Medical Outcomes Study Short-Form Health Research Articles

Associations of preloss and postloss factors with severe depressive symptoms and quality of life over the first 2 years of bereavement for family caregivers of terminally ill cancer patients.

Family caregivers carry heavy end-of-life (EOL) caregiving burdens, with their physical and psychological well-being threatened from caregiving to bereavement. However, caregiving burden has rarely been examined as a risk factor for bereavement adjustment to disentangle the wear-and-tear vs relief models of bereavement. Objective/Methods Preloss and postloss variables associated with severe depressive symptoms and quality of life (QOL) for 201 terminally ill cancer patients' caregivers over their first 2 years of bereavement were simultaneously evaluated using multivariate hierarchical linear modeling. Severe depressive symptoms (Center for Epidemiological Studies Depression Scale score > 16) and QOL (physical and mental component summaries of the Medical Outcomes Study Short-Form Health Survey) were measured 1, 3, 6, 13, 18, and 24 months postloss. Caregivers' likelihood of severe depressive symptoms and mental health-related QOL improved significantly from the second year and throughout the first 2 years of bereavement, respectively, whereas physical health-related QOL remained steady over time. Higher subjective caregiving burden and postloss concurrent greater social support and better QOL were associated with bereaved caregivers' lower likelihood of severe depressive symptoms. Bereaved caregivers' mental health-related QOL was facilitated and impeded by concurrent greater perceived social support and severe depressive symptoms, respectively. Severe depressive symptoms and mental health-related QOL improved substantially, whereas physical health-related QOL remained steady over the first 2 years of bereavement for cancer patients' caregivers. Timely referrals to adequate bereavement services should be promoted for at-risk bereaved caregivers, thus addressing their support needs and facilitating their bereavement adjustment.

Racial Comparisons of Postoperative Weight Loss and Eating-Disorder Psychopathology Among Patients Following Sleeve Gastrectomy Surgery.

Objective:To examine racial differences in post-operative eating-disorder psychopathology, psychosocial functioning, and weight loss among adults with loss-of-control (LOC) eating following sleeve gastrectomy.Methods:Participants were N=123 (n=74 Non-Hispanic White and n=49 Non-Hispanic Black) patients who underwent surgery within the previous 4-9 months and reported regular LOC-eating during the previous month. The Eating Disorder Examination Interview-Bariatric Surgery Version assessed LOC eating, eating-disorder psychopathology, and meal patterns. Participants completed self-report measures including the Beck Depression Inventory-II(BDI-II) and Medical Outcomes Study Short-Form Health Survey(SF-36).Results:Pre-surgical BMI did not differ by race, but Black patients had significantly less percent total-weight-loss and percent excess-weight-loss than White patients. Black and White patients did not differ significantly in LOC-eating frequency, onset time of post-operative LOC-eating, eating-disorder psychopathology, depressive symptoms, or physical or mental health-related quality-of-life (SF-36). White patients were significantly more likely to meet criteria for lifetime binge-eating disorder than Black patients. Black patients were significantly more likely to skip breakfast and dinner and engage in night eating than White patients.Conclusion:Our findings suggest that, among patients with LOC-eating following sleeve-gastrectomy surgery, there exist few racial differences in current eating-disorder psychopathology and psychosocial functioning although Black patients achieve less weight loss than White patients.

Effects of resistance exercise training and stretching on chronic insomnia.

Objective:The aim of this study was to assess the effects of resistance exercise and stretching on sleep, mood, and quality of life in chronic insomnia patients.Methods:Three 4-month treatments included: resistance exercise (n=10), stretching (n=10), and control (n=8). Sleep was evaluated with polysomnography, actigraphy, and questionnaires. Mood and quality of life were assessed with the Profile of Mood States (POMS) and the Medical Outcomes Study Short-Form 36-Item Health Survey (SF-36), respectively.Results:There were no significant treatment differences between resistance exercise and stretching. However, compared with the control treatment, resistance exercise and stretching led to significantly greater improvements in Insomnia Severity Index scores (-10.5±2.3, -8.1±2.0 vs. 2.3±1.8, respectively), and actigraphic measures of sleep latency (-7.1±4.6, -5.2±1.9 vs. 2.2±2.1 min), wake after sleep onset (-9.3±2.8, -7.1±3.0 vs. 3.6±4.2 min), and sleep efficiency (4.4±1.8, 5.0±0.8 vs. -2.3±2%). Pittsburgh Sleep Quality Index (PSQI) global scores (-5.3±0.8, -3.9±1.5 vs. -0.1±0.8) and sleep duration (1.2±0.3, 1.6±0.6 vs. -0.1±0.2 h) also improved following both experimental treatments compared with control. PSQI-Sleep efficiency increased after resistance exercise compared with control (19.5±3.9 vs. 2.1±4.3%). No significant differences were observed in polysomnography or quality of life measures. Tension-anxiety was lower in the stretching group than the control group.Conclusion:Moderate-intensity resistance exercise and stretching led to similar improvements in objective and subjective sleep in patients with chronic insomnia.Clinical trial registration:NCT01571115

Targeted therapy of underlying conditions improves quality of life in patients with persistent atrial fibrillation: results of the RACE 3 study

Atrial fibrillation (AF) reduces quality of life (QoL). We aim to evaluate effects of targeted therapy of underlying conditions on QoL in patients with AF and heart failure (HF). The Routine versus Aggressive risk factor driven upstream rhythm Control for prevention of Early atrial fibrillation in heart failure (RACE 3) study randomized patients with early persistent AF and HF to targeted or conventional therapy. Both groups received guideline-driven treatment. The targeted group received four additional therapies: mineralocorticoid receptor antagonists; statins; angiotensin converting enzyme inhibitors and/or receptor blockers; and cardiac rehabilitation including physical activity, dietary restrictions, and counselling. Quality of life was analysed in 230 patients at baseline and 1 year with available Medical Outcomes Study Short-Form Health Survey (SF-36), University of Toronto AF Severity Scale (AFSS) questionnaires, and European Heart Rhythm Association (EHRA) class. Improvements in SF-36 subscales were larger in the targeted group for physical functioning (Δ12 ± 19 vs. Δ6 ± 22, P = 0.007), physical role limitations (Δ32 ± 41 vs. Δ17 ± 45, P = 0.018), and general health (Δ8 ± 16 vs. Δ0 ± 17, P < 0.001). Dyspnoea at rest improved more (Δ-0.8 ± 1.3 vs. Δ-0.4 ± 1.2, P = 0.018) and EHRA class was lower at 1-year follow-up in the targeted group. Patients with AF at 1 year, improvement in physical functioning (Δ9 ± 9 vs. Δ-3 ± 16, P = 0.001), general health (Δ7 ± 16 vs. Δ-7 ± 19, P = 0.004), and social functioning (Δ6 ± 23 vs. Δ-4 ± 16, P = 0.041) were larger in the targeted group. A strategy aiming to treat underlying conditions improved QoL more compared with conventional therapy in patients with early persistent AF and HF. Its benefit was even observed in patients in AF at 1 year. Clinicaltrials.gov NCT00877643.

Validity and reliability of fatigue severity scale in stroke

ABSTRACTBackground: Fatigue is a frequent complaint after stroke and may be associated with dependence in activities of daily living, decreased quality of life, increased institutionalization and mortality. Although fatigue severity scale (FSS) is the most frequently used scale in stroke, validation studies are scarce.Objectives: This study aimed to examine the psychometric properties of FSS in subjects with stroke.Methods: A total of 46 subjects with stroke who were admitted for rehabilitation and 52 control subjects who were admitted for local musculoskeletal problems were included. A comprehensive assessment including functional independence measure, Folstein Mini-Mental State Examination, Hospital Anxiety and Depression Scale (HADS), visual analog scale for fatigue (VAS), FSS, and vitality subscale of 36-item Medical Outcomes Study Short-Form Health Survey (SF-36v) was conducted. FSS, VAS and SF-36v were repeated 7 days later.Results: FSS demonstrated excellent internal consistency in subjects with stroke (Cronbach’s alpha: 0.928). There was a moderate correlation between FSS and SF-36v (r = −0.498, p < 0.001). FSS was weakly correlated with HADS anxiety (r = 0.310, p = 0.041) and HADS depression (r = 0.334, p = 0.027). Test-retest reliability of SF-36v (ICC: 0. 746, CI: 0.518–0.866), VAS (ICC: 0.829, CI: 0.671–0.911) and FSS (ICC: 0.742, CI: 0.512–0.863, p < 0.001) was good. ICC values for individual items of FSS were good except for item 6.Conclusions: FSS is a valid and reliable scale to measure fatigue in stroke. FSS is not sensitive to differentiate fatigue in stroke from the control subjects with orthopedic problems with similar age and gender.

Comparison of Health Related Quality of Life in Transcatheter Versus Surgical Aortic Valve Replacement: A Meta-Analysis

Data on the effects of transcatheter aortic valve replacement (TAVR) compared to surgical aortic valve replacement (SAVR) on health-related quality of life (HRQOL) outcomes are limited. To assess the comparative HRQOL outcomes between TAVR and SAVR, we performed a systematic review and meta-analysis. PubMed and EMBASE databases were searched for articles that compared the HRQOL scores, Kansas City Cardiomyopathy Questionnaire (KCCQ), Medical Outcomes Study Short-Form Health Survey 12 or 36 (SF-12/36), or the EuroQoL 5 Dimension score (EQ-5D) at 30days and 1year between TAVR and SAVR. Mean difference (MD) and 95% confidence interval (CI) was calculated with inverse variance statistical method and random-effects model. A total of four studies with 4,125 patients (1268 transfemoral [TF]-TAVR, 1261 Non-TF TAVR [transsubclavian, transapical or transaortic], and 1,596 SAVR) were included in the studies. KCCQ overall summary scores and its subscales, SF-12/36, and EQ-5D were significantly higher in TF-TAVR compared to SAVR but were similar in non-TF TAVR vs. SAVR at 30 days. At 1-year follow-up, TF-TAVR and non-TF TAVR conferred similar HRQOL scores in KCCQ overall summary and subscales scores, SF-12/36, and EQ-5D compared to SAVR. Transfermoral-TAVR achieved better HRQOL at 30days but similar HRQOL at 1year compared to SAVR. Non-TF TAVR resulted in similar improvements in HRQOL at both 30days and 1year compared with SAVR.

Correlation formation in life quality, illness uncertainty, negative emotions and medical coping styles among pulmonary embolism patients

Objective To explore the correlation in life quality, illness uncertainty, negative emotions and medical coping modes among pulmonary embolism patients to construct a structural equation model in them. Methods From April 2015 to December 2016, 217 pulmonary embolism patients of Department of Pulmonary in a Class Ⅲ Grade A hospital in Tianjin were selected by convenience sampling. Patients were investigated with the 12-item Medical Outcomes Study (MOS) Short-Form Health Status Survey (SF-12) , Mishel's Uncertainty in Illness Scale (MUIS) , Hospital Anxiety and Depression Scale (HADS) , Medical Coping Modes Questionnaire (MCMQ) . The correlation analysis and structural equation model were used to explore the correlation in life quality, illness uncertainty, negative emotions and medical coping modes and to construct a structural equation model in them. Results In terms of mental health, avoidance of MCMQ had the strongest total effects (-0.95) on it; illness uncertainty had the strongest indirect effects (-0.55) on it. In terms of physical health, confrontation of MCMQ had the strongest direct effects (0.794) . Conclusions Bettering pulmonary embolism patients' illness uncertainty and medical coping modes can effectively improve their life quality. Key words: Quality of life; Pulmonary embolism; Structural equation model

Disability Outcome Measures in Phase III Clinical Trials in Multiple Sclerosis.

Accumulating neurological disability has a substantial impact on the lives of patients with multiple sclerosis (MS). As well as the established Expanded Disability Status Scale (EDSS), several other outcome measures are now available for assessing disability progression in MS. This review extends the findings of a previous analysis of relapsing-remitting MS (RRMS) trials published up to 2012, to determine whether there has been a shift in outcome measures used to assess disability in phase III clinical trials in RRMS and progressive MS. Forty relevant trials were identified (RRMS, n = 16; progressive MS, n = 18; other/mixed phenotypes, n = 6). Sustained EDSS worsening, particularly over 3 months, was included as an endpoint in almost all identified trials. Other disability-related endpoints included the Multiple Sclerosis Functional Composite z-score and scores for the physical component summary of the Multiple Sclerosis Impact Scale and Medical Outcomes Study Short-Form (36-item) Health Survey. Tests assessing manual dexterity, ambulation, vision and cognition were also employed, and in some trials, composite endpoints were used. However, there was no obvious trend in choice of disability outcome measures over time. Sustained EDSS worsening over short time periods continues to be the most widely used measure of disability progression in pivotal MS trials, despite its well-recognised limitations. A new tool set is needed for use in MS clinical trials that detects the benefit of potential treatments that slow (or reverse) progressive disability.Electronic supplementary materialThe online version of this article (10.1007/s40263-018-0530-8) contains supplementary material, which is available to authorized users.

Long-term follow-up on health-related quality of life in major depressive disorder: a 2-year European cohort study.

BackgroundMajor depressive disorder (MDD) is associated with significant impairments in health-related quality of life (HRQoL) and everyday functioning. This cohort study investigated the long-term development of HRQoL in patients with MDD and its association with patient characteristics, including depressive symptom severity and cognitive symptoms.MethodsThe Prospective Epidemiological Research on Functioning Outcomes Related to Major depressive disorder (PERFORM) study was a longitudinal cohort study conducted in 1,159 outpatients aged 18–65 years with MDD in France, Germany, Spain, Sweden, and the UK. The patients were either initiating antidepressant monotherapy or undergoing their first switch of antidepressant. HRQoL was assessed using the Medical Outcomes Study Short-Form 12-item Health Survey (SF-12) up to month 12 and the EuroQol Five Dimensions questionnaire up to month 24 (UK only). Depressive symptom severity was assessed up to month 24 by the patient-reported Patient Health Questionnaire and cognitive symptoms by the Perceived Deficit Questionnaire. Multivariate analyses were performed to identify patient characteristics associated with HRQoL.ResultsMental HRQoL was severely impaired at baseline versus normative data (mean [SD] SF-12 mental component summary [MCS], 26.5 [9.2]); mean (SD) physical component summary (PCS) total score was 45.2 (12.1). SF-12 MCS improved over 12 months of follow-up (38.7 [11.6] at month 12), while SF-12 PCS remained stable (45.3 [11.1]). At each assessment time point, there was a clear pattern of lower SF-12 MCS and PCS total score in patients experiencing greater cognitive problems. The mean EuroQol Five Dimensions questionnaire utility index score generally decreased (i.e., worsened) with increasing severity of cognitive and depressive symptoms at all time points up to 24 months. Multivariate analyses identified both depression severity and cognitive symptoms as strongly and significantly associated with poor HRQoL.ConclusionThese findings highlight the importance of recognizing and managing residual symptoms in patients with MDD, including the cognitive symptoms, to restore long-term psychosocial functioning.

Effect of parathyroidectomy and cinacalcet on quality of life in patients with end-stage renal disease-related hyperparathyroidism: a systematic review

Patients with end-stage renal disease (ESRD) have a decreased quality of life (QoL), which is attributable in part to ESRD-related hyperparathyroidism (HPT). Both cinacalcet and parathyroidectomy (PTx) are treatments for advanced HPT, but their effects on QoL are unclear. We performed a systematic review to evaluate the impact of cinacalcet and PTx on QoL. A systematic literature search was performed using PubMed and EMBASE databases to identify relevant articles. The search was based on the following keywords: 'parathyroidectomy' or 'cinacalcet', 'secondary hyperparathyroidism' or 'renal hyperparathyroidism' combined with 'quality of life' or 'SF-36' or 'symptomatology'. Only studies reporting on QoL at baseline and during follow-up were included. QoL scores were extracted from the selected manuscripts and weighted means were calculated. Due to a lack of available data on QoL improvement in patients using cinacalcet, a meta-analysis could not be performed. In all, eight articles reached our inclusion criteria. Of this, five articles reported the effect of PTx on QoL. All PTx studies were observational and non-controlled. The physical component scores of the 36-item Medical Outcomes Study Short-Form Health Survey increased significantly with a weighted mean of 35.5% (P < 0.05). Mental component scores increased with 13.7% (P < 0.05). Parathyroidectomy assessment of symptom scores improved from 561 preoperatively to 302 postoperatively (-259 points; -46.2%). Visual analogue scale scores decreased significantly for skin itching (46.6%), joint pain (30.4%) and muscle weakness (28.7%) (P < 0.05). Three studies on the effect of cinacalcet on QoL were included, including one randomized controlled trial. None of these studies showed significant improvement of physical component and mental component scores. PTx improved QoL in patients treated for ESRD-related HPT, whereas cinacalcet did not. The difference in impact between PTx and cinacalcet on QoL has not been compared directly.

Effect of outpatient nursing intervention in patients with chronic rhinosinusitis

Objective To investigate the effect of outpatient nursing intervention in patients with chronic rhinosinusitis (CRS) on the aspects of clinical efficacy, quality of life and nursing satisfaction after medical therapy. Methods The clinical efficacy according to the judgment standard for clinical effect was valued. Medical outcome study short-form 36-items health survey (SF-36) was used to assess the quality of life of the subjects. Satisfaction Questionnaire was used to evaluate the satisfaction scale of patients. Eighty subjects with CRS were randomly divided into the control group (40 cases) and the trial group (40 cases). The trial group was given nursing intervention on basis of usual nursing. In three months after treatment, the data and statistics analysis was purely descriptive by SPSS 20.0. Results Clinical efficacy: in the group, nineteen subjects were cured, fourteen subjects were improved and inefficacy occurred in seven subjects. The effective rate was 77.5% (31/40). In the trial group, twenty-six subjects were cured, twelve subjects were improved and inefficacy occurred in two subjects. The effective rate was 95.0% (38/40). There were differences in general data between the two groups (χ2=5.165, P=0.023). Quality of life: the average score of the control group was 58.10±5.04, while the average score of the trial group was 72.22±5.63, the average score of quality of life in the trial group was significantly higher than that in the control group (t=3.08, P=0.025) . Nursing satisfaction: there were significant differences in nursing satisfaction between the control group and the trial group (u=-7.048, P=0.000). Conclusions Outpatient nursing intervention can improve the effect of patients with chronic nasal sinusitis after medical therapy, improve the quality of life and improve nursing satisfaction. Key words: Quality of life; Sinusitis; Outpatient nursing intervention; Nursing satisfaction

Social participation, willingness and quality of life: A population-based study among older adults in rural areas of China.

The present study aimed to reflect the current situation of social participation in rural areas of China, willingness to participate in social activities, association between health-related quality of life and social participation, and factors related to social participation. A total of 2644 rural adults aged 60years and older were randomly selected and surveyed with a self-rating questionnaire. We used the unified definition of social participation in our study. The Medical Outcomes Study Short-Form Health Survey was used to measure health-related quality of life. The overall engagement of social activities was 26%. Those who participated in social activities were more likely to have high scores of health-related quality of life. Older men with a high educational level (OR 1.59, 95% CI 1.01-2.29) living alone or with a spouse (OR 1.51, 95% CI 1.08-2.12), high objective social support (OR 1.08, 95% CI 1.00-1.17) and high support utilization (OR 1.13, 95% CI 1.07-1.21) were inclined to engage in social participation. Older women with high individual income (OR 1.74, 95% CI 1.25-2.43), single marital status (OR 1.53, 95% CI 1.11-2.10), normal weight (OR 1.92, 95% CI 1.10-3.34), overweight (OR 2.28, 95% CI 1.24-4.19), living alone or with a spouse (OR 1.55, 95% CI 1.20-2.00), objective social support (OR 1.11, 95% CI 1.04-1.18) and subjective social support (OR 1.15, 95% CI 1.10-1.20) were more willing to engage in social participation. Engagement in social activities is relatively low in rural areas, and associations of willingness and health-related quality of life with social participation were found. Policy-makers and government workers should make appropriate types of encouragement policies around social participation for older adults in rural areas. Geriatr Gerontol Int 2017; 17: 1593-1602.

Validation of the Chinese Version of the Functional Outcomes of Sleep Questionnaire-10 in Pregnant Women.

We evaluated the psychometric properties of a Mandarin Chinese version of the Functional Outcomes of Sleep Questionnaire-10 (FOSQ-10) in pregnant women. A total of 228 first-trimester pregnant women participated in the study, which was conducted in an outpatient obstetric clinic at a medical center in Taipei, Taiwan. The Chinese version of the FOSQ-10 demonstrated satisfactory internal consistency (Cronbach alpha = .85), adequate corrected item-total correlations (from .40 to .67), and acceptable test-retest reliability over 7 days (ICC = .73). Construct validity was supported by exploratory factor analysis showing a one-factor structure with item loadings between .49 and .77. Significant associations with the Medical Outcomes Study Short-Form Health Survey 12 version 2 and Pittsburgh Sleep Quality Index supported criterion-related and convergent validity. Significant differences in the Chinese version of the FOSQ-10 total scores were found between women with clinically significant daytime sleepiness and those without, suggesting adequate discriminant validity. Ceiling effects were observed for all items, but no floor or ceiling effects were found for total scores. Findings suggest that the Chinese version of the FOSQ-10 is a valid and reliable instrument to identify important effects of sleep-related impairment in Chinese women during pregnancy. Further testing is needed in more diverse pregnant women, such as women with complicated pregnancies and those with sleep disorders. © 2016 Wiley Periodicals, Inc.

Reliability and Validity of the Medical Outcomes Study Short-Form Health Survey Version 2 (SF-12V2) Among Adults with Self-Reported Cancer using Medical Expenditure Panel Survey (2003-04)

Reliability and Validity of the Medical Outcomes Study Short-Form Health Survey Version 2 (SF-12V2) Among Adults with Self-Reported Cancer using Medical Expenditure Panel Survey (2003-04)

Establishing equivalence of a Chinese version of the stroke specific quality of life measure for stroke survivors

Introduction: The Stroke Specific Quality of Life Scale is a stroke-specific measure of health-related quality of life. However, there has been no Chinese (Hong Kong) version of the scale.Methods: A descriptive study was conducted to examine the reliability, validity and factor structure of the translated version (SSQOL-C) among stroke survivors. Participants completed SSQOL-C, and the Chinese versions of the Medical Outcomes Study Short-Form Health Survey (SF-36), Stroke Self-Efficacy Questionnaire (SSEQ-C) and Frenchay Activities Index (FAI). Thirty of these participants completed the same questionnaires after 4 weeks.Results: A total of 135 stroke survivors (mean age 58.90 ± 9.75) were recruited. SSQOL-C had good internal consistency with Cronbach’s alphas for each domain ranging from 0.63 to 0.90. Most domains had moderate to high correlations with similar dimensions of SF-36, SSEQ-C, FAI and Barthel ADL Index total scores (Spearman’s rho: 0.40–0.77, p < 0.01), suggesting acceptable convergent validity. Principal component analyses suggested an 11-factor model in contrast to the 12-factor model for the original scale with six new factors emerging and five original factors retained.Discussion: The results suggest SSQOL-C is a reliable and valid tool for measuring Chinese stroke survivors’ health-related quality of life. More studies are needed to confirm the 11-factor model of the scale.Implications for rehabilitationThe translated Chinese version of the Stroke Specific Quality of Life Scale is a reliable and valid tool for measuring Chinese stroke survivors’ health-related quality of life.An 11-factor model in contrast to the 12-factor model for the original scale with six new factors emerging and five original factors retained.

REM-related sleep-disordered breathing is associated with depressive symptoms in men but not in women.

The purposes of the present study are to determine the prevalence and demographic features of rapid eye movement (REM)-related sleep-disordered breathing (SDB) in Korean adults with newly diagnosed obstructive sleep apnea (OSA) and determine if REM-related SDB is associated with depressive symptoms and health-related quality of life (HRQoL) in OSA patients. In this cross-sectional study, we evaluated 1281 OSA adults who were consecutively recruited. REM-related SDB was defined as an overall apnea-hypopnea index (AHI) ≥5, an AHINREM <15, and AHIREM to AHINREM ratio of >2. The Epworth Sleepiness Scale (ESS), Beck Depression Inventory (BDI), and Medical Outcomes Study Short-Form Health survey (SF-36) were used to evaluate all patients. Multiple regression analyses were performed to determine the associations between REM-related SDB and clinical outcomes. The prevalence of REM-related SDB was 18% in this study. REM-related SDB was more commonly observed in patients with mild or moderate OSA (p<0.001) and women (p<0.001). The linear regression analysis showed that the presence of REM-related SDB was significantly associated with higher BDI scores, but only in men. AHIREM was positively associated with the BDI scores, but only in men with REM-related SDB. There were no differences in ESS and SF-36 scores between patients with and without REM-related SDB. Patients with REM-related SDB account for 18% of Korean OSA adults. REM-related SDB was associated with depressive symptoms, but only in men. AHIREM is positively related to the degree of depressive symptoms in men with REM-related SDB.

The Influence of Demographic and Psychosocial Factors on the Intensity of pain Among Chronic Patients Receiving Home-based Nursing Care.

Aim:To determine the influence of the demographic and the psychosocial factors on the intensity of pain manifestation among the chronic ill patients.Materials and Methods:A descriptive, cross-sectional study was carried out among 328 chronic patients under home-based nursing care in Southern State of Kerala, India, from July to August 2015. Each patient was interviewed during a scheduled home visit by a trained health professional. The translated version of the assessment tool questionnaire Medical Outcome Study-Short Form Health Survey was used for the data collection.Results:Sixty-four (19.5%) out of 328 patients reported pain as one of the primary symptoms of their disease. The percentage of the patients who were suffering from pain increases with the improvements in both the educational level and the monthly income (P = 0.002 and 0.019, respectively). The social interaction with the relatives and other community members was significantly related to pain manifestation (P = 0.013). A higher degree of social interaction was associated with lower pain intensity (P = 0.019).Conclusion:The results of this study showed that certain demographic and psychosocial factors carry a significant level of influence on the pain manifestation and its intensity among the chronic patients. Hence, improvements in education, economic status, and psychosocial support should be considered for the management of the chronic patients.

Associations between demographics and health-related quality of life for chronic non-malignant pain patients treated at a multidisciplinary pain centre: a cohort study.

To describe the associations between demographics and health-related quality of life for chronic non-malignant pain patients. A cohort study. A multidisciplinary Danish pain centre. All patients treated at the centre between 2007 and 2013. Levels of pain, anxiety and depression, and physical and mental status. The Hospital Anxiety and Depression Scale and the Medical Outcomes Study Short-Form Health Survey (SF-36) were used. A total of 1176 patients were included. The majority were women (64%), the mean age was 46.7 ± 14.4 (range 18-89), and 21% were able to work full or part time. On a Numeric Rating Scale from 0 to 10, median pain-intensity was 8 (interquartile range 7-8) and pain-discomfort 8 (interquartile range 7-9) at time of referral. More than half of the patients had symptoms of anxiety and depression. Most of the individual SF-36 domains had median scores between 0 and 40 (Scale from 0 to 100). Patients younger than 50 years of age as well as patients on sick leave/disability pension had significantly lower SF-36 scores. Level of pain, anxiety and depression decreased and SF-36-scores increased significantly after a course of treatment which in most cases consisted of both medical, physiotherapeutic and psychological treatment as well as health-oriented education. The chi-square test, Mann-Whitney U-test, the Kruskal-Wallis and Wilcoxon Signed-rank test were used for analyses. In order to improve treatment at a multidisciplinary pain centre, it may be of value to target treatments to different patient subgroups based on, amongst other things, age and employment status.

Sleep hygiene and its association with daytime sleepiness, depressive symptoms, and quality of life in patients with mild obstructive sleep apnea

PurposeTo investigate the direct and indirect associations of sleep hygiene with daytime sleepiness, depressive symptoms, and quality of life (QoL), in newly diagnosed, untreated patients with mild obstructive sleep apnea (OSA). MethodsData were collected from adults with mild OSA. The Sleep Hygiene Index (SHI), Sleep Problems Index-1 (SPI-1) of the Medical Outcomes Study-Sleep Scale, Epworth Sleepiness Scale (ESS), Beck Depression Inventory (BDI), and Medical Outcomes Study Short-Form Health survey (SF-36) were used to evaluate patients. To determine the indirect and direct associations between SHI and disease outcomes, the Sobel test and multiple linear regression analyses were used, respectively. When we evaluated the direct associations, we excluded 3 items of the original SHI which were more reflective of general health rather than sleep-specific habits and environments. ResultsIn total, 260 patients with mild OSA participated in this study. The average age, AHI, and SHI scores were 49.1years (SD 12.5), 9.3/h (SD 2.9), and 24.7 (SD 6.0), respectively. Here, ≥10% of participants indicated poor sleep hygiene behaviors on 7 of 13 items. Young age and men were associated with higher SHI scores (both p<0.01). The 13-item SHI scores were indirectly related to ESS, BDI, and SF-36 scores via SPI-1 (all p<0.05). The 10-item SHI scores were related to ESS (p=0.049) and SF-36 (p=0.001), but not to BDI, independently of SPI-1 or other confounding factors in mild OSA patients. Age, sex, AHI, and body mass index were not related to ESS, BDI, or total SF-36 scores. ConclusionsSleep hygiene is indirectly related to daytime sleepiness, depressive symptoms, QoL via sleep quality and also related to daytime sleepiness and QoL independent of sleep quality in mild OSA patients.

Deep Brain Stimulation in a Case of Mitochondrial Disease.

DBS has proven to be an effective therapy for Parkinson's disease, essential tremor, and primary dystonia. Mixed results have been reported in case series for other hyperkinetic disorders, and sparse data are available regarding secondary movement disorders. We report on the clinical effects of bilateral globus pallidus internus (GPi) DBS, a progressive mitochondrial cytopathy. A single patient with myoclonus and dystonia syndrome secondary to a mitochondrial cytopathy with history of perinatal hypoxia was identified from our University of Florida DBS database. Demographics, clinical, surgical, and DBS data were documented. At 6 months post-DBS, we observed a 32% (361 to 527) improvement on quality of life (36-item Medical Outcome Study Short-Form Health Survey; SF-36). Objective clinical scales revealed a 33% (143 to 96) improvement in the Unified Myoclonus Rating Scale (UMRS) total score. The UMRS action myoclonus subsection revealed a 29% (69 to 46) improvement. No significant changes were observed in the Burke-Fahn-Mardsen Dystonia Rating Scale (BFMDRS). After 1-year follow-up, a worsening of 59% (527 to 215) was observed in the SF-36 scale, of 19% (28.5 to 35) in the BFMDRS, and of 23% (96 to 124) in the UMRS. However, the frequency and intensity of action myoclonus scores remained lower when compared to baseline scores. Although we observed a loss of benefit in the long term for most quality-of-life and clinical outcomes, the DBS effects on action myoclonus seemed to remain stable. Longer follow-up studies are necessary to confirm our short-term and unblinded findings.