Mental Health Component Scores Research Articles

The evaluation of health-related quality of life for prostate cancer patients receiving androgen deprivation therapy

Objective To evaluate the health-related quality of life (HRQOL) for prostate cancer patients receiving androgen deprivation therapy (ADT). Methods We studied 200 patients with prostate cancer who were treated with primary ADT in Peking University People's Hospital from June 2014 to June 2015. The patients'average age was 73.9 years. The mean PSA level was 21.57 ng/ml when they were diagnosed with prostate cancer. Of these 200 patients, 79%(158/200) were localized and seclected ADT therapy due to age, body condition, basic diseases or individual will.21% (42/200) were locally advanced or metastasic, which accord with the indication of ADT therapy.The scales, including the MOS item short from health survey (SF-36), Functional Assessment of Cancer Therapy -General module (FACT-G), Functional Assessment of Cancer Therapy -Prostate instrument (FACT-P), Self-Rating Depression Scale (SDS) and Self-Rating Anxiety Scale (SAS) were used to evaluate their HRQOL. Results According to results of SF-36, the physical health component score and mental health component score was 67.41±16.39 and 64.81±17.51, respectively. They indicated that the overall quality of life of these patients was at an acceptable level. And the average score of domains exceeded 60 except general health domain, which the score was only 40.03±21.89. When it comes to FACT-P, the sum score, emotional well-being score and prostate cancer component score were 8.15±3.72, 12.30±4.04 and 77.41±9.95, respectively, which were less than half of their respective top score. However the physical well-being score was 20.41±4.29, which was a relatively satisfactory value. In addition, 61% (121/200) patient selected not at all in item I am able to have and keep an erection . The score of SDS and SAS was 46.76±8.29 and 43.25±9.69, respectively. And there were 23.0% (46/200) and 21.5% (43/200) patiens exhibited depression and anxiety, respectively. Conclusion In the present study, the prostate cancer patients receiving ADT showed acceptable HRQOL, but some patients sufferd from depression, anxiety and erectile dysfunction. Key words: Prostate cancer; Androgen deprivation therapy (ADT); Health-related quality of life (HRQOL)

Meditation in Stressed Older Adults: Improvements in self-rated mental health not paralleled by improvements in cognitive function or physiological measures.

To determine if mindfulness meditation (MM) in older adults improves cognition and, secondarily, if MM improves mental health and physiology, 134 at least mildly stressed 50-85 year olds were randomized to a six-week MM intervention or a waitlist control. Outcome measures were assessed at baseline and two months later at Visit 2. The primary outcome measure was an executive function/attentional measure (flanker task). Other outcome measures included additional cognitive assessments, salivary cortisol, respiratory rate, heart rate variability, Positive and Negative Affect Schedule (PANAS), Center for Epidemiologic Studies Depression (CESD), Perceived Stress Scale (PSS), Neuroticism-Extraversion-Openness (NEO) personality traits, and SF-36 health-related quality of life. 128 participants completed the study though Visit 2 assessments. There was no significant change in the primary or other cognitive outcome measures. Even after statistical adjustment for multiple outcomes, self-rated measures related to negative affect and stress were all significantly improved in the MM intervention compared to wait-list group (PANAS-negative, CESD, PSS, and SF-36 health-related quality of life Vitality and Mental Health Component). The SF-36 Mental Health Component score improved more than the minimum clinically important difference. There were also significant changes in personality traits such as Neuroticism. Changes in positive affect were not observed. There were no group differences in salivary cortisol, or heart rate variability. These moderate sized improvements in self-rated measures were not paralleled by improvements in cognitive function or physiological measures. Potential explanations for this discrepancy in stress-related outcomes are discussed to help improve future studies.

The impact of life events on adult physical and mental health and well-being: longitudinal analysis using the GoWell health and well-being survey.

BackgroundIt is recognised that life events (LEs) which have been defined as incidents necessitating adjustment to habitual life either permanently or temporarily, not only have the potential to be detrimental to health and well-being, but research suggests some LEs may be beneficial. This study aimed to determine the individual and cumulative occurrence of LEs; and to establish their effect on health and well-being.ResultsDemographic factors (gender, age and highest educational attainment), LE occurrence and self-reported health data were collected as part of the longitudinal GoWell community health and wellbeing survey (2008–2011). Self-reported health was measured using the SF-12 questionnaire for physical (SF-12 PCS) and mental health (SF-12 MCS) and the Warwick–Edinburgh mental well-being scale (WEMWBS) for well-being. Statistical analysis was performed using SPSSv21 and level of significance was set at p < 0.05. Results showed that the sample was 61.6 % (n = 768) female; 20.4 % (n = 254) were aged 16–39 years, 46.1 % (n = 575) 40–64 years and 33.5 % (n = 418) were over 65 years; 68.8 % (n = 819) had no qualifications/Scottish leaving certificates, with the remaining 31.2 % (n = 372) having their highest educational qualification above Scottish leaving certificates. Health score means were 49.3 SF-12 mental health component score (SF-12 MCS); 42.1 SF-12 physical health component score (SF-12 PCS); and 49.2 WEMWBS. Participants experienced 0–7 LEs over a three year period, with the most common being: housing improvement (44.9 %), house move (36.8 %), health event (26.3 %) and bereavement (25.0 %). Overall, an increase in LEs was associated with a health score decrease. Five LEs (relationship breakdown, health event, bereavement, victimisation and house move) had negative impacts on SF-12 MCS and two (new job/promotion and parenthood) had positive impacts. For SF-12 PCS only three (health event, bereavement and housing improvement) had a negative impact. Six (health event, victimisation, bereavement, relationship breakdown housing move and improvement) had negative impacts on well-being and two (new job/promotion, marriage) had positive effects.ConclusionsFindings from the current study confirm LEs have both detrimental and beneficial impacts on health and well-being. Further research is required to disentangle the complexity of LEs and the ways they affect health and well-being.

Changes in Health-Related Quality of Life During Rehabilitation in Patients With Operable Lung Cancer: A Feasibility Study (PROLUCA).

Introduction: Surgical resection in patients with non–small cell lung cancer (NSCLC) may be associated with significant morbidity, functional limitations, and decreased quality of life. Objectives: The objective is to present health-related quality of life (HRQoL) changes over time before and 1 year after surgery in patients with NSCLC participating in a rehabilitation program. Methods: Forty patients with NSCLC in disease stage I to IIIa, referred for surgical resection at the Department of Cardiothoracic Surgery RT, Rigshospitalet, were included in the study. The rehabilitation program comprised supervised group exercise program, 2 hours weekly for 12 weeks, combined with individual counseling. The study endpoints were self-reported HRQoL (Functional Assessment of Cancer Therapy–Lung, European Organization for Research and Treatment in Cancer–Quality of Life Questionnaire-QLQ-C30, Short-Form-36) and self-reported distress, anxiety, depression, and social support (National Comprehensive Cancer Network Distress Thermometer, Hospital Anxiety and Depression Scale, Multidimensional Scale of Perceived Social Support), measured presurgery, postintervention, 6 months, and 1 year after surgery. Results: Forty patients were included, 73% of whom completed rehabilitation. Results on emotional well-being (P < .0001), global quality of life (P = .0032), and mental health component score (P = .0004) showed an overall statistically significant improvement during the study. Conclusion: This feasibility study demonstrated that global quality of life, mental health, and emotional well-being improved significantly during the study, from time of diagnosis until 1 year after resection, in patients with NSCLC participating in rehabilitation.

A phase I/II pilot study assessing the preliminary efficacy of wall climbing for improving posttraumatic growth and quality of life in gynecologic cancer survivors

ObjectiveWe previously reported a pilot randomized controlled trial in gynecologic cancer survivors (GCS) suggesting that wall climbing is safe, feasible, and improves objective physical functioning. Here, we report the effects of wall climbing on posttraumatic growth, quality of life, and symptoms. MethodsGCS (N = 35) were randomized to either an 8-week wall climbing intervention (WCI; n = 24) or usual care (UC; n = 11). The primary efficacy outcome was posttraumatic growth assessed by the Posttraumatic Growth Inventory. Secondary outcomes included health-related quality of life assessed by the Short Form-36 (SF-36). ResultsAnalyses of covariance revealed a statistically significant or borderline significant effect favoring WCI over UC for the posttraumatic growth subscales of new possibilities (d = + 0.70; p = 0.065) and personal strength (d = + 0.76; p = 0.049) as well as the SF-36 mental health subscale (d = +0.61; p = 0.077) and the mental health component score (d = +0.80; p = 0.063). Conversely, a statistically significant or borderline significant effect favoring UC over WCI was found for the SF-36 bodily pain subscale (d = −0.50; p = 0.063) and the physical health component score (d = −0.58; p = 0.038). ConclusionsThis phase I/II study suggests that wall climbing may improve some aspects of posttraumatic growth and mental health in GCS but may also cause some bodily pain and reduced physical health. Larger phase II and III trials are needed to fully describe the potentially complex benefits and harms of wall climbing in GCS.

Inequalities in socio-economic characteristics and health and wellbeing of men with and without disabilities: a cross-sectional analysis of the baseline wave of the Australian Longitudinal Study on Male Health.

BackgroundInternationally, men with disabilities have higher rates of social and economic disadvantage and poorer health and wellbeing than men without disabilities. No single study has provided comprehensive, population-level information about the magnitude of such differences among adult men using a well-validated instrument to measure disability.MethodsWe analysed baseline data from Ten to Men – an Australian longitudinal study of male health. Ten to Men used a stratified multi-stage cluster random sample design to recruit a national sample of males aged 10 to 55 years residing in private dwellings. Data were collected between October 2013 and July 2014 from 15,988 males. This analysis was restricted to 18–55 year old participants with data available on age and disability (n = 13,569). We compared the demographic, socio-economic characteristics and health and wellbeing of men with and without disabilities using chi squared tests for proportions and t tests for continuous variables. Linear regression adjusted for age was used to assess the association between disability status and health and wellbeing, which were measured using the SF-12 mental and physical health component scores and the Personal Wellbeing Index.ResultsMen with disabilities were older and more likely to be born in Australia, speak English at home, be Aboriginal and Torres Strait Islander and were less likely to be married or de facto, or to live in urban areas. They were less likely to have completed secondary school, be employed and live in affordable housing, and were more likely to live on low incomes, in more socio-economically disadvantaged areas, and in rental accommodation and to experience shortages of money. Among employed men, those with disabilities were less likely to be in high skilled jobs, worked less hours on average, and were more likely to report that they would prefer to work more. Men with disabilities had lower levels of social support and community participation and poorer mental and physical health and overall wellbeing.ConclusionAdult men with disabilities experience marked social and economic disadvantage and poorer health and wellbeing. Improving the health and wellbeing of disabled men should be a priority for public health researchers and policy-makers.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3700-y) contains supplementary material, which is available to authorized users.

Laminectomy and fusion versus laminoplasty for the treatment of degenerative cervical myelopathy: results from the AOSpine North America and International prospective multicenter studies

Background ContextIt remains unclear whether cervical laminoplasty (LP) offers advantages over cervical laminectomy and fusion (LF) in patients undergoing posterior decompression for degenerative cervical myelopathy (DCM). PurposeThe objective of this study is to compare outcomes of LP and LF. Study Design/SettingThis is a multicenter international prospective cohort study. Patient SampleA total of 266 surgically treated symptomatic DCM patients undergoing cervical decompression using LP (N=100) or LF (N=166) were included. Outcome MeasuresThe outcome measures were the modified Japanese Orthopaedic Association score (mJOA), Nurick grade, Neck Disability Index (NDI), Short-Form 36v2 (SF36v2), length of hospital stay, length of stay in the intensive care unit, treatment complications, and reoperations. MethodsDifferences in outcomes between the LP and LF groups were analyzed by analysis of variance and analysis of covariance. The dependent variable in all analyses was the change score between baseline and 24-month follow-up, and the independent variable was surgical procedure (LP or LF). In the analysis of covariance, outcomes were compared between cohorts while adjusting for gender, age, smoking, number of operative levels, duration of symptoms, geographic region, and baseline scores. ResultsThere were no differences in age, gender, smoking status, number of operated levels, and baseline Nurick, NDI, and SF36v2 scores between the LP and LF groups. Preoperative mJOA was lower in the LP compared with the LF group (11.52±2.77 and 12.30±2.85, respectively, p=.0297). Patients in both groups showed significant improvements in mJOA, Nurick grade, NDI, and SF36v2 physical and mental health component scores 24 months after surgery (p<.0001). At 24 months, mJOA scores improved by 3.49 (95% confidence interval [CI]: 2.84, 4.13) in the LP group compared with 2.39 (95% CI: 1.91, 2.86) in the LF group (p=.0069). Nurick grades improved by 1.57 (95% CI: 1.23, 1.90) in the LP group and 1.18 (95% CI: 0.92, 1.44) in the LF group (p=.0770). There were no differences between the groups with respect to NDI and SF36v2 outcomes. After adjustment for preoperative characteristics, surgical factors and geographic region, the differences in mJOA between surgical groups were no longer significant. The rate of treatment-related complications in the LF group was 28.31% compared with 21.00% in the LP group (p=.1079). ConclusionsBoth LP and LF are effective at improving clinical disease severity, functional status, and quality of life in patients with DCM. In an unadjusted analysis, patients treated with LP achieved greater improvements on the mJOA at 24-month follow-up than those who received LF; however, these differences were insignificant following adjustment for relevant confounders.

Self-reported physical and mental health of Australian carers: a cross-sectional study

ObjectiveTo report on self-reported physical and mental health of informal carers in rural regions of New South Wales, Australia.MethodsA cross-sectional community-based sample (n=222) of carers completed a questionnaire incorporating self-reported...

The impact of depressive symptoms on health-related quality of life in patients with subjective cognitive decline, mild cognitive impairment, and Alzheimer's disease.

Health-related quality of life (HRQOL) is an important issue in the context of dementia care. The purpose of this study was to investigate the association between HRQOL and depressive symptoms in patients with subjective cognitive decline (SCD) and subtypes of mild cognitive impairment (MCI) and Alzheimer´s disease (AD). In this cross-sectional, observational study, a control group and four experimental groups (SCD, non-amnestic MCI, amnesticMCI, AD) were compared. Neuropsychological measurers (NTBV) and psychological questionnaires were used for data collection. The control group scored higher than patients with SCD, naMCI, aMCI, or AD for the Mental Health Component Score (MHCS) of the Short Form of the Health Survey (SF-36). The Physical Health Component Score (PHCS) of the SF-36 differed only between some groups. Furthermore, cognitive variables were more strongly associated with the physical aspects of HRQOL, whereas depressive symptoms were more strongly related with the mental aspects of HRQOL. HRQOL and depressive symptoms are closely related in patients with cognitive impairments. Therefore, it is of great importance to assess patients with subjective impairment carefully in terms of depressive symptoms.

Health related quality of life in patients with end stage kidney disease treated with haemodialysis in Malawi: a cross sectional study.

BackgroundHaemodialysis in Malawi consumes a disproportionate amount of the national health budget, costing approximately $20,000 per patient per year. Adjunctive therapeutic agents for end stage kidney disease and laboratory services to measure standard dialysis outcomes are not routinely available. Therefore, alternative outcome measures of the efficacy of haemodialysis in Malawi are required. We measured health related quality of life of adult patients in Malawi treated with haemodialysis for end stage kidney disease.MethodsWe performed a cross-sectional study of patients receiving haemodialysis for end stage kidney disease at 4 dialysis centres in Malawi between 24/10/2012 and 30/11/012. Patients were included if they were >18 years of age and had been receiving haemodialysis for >3 months. We used the Kidney Disease Quality of Life Instrument Short Form to assess health related quality of life.ResultsWe recruited 22 of 24 eligible patients (mean age 44.8 ± 16.0 years, 59.1 % male, median duration on haemodialysis 12 months (Inter-quartile range 6–24 months)). Overall health related quality of life was low (mean score 59.9 ± 8.8, maximum possible score 100) with the lowest scores recorded for physical health component summary score (50.4 ± 22.8) compared to mental health component summary (61.3 ± 23.0) and kidney disease component summary (67.9 ± 13.2). Low household income (<$4000 per year) was associated with lower mental health component scores (adjusted r2 = 0.413, p = 0.033).ConclusionsQuality of life of haemodialysis patients in Malawi can be easily measured using a validated questionnaire and provides an alternative and important measure of the efficacy of haemodialysis therapy. Physical health scores were particularly low and this may affect income generating capacity. Increased efforts are required to improve the quality of life of haemodialysis patients in Malawi with a particular focus on the burden of physical symptoms.Electronic supplementary materialThe online version of this article (doi:10.1186/s12882-016-0292-9) contains supplementary material, which is available to authorized users.

Treating Benign Paroxysmal Positional Vertigo in the Patient With Traumatic Brain Injury: Effectiveness of the Canalith Repositioning Procedure.

The aim of this study was to determine the effectiveness of the canalith repositioning procedure (CRP) in the treatment of benign paroxysmal positional vertigo (BPPV) among patients after mild-to-moderate traumatic brain injury. An unblinded, nonrandomized, case comparison interventional study with repeated measures (1, 5, 9, and 12 weeks postenrollment) of three groups of patients with traumatic brain injury (BPPV, n = 21; nonspecific dizziness, n = 23; no dizziness, n = 12) was conducted. Patients in the BPPV group received the CRP at baseline and repeatedly until a negative Dix-Hallpike Maneuver was observed. Participants in the other two groups did not receive the CRP. Symptom resolution at the 12-week follow-up was observed in 75% of patients in the BPPV group versus 8.3% in the nonspecific dizziness group (p = .0006). A significant Group × Time interaction was observed for the Dizziness Handicap Inventory (F = 4.2, p = .003) and 36-item Short Form Health Questionnaire physical component scores (F = 2.16, p = .035) with the BPPV group showing significantly improved scores by the 12-week follow-up. Although there were between-group differences on the 36-item Short Form Health Questionnaire mental health component scores (F = 4.06, p = .022), changes over time were not significant in the groups. Treatment with the CRP for posttraumatic BPPV resulted in significant symptom resolution and improvement in perceived physical health status.

Abstract 7: Sex Differences in Financial Barriers and the Relationship to Recovery After Acute Myocardial Infarction

Background: Financial barriers to healthcare services and medications have been associated with worse outcomes following acute myocardial infarction (AMI). Their prevalence and impact may be even greater in younger adults without access to Medicare and, specifically, in young women, who are more likely than men to forego needed medical care in the face of economic hardship. We assessed sex differences in the prevalence and potency of financial barriers in young patients with AMI and whether they help explain poorer outcomes in women. Methods: We used data from the VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) study, the largest multicenter prospective study of young adults (≤55 years old) with AMI. Patients were characterized as having financial barriers to medications, services, both, or none based on self-report responses at the index hospitalization for AMI. One-year outcomes after AMI were assessed including general health status (Short Form-12 physical and mental health component scores) and angina-related quality of life (Seattle Angina Questionnaire). Multivariable linear regression was used to examine the relationship between financial barriers and outcomes, testing for interactions with sex. All models were adjusted for baseline health status, socio-demographics, comorbidities, clinical presentation, and inpatient care. In a secondary analysis, we investigated the unadjusted association of financial barriers with healthcare access and utilization at 1-month. Results: Of the 3437 patients in the study, financial barriers to healthcare services (30.5%) and medications (20.6%) were common. Significantly more women than men reported financial barriers to medication (22.3% vs. 17.2%, P &lt; 0.01). Compared with patients reporting no financial barriers, patients with financial barriers to both services and medications were more likely to have lower physical health (mean difference (MD) = -2.87, P &lt; 0.001), lower mental health (MD= -3.14, P &lt; 0.001), and lower quality of life (MD = -5.81, P &lt; 0.001) one year post-AMI. No sex difference in the effect of financial barriers on health outcomes was observed (interaction P &gt; 0.1 for all outcomes). Rates of 1-month healthcare access and utilization were similar in men and women. However, 1-month after AMI, patients with at least one financial barrier reported significantly lower adherence to medications, higher rates of not participating in cardiac rehabilitation after referral, and greater difficulty scheduling follow-up visits than patients with no financial barriers. Conclusion: Financial barriers are common among young adults and are associated with worse health outcomes 1-year after AMI. While the potency of financial barriers on health outcomes did not vary by sex, the greater prevalence of financial barriers among women may in part explain why young women have worse outcomes than their male peers.

Pathways Between Discrimination and Quality of Life in Patients with Type 2 Diabetes.

Discrimination is a social determinant that has been linked to poor physical and mental health outcomes. This study aimed to examine the pathway whereby discrimination influences quality of life in patients with type 2 diabetes. Six hundred fifteen patients were recruited from two adult primary care clinics in the southeastern United States. Measures included perceived discrimination, perceived stress, social support, and social cohesion and were based on a theoretical model for the pathways by which perceived discrimination influences mental and physical health. Quality of life was measured using the SF-12 questionnaire. The final model [χ(2)(106) = 157.35, P = 0.009, R(2) = 0.99, root mean square error of approximation = 0.03, comparative fit index = 0.99] indicates direct effects of higher perceived stress (r = -1.02, P < 0.05) and lower social support (r = 0.36, P < 0.001) significantly related to decreased mental health component score (MCS) of quality of life. Discrimination and social cohesion were not significantly directly related to MCS. However, higher discrimination (r = 0.47, P < 0.001), higher social cohesion (r = 0.14, P < 0.05), and lower social support (r = -0.43, P < 0.001) were significantly directly related to increased stress. No significant paths were found for the physical component score of quality of life. Perceived discrimination was significantly associated with stress and served as a pathway to influence the mental health component of quality of life (MCS). Social support had a direct and an indirect effect on MCS through a negative association with stress. These results suggest that future interventions should be developed to decrease stress and increase social support surrounding discrimination to improve the MCS of quality of life in patients with diabetes.

Adult spinal deformity: a very heterogeneous population of patients with different needs.

The purpose of this study was to analyze and demonstrate the heterogeneity in adult spinal deformity (ASD) populations by baseline health-related quality of life (HRQL) data. ASD was defined as patients over 18 years of age with any of the following: coronal deformity >20°, sagittal vertical axis (SVA) >5 cm, pelvic tilt >25°, or thoracic kyphosis >60°. Three hundred fifty-two patients meeting the above definition of ASD were analyzed for measures of HRQL (Oswestry disability index [ODI], SRS-22 [Scoliosis Research Society-22], and SF-36 [Short form-36 health survey] questionnaires) at presentation. Age groups were defined as 18-40, 40-60, and >60 years. Deformity was analyzed as either degenerative (DS) or idiopathic (IS) (294 patients; 71 degenerative, 223 idiopathic). There were significant differences between age groups--predominantly between the lower age group (18-40) and others--for all HRQL parameters except SRS-22 mental health and SF-36 mental component score. Similarly, HRQL measures for DS and IS deformities were significantly different. Regarding location of main curves, thoracolumbar/lumbar (TL/L) (70.2%) was dominant for the DS group and thoracic (55%) for the IS group. Mean age was 65 years for the DS group and 36 for the IS group, which were significantly different. Radiographic parameters were also significantly different between these groups, with IS patients having more coronal deformity and better sagittal balance. ASD patients are very heterogeneous at presentation, depending on age and diagnosis. There is a distinct need to stratify ASD as early and late presentation ASD and/or by diagnosis. Patients with IS deformity may be very different from those with DS deformity, even at time of presentation. These differences must be taken into consideration in treatment of these patients, as well as for the analysis of the results of treatment.

Quality of life among pulmonary hypertension patients in Finland

BackgroundThe purpose of the study was to examine pulmonary hypertension (PH) patients’ quality of life (QOL) for the first time in Finland.MethodsThis was a non-interventional, cross-sectional study. The SF-36v2 questionnaire was sent to the PH patients who had been referred to or followed up on at the Helsinki University Central Hospital's pulmonary clinic for idiopathic pulmonary arterial hypertension, associated pulmonary arterial hypertension (APAH), or chronic thromboembolic PH (CTEPH). The patients were on pulmonary arterial hypertension (PAH) – specific drugs, were at least 18 years old, and had signed an informed consent.ResultsThere were 62 patients who fulfilled the inclusion criteria, and 53% of respondents rated their health as moderate. Similarly, 55% of respondents rated their health status approximately the same compared to their situation 1 year ago. QOL was impaired in all other subscales, except for the mental health and mental component score. A majority of patients suffered from PH symptoms, which worsened their QOL. The greatest impact on their QOL was associated with a high World Health Organization (WHO) functional class (FC), poor performance in a 6-min walking test (6MWT), symptoms, oxygen therapy, elevated pro-brain natriuretic peptide, pericardial effusion, APAH etiology, and being retired from work.ConclusionsThe respondents had a reduced QOL, compared to the general population, in all other subscales, except for mental health. APAH patients had the worst QOL. Good results in functional capacity measures (WHO FC, 6MWT) were associated with a better QOL. Patients’ QOL can be improved by reducing the symptoms of PAH.

Assessment of Anemia and Quality of Life in Patients With Renal Transplantation

PurposeAnemia is associated with poor quality of life in dialysis patients. However, data on this association are scarce on transplant patients. We aimed to find the frequency of anemia, and the effect of anemia on the quality-of-life parameters in patients who have undergone kidney transplantation. MethodsAnemia was defined by a hemoglobin (Hgb) level of <12 g/dL and severe anemia by a Hgb level of <10 g/dL. All patients were evaluated with the Kidney Disease Quality of Life (KDQOL-SF) scale forms. ResultsTwo hundred patients (128 male and 72 female; mean age, 39.2 ± 11.5 years) were examined. Anemia was found in 19% and severe anemia was found in 4.5% of all patients. Low glomerular filtration rate, young age, and female gender were demographic parameters associated with anemia. Parathormone levels were higher in the anemic group. The use of angiotensin converting enzyme inhibitors, angiotensin receptor blockers, and mammalian target of rapamycin inhibitors was significantly higher in the anemic group. In addition, patients with anemia had a lower KDQOL-SF mental health component score than that of the patients without anemia. ConclusionsAnemia was related to the degree of renal function in posttransplant patients. Anemia had an important influence on mental health in renal transplant patients.

Validation of the Chinese Western Ontario and McMaster Universities Osteoarthritis Index in Patients From Mainland China With Osteoarthritis of the Knee.

To establish the reliability, validity, and sensitivity to change of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) among Chinese subjects with osteoarthritis (OA) of the knee, living in mainland China. A multicenter, randomized, double-blind, placebo-controlled, parallel-group study was conducted for validation of the electronic personal digital assistant version of the WOMAC Numerical Rating Scale (NRS) 3.1 Index in China. A total of 287 subjects with OA of the knee were randomized to receive either meloxicam (15 mg) or placebo. Psychometric properties of the WOMAC were evaluated by estimating the reliability, validity, and sensitivity to change. Equivalence of the electronic version was also compared with the paper version. Intraclass correlation coefficients for the WOMAC pain, stiffness, and physical function subscales were 0.81, 0.76, and 0.85, respectively, indicating good test-retest reliability. Similarly, internal consistency was strong (Cronbach's alpha for the 3 WOMAC subscales was 0.84, 0.86, and 0.96, respectively). Pearson's correlation coefficients for WOMAC pain and Short Form 36 health survey (SF-36) bodily pain, as well as WOMAC physical function and SF-36 physical functioning domains were >0.4, indicating convergent validity, whereas the coefficients for all 3 WOMAC domains with SF-36 mental health and mental health component scores were <0.4, indicating divergent validity. There was strong discriminant validity between healthy volunteers and OA patients. The effect sizes of change from baseline to week 12 in WOMAC subscale scores were large, demonstrating sensitivity to change. Equivalence between paper and electronic versions was very high. The culturally and linguistically validated Chinese version of the WOMAC NRS 3.1 for mainland China is psychometrically robust in its validity, reliability, and sensitivity to change for patients with OA of the knee.

Depression Screening in Chronic Disease Management

This pilot project aimed to improve depression symptoms and quality-of-life measures for individuals in a worksite disease management program. Two hundred forty-three individuals were invited to participate, out of which 69 enrolled. The participants had a history of diabetes, hypertension, or hyperlipidemia, and demonstrated depression using the Patient Health Questionnaire-9 (PHQ-9). The project consisted of counseling sessions provided every 2 to 4 weeks by a family nurse practitioner. PHQ-9 scores and those of an instrument that measures quality of life, the Veteran's Rand-12 (VR-12), were compared pre-intervention and post-intervention to evaluate the effectiveness of the project. PHQ-9 and VR-12 Mental Health Component (MHC) scores improved significantly after 3 months of nurse practitioner-led individual counseling sessions. This project demonstrated that depression screening and therapeutic management, facilitated by a nurse practitioner, can improve depression and perceived quality of life in individuals with hypertension, hyperlipidemia, or type 2 diabetes.

Mental Health Following Acquisition of Disability in Adulthood--The Impact of Wealth.

BackgroundAcquisition of a disability in adulthood has been associated with a reduction in mental health. We tested the hypothesis that low wealth prior to disability acquisition is associated with a greater deterioration in mental health than for people with high wealth.MethodsWe assess whether level of wealth prior to disability acquisition modifies this association using 12 waves of data (2001–2012) from the Household, Income and Labour Dynamics in Australia survey–a population-based cohort study of working-age Australians. Eligible participants reported at least two consecutive waves of disability preceded by at least two consecutive waves without disability (1977 participants, 13,518 observations). Fixed-effects linear regression was conducted with a product term between wealth prior to disability (in tertiles) and disability acquisition with the mental health component score of the SF–36 as the outcome.ResultsIn models adjusted for time-varying confounders, there was evidence of negative effect measure modification by prior wealth of the association between disability acquisition and mental health (interaction term for lowest wealth tertile: -2.2 points, 95% CI -3.1 points, -1.2, p<0.001); low wealth was associated with a greater decline in mental health following disability acquisition (-3.3 points, 95% CI -4.0, -2.5) than high wealth (-1.1 points, 95% CI -1.7, -0.5).ConclusionThe findings suggest that low wealth prior to disability acquisition in adulthood results in a greater deterioration in mental health than among those with high wealth.

Health locus of control and cardiovascular risk factors in veterans with type 2 diabetes.

Perceptions of control impact outcomes in veterans with chronic disease. The purpose of this study was to examine the association between control orientation and clinical and quality of life (QOL) outcomes in male veterans with type 2 diabetes (T2DM). Cross-sectional study of 283 male veterans from a primary care clinic in the southeastern US. Health locus of control (LOC) was the main predictor and assessed using the Multidimensional Health LOC Scale. Clinical outcomes were glycosylated hemoglobin A1c (HbA1c), systolic and diastolic blood pressure, and low-density lipoprotein cholesterol (LDL-C). Physical (PCS) and mental (MCS) health component scores for QOL were assessed using the Veterans RAND 12-Item Health Survey. Unadjusted and adjusted multivariate analyses were performed to assess associations between LOC and outcomes. Unadjusted analyses showed internal LOC associated with HbA1c (β = 0.036; 95% CI 0.001, 0.071), external LOC:powerful others inversely associated with LDL-C (β = -0.794; 95% CI -1.483, -0.104), and external LOC:chance inversely associated with MCS QOL (β = -0.418; 95% CI -0.859, -0.173). These associations remained significant when adjusting for relevant covariates. Adjusted analyses also demonstrated a significant relationship between external LOC:chance and PCS QOL (β = 0.308; 95% CI 0.002, 0.614). In this sample of male veterans with T2DM, internal LOC was significantly associated with glycemic control, and external was significantly associated with QOL and LDL-C, when adjusting for relevant covariates. Assessments of control orientation should be performed to understand the perceptions of patients, thus better equipping physicians with information to maximize care opportunities for veterans with T2DM.