Mental Component Score Scores Research Articles

Association of the lupus low disease activity state (LLDAS) with health-related quality of life in a multinational prospective study

BackgroundSystemic lupus erythematosus (SLE) is associated with significant impairment of health-related quality of life (HR-QoL). Recently, meeting a definition of a lupus low disease activity state (LLDAS), analogous to low disease activity in rheumatoid arthritis, was preliminarily validated as associated with protection from damage accrual. The LLDAS definition has not been previously evaluated for association with patient-reported outcomes. The objective of this study was to determine whether LLDAS is associated with better HR-QoL, and examine predictors of HR-QoL, in a large multiethnic, multinational cohort of patients with SLE.MethodsHR-QoL was measured using the Medical Outcomes Study 36-item short form health survey (SF-36v2) in a prospective study of 1422 patients. Disease status was measured using the SLE disease activity index (SLEDAI-2 K), physician global assessment (PGA) and LLDAS.ResultsSignificant differences in SF-36 domain scores were found between patients stratified by ethnic group, education level and damage score, and with the presence of active musculoskeletal or cutaneous manifestations. In multiple linear regression analysis, Asian ethnicity (p < 0.001), a higher level of education (p < 0.001), younger age (p < 0.001) and shorter disease duration (p < 0.01) remained significantly associated with better physical component scores (PCS). Musculoskeletal disease activity (p < 0.001) was negatively associated with PCS, and cutaneous activity (p = 0.04) was negatively associated with mental component scores (MCS). Patients in LLDAS had better PCS (p < 0.001) and MCS (p < 0.001) scores and significantly better scores in multiple individual SF-36 domain scores. Disease damage was associated with worse PCS (p < 0.001), but not MCS scores.ConclusionsEthnicity, education, disease damage and specific organ involvement impacts HR-QoL in SLE. Attainment of LLDAS is associated with better HR-QoL.

When global rating of change contradicts observed change: Examining appraisal processes underlying paradoxical responses over time.

Interpreting change scores is challenging when patients' global rating of change (GRC) scores contradict their observed change scores. We examine appraisal processes associated with having GRC-observed change contradictions. This secondary analysis of longitudinal multiple sclerosis (MS) registry data examined predictors of GRC scores in the whole sample (n=858). Logistic modeling then examined predictors of membership in one of two paradoxical subgroups (n=525): (a) Worsened GRC with unchanged observed Rand-12 Mental Component scores (MCS) (Symptom-Maximizers, n=171) versus no change GRC among stable MCS subsample; and (b) same GRC with declined observed MCS scores (Symptom-Minimizers, n=84) versus declining GRC among declining MCS subsample. Independent variables were cognitive appraisal processes from the Quality of Life (QOL) Appraisal Profile. GRC scores were more strongly associated with appraisal processes than with change in patient-reported outcomes (PROs) (R 2=11 and 2%, respectively). Symptom-Maximizers tended to focus on MS-related experiences and emphasize big changes; over time, they decreasingly defined QOL in terms of independence, increasingly focused on their MS, and increasingly compared themselves to doctor's predictions (Pseudo R 2=0.20). In contrast, Symptom-Minimizers tended not to recall recent episodes; over time, they focused increasingly on goals related to living situation and emphasized long-term concerns (Pseudo R 2=0.25). Appraisal explains more variance in GRC scores than do changes in PROs. People whose GRC assessment contradicts their observed change can be characterized by distinct cognitive appraisal processes reflecting response shift.

Correlates of health related quality of life in adult patients with spinal muscular atrophy.

To improve care for patients with spinal muscular atrophy (SMA), we assessed the physical and mental quality of life (QoL) in 62 adult patients with SMA. Physical component scores (PCS) and mental component scores (MCS) of the Short Form-36 Health Survey (SF-36) were obtained. Correlations with demographics, disease severity, and emotional distress were assessed. We used hierarchical multiple regression analysis to identify determinants of QoL. PCS scores were lower, and MCS scores higher than in the healthy reference population. Patients with milder SMA types reported lower scores on several MCS domains. Motor skills scores and emotional distress explained 16% of the variance in PCS. SMA type and emotional distress explained 10% and 45% of the variance of MCS, respectively. Patients with milder forms of SMA tend to have a reduced mental QoL. Psychological interventions to reduce emotional distress may improve both mental and physical QoL. Muscle Nerve 54: 850-855, 2016.

Evaluation of Health-Related Quality of Life among Tuberculosis Patients in Two Cities in Yemen.

BackgroundThe health-related quality of life (HRQoL) of Tuberculosis (TB) patients is important because it directly influences the outcome of TB patients in several aspects. The current study aims to evaluate and to find the factors influencing the HRQoL of TB patients in two major TB-prevalent cities (Taiz and Alhodidah) in Yemen.MethodsA prospective study was conducted, and all TB patients meeting the HRQoL criteria were asked to complete the HRQoL SF-36 survey. The records of TB patients were examined for disease confirmation, and a follow-up was consequently performed for patients during treatment between March 2013 and February 2014 in Taiz and Alhodidah Cities. HRQol scores were calculated by using QM scoring software version 4.5, in which the physical component score (PCS) and mental component score (MCS) were obtained. The scores obtained between 47–53 normal based score (NBS) were considered equivalent to the US normal score. Low scores indicate the poor health situation of TB patientsResultsA total of 243 TB patients enrolled in the study at the beginning of the treatment. A total of 235 and 197 TB patients completed the questionnaire at the end of the intensive phase (I.P.) and continuation phase (C.P.), respectively. The final dropout rate was 16.2%. The mean PCS and MCS scores at the beginning of treatment were low, thus showing the poor health situation of TB patients. The mean PCS scores at the beginning of treatment, end of I.P., and end of treatment were (36.1), (44.9), and (48), respectively. Moreover, the mean MCS score at the beginning of treatment, end of I.P., and end of treatment were (35.1), (42.2), and (44.3), respectively. The result shows that significant increases are observed at the end of I.P. for PCS and MCS because of the treatment and slight changes at the end of C.P. Despite this finding, the MCS score remains below the normal range (47), thus indicating a significant risk of depression among TB patients. Furthermore, general linear repeated measure ANOVA was performed for selected variables, to examine the changes of PCS and MCS over time. It was found that Alhodiah city, chewing khat habit, stigmatization, and duration of treatment more than six months were greatly associated with low mean MCS score of TB patient, indicating great risk of depression which may result in poor treatment outcome.ConclusionTB patients in Yemen were found to have poor QoL, with a significant likelihood of depression. Highly risk depression was found among TB patients in Alhodiah city, khat chewers, stigmatization and having a duration of treatment more than 6 months. Therefore, additional efforts should be made to improve their QoL because it may affect the final clinical outcome of patients.

Health status and return to work in trauma patients at 3 and 6months post-discharge: an Australian major trauma centre study.

The aim of this study was to describe post-discharge outcomes, and determine predictors of 3 and 6months health status outcomes in a population of trauma patients at an inner city major trauma centre. This was a prospective cohort study of adult trauma patients admitted to this hospital with 3 and 6months post-discharge outcomes assessment. Outcome measures were the Physical Component Scores (PCS) and Mental Component Scores (MCS) of the Short Form 12, EQ-5D, and return to work (in any capacity) if working prior to injury. Repeated measures mixed models and generalised estimating equation models were used to determine predictors of outcomes at 3 and 6months. One hundred and seventy-nine patients were followed up. Patients with lower limb injuries reported lower mean PCS scores between 3 and 6months (coefficient -4.21, 95% CI -7.58, -0.85) than those without lower limb injuries. Patients involved in pedestrian incidents or assaults and those with pre-existing mental health diagnoses reported lower mean MCS scores. In adjusted models upper limb injuries were associated with reduced odds of return to work at 3 and 6months (OR 0.20, 95% CI 0.07, 0.57) compared to those without upper limb injuries. Predictors of poorer physical health status were lower limb injuries and predictors of mental health were related to the mechanism of injury and past mental health. Increasing injury severity score and upper limb injuries were the only predictors of reduced return to work. The results provide insights into the feasibility of routine post-discharge follow-up at a trauma service level.

The association between psychiatric factors and the development of chronic dysphagia after anterior cervical spine surgery

Little data are available regarding the influence of psychiatric factors on chronic dysphagia after anterior cervical spine surgery. The purpose of this study was to identify associations between psychiatric factors and the development of chronic dysphagia in patients after anterior cervical spine surgery. The authors prospectively examined 72 patients with degenerative disc disease of the cervical spine who were treated by single-level anterior cervical discectomy and fusion. Demographic data including age, gender, body mass index, and smoking status were collected. Short form-36, mental component scores (MCS), physical component scores (PCS), Neck Disability Indices (NDI), and the Neck Pain and Disability Scale (NPDS) were assessed before surgery and at final follow-up. Psychiatric conditions were evaluated using the Zung depression scale and the Zung anxiety scale. At 1 year postoperatively, patients were contacted by telephone to determine the presence and severity of dysphagia. For statistical analyses, patients were divided into two groups: group I, those with No or Mild dysphagia; and group II, those with Moderate or Severe dysphagia at 1 year after surgery. Potential risk factors of chronic dysphagia were evaluated by multivariate logistic regression analysis. The patients included 22 women and 50 men of overall average age 47.1 ± 7.8 years. The prevalences of No/Mild (group I) and Moderate/Severe (group II) dysphagia were 69.4% (50 patients) and 30.6% (22 patients), respectively. Mean preoperative NDI, NPDS, PCS, and MCS scores of 34.2, 44.8, 33.7, and 46.2 in the 72 study subject improved to 9.9, 16.1, 55.1, and 56.2, respectively, at 1 year after surgery. The mean preoperative ZDS and ZAS scores were 35.2 and 34.2, respectively. The two study groups were significantly different in terms of the presence of a psychiatric problem, preoperative NDIs, and MCS scores. However, multivariate logistic regression showed that the presence of a psychiatric problem prior to surgery (P = 0.005) was the only significant predictor of chronic dysphagia. The presence of a psychiatric problem seems to be an important risk factor of chronic dysphagia in patients with cervical disc herniation. The study shows that psychiatric factors should be evaluated prior to surgery to determine the risk of chronic dysphagia.

Promoting resilience and wellbeing through an outdoor intervention designed for Aboriginal adolescents

Aboriginal people in Canada (First Nations, Inuit and Métis) have a lower health status compared to the Canadian population. There is a particular concern about the mental health and wellbeing of First Nations adolescents living on reserves. Interventions following principles of outdoor education and adventure therapy appear to be an appropriate fit for this population. These approaches have proven effective in non-Aboriginal populations, yet there is very little evidence on the efficacy of these types of program for Aboriginal adolescents. The primary purpose of this study was to evaluate the impact of an outdoor adventure leadership experience (OALE) on the resilience and wellbeing of First Nations adolescents from one reserve community. The secondary purposes were to explore whether this impact was sustainable, and whether there were any intervening factors that may have influenced the impact. The collaborative research team used a mixed-method design to evaluate the 10-day OALE for adolescents from Wikwemikong Unceded Indian Reserve in northern Ontario, Canada. The main outcome assessed was resilience, measured by self-report, using the 14-Item Resilience Scale (RS-14). Several other exploratory measures assessed other aspects of health and well-being. The questionnaire package was administered at three different time periods: (T1) one day before the OALE; (T2) one month after the OALE; and (T3) one year after the OALE. The Mental Component Score (MCS) of the SF-12v2 was used to confirm any changes in resilience. Open-ended questions were appended to the questionnaire at the 1-year point to identify any intervening factors that may have impacted any changes in resilience and wellbeing. The primary analysis compared mean RS-14 scores at T1 with those at T2. Responses to the open-ended questions were analyzed using content analysis. Over two summers (2009 and 2010), 73 youth 12-18 years of age from Wikwemikong participated in a standardized 10-day OALE program. This represented 15% of the on-reserve population of adolescents in this age range. Survey responses from 59 (80.8%) participants were available for analysis at T1, compared to 47 (64.4%) at T2 and 33 (45.2%) at T3. The mean RS-14 score was 73.65 at baseline, and this improved 3.40 points (p=0.011) between T1 and T2. However, the resilience scores at T3 (1 year post-OALE) had a mean of 74.19, indicating a return back to pre-OALE levels. The mean MCS score at T1 was 48.23 and it improved over the subsequent two time periods. Several intervening factors reported at T3 may have influenced the decrease in resilience scores from T2 to T3. These included changes in family living situation, death in the family, and other life stressors that occurred over the course of the year. Outcome scores from this study provide a unique glimpse into the self-reported health and wellbeing for adolescents within one First Nations community in Canada. The OALE program was beneficial in promoting resilience for adolescents in Wikwemikong over the short-term. Future studies are necessary to assess whether the OALE (or similar outdoor type interventions) are effective within other communities.

The impact of overweight and obesity on health-related quality of life and blood pressure control in hypertensive patients

Hypertension and obesity deteriorate patient health-related quality-of-life (HRQoL). This study assessed the impact of overweight and obesity on HRQoL and blood pressure (BP) control in hypertensive participants, according to sex. HRQoL was assessed using the 12-item Short Form Health Survey in 11,498 white patients treated for hypertension for at least 12 months. Nutritional status was diagnosed according to WHO criteria. Overweight and obesity were associated with worse BP control, regardless of sex. In women, overweight and especially obesity were inversely associated with all analyzed HRQoL dimensions. Among men, obesity decreased all HRQoL dimensions, and overweight influenced only physical functioning, role physical, bodily pain, vitality, general health, and Physical Component Score (PCS) but not Mental Component Score (MCS). Overweight in men did not influence social functioning, or emotional and mental health. The BMI values associated with optimal PCS and MCS scores were higher for men than for women. Age-adjusted multivariate regression analysis revealed that PCS score was associated with obesity, higher education level, comorbidities, and antihypertensive therapy duration, whereas MCS score was associated with female sex. Polydrug BP control diminished PCS and MCS. Overweight and obesity deteriorate BP control, regardless of age and polytherapy. BMI values associated with optimal HRQoL are higher for men than women treated for hypertension. Obesity more strongly diminishes the physical versus mental HRQoL component, regardless of sex. Overweight worsens HRQoL physical components in both sexes and mental component-only in women.

AB0582 Improvements in health-related quality of life (HRQOL) in patients with rheumatoid arthritis (RA) receiving secukinumab: Results of a dose-finding study

BackgroundInterleukin (IL)-17A is a key inflammatory mediator in pathogenesis of RA. Secukinumab is a fully human monoclonal antibody that selectively binds and neutralizes IL-17A.ObjectivesTo assess the effects of secukinumab administration...

Age, mode of conception, health service use and pregnancy health: a prospective cohort study of Australian women

BackgroundThere is limited evidence about the ways in which maternal age and mode of conception interact with psychological, sociodemographic, health and health service factors in governing pregnancy health. The aim of this study was to establish in what ways maternal age and mode of conception are associated with, health behaviours, health service use and self-rated physical and mental health during pregnancy.MethodA prospective cohort study was conducted in a collaboration between universities, infertility treatment services and public and private obstetric hospitals in Melbourne and Sydney, Australia,. Consecutive cohorts of nulliparous English-literate women at least 28 weeks pregnant who had conceived through ART (ARTC) or spontaneously (SC) in three age-groups: 20–30; 31–36 and at least 37 years were recruited. Data were obtained via structured individual telephone interviews and self-report postal questionnaires at recruitment and four months postpartum. Study-specific questions assessed: sociodemographic characteristics; reproductive health; health behaviours and health service use. Standardized instruments assessed physical health: SF 12 Physical Component Score (PCS) and mental health: SF12 Mental Component Score (MCS); State Trait Anxiety Inventory and Edinburgh Postnatal Depression Scale. The main outcome measures were the SF 12 PCS, SF12 MCS scores and pregnancy-related hospital admissions.ResultsOf 1179 eligible women 791 (67%) participated, 27 had fertility treatment without oocyte retrieval and were excluded and 592/764 (78%) completed all pregnancy assessments. When other factors were controlled speaking a language other than English, having private health insurance and multiple gestation were associated with worse physical health and having private health insurance and better physical health were associated with better mental health. Pregnancy-related hospital admissions were associated with worse physical health and multiple gestation.ConclusionsMaternal age and mode of conception are not associated with pregnancy health and health service use when sociodemographic factors are considered.

Assessment of Patient Reported Outcomes (PROs) From the Enestnd Trial with Minimum Follow-up of 36 Cycles.

AbstractAbstract 3166 Background:In ENESTnd, nilotinib (NI) significantly reduced progression and demonstrated superior molecular response rates vs. imatinib (IM) in patients newly diagnosed with Philadelphia chromosome positive chronic phase chronic myelogenous leukemia (CML-CP). Additionally, fewer NI patients discontinued therapy vs. IM (Table 1). Previously reported 24-month analyses of PROs indicated similar health-related quality of life (HRQoL) and functioning mean scores between the treatment arms, and scores similar to general population norms. Aim:To evaluate the PROs for patients in ENESTnd with minimum follow-up of 36 cycles and to understand cohort-level (per treatment arm) HRQoL outcomes Methods:In ENESTnd, nNewly diagnosed CML-CP patients were randomized to NI 300 mg twice daily (BID), NI 400 mg BID, or IM 400 mg once daily (QD). HRQoL was assessed using the Functional Assessment of Cancer Therapy – Leukemia (FACT-Leu) and the Short Form 36 Health Survey (SF-36). The FACT-Leu has two components: a) the FACT-General (FACT-G) which measures physical, social/family, emotional, and functional well-being and b) a 17-item leukemia specific subscale. The SF-36 assesses eight domains (physical functioning, role-physical, bodily pain, general health, vitality, social functioning, role-emotional, and mental health) that enable a mental component score (MCS) and physical component score (PCS). Questionnaires were administered at enrollment and end of cycles 3, 12, 24, and 36. Mixed effects models for longitudinal data were used to compare trends over time between treatment arms. Study discontinuation prevented collection of PROs from patients with inadequate response or intolerance to treatment. Pattern-mixture models were fit to attempt to control for missing PRO data resulting from discontinuation or other reasons. Separately, missing data were imputed consistently across arms for cohort-level analysis of the FACT-Leu subscale so mean cohort scores could be reported (Table 1). Results:In both mixed effects and pattern-mixture models, FACT-Leu subscale, FACT-G, and SF-36 scores (PCS and MCS) were similar across treatment arms over time. Of the patients remaining on study and completing PRO questionnaires, SF-36 PCS and MCS scores at cycle 36 in all arms were comparable to the general US population; FACT-G scores were slightly better (Table 2). In the cohort-level analysis with imputation according to reason, IM FACT-Leu subscale scores began to trend increasingly lower vs. NI arms beginning at day 168 (Figure 1). By day 1008, the IM arm mean score is 10% and 13% lower than the NI 300 mg and NI 400 mg arms, respectively (Figure 1). Higher rates of discontinuation in the IM arm are the main factors that lead to the HRQoL deficit. Conclusions:In ENESTnd, patients who respond to and tolerate treatment have consistent HRQoL that is comparable to the general population. Cohort-level analysis indicates that discontinuation rates due to inadequate response and intolerance must be considered when determining the HRQoL across the entire cohort. These results suggest that in a population of newly diagnosed patients with CML-CP, NI results in higher HRQoL than IM. These findings may have particularly important implications for payers and policy makers when evaluating treatment options.Table 1IM 400mg QD (n=283) (%)NI 300mg BID (n=282) (%)NI 400mg BID (n=281) (%)Imputed FACT-LEUbStill on treatment61.870.973.7MeanDisease progression3.50.71.40Suboptimal response/treatment failure4.21.82.814Adverse events/lab abnormalities11.09.914.214Death0.41.40.40Other a6.77.86.414aIncludes abnormal test result(s), condition no longer requires study drug, consent withdrawn, lost to follow-up, administrative problems, protocol deviationbImputed values per time point, 14 represents the lowest recorded scoreTable 2Mean (SD)IM 400mg QD (n=152)NI 300mg BID (n=176)NI 400mg BID (n=185)General US Pop.SF-36 PCS49.1 (9.0)47.9 (9.5)49.1 (8.2)49.6 (10.0)cSF-36 MCS51.3 (9.6)50.2 (9.7)49.9 (9.0)50.5 (9.9)cFACT-G86.0 (15.7)84.5 (15.4)85.1 (15.0)80.1 (18.1)dFACT-Leu subscale54.7 (9.4)54.9 (8.9)55.4 (8.5)NAcFor ages 45–54 (http://www.sf-36.org/research/sf98norms.pdf)dEval Health Prof 2005; 28:192–211. [Display omitted] Disclosures:Beaumont:Novartis: Research Funding. Magestro:Novartis: Employment. Coombs:Novartis: Employment. Fan:Novartis Pharmaceuticals Corp: Employment. Kemp:Novartis Pharmaceuticals Corp: Employment. Waltzman:Novartis: Employment.

PCV86 Comparison of Charlson, Elixhauser and HRQoL-CI Risk Adjustment Measures in Predicting Health-Related Quality of Life in Heart Failure Patients

Comorbidities in Heart Failure (HF) patients are highly prevalent, adversely affecting health related quality of life (HRQoL). Health related quality of life-comorbidity index (HRQoL-CI) has been recently developed to risk adjust HRQoL. The aim of this study was to compare the performance of HRQoL-CI with Charlson and Elixhauser measures in predicting HRQoL in HF patients. The Medical Expenditure Panel Survey 2002-2008 data was used for this retrospective cross-sectional study. All adults (age >18 years) diagnosed with HF were included in the study. International Classification of Disease, 9th Revision, Clinical Modification and Clinical Classification Codes were used to identify HF patients, as well as to construct different risk adjustment measures (D'hoore adaptation of Charlson, Elixhauser and HRQoL-CI). HRQoL is documented in MEPS using short form health survey (SF-12), with physical component score (PCS) and mental component score (MCS). Linear regression analysis was conducted with PCS and MCS scores as dependent variables. Age, race and sex were included as baseline variables in all models while incorporating Charlson/D'hoore, Elixhauser, and HRQoL- CI measures one at a time. Adjusted R2 were compared to assess the comparative performances of risk-adjustment measures. The mean age was 68±13 years, with 80.63% non-Hispanic whites. The average PCS and MCS for HF patients were 45.53±12.28 and 30.64±11, respectively. HRQoL-CI (R2 = 0.2083) outperformed Elixhauser (R2 = 0.1784) and Charlson/D'hoore (R2 = 0.1359) in predicting PCS. Whereas, Elixhauser (R2 = 0.2184) had the best prediction of MCS compared to HRQoL-CI (R2 = 0.1920) and Charlson/D'hoore (R2 = 0.0918). No single comorbidity measure was best in predicting both PCS and MCS in HF patients; HRQoL-CI performed best in predicting PCS whereas Elixhauser measure had the best prediction for MCS. Selection of risk adjustment method should be based on the type of dimension used to evaluate HRQoL.

A Study of Quality of Life and its Determinants among Hemodialysis Patients Using the KDQOL-SF Instrument in One Center in Saudi Arabia

We aimed to assess quality of life (QOL) among Saudi hemodialysis (HD) patients and the impact on the QOL of a certain demographic and clinical factors. The QOL was assessed using an Arabic version of Kidney Disease Quality of Life Instrument Short Form (KDQOL-SF). Mean scores were compared for individual domain scores and for the three composite summary scores, namely the mental component score (MCS), the physical component score (PCS) and kidney-disease component score (KDCS). The study included one hundred chronic HD patients from King Abdulaziz Medical City, Riyadh. The overall mean score was 60.4. Domains with very low scores were "cognitive function", "role-emotional", "role-physical" and "work status". Domains with high scores were "patient satisfaction", "dialysis staff encouragement" and "quality of social interaction". The mean scores for "KDCS", "MCS" and "PCS" were 59.7, 54.2 and 52.7 respectively. KDC scores were higher among males and the married group. PCS scores were higher among males, patients aged < 40 years, and the higher income group. MCS scores were higher among males and the higher income groups. There was a positive correlation between "KDCS" and "MCS"(r=0.62, P=0.0001); and between "KDCS" and "PCS" (r=0.65, P=0.0001). The current study provides a detailed description of the QOL scores of a group of Saudi HD patients and the impact of certain factors on their QOL. Low scores were seen in the "work status", "cognitive function", "role-physical" and "role-emotional" while high scores were seen in "patient satisfaction", "dialysis staff encouragement" and "quality of social interaction" domains.

The influence of fault on health in the immediate post-crash period following road traffic crashes

ObjectiveTo compare the early health status of people who sustained injuries during road traffic crashes (RTC) in which they were at fault (AF), with people who sustained injuries in RTC in which they were not at fault (NAF). DesignProspective cohort study. SubjectsPeople presenting to the emergency department with mild to moderate musculoskeletal injuries following RTC. Main outcome measuresPhysical Component Score (PCS) and Mental Component Score (MCS) of the Short Form 36 (SF-36) health status measure; Hospital Anxiety and Depression Scale (HADS) and the Functional Rating Index (FRI) recorded immediately post-crash. Results193 people participated in the study and were enrolled a mean of 9.3days following the crash. The mean age was 37years and 60% were female. 71% were NAF. There was a significantly higher number of females in the NAF group (65% compared with 35% males; p<0.001). Neck and back injuries were reported by 90.4% of the NAF group compared to 69.1% of the AF group (p<0.001). There were no significant differences in PCS, FRI or pain intensity between the two groups at a mean of 9.3days after the crash. The mean MCS for the NAF group was significantly worse than for the AF group (31.4 compared to 37.3; p=0.005). The SF-36 domain revealed a significantly worse adjusted mean role emotional score for the NAF group (23.4 compared to 32.5, p=0.002). Females had significantly worse MCS score than males (30.6 and 38.1 respectively; p<0.001) and worse adjusted mean anxiety and depression scores (10 compared to 7.8; p=0.002 and 7.6 compared to 5.5; p=0.002 respectively). ConclusionsDespite there being no difference in physical health status, the NAF group demonstrated more emotional and mental disturbance than the AF group; and this was significantly worse for females. Treatment strategies should focus on addressing early pain and disability as well as providing appropriate psychological interventions, particularly for people not at fault following RTC.

Sex Differences in the Association of Youth Body Mass Index to Adult Health-related Quality of Life: The Physical Activity Longitudinal Study

Objective: The long-term consequences of youth overweight on adult health-related quality of life (HRQL) have not been documented. This study examines sex differences in the association between youth body mass index (BMI) and adult HRQL. Methods: Subjects included 139 male and 142 female participants aged 7-18 in the 1981 Canada Fitness Survey, followed up in 2002-04. The associations of youth BMI to adult HRQL (SF-36) were examined with bivariate correlations, differences in means and multivariate linear regression analyses. Results: Bivariate analyses revealed positive associations between youth overweight and mental aspects of adult HRQL in females, and weak negative associations with physical aspects, but no significant associations in males. All overweight male and female youth scored the maximum (100) on Role Emotional (RE). In females, compared to healthy weight youth, overweight youth scored 16.0, 13.4, 12.7, and 10.9 points higher on general health (GH), vitality (VT), mental health (MH), and the mental component score (MCS) in adulthood, respectively; a 1 unit increase in youth BMI led to 1.7, 1.5, and 1.4 point increases in adult VT, MH and MCS scores, respectively. Associations were attenuated with the removal of adult BMI from the models, but remained strong for MH and MCS. Conclusions: Overweight in youth did not have a significant negative impact on HRQL two decades later; rather, a positive association was found with mental aspects of adult HRQL in females. Key words: Body mass index; body weight; adolescent obesity; longitudinal studies; mental health; quality of life

Sex differences in the association of youth body mass index to adult health-related quality of life: the physical activity longitudinal study.

The long-term consequences of youth overweight on adult health-related quality of life (HRQL) have not been documented. This study examines sex differences in the association between youth body mass index (BMI) and adult HRQL. Subjects included 139 male and 142 female participants aged 7-18 in the 1981 Canada Fitness Survey, followed up in 2002-04. The associations of youth BMI to adult HRQL (SF-36) were examined with bivariate correlations, differences in means and multivariate linear regression analyses. Bivariate analyses revealed positive associations between youth overweight and mental aspects of adult HRQL in females, and weak negative associations with physical aspects, but no significant associations in males. All overweight male and female youth scored the maximum (100) on Role Emotional (RE). In females, compared to healthy weight youth, overweight youth scored 16.0, 13.4, 12.7, and 10.9 points higher on general health (GH), vitality (VT), mental health (MH), and the mental component score (MCS) in adulthood, respectively; a 1 unit increase in youth BMI led to 1.7, 1.5, and 1.4 point increases in adult VT, MH and MCS scores, respectively. Associations were attenuated with the removal of adult BMI from the models, but remained strong for MH and MCS. Overweight in youth did not have a significant negative impact on HRQL two decades later; rather, a positive association was found with mental aspects of adult HRQL in females.

Surgical intervention for thoracic outlet syndrome improves patient's quality of life

To assess long-term quality of life outcomes in patients following transaxillary first-rib resection and scalenectomy for thoracic outlet syndrome (TOS). This was a prospective observational study using the Short-Form 12 (SF-12) and Disability of Arm, Hand, and Shoulder (DASH) instruments between February 2005 and March 2008 in patients with TOS presenting to an academic medical center for preoperative surgical evaluation after failing physical therapy protocol. Surveys were conducted preoperatively and then again at 3, 6, 12, 18, and 24 months after surgery. Longitudinal data analysis was performed with population-averaged models using generalized estimating equations (GEE) method for average rate of recovery. Kaplan-Meier method was used to analyze time to return to work. A total of 70 out of 105 eligible patients (66.7%) completed the study protocol (44 neurogenic; 26 venous), returning 243 valid SF-12 surveys (162 neurogenic; 81 venous) and 188 valid DASH surveys (124 neurogenic; 64 venous). Half (50%) of the neurogenic patients and 77% of the venous patients returned to full-time work or activity within the study follow-up, with half of them doing so by 4 months and 75% of them by 5 months. There was no statistically significant difference in return to work between the neurogenic or venous patients. Neurogenic patients had baseline SF-12 Physical Component Scores (PCS) similar to chronic heart failure patients and were significantly worse than venous patients (33.8 vs 43.6, P < .001). In contrast, no difference existed in Mental Component Scores (MCS) (44.5 vs 43.5, P = .78). In follow-up, on average, PCS scores for neurogenic patients improved 0.24 points (P < .001) and MCS scores improved 0.15 points per month (P = .01); while PCS scores for venous patients improved 0.40 points (P = .004) and MCS scores improved 0.55 points per month (P < .001). Additionally, neurogenic patients had baseline DASH scores that were similar to patients with rotator cuff tears, and they were also significantly worse than venous patients (50.2 vs 25.0, P < .001). DASH scores, on average, also improved 0.85 points (P < .001) for neurogenic patients and 0.81 points (P < .001) for venous patients per month. The use of the SF-12 and DASH instruments in patients with TOS demonstrated significant improvement in patients postoperatively. Venous TOS patients typically improved both physical and mental scores in shorter periods of time than their neurogenic counterparts. Neurogenic and venous TOS patients returned to full-time work/activity within the same length of time postoperatively. However, neurogenic patients required more secondary interventions. We conclude that in appropriately selected patients with either neurogenic or venous TOS, surgical intervention can improve their quality of life over time.

Retrograde Drilling of Osteochondral Lesions of the Talus

This study evaluates the use of retrograde drilling in medial osteochondral lesions of the talus (OLTs) with intact articular surfaces. During a 2-year period, 8 consecutive patients underwent surgical treatment for symptomatic posterior medial OLT. All patients underwent arthroscopy of the ankle followed by retrograde drilling of the talar lesion. A novel cannulated system was used to target the lesion, remove the necrotic segment, and then backfill using Grafton gel. The average age of the patients was 36 years old (range, 12-49 years). Follow-up ranged from 8 to 44 months (mean 24 months). One patient was lost to follow-up. Of the remaining 7, outcomes were assessed with a modified American Orthopaedic Foot and Ankle Society (AOFAS) ankle/ hindfoot scale and the SF-12 general health survey. Four patients had repeat magnetic resonance imaging scans at 1-year follow-up. The preoperative AOFAS scores from the modified hindfoot scale ranged from 0 to 41 (mean 22). Postoperative scores ranged from 52 to 68 (mean 56), with a mean improvement of 34 points. The SF-12 has 2 components: the physical component score (PCS) and the mental component score (MCS). Mean preoperative and latest follow-up SF-12 PCS scores were 35.8 and 44.0, respectively. Mean preoperative and latest follow-up SF-12 MCS scores were 40.7 and 52.8, respectively. In this limited series, this technique appears to give comparable short-term results to previously described techniques. Use of a cannulated system simplifies the surgical procedure. Overall, this procedure offers decreased operative time and maximizes safety and accuracy with retrograde talar drilling.

Proteinuria Is a Determinant of Quality of Life in Diabetic Nephropathy: Modeling Lagged Effects with Path Analysis

Background: Diabetic nephropathy with overt proteinuria often progresses relentlessly to end-stage renal disease (ESRD). Material and Methods: To answer the question whether it is impaired glomerular filtration rate (GFR) or its precursor proteinuria which is more related with multiple domains of health-related quality of life (HRQOL), we measured GFR and proteinuria in 44 patients with type 2 diabetes and overt nephropathy and repeated the measurements after 4 months. 38 patients with ESRD due to diabetic nephropathy served as a control group. We used path analysis to examine the association of baseline proteinuria and GFR with baseline and subsequent HRQOL scales. Results: Compared to patients with ESRD, patients with non-dialysis CKD had Kidney Disease Burden (KDB) that was, on a scale from 0 to 100, 19.8 better (95% CI 6.9–32.8) (p = 0.003). Mental component score (MCS) did not differ and physical component score (PCS) was worse in non-dialysis CKD patients by 8.5 (p < 0.001). Proteinuria at baseline was a predictor of PCS, MCS and KDB score at 4 months, suggesting a lagged effect of proteinuria on HRQOL after controlling for the autoregressive effects. GFR was not shown to have a significant impact on HRQOL. One log unit increase in proteinuria was associated with 3.8 (p = 0.011) fall in PCS, 3.3 (p = 0.043) fall in MCS and 10.6 (p = 0.006) fall in KDB. Conclusion: In patients with advanced diabetic nephropathy, we found that proteinuria has a lagged and profound effect on multiple domains of HRQOL.

Should aggregate scores of the Medical Outcomes Study 36-item Short Form Health Survey be used to assess quality of life in knee and hip osteoarthritis? A national survey in primary care

To assess the relevance of using the aggregate physical component score (PCS) and mental component score (MCS) of the Medical Outcomes Study 36-item Short Form Health Survey (SF-36) for patients with knee and hip osteoarthritis (OA). We conducted a cross-sectional national survey in a primary care setting in France. A total of 1474 general practitioners enrolled 4183 patients with hip or knee OA. Construct validity of PCS and MCS was assessed by convergent and divergent validity and factor analysis. Records of 4133 patients (98.8%) were analyzed (2540 knee, 1593 hip OA). PCS mean scores were 32.0+/-8.4 and 31.8+/-8.4 and MCS scores 47.1+/-11.0 and 46.8+/-11.1, for knee and hip OA, respectively. Acceptable convergent and divergent validity was observed, and correlation between PCS and MCS mean scores was low (r=0.14). However, factor analysis performed on the eight subscale scores failed to support the use of PCS and MCS aggregate scores. It extracted two factors which were similar for both OA types and differed from the a priori stratification. Scores for two subscales usually attributed to MCS - emotional role and social functioning - were shared between factors, and scores for another subscale - general health perception - usually belonging to the PCS was in the mental component factor. Our results suggest that aggregate scores from the PCS and MCS of the SF-36 as they are currently defined may not be optimal for used in hip and knee OA patients to assess health-related quality of life.