing homes is often associated with a change in the way the elderly live, possibly impacting quality of life (QOL). We aimed to assess QOL in elderly without dementia living in nursing homes, and to examine the association between QOL and sociodemographic features, comorbidities, level of dependency, and depression. We carried out a cross-sectional survey involving 42 old subjects living in Manouba nursing home. The Mini-mental state examination, the Geriatric depression scale, the Activity of daily living, the Cumulative illness rating scale-geriatric, and the 36-item Medical outcomes study short-form health survey-SF36 were used to assess cognitive functions, depression, level of dependency, comorbidities and QOL, respectively. All dimensions of the physical and mental components of QOL were altered in our population, with an overall mean score of less than 66.7 for all domains. A significant correlation was found between the two physical and mental components of QOL and the level of dependency, depression scores as well as comorbidity scores. In the final model of hierarchical regression, which included demographic (age and gender), clinical (level of dependency and comorbidities), and psychosocial (depression and social support) variables, only social support was significantly associated with both QOL dimensions. Strengthening social support in institutions is strongly recommended, especially activities that promote interaction. When family members remain involved in the lives of their older relatives after institutionalization, policies such as family visits and the involvement of family members in the care provided should be strongly encouraged.

Ensemble programme for early intervention in informal caregivers of psychiatric adult patients: a protocol for a randomised controlled trial

IntroductionInformal caregivers play a major role in the support and maintenance of community patients with severe psychiatric disorders. A pilot study showed that an individualised brief intervention such as the...

The Transition From Spousal Caregiver to Widowhood: Quantitative Findings of a Mixed-Methods Study.

BACKGROUND: The number of persons diagnosed with dementia is projected to triple to 14 million by 2050. The significance of these projections is particularly relevant to older women (>65 years), who are more likely to provide dementia caregiving for a husband than vice versa. Research has identified consistent themes around the impact of caregiving during the caregiving experience, yet there is limited research exploring the ongoing impact during the transition to widowhood. Moreover, there is a paucity of research examining differences between rural and urban spousal dementia caregivers. AIMS: The aims were to compare differences between older rural and urban spousal caregivers on physical and mental health factors affecting the transition from caregiver to widow and to identify resources the women used during this transition over 12 months. METHOD: This mixed-methods longitudinal study recruited 13 urban and nine rural female spousal caregivers. Participants were interviewed three times over 12 months. The dependent variables were depression (measured using Center for Epidemiologic Studies Depression Scale), physical and mental functioning (measured using the 12-item Medical Outcomes Study–Short Form Health Survey Version 2). RESULTS: No statistically significant differences were detected between rural and urban female caregivers on the dependent variables. However, rural caregivers scored higher on depression and lower on both physical and mental functioning compared to their urban counterparts. CONCLUSIONS: The findings have clinical and research implications. Psychiatric nurses are well positioned to provide education related to dementia information deficits; implement interventions that facilitate bereavement, resilience, self-care, and identity; advocate for additional services; and conduct larger scale studies with a more diverse sample of female spousal caregivers.

Unmet needs in ankylosing spondylitis patients receiving tumour necrosis factor inhibitor therapy; results from a large multinational real-world study

BackgroundSymptoms and comorbidities of ankylosing spondylitis (AS) considerably reduce health-related quality of life (HRQoL) and ability to work. This real-world study assessed rates of tumour necrosis factor inhibitor (TNFi) use and switching, treatment failure, and associations between failing TNFi and HRQoL, work productivity and activity impairment (WPAI).MethodsAS patients and their treating physicians completed questionnaires capturing patient demographics, clinical status, TNFi treatment history, reasons for switching TNFi, HRQoL and WPAI. Current TNFi was determined as “failing” if, after ≥3 months, physician-rated disease severity had worsened, remained severe, was “unstable/deteriorating”, physicians were dissatisfied with disease control and/or did not consider treatment a “success”.ResultsThe analysis included 2866 AS patients from 18 countries. Of 2795 patients with complete treatment data, 916 (32.8%) patients had never received TNFi therapy, 1623 (58.1%) patients were receiving their 1st TNFi and 200 (7.2%) patients had ever received ≥2 TNFi (treatment switch). Primary or secondary lack of efficacy were the commonest reasons for switching, and the mean delay in switching after primary lack of efficacy was 11.1 months. 232 (15.4%) patients on TNFi were currently “failing” who, compared to those with treatment success, reported poorer HRQoL: 5-dimension EuroQoL (EQ-5D-3 L): 0.63 vs. 0.78; Medical Outcomes Study Short-Form Health Survey version 2 (SF-36v2) mental component summary (MCS): 41.8 vs. 46.3; physical component summary (PCS): 40.2 vs. 45.1; impaired work productivity: 46.4% vs. 25.0%; and activity: 44.5% vs. 29.6%; all P < 0.001.ConclusionsAmong AS patients, switching TNFi is uncommon and delayed by nearly 1 year despite primary lack of efficacy. Patients currently failing TNFi experience worse physical function, HRQoL and work productivity.

Gender difference in health issues and cognitive functions among an Egyptian normal elderly population

BackgroundAging is associated with changes in cognitive functions. However, many other factors may affect cognitive functions and this interaction needs further assessment.ObjectivesTo detect gender differences in sleep quality, nutritional status, and health-related quality of life and their impact on performance in verbal fluency tasks among apparently healthy elderly.Subjects and methodsThe study was conducted on 102 normal aged subjects, 51 males and 51 females. Subjects were divided according to age into group ≥ 60 years and group < 60 years as a control. They were subjected to clinical assessment, Medical outcome study Short-Form 36-item Health Survey, Pittsburgh sleep quality index, mini nutritional assessment and Category Verbal fluency for animals and girls’ names.ResultsAmong the older group, females had significantly poorer physical and mental health, sleep quality and nutritional status than males (p value 0.001, 0.003, 0.012, and 0.014, respectively). Older females had significantly lower performance in verbal fluency (girls’ names) compared to younger females (p value 0.013), but no significant gender difference was found among the older group. Verbal fluency tasks are correlated to the level of education in both males and females (r 0.392 and 0.42, p value 0.029 and 0.019, respectively), However, in older males, it is also correlated to sleep latency (r 0.41 and p value 0.021).ConclusionOlder females had poorer sleep quality, lower health-related quality of life and lower nutritional status. No gender difference was found in verbal fluency tasks. Although no single variable could independently affect verbal fluency, education remains the main player in the difference in performance.

Predictors of community reintegration and quality of life after hip fracture among community-dwelling older adults.

We aim to explore factors contributing to community reintegration and health-related quality of life (HRQoL) among community-dwelling older adults three months after discharge from inpatient rehabilitation following hip fracture. We performed a prospective cohort study with follow-up. Thirty-three consecutive patients (age 66-89) after surgery for hip fracture repair were recruited from an inpatient rehabilitation unit. Participants were 65+ years old, did not have dementia, and were independent in basic activities of daily living (BADL) at discharge. We examined the contribution of independent variables measuring BADL, cognition, emotional status, pain and social support to the explained variance of two main outcomes: the Reintegration to Normal Living Index (RNLI), measuring self-reported ability to participate in activities and return to life roles; and the Medical Outcomes Study Short-Form Health Survey (SF-12), assessing mental and physical aspects of HRQoL. Stepwise regression analyses revealed that: social support and pain while walking significantly explained 42.1% of variance in the RNLI; social support significantly explained 31.1% of the variance in the SF-12-physical subscale; the number of falls in the previous year, social support and executive functions assessed by the clock drawing test significantly explained 61.9% of the variance in the SF-12 mental subscale. Social support, pain while walking and the number of falls in the previous year can predict community reintegration and HRQoL among older adults three months after discharge from rehabilitation following a surgical hip fracture repair. These factors need to be addressed in rehabilitation programs.