MOS 36-Item Short-Form Health Research Articles

Discordant assessment of lupus activity between patients and their physicians: the Singapore experience

Patients with systemic lupus erythematosus often assess their disease activity differently from their physicians. We studied the factors associated with this discordance. The data provided by 534 systemic lupus erythematosus patients were analyzed. We compared the physician and patient assessments of lupus activity on a visual-assessment scale from the same visit. We collected clinical data and scores from MOS 36-Item Short-Form Health Survey, Systemic Lupus Erythematosus Quality-of-Life Questionnaire, Rheumatology Attitudes Index, Systemic Lupus Erythematosus Disease Activity Index, and revised Systemic Lupus Activity Measure. Patients tended to score their disease activity higher than do their physicians, when these factors were present: poorer general health assessment, presence of thrombocytopenia, hypertension and urinary sediments, and difficulty in carrying groceries. Physicians tended to score the disease activity higher than do the patients in these circumstances proteinuria, hemolysis, use of azathioprine or cyclophosphamide, tiredness, photosensitivity, higher revised Systemic Lupus Activity Measure score, casturia, and patient report of being more easily ill than are other patients. There was only moderate correlation between the discordance in the baseline and the subsequent visits. The physician assessment of disease activity at baseline correlated better with an objective measure of disease activity (revised Systemic Lupus Activity Measure) in the subsequent visit than the patient assessment. In conclusion, discordance in the perception of disease activity between patients and physicians may be amenable to intervention.

The Preventive Health Behaviors of Long-Term Survivors of Cancer and Hematopoietic Stem Cell Transplantation Compared with Matched Controls

Little is known about the health promotion, prevention, and disease screening behaviors of cancer survivors treated with hematopoietic cell transplantation (HCT), who undergo arduous treatment and may be at particular risk for late effects and secondary malignancies. The purposes of this study were to examine the current health and secondary prevention behaviors of long-term HCT survivors compared with matched controls without cancer, and to identify sociodemographic and clinical factors associated with appropriate preventive practices. HCT survivors (n = 662) were drawn from 40 North American transplantation centers. Peer-nominated acquaintances of survivors matched on sex, age, education, and marital status served as controls (n = 158). Data were collected a mean of 6.7 years post-HCT (range, 1.8-22.6 years). Despite a greater frequency of physical exams, the HCT survivors had similar health and screening behaviors as the matched controls. Sociodemographic factors were associated with health prevention behaviors in expected ways. Some differences between disease group and type of transplant were found, with survivors of acute leukemia less likely to report regular exercise, autologous transplant survivors more likely than allogeneic transplant survivors to report screenings for breast and cervical cancer, and allogeneic transplant survivors more likely than autologous transplant survivors to report undergoing a skin exam in the previous year. Despite higher levels of engagement with health care providers, HCT survivors had similar health behaviors as matched controls and comparable to those reported by cancer survivors who did not undergo HCT. There remains considerable room for improvement. These findings support the need for further education of both HCT survivors and health practitioners.

Assessment of health-related quality of life of patients with chronic arthritis

The assessment of the quality of life as a subjective measure of therapeutic intervention outcome appears to be increasingly adopted by different fields of medicine. In contrast to conventional indicators of condition, which are recognized as objective outcomes, the health-related quality of life (HRQoL) focuses on the patient himself. HRQoL has been determined as the perception of the individual of his or her situation in the current culture and value system; it includes wishes, expectations and emotional responses of the individual related to his or her health. Chronic arthritis leads to irreversible structural changes in joints and consequently to impaired physical function and reduced HRQoL. Today there are validated disease specific ("target") questionnaires to assess HRQoL in patients with rheumatoid arthritis and ankylosing spondylitis, but not yet in patients with psoriatic arthritis. A disease specific questionnaire makes easier approach to patients suffering from a specific rheumatic condition; it enables the comparison of HRQoL among patients suffering from the different types of chronic arthritis. The most frequently used questionnaire in the assessment of the HRQoL of patients suffering from chronic arthritis is the generic MOS 36-Item Short-Form Health Survey (SF-36) which is considered as the "gold standard". It is a generic questionnaire for the assessment of HRQoL in patients with chronic arthritis. To our knowledge, there are only a few studies focused on the HRQoL of patients suffering from chronic arthritis in Serbia and Montenegro.

Test-retest evaluation of HAT-QoL and SF-36 in an HIV-seropositive sample

We sought to correct previously reported psychometric and content problems of the HIV/AIDS-Targeted Quality of Life Instrument (HAT-QoL) and to assess test-retest reliability of this revised HAT-QoL as well as the MOS 36-Item Short-Form Health Survey (SF-36) when used in an HIV-seropositive outpatient sample. A total of 153 participants randomly sampled from an HIV specialty and general medical clinics completed a test booklet that contained HAT-QoL and the SF-36; a random subsample of 60 participants were asked to return in approximately two weeks to complete the instruments again. Using the baseline sample, internal consistency coefficients of all final HAT-QoL dimensions were ≥0.80. The retest subsample, for which there were no significantly different characteristics than the baseline sample, completed the instruments again an average of 14.7 days after baseline completion. For HAT-QoL, only one (Provider Trust) of the nine dimensions revealed a significant test-retest difference (+5.9, p=0.05). All HAT-QoL intraclass correlation coefficients (ICCs) were ≥0.64 (seven values were ≥0.73). All effect sizes were small. For SF-36, two dimensions (Physical Functioning and Social Functioning) revealed significant test-retest differences, and one dimension (Mental Health) revealed a difference approaching significance (p=0.06). The SF-36 ICCs were similar to those for HAT-QoL, with the exception of three dimensions – Vitality, Role-Emotional and Mental Health (all were<0.56). Though most effect sizes were small, Social Functioning and Mental Health estimates were approaching more moderate effect sizes. HAT-QoL reveals considerable short-term stability and has psychometric features in the seropositive population comparable to instruments such as SF-36, while obtaining unique information.

Subjective sleepiness among patients with obstructive sleep apnea-hypopnea syndrome who were treated with a continuous positive airway pressure device

It has been reported that continuous positive airway pressure (CPAP) improves daytime sleepiness in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). However, in some patients, the Epworth sleepiness scale (ESS) score is high even on CPAP. We assessed the prevalence, quality of life (QOL), and other factors related to subjective sleepiness among Japanese patients with OSAHS who were treated with CPAP. Data regarding the patients’ characteristics, ESS score, QOL using the MOS 36-item short-form health survey, symptoms or problems, and CPAP-related factors, including CPAP compliance, were collected. The patients were divided into two groups according to their ESS score (≥11 or <11). Overall, 484 patients were assessed, of whom 108 (22.3%) had subjective sleepiness on CPAP. Patients with subjective sleepiness on CPAP had a lower score on several SF-36 subscales. On multivariate logistic analysis regression, shorter sleeping time (odds ratio [OR] 0.67 [0.53–0.85]), presence of mask-related problems (OR 1.96 [1.24–3.11]), and poor compliance (OR 1.68 [1.01–2.63]) were significantly associated with subjective sleepiness on CPAP. In conclusion, the prevalence of subjective sleepiness on CPAP among Japanese OSAHS patients was determined. Such patients had an impaired QOL. As significant associations between several factors and such sleepiness were found, these factors should be addressed in such patients.

A Randomized, Double-Blind, Sham-Controlled Study of Granulocyte/Monocyte Apheresis for Active Ulcerative Colitis

Activated granulocytes and monocytes/macrophages are implicated in the pathogenesis of ulcerative colitis. Open-label studies and clinical experience in Japan and Europe have suggested that granulocyte/monocyte apheresis is safe and effective in treating ulcerative colitis. We evaluated the efficacy of granulocyte/monocyte apheresis in a randomized, double-blind, sham-controlled trial in patients with active moderate-to-severe ulcerative colitis (Mayo score 6-11) in community-based and tertiary care centers. As intervention, we used granulocyte/monocyte apheresis with the Adacolumn Apheresis System (JIMRO, Ltd, Takasaki, Japan) or sham apheresis in a 2:1 ratio for 9 weeks of treatment in a North American pivotal study (N = 168) and in a smaller, companion study of identical design conducted in Europe and Japan (N = 47). In the pivotal study, clinical remission rates (Mayo score 0-2, with scores of 0 on rectal bleeding and 0 or 1 on endoscopic examination) were 17% and 11% for the granulocyte/monocyte apheresis (n = 112)- and sham-treatment groups, respectively (n = 56; P = .361). Clinical response (Mayo score reduction of >/=3 points from baseline) was observed in 44% and 39% of patients, respectively (P = .620). Similar changes were observed for the apheresis- and sham-treatment groups for endoscopic remission and response, and changes in Mayo and quality-of-life scores. The companion study and pooled data from both studies also yielded similar results. In this study, granulocyte/monocyte apheresis was well tolerated but did not demonstrate efficacy for induction of clinical remission or response in patients with moderate-to-severe ulcerative colitis.

Combination of antidepressants and cognitive behaviour therapy

This study examined the association of various clinical features of obsessive-compulsive disorder (OCD) with quality of life (QoL) in 102 adults with a principal diagnosis of OCD. Participants were assessed by trained clinicians using the Anxiety Disorders Interview Schedule 4th edition, the Yale-Brown Obsessive-Compulsive Scale, and an unstructured clinical interview. Subjects completed the MOS-36 Item Short Form Health Survey, and Beck Depression Inventory-II. Obsessive-compulsive symptom severity was negatively correlated with emotional health, social functioning and general health QoL. Depressive symptoms mediated the relationship between obsessive-compulsive symptom severity and emotional health, social functioning and general health QoL. Additionally, interference of obsessive-compulsive symptoms mediated the relationship between obsessive-compulsive symptom severity and emotional health, social functioning and general health QoL. Resistance against obsessive-compulsive symptoms mediated the relationship between obsessive-compulsive symptom severity and social functioning QoL. Diminished QoL is present in persons with OCD and is essential in understanding the complete clinical picture of OCD.

Cocaine rapid evaluation screening trials: Design, results, and lessons learned

This study examined the association of various clinical features of obsessive-compulsive disorder (OCD) with quality of life (QoL) in 102 adults with a principal diagnosis of OCD. Participants were assessed by trained clinicians using the Anxiety Disorders Interview Schedule 4th edition, the Yale-Brown Obsessive-Compulsive Scale, and an unstructured clinical interview. Subjects completed the MOS-36 Item Short Form Health Survey, and Beck Depression Inventory-II. Obsessive-compulsive symptom severity was negatively correlated with emotional health, social functioning and general health QoL. Depressive symptoms mediated the relationship between obsessive-compulsive symptom severity and emotional health, social functioning and general health QoL. Additionally, interference of obsessive-compulsive symptoms mediated the relationship between obsessive-compulsive symptom severity and emotional health, social functioning and general health QoL. Resistance against obsessive-compulsive symptoms mediated the relationship between obsessive-compulsive symptom severity and social functioning QoL. Diminished QoL is present in persons with OCD and is essential in understanding the complete clinical picture of OCD.

Teaching ethics and medical conduct in developing countries under unstable political conditions

This study examined the association of various clinical features of obsessive-compulsive disorder (OCD) with quality of life (QoL) in 102 adults with a principal diagnosis of OCD. Participants were assessed by trained clinicians using the Anxiety Disorders Interview Schedule 4th edition, the Yale-Brown Obsessive-Compulsive Scale, and an unstructured clinical interview. Subjects completed the MOS-36 Item Short Form Health Survey, and Beck Depression Inventory-II. Obsessive-compulsive symptom severity was negatively correlated with emotional health, social functioning and general health QoL. Depressive symptoms mediated the relationship between obsessive-compulsive symptom severity and emotional health, social functioning and general health QoL. Additionally, interference of obsessive-compulsive symptoms mediated the relationship between obsessive-compulsive symptom severity and emotional health, social functioning and general health QoL. Resistance against obsessive-compulsive symptoms mediated the relationship between obsessive-compulsive symptom severity and social functioning QoL. Diminished QoL is present in persons with OCD and is essential in understanding the complete clinical picture of OCD.

Integrated treatment of male and female desire disorders

This study examined the association of various clinical features of obsessive-compulsive disorder (OCD) with quality of life (QoL) in 102 adults with a principal diagnosis of OCD. Participants were assessed by trained clinicians using the Anxiety Disorders Interview Schedule 4th edition, the Yale-Brown Obsessive-Compulsive Scale, and an unstructured clinical interview. Subjects completed the MOS-36 Item Short Form Health Survey, and Beck Depression Inventory-II. Obsessive-compulsive symptom severity was negatively correlated with emotional health, social functioning and general health QoL. Depressive symptoms mediated the relationship between obsessive-compulsive symptom severity and emotional health, social functioning and general health QoL. Additionally, interference of obsessive-compulsive symptoms mediated the relationship between obsessive-compulsive symptom severity and emotional health, social functioning and general health QoL. Resistance against obsessive-compulsive symptoms mediated the relationship between obsessive-compulsive symptom severity and social functioning QoL. Diminished QoL is present in persons with OCD and is essential in understanding the complete clinical picture of OCD.

Neurobiology and treatment of cocaine dependence

This study examined the association of various clinical features of obsessive-compulsive disorder (OCD) with quality of life (QoL) in 102 adults with a principal diagnosis of OCD. Participants were assessed by trained clinicians using the Anxiety Disorders Interview Schedule 4th edition, the Yale-Brown Obsessive-Compulsive Scale, and an unstructured clinical interview. Subjects completed the MOS-36 Item Short Form Health Survey, and Beck Depression Inventory-II. Obsessive-compulsive symptom severity was negatively correlated with emotional health, social functioning and general health QoL. Depressive symptoms mediated the relationship between obsessive-compulsive symptom severity and emotional health, social functioning and general health QoL. Additionally, interference of obsessive-compulsive symptoms mediated the relationship between obsessive-compulsive symptom severity and emotional health, social functioning and general health QoL. Resistance against obsessive-compulsive symptoms mediated the relationship between obsessive-compulsive symptom severity and social functioning QoL. Diminished QoL is present in persons with OCD and is essential in understanding the complete clinical picture of OCD.

The Effect of Auditory Stress on Perception of Intraesophageal Acid in Patients With Gastroesophageal Reflux Disease

Most patients with gastroesophageal reflux disease (GERD) report that stress exacerbates their symptoms, yet mechanisms underlying this association remain unknown. We sought to determine the effect of an acute laboratory stressor on perceptual and emotional responses to intraesophageal acid perfusion in healthy controls and patients with GERD. Forty-six patients with heartburn and 10 healthy controls underwent upper endoscopy and, if negative, pH monitoring. Assessment of psychologic factors and health-related quality of life was done by a questionnaire. Perceptual and emotional responses to intraesophageal acid at baseline, during auditory stress, and during an auditory control condition were determined using a randomized crossover design. Plasma levels of norepinephrine, adrenocorticotropic hormone, and cortisol were assessed. Twenty-nine subjects were identified as nonerosive reflux disease and 17 as erosive esophagitis. Quality of life, psychologic profile, and personality assessment variables were similar among the 2 patient groups and the controls. There was a significant reduction in mean lag time to initial symptom perception and an increase in mean intensity rating and mean acid perfusion sensitivity score in the 2 patient groups during the stress period, which was not seen during the control condition. Healthy controls demonstrated lack of a significant change in all parameters of stimulus response functions to acid, regardless of condition. Acute auditory stress can exacerbate heartburn symptoms in GERD patients by enhancing perceptual response to intraesophageal acid exposure. This greater perceptual response is associated with greater emotional responses to the stressor.

Factors associated with menopausal symptoms and their relationship with the quality of life among Turkish women

Objectives The aim of this study was to investigate factors associated with menopausal symptoms and their relationship with the quality of life among Turkish women. Methods This is a cross-sectional study and included 886 women. Data were collected with a questionnaire including questions about demographics and independent variables tested, the Menopause Symptom Checklist and The MOS 36-Item Short Form Health Survey. Results The mean age of the women included in the study was 48.62 years (standard deviation (S.D.) = 5.75, range: 40–60 years). Of all women, 32.1% were premenopausal, 23.9% perimenopausal and 44.2% postmenopausal. Stepwise multiple regression analyses, performed to determine factors associated with menopausal symptom score, revealed 12 statistically significant variables which increased the strength of the model. These variables were as follows in the order of their contribution to the strength of the model: health problems, recent life stresses, being a primary school graduate, absence of relaxation methods, number of pregnancy, financial problems, tea consumption, inadequate and unbalanced nutrition, coffee consumption, age, being a secondary school graduate and dissatisfaction in marriage. Besides, there was a significant and moderately negative relation between total menopausal symptom scores and quality of life scores. Conclusions A large number of factors were associated with experiencing menopausal symptoms and menopausal symptoms had negative effects on the quality of life among Turkish women. Stress management and health promoting practices should be incorporated into menopausal care programs to improve health and quality of life of middle-aged women.

The perceived burden among Chinese family caregivers of people with schizophrenia

The aim of this study was to examine the level of perceived burden of the Chinese families caring for a relative with schizophrenia and to test its associations with their demographic characteristics, social and family factors and health condition. Despite the increased demands on family members to provide care for patients with schizophrenia in community care, little is known about the level of family burden among these family caregivers and its relationship with their demographic, social and cultural backgrounds. This was a cross-sectional descriptive study. A total of 203 family caregivers were recruited from three regional psychiatric outpatient clinics in Hong Kong. They were asked to complete a set of well-validated questionnaires, consisting of the Chinese version of four instruments - Family Burden Interview Schedule, Family Assessment Device, Six-item Social Support Questionnaire and MOS 36-Item Short Form Health Survey and a socio-demographic data sheet. Statistical analyses were conducted to test the differences in mean burden scores between subgroups, the inter-relationships among the mean scores of the scales and socio-demographic variables and the predictors of family burden. The families who perceived a higher level of caregiver burden were those who lived in a family with poorer functioning, worse health status and less satisfaction of social support. The caregivers' burden score was positively correlated with their age; conversely, it was negatively correlated with their monthly household income and number of family members living with patient. Social support was the best predictor of caregiver burden. These findings increase our understanding about the socio-demographic and cultural variables influencing the well being of family caregivers of a relative with schizophrenia. Helping families to maintain and enhance a supportive social network may represent a useful means to reduce family burden in schizophrenia. This understanding helps health professionals and researchers to identify different sources and domains of burden from a Chinese cultural perspective and take into account of these factors when planning interventions for family caregivers.

Burnout in health care providers of dialysis service in Northern Italy a multicentre study

Few data are available regarding the prevalence of burnout among dialysis health care workers. Aims of the present study were to assess and compare burnout levels in a sample of nurses and physicians working in dialysis units, and to investigate their relationships with quality of life, in a cross-sectional observational study. A total of 344 workers from 10 dialysis centres in Northern Italy completed a battery of questionnaires including the Maslach Burnout Inventory, the MOS-36 Item Short Form Health Survey [SF36: physical (PCS) and mental (MCS) component scores] and the 30-item General Health Questionnaire (GHQ30). Data on social and demographic characteristics and working conditions were also collected. General Estimating Equations models were used for the analysis. Overall, burnout scores were lower than the Italian normative sample, with no significant differences between physicians and nurses. However, 30% of nurses had high emotional exhaustion vs 18% of physicians (adjusted OR 2.38, P = 0.003). Emotional exhaustion was also predicted by number of worked hours and months worked in dialysis in the previous 2 years. Depersonalisation was predicted by male gender and bad relationship with coworkers. Having no children and having a permanent hospital position predicted low personal accomplishment. PCS was lower in nurses (50.0 vs 53.3, P < 0.001), while no significant difference was found for MCS and GHQ30. Lower PCS was associated with emotional exhaustion (P = 0.007) and GHQ30 > 5 with depersonalization (P = 0.032). Although burnout is not a general problem in dialysis health care providers, a subgroup of them may be identified, who would benefit from supportive measures to prevent this condition. Nurses appeared more burned-out in the emotional exhaustion scale than physicians.

Effects of insulin vs. glibenclamide in recently diagnosed patients with type 2 diabetes: a 4‐year follow‐up

To compare effects of early insulin vs. glibenclamide treatment on beta-cell function, metabolic control and quality of life (QL) in recently diagnosed patients with type 2 diabetes. Forty-nine patients with type 2 diabetes diagnosed 0-2 years before inclusion were randomized to two daily injections of premixed 30% soluble and 70% NPH insulin or glibenclamide at six diabetic clinics in Sweden. C-peptide-glucagon tests were performed yearly after 3 days of withdrawal of treatment. Thirty-four patients completed 4 years of study. Daily dose of insulin was increased from 20.4 +/- 1.8 U at year 1 to 26.1 +/- 2.9 U at year 4 (p = 0.005). Glibenclamide dosage increased from 2.7 +/- 0.4 mg at year 1 to 4.5 +/- 0.8 mg at year 4 (p = 0.02). Weight increased more in insulin than in glibenclamide treated (+4.4 +/- 0.8 vs. +0.3 +/- 1.0 kg, p < 0.005). Following short-term withdrawal of treatment, the C-peptide responses to glucagon were significantly higher in the insulin vs. glibenclamide group at years 1 (p < 0.01) and 2 (p < 0.02). HbA1c improved identical during the first year but thereafter deteriorated in the glibenclamide group (p < 0.005 for difference at year 4). Ratios of proinsulin to insulin were higher during treatment in glibenclamide- vs. insulin-treated patients after year 2. QL after 4 years as measured by the MOS 36-item Short-Form Health Survey (SF-36) form was not significantly altered. In a 4-year perspective, beta-cell function deteriorated in both groups. However, deterioration occurred faster in the glibenclamide group, indicating that alleviating demands on secretion by insulin treatment is beneficial.

太極拳運動実施高齢者の健康関連QOL―同年代国民標準値との比較―

We assessed health-related quality of life (HRQOL) of community-dwelling older people who practiced Tai Chi in a cross-sectional study using the MOS 36-item short-form health survey (SF-36, Japanese version). SF-36 and another questionnaire about age, sex, experience with Tai Chi, were distributed to 903 people who were above 65 years old and belonged to the Japan Health Tai Chi Association. Of these, 804 people responded (89.04%). From the SF-36, we used the sub-scores for physical functioning (PF), physical role (PR), bodily pain (BP), general health (GH), vitality (VT), social functioning (SF), role emotional (RE), and mental health (MH). These sub-scores were compared with those obtained from age-matched national standards for groups 60 to 69 years old and 70 to 80 years old respectively (n=1.040). The 60- to 69-year-old subjects had significantly higher PF (p<0.01), GH (p<0.05), and MH (p<0.01) than the national averages. For the 70- to 80-year old subjects, PF (p<0.01), PR (p<0.01), BP (p<0.05), GH (p<0.01), VT (p<0.01), RE (p<0.01), and MH (p<0.01) were significantly higher than the national averages. The number of years and the frequency of practicing Tai Chi statistically significantly correlated with MH and PF, and GH and PF, respectively. The HRQOL of the people who practiced Tai Chi was better than age-matched national standards. Although the number of years and the frequency of practicing Tai chi statistically significantly correlated with the sub-scores of the HRQOL, the adjusted (R(2)) were low.

Multidisciplinary Congestive Heart Failure Clinic for Older Women: A Randomized Controlled Trial

Objectives: To determine whether a multidisciplinary clinical pathway, a blueprint of the patient care processes for female patients over age 65, will improve patients' quality of life and functional capacities in comparison to usual care for CHF. Design: A randomized controlled trial. The intervention consisted of a series of 12 visits over 6 weeks to optimize medical care, and to engage in an exercise program with strong educational, counseling and dietary management, involving physician, nursing, dietary, physiotherapy, pharmacy, occupational therapy and social work. Setting: Patients were referred from the Ottawa Hospital and the community with a diagnosis of CHF and were screened to ensure they met the eligibility criteria. Participants: Ninety-one community dwelling women aged 63 to 89 with the diagnosis of CHF were enrolled in this study. Measurements: The primary outcome measure was the Minnesota Living with Heart Failure Questionnaire (MLHFQ). The secondary outcome measures included the MOS 36-Item Short-Form Health Survey (SF-36), the Folstein Mini-mental State Examination (MMSE), the 15 item Geriatric Depression Scale (GDS), the Physical Self-Maintenance Scale (PSMS), and survival and health service utilization over 6 months. Results: There was no difference between the two groups in MMSE or GDS scores by the end of six weeks cycle. Comparison of change from baseline MLHFQ score, including physical and emotional components, did not show a difference (P < 0.470). There was also no difference between the two groups in functional outcome as measured by change from baseline PSMS score (P < 0.321). The treatment group had a tendency to more ER visits (for all reasons and for CHF) and hospitalizations. The treatment group had significantly more cardiologist visits during the study period (P < 0.0001). Conclusion: It is feasible to conduct a randomized study in a frail community-based older female population and to test a complex multidisciplinary pathway. Future studies should provide further insight into the optimal intensity and duration of heart failure management programs, and which patients derive the greatest benefit.

Impact of chronic disease on quality of life in the Bella Coola Valley

North American rural residents have higher rates of chronic disease and they report being ill more frequently compared to their urban counterparts. We recently studied health-related quality in residents living in the isolated, rural community of Bella Coola, Canada. To assess health-related quality of life parameters in adults suffering from chronic disease and living in the rural, remote community of Bella Coola. Design, mixed methods: (1) mailed health-related survey; (2) retrospective chart review. people aged 17 years and older living in the Bella Coola Valley and having a chart at the Bella Coola Medical Clinic as of September 2001 were asked to complete a detailed health-related quality of life survey during the period August to December 2001. demographics (age, sex, weight [BMI], ethnicity). Health-related quality of life was measured using the MOS 36-item Short Form Health Survey (SF-36), and the US Centers for Disease Control healthy day's items. Chronic diseases studied included diabetes mellitus, hypertension, chronic obstructive lung disease, coronary artery disease, hyperlipidemia, depression/anxiety, cancer, osteoarthritis, inflammatory arthritis and chronic back/neck pain. Response rate to the survey was 38% (675/1770). Compared to total clinic population relatively more female (57% vs 49%), non-Aboriginal (63% vs 57%) and older people (48.9 vs 43.5 years) answered the survey. The most prevalent chronic diseases among the survey respondents were hypertension (17%), depression/anxiety (13%), hyperlipidemia (11%), chronic back/neck pain (11%), and osteoarthritis (9%). Linear regression analysis was performed for each of the SF-36 domains and CDC healthy day items. The presence of chronic disease is associated with significant differences in HRQOL item scores and the greater the number chronic diseases present the worse the HRQOL item scores. People living in the rural remote community of Bella Coola who have chronic disease experience significant impairment in their health-related quality of life. The greater the number of coexisting chronic diseases a person has, the more likely that poor HRQOL scores will be reported.

Estudo da qualidade de vida em pessoas com lesão medular traumática

Centers of research all over the world are accomplishing studies about quality of life in several chronic conditions, for promoting interventions that promote improvement. This fact extends to spinal cord injury patients. This is a study with the aim of evaluating the quality of life of traumatic spinal cord injury people in the city of Fortaleza, Ceará, Brazil. Participating in the study, 32 paraplegic adult patients with complete traumatic spinal cord injury; most were male, aged 20 to 47 years old and 5 to 10 years of lesion. The instrument used for collection of data was The MOS 36-item Short-Form Health Survey. As results we found that the traumatic spinal cord injury patient possesses great compromising of the quality of life, in all your domains, mainly in what it refers to the "social aspects".