Mental Health Quality Of Life Scores Research Articles

Patient-Reported Quality of Life in Adolescents and Young Adults with Cancer before, during, and after Radiation Therapy

<h3>Purpose/Objective(s)</h3> Adolescents and young adults (AYAs, 15-39 yo) with cancer have unique vulnerabilities that affect quality-of-life (QOL) during treatment and in survivorship. Yet, few studies have assessed QOL in AYAs with cancer who received radiation therapy (RT). Therefore, we performed a cross-sectional study in AYAs with cancer who completed patient-reported outcomes (PROs) assessing QOL before, during, or after RT. <h3>Materials/Methods</h3> We identified 265 AYAs with cancer who were treated with RT and completed an AYA PRO survey from 2019-2022. The survey containing ten validated PRO instruments from the PROMIS inventory: Global Physical and Mental Health, Anxiety, Depression, Fatigue, Sleep Disturbance, Social Roles, Pain Interference, and Cognitive Function (score of 50 represents the mean from the reference U.S. general population; higher score represents more of the concept being measured). Patients were stratified into 3 cohorts based on the date of PRO completion: before RT, peri-RT (during RT or within 6 months of RT completion), or after RT (6+ months following RT completion). Mean (standard deviation [SD]) PRO scores were calculated. Patient characteristics were extracted from the medical record. Kruskal-Wallis analysis was used to compare scores between cohorts. ANOVA and t-test analyses were used to compare scores between co-variates. <h3>Results</h3> 87 (33%) patients completed PROs before RT, 84 (32%) peri-RT, and 94 (35%) after RT; median [IQR] age was 28 [21-33], 26 [20-32], and 22 [17-27], respectively. Cancer types varied; most had sarcoma (26%) or CNS cancer (23%). Compared to the before RT cohort, the peri-RT cohort had worse Global Physical and Mental Health PRO scores [SD] (48.7 [8.9] vs. 44.9 [9.8] (p=0.03) and 50.9 [8.6] vs. 46.2 [10.3] (p<0.01), respectively). These PRO scores were similar between the peri- and after RT cohorts (44.9 [9.8] vs. 45.5 [9.8] (p=0.68) and 46.2 [10.3] vs. 47.9 [9.6] (p=0.26), respectively). Compared to the before RT cohort, the peri- and after RT cohorts had better Anxiety PRO scores [SD] (55.2 [9] vs. 52.6 [10.4] and 51 [10], respectively, p=0.02). Remaining PRO scores were similar between cohorts (p>0.05). In the peri-RT cohort, patients with any acute RT toxicity had worse Pain Interference PRO scores [SD] vs. patients with none (50.8 [8.9] vs. 44.7 [5.7], p=0.03). In the after RT cohort, adolescents (15-18 yo) and young adults (26-39 yo) had worse Global Mental Health PRO scores [SD] vs. emerging adults (19-25 yo) (46.9 [9.1] and 47.9 [11.2], respectively, vs. 53.8 [9.2], p=0.04); patients with any late RT toxicity had worse Sleep Disturbance PRO scores [SD] vs. patients with none (58.4 [8] vs. 52.4 [9.2], p<0.001). <h3>Conclusion</h3> AYAs with cancer reported lower general physical and mental health QOL scores during RT, which persisted into survivorship. Developmental age, stage, and presence of RT toxicities may contribute to differing scores. Future longitudinal analyses are needed to improve QOL for AYAs receiving RT.

Prospective associations of better quality of the diet with improved quality of life over 7.5 years in people with multiple sclerosis

BackgroundThere is increasing interest in the role of diet in multiple sclerosis (MS) progression and whether a healthier diet may lead to improved health and wellbeing in people living with MS (plwMS). ObjectiveTo assess the prospective relationship of the quality of dietary intakes with quality of life (QoL) in an international cohort of plwMS followed over 7.5 years. MethodsData from the Health Outcomes and Lifestyle In a Sample of people with Multiple sclerosis (HOLISM) cohort from baseline to 7.5-year review were analysed. Quality of the diet was assessed using the Diet Habits Questionnaire (DHQ). QoL was measured by the MSQOL-54, including physical and mental health composite scores and multiple subdomains. Linear regression was used to determine cross-sectional and prospective relationships with QoL, adjusted for clinical and demographic covariates. ResultsAmongst 948 participants, median physical- and mental-health QoL scores at 7.5-year review were 66.9 and 78.2, respectively. Baseline total DHQ was positively associated with subsequent change in physical-QoL to 7.5-year review, such that participants in the top two quartiles of baseline DHQ had 0.65 and 0.64 higher physical-QoL per year, though a similar association with mental-QoL did not persist on adjustment. Baseline meat consumption was associated with 0.38 lower physical-QoL per year, while baseline dairy consumption was associated with 0.50 and 0.41 lower physical- and mental-QoL per year, respectively. ConclusionsThese results suggest efforts to improve the quality of dietary intake could be beneficial to the wellbeing of plwMS. Subject to replication, this aspect of lifestyle could be a useful intervention in better managing MS.

PD25-03 THE INCIDENCE AND PREDICTORS OF FINANCIAL TOXICITY IN A PROSPECTIVE COHORT OF PATIENTS WITH NON-MUSCLE INVASIVE BLADDER CANCER

You have accessJournal of UrologyHealth Services Research: Value of Care: Cost and Outcomes Measures II (PD25)1 Sep 2021PD25-03 THE INCIDENCE AND PREDICTORS OF FINANCIAL TOXICITY IN A PROSPECTIVE COHORT OF PATIENTS WITH NON-MUSCLE INVASIVE BLADDER CANCER Vidit Sharma, Katherine E Fero, Patrick M Lec, Valerie S Lee, Isaac J Ergas, Janise M Roh, Karim Chamie, Mark Schoenberg, David S Aaronson, Devon K Check, Reina Haque, Lawrence H Kushi, Li Tang, and Marilyn L Kwan Vidit SharmaVidit Sharma More articles by this author , Katherine E FeroKatherine E Fero More articles by this author , Patrick M LecPatrick M Lec More articles by this author , Valerie S LeeValerie S Lee More articles by this author , Isaac J ErgasIsaac J Ergas More articles by this author , Janise M RohJanise M Roh More articles by this author , Karim ChamieKarim Chamie More articles by this author , Mark SchoenbergMark Schoenberg More articles by this author , David S AaronsonDavid S Aaronson More articles by this author , Devon K CheckDevon K Check More articles by this author , Reina HaqueReina Haque More articles by this author , Lawrence H KushiLawrence H Kushi More articles by this author , Li TangLi Tang More articles by this author , and Marilyn L KwanMarilyn L Kwan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002018.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Even though non-muscle invasive bladder cancer (NMIBC) has high costs care, the patient-level impact of this cost (“financial toxicity”) has been understudied. We describe predictors and quality-of-life (QOL) implications of financial toxicity in a prospective cohort of NMIBC survivors. METHODS: The Bladder Cancer Epidemiology, Wellness, and Lifestyle Study is a prospective cohort of newly diagnosed NMIBC patients at Kaiser Permanente Northern and Southern California. Financial toxicity was assessed using the COST-FACIT questionnaire (scale 0 to 44, with lower score having more financial toxicity) at 2-years post-diagnosis. QOL was assessed using the PROMIS global health questionnaire’s physical and mental health domains at 2-years post-diagnosis. Demographic and oncologic associations with financial toxicity were examined using descriptive statistics and multivariable generalized linear regression models. RESULTS: In a cohort of 412 participants, the mean (SD) COST and PROMIS physical and mental health QOL scores at 2-years post-diagnosis were: 36.6 (7.3), 16.2 (2.3), 15.4 (2.7), respectively. The correlation between the COST and PROMIS physical and mental health scores was r=0.36 (p<0.01) and r=0.38 (p<0.01), respectively, suggesting a modest association between financial toxicity and QOL. Between 4–16% of participants reported some financial strain from NMIBC on specific COST questions (Figure 1). At 2-years, 5% of patients described the financial burden of NMIBC as being significant, and 2% of patients experienced financial distress from treating their cancer. On regression analysis, younger age (coefficient -0.12, p<0.01) and NMIBC progression (coefficient -2.9, p=0.04) were associated with increased financial toxicity (reduced COST score). Gender or race/ethnicity were not significantly associated with financial toxicity. CONCLUSIONS: In a vertically integrated health system, financial toxicity from NMIBC was less prevalent than reported in prior studies in conventional health systems. However, younger age and NMIBC progression were associated with increased financial toxicity, suggesting a need to identify mitigation strategies for such patients. Source of Funding: Vidit Sharma is supported by the VA HSRD fellowship © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e432-e432 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Vidit Sharma More articles by this author Katherine E Fero More articles by this author Patrick M Lec More articles by this author Valerie S Lee More articles by this author Isaac J Ergas More articles by this author Janise M Roh More articles by this author Karim Chamie More articles by this author Mark Schoenberg More articles by this author David S Aaronson More articles by this author Devon K Check More articles by this author Reina Haque More articles by this author Lawrence H Kushi More articles by this author Li Tang More articles by this author Marilyn L Kwan More articles by this author Expand All Advertisement Loading ...

Physical activity, ethnicity, and quality of life among breast cancer survivors and population-based controls: the long-term quality of life follow-up study.

To explore the relationship between physical activity (PA) and quality of life (QOL) among Hispanic and non-Hispanic white breast cancer (BC) cases and population-based controls from the New Mexico 'Long-Term Quality of Life Study'. Self-reported PA (low, moderate, vigorous MET hours/week) at baseline and follow-up interviews (12-15years) were available for 391 cases and controls and modeled using multiple linear regressions with SF-36 mean composite scores for physical and mental health. The change in PA from baseline to follow-up and interactions with ethnicity were also examined. Models were adjusted for age at diagnosis/baseline interview, education, comorbidities, body mass index, and change in PA. PA intensities at each timepoint did not differ by case/control status; however, the change in vigorous PA was lower among cases (p = 0.03). At follow-up, low intensity PA increased mental health QOL scores among cases; however, the interaction between low intensity PA and ethnicity was statistically significant among controls indicating decreased mental health among Hispanics (p = 0.02). Change in moderate PA was associated with increased physical and mental health among cases (physical: β = 0.186, p = 0.008; mental: β = 0.225, p = 0.001) and controls (physical: β = 0.220, p < 0.0001; mental: β = 0.193, p = 0.002), when controlling for confounders. Our results demonstrate that all levels of PA are important for mental health among BC cases, while activities of higher intensity are important for physical health among women overall. The statistical interaction observed between ethnicity and low intensity PA among controls for mental health warrants further research to provide a meaningful interpretation.

Quality of Life in Adolescent and Young Adult Women With Dyspareunia and Endometriosis

PurposeThe purpose of this study is to quantify the prevalence of dyspareunia and its impact on quality of life (QOL) in adolescent and young adult women (AYA) diagnosed with endometriosis. MethodsEligible participants from the Women’s Health Study: From Adolescence to Adulthood, a longitudinal cohort study, were AYA 18–25 years who reported having had sexual intercourse. We included n = 151 AYA with a surgical diagnosis of endometriosis and n = 287 without known endometriosis. Participants completed a questionnaire including the Short Form-36 (SF-36) QOL survey, on which lower scores indicate impairment. Dyspareunia was defined as answering “yes” to having had pain during/within 24 hours following sexual intercourse. Normative-based scores for SF-36 subscales were calculated and compared between groups using linear regression adjusted for age, body mass index, educational level, and race. ResultsParticipants with endometriosis experienced dyspareunia twice as often (79%) than AYA without endometriosis (40%, p < .0001). In participants with and without endometriosis, all SF-36 subscale scores were significantly lower in AYA with dyspareunia than without. For six subscales, the negative impact was significantly stronger in AYA with endometriosis than those without, and mean scores were all less than the normative score, indicating impairment. ConclusionsMore than three quarters of AYA with endometriosis and two thirds without experience dyspareunia that negatively impacts both physical and mental health QOL scores. This impairment is stronger in those with endometriosis. Given the importance of relationships and peer engagement for identity formation during adolescence, dyspareunia could be particularly impactful. Clinicians should ask patients not only about contraception and prevention of sexually transmitted infections, but inquire about how dyspareunia may impact mental and physical well-being.

Quality of Life in Jugular Paraganglioma Following Radiosurgery.

The treatment paradigm for jugular paraganglioma (JP) has changed considerably over time with the wider adoption of stereotactic radiosurgery (SRS). To the best of the authors' knowledge, there are no published studies that use validated patient-reported outcome measures to ascertain quality of life (QoL) outcomes following SRS for JP when used in single or combined modality treatment regimens. Cross-sectional survey. Tertiary referral center. Adult patients with JP treated with primary SRS or SRS following primary surgery between 1990 and 2017. Surgery and/or Gamma Knife SRS. Global and treatment-related QoL and differences in QoL based on treatment approach. Sixty-nine surveys were distributed and a total of 26 completed surveys were received (38% response rate). Among respondents, the median age at SRS was 53 years and 16 of the 26 patients (62%) were female. Median follow-up was 97 months. Nineteen patients (73%) were treated with primary SRS or staged SRS following intentional subtotal resection (STR; hereafter referred to as "staged SRS"), while the remainder (n = 7, 27%) were treated with SRS for recurrent JP. Median physical and mental health QoL PROMIS-10 T-scores regardless of treatment strategy were 39.8 and 38.8, respectively, while median SF36 physical and mental component subscores were similar to national averages and non-tumor controls. When comparing general physical and mental health QoL scores, there was no significant difference between patients treated with primary or staged SRS and those treated with SRS for recurrent JP. However, age-adjusted swallowing function among patients treated with primary or staged SRS was better than in those patients treated with SRS for recurrent JP (p = 0.05). Patients treated with primary or staged SRS for JP tend to exhibit better swallowing outcomes than those treated with SRS for recurrent JP. However, the majority of overall and disease-specific quality of life measures were not different between groups. Based on the low incidence of new cranial neuropathy following SRS, it is likely that initial surgical morbidity is the primary contributor to this outcome. Disease-specific overall quality of life measures, akin to those already used for other benign skull base tumors, are necessary to better gauge physical and mental health outcomes following treatment for JP. Though limited by small sample size, this represents the first study to gauge QoL outcomes following treatment for JP.

A Mediterranean-style dietary intervention supplemented with fish oil improves diet quality and mental health in people with depression: A randomized controlled trial (HELFIMED)

Objectives: We investigated whether a Mediterranean-style diet (MedDiet) supplemented with fish oil can improve mental health in adults suffering depression.Methods: Adults with self-reported depression were randomized to receive fortnightly food hampers and MedDiet cooking workshops for 3 months and fish oil supplements for 6 months, or attend social groups fortnightly for 3 months. Assessments at baseline, 3 and 6 months included mental health, quality of life (QoL) and dietary questionnaires, and blood samples for erythrocyte fatty acid analysis.Results: n = 152 eligible adults aged 18–65 were recruited (n = 95 completed 3-month and n = 85 completed 6-month assessments). At 3 months, the MedDiet group had a higher MedDiet score (t = 3.95, P < 0.01), consumed more vegetables (t = 3.95, P < 0.01), fruit (t = 2.10, P = 0.04), nuts (t = 2.29, P = 0.02), legumes (t = 2.41, P = 0.02) wholegrains (t = 2.63, P = 0.01), and vegetable diversity (t = 3.27, P < 0.01); less unhealthy snacks (t = −2.10, P = 0.04) and red meat/chicken (t = −2.13, P = 0.04). The MedDiet group had greater reduction in depression (t = −2.24, P = 0.03) and improved mental health QoL scores (t = 2.10, P = 0.04) at 3 months. Improved diet and mental health were sustained at 6 months. Reduced depression was correlated with an increased MedDiet score (r = −0.298, P = 0.01), nuts (r = −0.264, P = 0.01), and vegetable diversity (r = −0.303, P = 0.01). Other mental health improvements had similar correlations, most notably for increased vegetable diversity and legumes. There were some correlations between increased omega-3, decreased omega-6 and improved mental health.Discussion: This is one of the first randomized controlled trials to show that healthy dietary changes are achievable and, supplemented with fish oil, can improve mental health in people with depression.

The Relationship of Patient–Provider Communication on Quality of Life among African-American and White Cancer Survivors

Prior research has demonstrated poorer patient–provider communication ratings among African American compared to White patients. The quality of patient–provider communication has been shown to impact treatment outcomes among cancer patients. A secondary data analysis design was used to determine the relationship of six patient–provider communication variables on the physical health quality of life (PHQOL) and mental health quality of life (MHQOL) of African American and White cancer patients (N = 479). We also examined whether the relationship between communication patterns and QOL differed based on race/ethnicity. Mean physical and mental health QOL scores for the sample were 69.8 and 77.6, respectively. After controlling for significant sociodemographic, clinical, and hospital variables, results showed that patients who experienced fewer interpersonal communication barriers who were more satisfied with the information given by providers had higher PHQOL and MHQOL scores. Additionally, patients who felt more comfort in asking questions or had fewer unmet information needs had higher MHQOL. A stratified analysis showed that the relationship of overall satisfaction with information on MHQOL was stronger among African American patients than White patients. Future research should focus on the development of interventions to improve patient–provider communication as a means for enhancing QOL outcomes among cancer survivors.

Effects of a Mediterranean-style diet on mental health and quality of life in people with depression

Background/Aims: Poor diets are an independent risk factor for depression while healthy diets are protective. Traditional Mediterranean diets (MedDiet) are associated with reduced cardiovascular disease risk which overlaps with depression. We investigated whether MedDiet can improve mental health. Methods: A total of 163 adults aged 18-65 with self-reported depression participated in a randomised controlled trial (RCT) providing nutrition education and fortnightly food hampers and cooking workshops for 3 months with 6 months follow-up. The control group attended fortnightly social groups. Participants completed mental health, quality of life (QoL) and dietary questionnaires. Data were analysed using linear mixed modelling and Pearson correlations. Results: In comparison to the control group at 3 months the treatment group had a higher MedDiet score (t = 4.27, p < 0.001), consumed more vegetables (t = 3.95, p < 0.001), fruit (t = 2.11, p = 0.037), nuts (t = 2.43, p = 0.016), wholegrains (t = 2.39, p = 0.018) and legumes (t = 2.45, p = 0.016), greater diversity of vegetables (t = 3.46, p = 0.001) and fruit (t = 2.08, p = 0.040) and less unhealthy snacks (t = -2.20, p = 0.030) and red meat/chicken (t = -2.25, p = 0.026). The treatment group had reduced depression scores (t = -2.02, p = 0.045), and higher mental health QoL scores (t = 2.17, p = 0.032). Reduced depression scores were correlated with increased MedDiet (r = -0.275, p = 0.006), consumption of nuts (r = -0.251, p = 0.011), legumes (r = -0.233, p = 0.018), and greater diversity of vegetables (r = -0.284, p = 0.004). Similar correlations were seen with other mental health and QoL improvements, particularly for legumes and diversity of vegetables and fruit. All changes were sustained at 6 months. Conclusions: This is one of the first RCTs to show a benefit of diet for mental health.;

Abstract P1-09-27: High serum levels of 25-hydroxyvitamin D are associated with better quality-of-life, and lower levels of perceived stress, depression, and fatigue among breast cancer survivors

Abstract Background: Recent evidence suggests a role for vitamin D in breast cancer etiology and survival. Although data are not definitive, breast cancer survivors might derive additional benefits from adequate vitamin D levels, including better quality-of-life (QoL) and psychosocial well-being. Objective: Using a prospective study design, we examined associations between QoL and psychosocial functioning among breast cancer survivors and circulating 25(OH)D levels at the time of initial breast cancer diagnosis and 1 year post diagnosis. Methods: Women (n=504) with incident breast cancer (stages 0-III) were recruited prior to initiating breast cancer treatment at Roswell Park Cancer Institute (RPCI), with 372 patients also providing data 1 year later. Demographic and clinical data were obtained from the RPCI Surgical Oncology Breast Database. At each time point, participants provided blood samples and completed surveys on mental and physical health (SF36 Health Survey), perceived stress (Perceived Stress Scale), depression (Center for Epidemiologic Studies Depression Scale), and their experiences with fatigue (Multidimensional Assessment of Fatigue Scale). Serum 25(OH)D levels were measured by immunochemiluminometric assays. Results: Median 25(OH)D levels at diagnosis and 1 year post were 23.8 ng/ml (range 0.1-67.4) and 26.6 ng/ml (range 3.0 – 80.0), respectively. At the time of diagnosis, multivariate logistic regression analyses indicated that women with sufficient levels of 25(OH)D (≥ 30 ng/ml) had ∼50% lower odds of reporting poor physical health (OR=0.52, 95% CI: 0.29, 0.90) or poor mental functioning (OR=0.54, 95% CI: 0.31, 0.95) compared to women with deficient levels (&amp;lt;20 ng/ml). Women with higher 25(OH)D were also less likely to report high levels (&amp;gt;median) of perceived stress (OR=0.45, 95% CI: 0.26-0.80), depression (OR=0.46, 95% CI: 0.25-0.83) or fatigue (OR=0.54, 95% CI: 0.31, 0.92). Findings were similar 1 year later, with reduced odds of poor physical health (OR=0.47, 95% CI: 0.24-0.93), poor mental health (OR=0.62, 95% CI: 0.33, 1.13), high levels of perceived stress (OR=0.67, 95% CI: 0.36, 1.25), depression (OR=0.33, 95% CI: 0.15, 0.71), and fatigue (OR=0.45, 95% CI: 0.24, 0.84). Changes in vitamin D levels over the 1 year period were also assessed. While none of the relationships were significant, women in the upper tertile of vitamin D change (&amp;gt;3.99 ng/ml) were more likely to report low mental health and higher levels of perceived stress at 1 year compared to patients with declines in 25(OH)D of &amp;gt;0.95 ng/ml, but were less likely to report poor physical health or fatigue. This may have been due, in part, to women being somewhat more likely to use vitamin D supplements if they reported lower mental health QoL scores. Changes in circulating 25(OH)D levels during this 1 year period were strongly associated with use of supplements (p=0.001). Conclusions: Breast cancer survivors with adequate vitamin D levels were less likely to report poor QoL compared to women with deficient vitamin D levels. Maintenance of optimal vitamin D levels may help improve breast cancer patients’ QoL as they go through breast cancer treatment. Citation Format: Chi-Chen Hong, Song Yao, Yali Zhang, Shicha Kumar, Christine Ambrosone. High serum levels of 25-hydroxyvitamin D are associated with better quality-of-life, and lower levels of perceived stress, depression, and fatigue among breast cancer survivors [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P1-09-27.

Fear of recurrence, treatment satisfaction, and quality of life after radical prostatectomy for prostate cancer

Fear of cancer recurrence (FOR) is common in prostate cancer patients, but little research has examined the impact of FOR on quality of life (QOL) or the mechanism by which these fears become intensified. The objective of this study was to examine treatment satisfaction (TS) as a moderator of the relationship between FOR and QOL. Data were drawn from the CaPSURE database, a 12,000-man national observational prostate cancer registry. Three hundred and thirty-three patients who underwent radical prostatectomy (RP) to treat their prostate cancer completed self-report measures. TS was measured 0-6 months post-RP with a nine-item scale developed for this study, FOR was measured 6-12 months post-RP with a previously validated five-item scale, and QOL was measured 12-18 months post-RP with the Short Form 36. After controlling for age, education, number of comorbid medical conditions, and cancer severity, lower FOR (B = -0.12, p < 0.0001), higher TS (B = 0.09, p < 0.001), and the interaction of TS x FOR (B = 0.87, p < 0.05) significantly predicted higher mental health QOL scores. Furthermore, lower FOR (B = -0.08, p < 0.01), and the interaction of TS x FOR (B = -1.11, p < 0.01) significantly predicted higher physical health QOL scores. TS levels mitigated the impact of high FOR on lower levels of QOL. Specifically, patients who reported lower TS and greater FOR endorsed significantly lower levels of QOL compared to other patients in the sample.

Quality of life and lifestyle among city dwellers participating in the medical programs

In order to offer health education to the general population, taking into account not only their physical health but also their QOL (quality of life), it is necessary to clarify what guidance should be provided in the sight of QOL. In this study, the relationship between QOL and lifestyle was investigated in 615 Japanese (402 males, 213 females; ranging in age from teens to nineties; mean age, 43.4 +/- 16.3 years) undergoing medical checkups. After informed consent was obtained, subjects completed a questionnaire incorporating the Medical Outcome Study 36-item Short Form Health Survey as a QOL scale in addition to questions concerning individual and lifestyle factors. The results showed that most individual factors and lifestyle factors evaluated were related to QOL. In particular, the physical health QOL of elderly subjects, females, and single subjects, was lower than that of other subjects. Moreover, subjects who ate 'irregular meals' and had 'less than 6 h sleep' reported lower mental health QOL scores than those who ate 'regular meals' and had '6 h or more sleep'. Smoking and alcohol consumption were not as significantly related to QOL as anticipated. Taking these findings into account, it is clear that it is necessary to offer medical and health services focusing on meals and sleep for medical program attendants in order to improve QOL.

Surgical outcome in gastro-esophageal reflux disease patients with inadequate response to proton pump inhibitors.

Laparoscopic fundoplication (LF) has been shown to be effective in treatment of patients with gastro-esophageal reflux disease (GERD) requiring long-term medical therapy. Its effectiveness in patients with poor response to proton pump inhibitors (PPIs) has been questioned. We prospectively followed 445 patients with proven GERD inadequately controlled on PPI (up to 120 mg/day) and 274 GERD patients with good response to PPIs (20-120 mg/day) after LF. Patients in both groups underwent 24 h pH testing, esophageal manometry, symptom score evaluation, and quality-of-life (QOL) assessment (SF-36) before and at 6 months, 2 years, and 5 years after surgery. LF was associated with a marked improvement in percentage acid reflux, lower esophageal sphincter pressure, and symptom control in both groups of patients; however, the poor responders to PPIs also had a significant improvement in both physical and mental health component of the QOL assessment. Laparoscopic fundoplication provides an excellent symptom control for GERD patients, even those who have responded inadequately to large doses of PPIs. GERD patients who respond poorly to PPI therapy have significantly lowered physical and mental health QOL scores. Laparoscopic fundoplication in this group of patients leads to marked improvement of both components of QOL by 2 years after surgery.