Perceived Quality Of Life Research Articles

Quality of Life, Anxiety and Depression in Women Treated with Hysteroscopic Endometrial Resection or Ablation for Heavy Menstrual Bleeding: Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Background and Objectives: Hysteroscopic endometrial resection (ER) or global endometrial ablation (GEA) are feasible methods to treat heavy menstrual bleeding (HMB). The aim of this systematic review and meta-analysis of randomized controlled trials (RCTs) was to assess patient's quality of life (QoL) in women treated with ER/GEA compared to hysterectomy. Materials and Methods: Electronic searches in MEDLINE Scopus, ClinicalTrials.gov, EMBASE, PROSPERO and Cochrane CENTRAL were conducted from their inception to July 2022. Inclusion criteria were RCTs of premenopausal women with HMB randomized to conservative surgical treatment (ER/GEA) or hysterectomy. The primary outcome was the evaluation of QoL using the SF-36 score. Results: Twelve RCTs (2773 women) were included in the analysis. Women treated with hysteroscopic ER/GEA showed significantly lower scores for the SF-36 general health perception (mean difference (MD) -8.56 [95% CI -11.75 to -5.36]; I2 = 0%), social function (MD -12.90 [95% CI -23.90 to -1.68]; I2 = 91%), emotional role limitation (MD -4.64 [95% CI -8.43 to -0.85]; I2 = 0%) and vitality (MD -8.01 [95% CI -14.73 to -1.30]; I2 = 74%) domains relative to hysterectomy. Anxiety, depression scores and complication rates were similar between treatments. Relative to uterine balloon therapy, amenorrhea was more common with EA/GER (relative risk 1.51 [95% CI 1.03 to 1.20] I2 = 28%), but posttreatment satisfaction was similar. Conclusions: Women's perception of QoL might be seen to be less improved after hysteroscopic ER/GEA rather than hysterectomy. However, such findings need to be confirmed by additional trials due to the high number of outdated studies and recent improvements in hysteroscopic instrumentation and techniques.

Patients Reported Outcomes (PROs) Are Still Unsatisfactory Among AML Long-Term Survivors: The Impact of Chronic GvHD in a Prospective Study on 15 Years Transplant Activity

Background Acute myeloid leukemia (AML) represents the main indication to allogeneic hemopoietic stem cell transplantation (HSCT) and improvement of overall survival (OS) has been a major achievement provided by this treatment option. Unfortunately, graft-versus-host disease (GvHD) still represents the main complication affecting HSCT, increasing transplant related mortality (TRM) and worsening quality of life (QoL). While the mortality impact of GvHD is well recognized, the impact on QoL is still poorly characterized. The collection of patients reported outcomes (PROs) in routine practice is limited. The most common PRO measures used are the Lee chronic GvHD (cGvHD) symptom scale, the FACT-BMT and the NIH Form B. We aimed to analyze the perception of QoL in AML long-term survivors after HSCT according to the FACT-BMT scale. Methods Our analysis consisted of a prospective single-center study in a cohort of 510 patients affected by either de novo AML or secondary AML and treated with HSCT between January 2004 and December 2019 at our Institute. Data were censored April 1st, 2022. The follow-up was performed according with our Long Term Follow Up institutional program. The FACT-BMT questionnaire was administered as a paper questionnaire. A written consent was given in accordance with the Declaration of Helsinki. Results Overall, the 2-year OS was 51% and the 5-year OS for patients alive at 2 years was 80% (95% CI - 74-85%). For patients alive and in complete remission at 2 years post-HSCT the probability of 5-year OS was 84.5% (95% CI - 78-89,2%), the 5-year TRM 6.3% (95% CI - 0.5-23.3%) without evidence of a "plateau” effect, while the 5-year relapse incidence was 12.91% (95% CI - 4.91-24.91%) reaching a plateau. Both univariate and multivariate analysis showed that age and status of disease at transplant have a significant impact on long-term survival; univariate analysis instead did not show any impact of the year of treatment and of GvHD prophylaxis. Overall, among 195 patients alive and in complete remission at last follow-up, 70 patients completed the questionnaire. PROs analysis confirmed a better perception of QoL for patients that did not experience cGvHD versus patients affected by cGvHD; no difference emerged according to age and time after transplant. Of note, patients affected by cGvHD showed worst functional well-being (p 0.0293), worst physical well-being due to side effects (p <0.0001), less satisfaction about the appearance of their body (p 0.0152) and less satisfaction about their sexual life (p 0.0445 - 10 patients preferred not to answer). Overall, among patients without cGvHD, other side effects after HSCT were not perceived worse than they had imagined, while among those with cGvHD, most patients complained about this perception (p 0.0009). Conclusion QoL in patients cured from AML by HSCT is still far from being satisfactory, most of all among patients with cGvHD. Dedicated counselling and support to address QoL is a relevant unmet medical need. Systematic evaluation of PROs will optimize the care of HSCT survivors, potentially enhancing patient-provider communication and allowing the development of measure for both prevention and treatment of GvHD.

Shedding Light on the Lifestyle and Participation of Portuguese Adolescents with Chronic Conditions-Data from the HBSC 2018 Study.

Variables associated with lifestyle can constitute either risk or protective factors for the development and progression of chronic conditions (CC). This study intends to explore the differences between adolescents with and without CC and between adolescents whose school participation is affected/not affected by the existing CC with regard to variables related to lifestyle (i.e., sleep, physical activity, BMI, and leisure). In addition, it also intends to analyze the influence of these variables (i.e., CC and lifestyle) regarding the adolescents' quality of life (QoL). This work is part of the Portuguese HBSC 2018 study. A total of 8215 adolescents participated (52.7% female), with an average age of 14.36 years (SD = 2.28). The results showed that the adolescents with CC and whose school attendance and participation are affected by their CC exhibit more sleep difficulties (i.e., they experience lower sleep quality and have a higher degree of sleepiness), higher BMI levels (i.e., higher values of overweight and obesity), less participation in leisure activities, and a lower perception of QoL. A higher perception of QoL is associated with school participation unaffected by the existing CC, sleeping well, a low level of sleepiness, a more frequent practice of physical activity, a lower BMI, and a greater involvement in leisure activities. Adolescent health and well-being are a prominent issue in terms of public policies, with behavior and lifestyle playing a significant role in this domain. This message needs to be reinforced in regard to families, educators, healthcare professionals, and public sector policies, particularly concerning students with CC.

Music-oriented parent counseling to promote improvement in level of parental stress, quality of life and the use of music in everyday life among parents of children with autism: A mixed-methods randomized controlled study

ABSTRACT Introduction Music-Oriented Parent Counseling (MOPC) is a clinical way to work with parents, using musical improvisations and listening. This study examined effects of MOPC on level of stress, quality of life perception and daily use of music by the parents of autistic children. Method Fourteen parents of young autistic children received either three MOPC sessions (n = 7) or ten MOPC sessions (n = 7), parallel to either music therapy (MT) or standard care for their children. Change in parental stress, parents’ perception on children’s and families’ quality of life and the daily use of music (routine and joint music activities) were measured with standardized assessments and parent interviews. Descriptive and inferential parametric statistics were conducted, as well as thematic analysis. Results We found little change and no significant effect on parental stress. Children’s quality of life showed improvement with but not without MT and a tendency towards a larger improvement with high-intensity than low-intensity MOPC. Family quality of life showed less change but a somewhat larger improvement in high-intensity than low-intensity MOPC. Routine music activities increased in high-intensity MOPC but decreased in low-intensity MOPC; joint music activities showed less change but a similar trend. Qualitative analysis of the interviews suggested that parents participating in high-intensity MOPC felt less stressed, perceived improved quality of life, and increased music use. Discussion Findings provide preliminary support for high-intensity MOPC to help parents of autistic children increase children’s and families’ quality of life and music use. More research is needed to confirm these findings.

Mental Health and Quality of Life among Dental Students during COVID-19 Pandemic: A Cross-Sectional Study.

Students are particularly vulnerable from the mental health aspect, which was especially recognized during the COVID-19 pandemic. This study aimed to reveal the impact of COVID-19 on quality of life (QoL) and mental health among dental students. The study was conducted on a sample of 797 students (207 male and 592 female) with an average age of 21.7 ± 2.4, from the School of Dental Medicine, University of Belgrade. The measurements used in the study were the Demographic and Academic Questionnaire, Questionnaire about exposure to COVID-19, COVID-19-Impact on QoL Questionnaire (COV19-QoL), Generalized Anxiety Disorder 7-item (GAD-7) scale, and Patient Health Questionnaire (PHQ-9). The mean total score for COV19-QoL was 2.9 ± 0.9, while the diagnostic criteria of GAD-7 and depression met 19.9% and 31.4% of students, respectively. There was a positive and strong correlation between QoL, anxiety, and depression. During COVID-19, predictors for lower perceptions of QoL were female gender and death of close relatives (p = 0.049, p = 0.005, respectively). At the same time, predictors for GAD were female gender, living in dormitories, and death of close relatives (p = 0.019, p = 0.011, p = 0.028, respectively), while for depression they were year of study, living with parents, and death of close relatives due to COVID-19 (p = 0.012, p = 0.008, p = 0.029, respectively). The study showed that students' QoL and mental health during the pandemic were at high risk.

Surveillance with Electronic PROs and ctDNA in p16+ Oropharynx Cancer: Lessons from the Prospective FOCUS Registry (Follow Up for HPV-Related Oropharynx Cancer Concentrated on Symptom Change)

<h3>Purpose/Objective(s)</h3> Optimal surveillance algorithms are not well defined in p16+ oropharynx cancer. Prior work suggests that recurrences are rarely detected during routine clinical follow up but we previously have shown a minimal clinically important difference (MCID) in PRO symptoms may be sensitive for detection of treatment failure. We instituted a prospective registry incorporating electronic PROs (ePRO) and blood ctDNA into surveillance. Primary objective was feasibility of electronic survey administration and compliance, with noncompliance defined as failure to complete 2 consecutive surveys. <h3>Materials/Methods</h3> Eligibility included stage I-III p16+ oropharynx cancer 3-38 months post definitive therapy and negative 3mo PET (HUM00183387). EORTC QLQ30/HN35 were collected by email monthly and blood HPV ctDNA was drawn every 3 months. <h3>Results</h3> Since 1/2021, 85 patients have been enrolled, of which 63 completed electronic consent while 24 patients were lost due to disinterest (3/24), technological challenges (3/24) and unable to be contacted by phone (18/24). Of the 63 consented patients, 41 (65%) were compliant (C) and 22 (35%) noncompliant (non-C) in answering monthly surveys, with a median follow up of 7.9 months and a median 7.5 surveys/participant. There was no difference in frequency of standard clinic-based follow up between C and non-C patients (p=0.97). Non-C patients were older (mean age 66.2 vs 60.5, p=0.007) and more likely to be enrolled in Medicare/Medicaid (54.5% vs 22%, p=0.009). There were no significant differences in baseline reported ePRO subscales at 1 month among C and non-C patients, suggesting that patient perception of QOL did not impact initial survey participation. Longitudinal ePRO analysis revealed that 29/53 patients with analyzable data reported a MCID change in at least 1/8 prespecified symptom categories, however there was no correlation between change in patients' perceived symptoms and continued survey compliance (p =0.9). 67 patients (79%) had ctDNA collected, with 151 post-treatment tests and a mean of 1.9 tests per patient. Five tests were detectable: 3 "indeterminate" values followed by undetectable tests, 1 detectable in a patient currently NED, and 1 detectable in a patient with recurrence. To date, there are 2 recurrences in this registry. <h3>Conclusion</h3> Patient participation in longitudinal ePROs was challenging in our cohort particularly among elderly patients, with only 65% compliance; however, about half of patients reported clinically meaningful MCID changes in at least 1/8 subcategories. This presents an opportunity for future studies to assess whether intervention upon reported MCID changes may impact compliance or post treatment QOL. ctDNA collection is feasible and may be incorporated into future surveillance algorithms given high patient compliance.

Prevelance of depression and anxiety with their effect on quality of life in chronic kidney disease patients

Chronic kidney disease is one of the most common chronic diseases globally. Many studies have shown it is strongly associated with increased social and psychological problems such as depression and anxiety which are considered as common psychiatric disorders that occur in patients with chronic kidney disease. We investigated the prevalence of depression, anxiety and perception of quality of life in a sample of chronic kidney disease patients at the Jordan University Hospital. We aimed to see any association of the mental health in these patients; mainly depression and anxiety with their quality of life and correlation to socio-demographics or laboratory and metabolic profile of this population. 103 chronic kidney disease patients were interviewed using a questionnaire in the Nephrology outpatient clinics of the Jordan University Hospital, the questionnaire included four sections, the first sections handled socio-demographic data. Also, it contains a brief Clinical and laboratory parameter of our patients. The second part consisted of the 9-item Patient Health Questionnaire (PHQ-9) that used to measure the severity of depression. The third part included the 7-item Generalized Anxiety Disorder (GAD-7) to evaluate the severity of anxiety, the fourth part assessed participants quality of life (QOL) using The World Health Organization Quality of Life, Short Form (WHOQOL-BREF) questionnaire. More than half of the participants have depression and anxiety with a percentage of 58.3% and 50.5%, respectively. There was a negative moderate to strong correlation between depression score and quality of life domains scores (p < 0.001).Only marital status had a significant relationship with depression (p < 0.001).Weak positive correlation between Glomerular Filtration Rate and anxiety score (p = 0.04),with significant positive correlation between lipid profile and anxiety score. There was a negative correlation between anxiety score and quality of life domains scores. Females had higher anxiety score than males (p = 0.27). Patients who do not work had a lower physical functioning score compared to others (p value = 0.024).Patients with higher serum Hemoglobin had higher physical and psychological scores. Anxiety, Depression are common among our chronic kidney disease patients, more interventions are needed to improve the mental health of our patients and their quality of life perception. This kind of study allows us to gain a deeper understanding regarding the effects of chronic kidney disease on psychosocial well-being of those patients, and helps health care providers to put depression, anxiety and Quality of life into consideration when treating patients.

Associations between Perception of Help-Seeking Behaviors and Quality of Life among Older People in Rural Communities: A Cross-Sectional Study.

Older people’s help-seeking behaviors (HSBs) may be limited because of various factors and are essential in improving healthcare in aging societies. This cross-sectional study investigated the association between perception of HSBs, concrete HSBs, quality of life (QOL), and other variables among people over 65 in rural Japan using standardized questionnaires. Participants were divided into high or low health status index score groups based on a median split. Logistic regression was used to assess the association between perception of HSBs and high QOL while controlling for age, sex, living conditions, annual health checks, having chronic diseases, regular clinic visits, smoking, habitual alcohol consumption, education, living conditions, social support, social capital, socioeconomic status (SES), and health literacy. Participants in the high QOL group were younger (p < 0.001), and had fewer chronic diseases and regular clinic visits than those in the low QOL group (p < 0.001). The multivariate logistic regression model revealed that age, chronic diseases, tobacco usage, family consultation, and consulting primary care physicians negatively predicted QOL. High SES, social capital and support, and HSB intention positively predicted QOL. Self-efficacy and intention regarding HSBs should be investigated to improve health among older rural people.

An Association of Quality of Life and Ageing Perceptions among Community Dwelling Older Adults in Uganda.

Uganda's population, though, largely characterized by young people, has seen the number of people aged 60 and over grow from 686,000 twenty years ago, to 1,433,596 in 2014. Effective caring for the well-being of this population requires strategic and deliberate planning that involves Quality Of Life (QoL) assessments. QoL assessments among the elderly are important in evaluating the efficacy of strategies, such as health interventions, welfare programs, health care and well-being of the elderly. However, elderly in Uganda face several challenges, ranging from loneliness, poor housing, lack of social and financial support and poor health. These may negatively affect older persons' quality of life and consequently their perceptions and attitudes towards aging. The study was carried out in 2019 in the communities of Nansana and Busukuma town councils in Wakiso district, Uganda. The participants were 380 people 60 years and older. To establish the association between perceptions of ageing and QoL, this study utilized a locally adapted version of the Older Person's Quality of Life Questionnaire (OPQOL) and the Brief Ageing Perceptions Questionnaire (B-APQ). The OPQOL assesses three domains of QoL: Health QoL (HQoL); Social economic QoL (SQoL); and Psychosocial QoL (PQoL). The B-APQ assesses perceptions about physical age, participation in social activities, and perceptions about ability to regulate emotions as one ages. Pearson's Chi-square tests were used to characterize the relationship between the perceptions and quality of life. The majority of the respondents, 61% (95%CI 56.7-64.8), had negative perceptions towards ageing. Eighty six percent had poor HQoL, 90% poor SQoL and 83% poor PQoL. There was a significant association between good HQoL and positive perception about participation in social activities (X2 = 7.3670, P = 0.007) as well as with positive perception on regulation of emotions (X2 = 18.1803, P<0.001). There was a significant association between good SQoL and positive perception about participation in social activities (X2 = 5.3472, P = 0.021), as well with positive perception on regulation of emotions (X2 = 10.5128, P<0.001). A significant association between good PQoL and positive perception on regulation of emotions (X2 = 9.2414, P= 0.002). Positive perceptions of ageing are associated with good QoL. Directly addressing perceptions of ageing could be a low cost and effective strategy to improve the QoL of older persons in SSA.

Quality of life in patients with heart failure and improved ejection fraction: one year changes and prognostic implication

Abstract Background Inconsistent and controversial results have been reported about the association of quality of life (QoL) and left ventricular ejection fraction (LVEF) in patients with heart failure (HF). The 2021 universal definition of HF specifically describes the criteria for the patients with HF and improved LVEF (HFimpEF): HF with a baseline LVEF ≤40%, a ≥10 point increase from baseline LVEF, and a second measurement of LVEF &amp;gt;40%. Purpose 1) To assess whether patients with HF and reduced LVEF (HFrEF) at first visit in an outpatient HF Clinic that fulfil the HFimpEF criteria one year later presented a higher improvement in QoL assessed by the Minnesota Living With Heart Failure Questionnaire (MLWHFQ) than those patients that did not fulfil HFimpEF criteria. 2) To assess the prognostic role of QoL on outcomes in HFimpEF patients. Methods In a prospective registry of real-life HF outpatients LVEF and QoL evaluated by MLWHFQ were assessed at first visit at the HF Clinic and at one year of follow-up. Results From August 2001 to August 2021, baseline and one year LVEF and MLWFQ scores were available in 1040 patients with an initial LVEF ≤40%. Table 1 shows baseline demographic and clinical characteristics of patients. In summary, mean age was 65.2±11.7 years, 75.9% of the patients were men, the main aetiology was ischaemic heart disease (52.9%) and patients were mostly in New York heart Association (NHYA) class II (71.1%) and III (21.6%). Baseline LVEF was 28.5% ± 7.3 and baseline MLWHFQ score was 30.2±19.5. At one year, mean LVEF increased to 38.0±12.2 while MLWHFQ scores improved to 17.4±16.0. There were 361 patients that fulfilled the HFimpEF criteria (34.7%). These patients significantly and markedly improved both LVEF (from 28.7±6.6 to 50.9±7.6, p&amp;lt;0.001) and QoL (from 32.9±20.6 to 16.9±16.0, p&amp;lt;0.001). Although in patients that did not fulfil the criteria of HFimpEF both LVEF (from 28.4±7.6 to 31.1±7.9, p&amp;lt;0.001) and QoL (from 28.7±18.8 to 17.6±15.9, p&amp;lt;0.001) also significantly improved, the improvement in QoL was significantly higher in HFimpEF patients (−16.0±23.8 vs. −11.1±20.3, p=0.001), taking into account that baseline MLWHFQ score was worse in HFimpEF patients (p=0.001). However, at one year QoL was similar when both groups were compared (p=0.50). MLWHFQ score at one year proved to be superior to QoL improvement (using a cut-off of at least 5 points) from the prognostic point of view. Conclusions QoL improved both in patients with and without HFimpEF criteria, and QoL perception at one year was similar in both groups, suggesting the influence of other factors other than LVEF in QoL perception. QoL at one year revealed to be superior to QoL changes from baseline from the prognostic point of view. Funding Acknowledgement Type of funding sources: None.

Impacts of childhood malocclusion on the family.

To analyze the effects of children's malocclusions and associated quality of life on family relationships by evaluating psychometric characteristics of the Family Impact Scale (FIS) in adolescents seeking orthodontic treatment. Included were 334 participants (children aged 11-14years; 53% female and 47% male) and their parents (84% mothers, 16% fathers) who were recruited at two dental clinics in Croatia. The Child Perception Questionnaire, Parental-Caregiver Perception Questionnaire, and FIS were administered. Malocclusion severity was estimated using the Index of Orthodontic Treatment Need Dental Health Component. The presence of caries was also recorded. Factor analysis, t‑test, Pearson correlation, and multiple linear regression analysis were used for statistical analysis. Unidimensional FIS measuring global family impacts had higher internal consistency (α = 0.73-0.81) compared to the specific dimensions of family impacts (α = 0.60-0.69). Global family impacts were higher in children with more severe malocclusions and existing dental caries, primarily influencing parental activity, and parental emotions dimensions (p < 0.05). In multiple regression, parental perception of child's emotional well-being, oral symptoms, and social well-being (p < 0.001) were significant predictors of global family impacts, whereas child's quality of life perception, malocclusion severity, or child sex were not. Reduction of an increased overjet by orthodontic treatment affected changes in the global family impacts, mainly by reducing the emotional issues of parents (p < 0.05). The child's malocclusion influenced the family, primarily parental emotions. Family influences were mostly determined by parental perception of the child's altered psychosocial well-being. The FIS had adequate psychometric properties.

An Explorative Study of Affiliate Stigma, Resilience, and Quality of Life Among Parents of Children with Autism Spectrum Disorder (ASD).

PurposeChildren diagnosed with ASD usually have impaired social functions, exhibit repetitive, stereotyped and self-stimulatory behaviors, which make them prone to be stigmatized by the public. However, stigma not only affects those with stigmatization characteristics such as children with ASD but also tends to include other people related to them including parents. This is called affiliate stigma. However, affiliate stigma is unlikely to occur if public awareness is high. Considering that awareness of ASD is still comparatively low in this region and that, as a review of the literature showed, there have been limited studies on stigma and ASD conducted in South-East Asia, particularly in Malaysia, this study is of great significance, especially in the context of the East and other developing countries. The aim of this study was to explore parents’ experiences of caring and perceptions of affiliate stigma, resilience and quality of life (QoL) when caring for a child with ASD.MethodsThis paper is part of the sequential explanatory mixed-methods study in which, after a cross-sectional study of 144 parents, a qualitative approach was used to explore parents’ experiences of caring and their perceptions of affiliate stigma, resilience, and QoL. Participants were recruited when they were accompanying their children to therapy at two tertiary public hospitals in one of the north-eastern states of Malaysia. Eleven parents of children with ASD aged 2–12 years participated. Qualitative data analysis followed Braun and Clarke’s methodology of thematic analysis.ResultsFour themes were identified: the meaning of QoL, ASD and life adjustment, perceived stigma, and resilience.ConclusionThis is the first Southeast Asian study on parent-perceived affiliate stigma, resilience, and QoL in the context of ASD. These findings can inform healthcare personnel and policymakers into day-to-day parenting realities and therefore an effort to coordinate support services across all disciplines could be made to improve outcomes for both parents and children.

345.8: Professional Employment in Patients on Ventricular Assist Device Support – A Multi-Center Prevalence Study

Background: Ventricular assist device (VAD) implantation aims to support end-stage heart failure patients for the long-term. For patients in productive age ranges, return to an active and productive work life can be seen as a surrogate marker for functional recovery, and psychosocial re-integration. This study aimed to assess professional employment, explore determinants, and the impact of adverse events on professional employment in stable outpatients on ongoing assist device support. Methods: A national, multi-center study considered rates of professional employment and its relation to sociodemographic (age, gender, education, family), psychosocial (anxiety, depression, quality of life (QoL), and clinical adverse (thromboembolic, bleeding, driveline infection) outcomes in a large sample of 375 stable outpatients on ongoing VAD support. Valid patient-reported outcome measures were administered (WPI, KCCQ, HADS). Retirement age for women (<60yrs), and men (<65yrs) was considered. Results: The overall sample consisted of 14% (n=53) female patients, mean age for the entire sample being 58±11years, mean time post-implant was 18±11mts, and ranged from 3-36mts. A minority of 15.15% (n=35; 95% CI 10.9-20.6) of the sample were full- or half-time employed. 52.3% (n=196) reported to be unemployed or retired illness-related, and 37.1% (n=139) were retired age-related. For the majority of those working the implant reason was bridge to transplantation 82.9% (n=29), and six patients were bridged to recovery. A regression model after variable selection (R2 Tjur 0.189) revealed younger age (OR 0.95; 95% CI 0.91-0.98; p=0.005), and higher education (OR 3.05; 95% CI 1.72-5.69; p<0.001) to support professional employment. Working patients reported on higher QoL using the KCCQ overall sum-score (OR 1.04; 95% CI 1.01-1.07; p=0.007), and the odds for those working was 2.18 (95% CI 0.89-5.41; p=0.08) indicating no significant relation for working and having had a history of one or more adverse events. Conclusions: In this national sample, professional employment rates in patients on ongoing VAD support were rather small; however, those employed perceived better overall QoL. Professional employment was not significantly related to clinical adverse events relevant to this population. Future clinical strategies need to be initiated to support psychosocial re-integration in terms of professional employment for patients on VAD support being in the respective age ranges, which may increase patients’ overall QoL perceptions.

Physicians perceive that ostomates have decreased quality of life but not overall health: An international survey of physicians.

The aim of this work was to evaluate physicians' perceptions of ostomates' quality of life (QoL) and comfort of care among an international sample of physicians caring for ostomates. This was a cross-sectional survey study. We conducted a survey of primary care physicians (PCP), gastroenterologists (GI), and general surgeons (GS) from three continents using the SERMO online physician platform. We piloted the survey for content, clarity and domain development using a pilot sample of physicians from each speciality before use. We summarized responses to questions related to physician comfort of ostomate care with descriptive statistics. We conducted multiple logistic regression with the primary outcome of physician perception of ostomate QoL. A total of 617 physicians (PCP 264, GI 176, GS 177) completed the survey representing North America, Europe and Australia similarly. The average age was 46 years and 21% were women. Ninety per cent of physicians care for an ostomate at least once per month. Eighty eight per cent had access to enterostomal nurses. Eighty two per cent of physicians believed that ostomates have decreased QoL. Forty seven per cent believed that ostomates have decreased overall health. Almost half of respondents answered incorrectly to a 'bogus question' citing fake clinical evidence supporting a negative impact of ostomies on social relationships. Increased physician comfort in ostomy care (OR 1.30, p= 0.04) and US-based physicians (OR 1.75, p= 0.01) were associated with increased odds of answering that ostomates have no decreased QoL. Among a diverse international sample, most physicians believe that ostomates have decreased QoL but not overall health. Physician implicit bias, physician comfort and geographical variability account for these findings. Targeted efforts to increase physician comfort in ostomate care and establish universal best practices is needed.

Relationship Between Effective Communication and Health-Related Quality of Life in Cancer Patients: Meta-analysis, and a Single Institution Experience in Qatar

Aim: To determine the relationship between effective communication and the Quality of Life (QoL) of cancer patients through conducting a Meta-analysis (MA) to quantify and summarize the evidence and present the results of our local findings in the National Center for Cancer Care &amp; Research (NCCCR) of HMC in Qatar. Methods: MA was conducted via searching four online databases including PubMed, Medline, EMBASE and Psych info electronic and grey literature database, ProQuest dissertations. The MA encompassed published cross-sectional, longitudinal studies and a postgraduate PhD dissertation, that investigated the communication among cancer patients on one hand, and health care professionals (HCPs) and health caregivers (HCGs), and their impact in the QoL, on the other hand. Out of 20,796 hits, 204 full-text articles were assessed for eligibility. The final eligible studies were 19 articles that satisfied the inclusion criteria (18 published papers and one PhD dissertation). The quality of encompassed studies was calculated according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Comprehensive (CMA) software version 2 was used to perform the MA. The pooled effect size was calculated using the random effect and ANOVAs were performed for moderation analyses for categorical moderators and meta regression analysis for continuous moderators. In addition, publications bias analysis was also performed. The Cochrane software “Review Manager v5.3” was employed to examine the quality of the included studies. Patient perception of physician’s communication skills was compared with the perception of physicians using the American Board of Internal Medicine (ABIM) communication assessment tool and QoL of cancer patients was assessed via FACTG questionnaire. Correlation coefficients of perception of patients were carried out using positive correlation analysis via SPSS V.26. Results: Communication had a significant positive impact on the QoL of cancer patients and a significant association and moderation was observed for the mental component summary (MCS). Furthermore, a significant positive impact of involving Health Caregivers (HCGs) in communication on the QoL of cancer patients was also found. Covariate analysis indicated a true variation in effect sizes between studies and confirmed the existence of inconsistencies among different studies due to the diverse definitions and assessment tools used to measure the outcomes. The heterogeneity assessment offered explanation where possible to the consistencies and diversities between studies. Clinical and design heterogeneities were observed and reported. Our local pilot study in Qatar suggested a significant positive correlation between QoL and patients perception of physicians’ communication skills, r = 0.222, P=0.3. Moreover, our pilot study suggests a significant discrepancy between the patients perceptions &amp; HCP perceptions, of the different communication skills set (Interpersonal, Content, Total Communication Skills). The patients reporting a lower perception 57% vs 86% total communication skills p=0.0028, 58% vs 88% for IP communication skills p=0.0003, and 55% vs 84% for content communication skills p=0.0042. Conclusion: This MA covered a gap that existed in the literature among published systematic reviews and meta-analyses. It confirmed a significant correlation between communication and QoL of cancer patients irrespective of cancer type, age group, culture, gender, prognosis, or year of study. These results were global, transcontinental, and transcultural. It clearly highlighted the significant need to communicate with cancer patients and how much its benefits improve their QoL, as well as medical services. The results can be used to inform policy makers and health practitioners. Future Interventions should take into account these results to improve the communication between health practitioners and cancer patients and the involvement of families in the communication process. The health care system should consider communication as a vital component of providing a holistic patient and family centered care. The umbrella of QoL, provides a clear picture about patients and their families’ conditions and dictates that their communication needs are addressed as part of a standard of care. Furthermore, communication with its wide list of components should undergo a crucial level of studying, researching, critiquing and standardization, so that patients’ right to access a high standard of care is guaranteed across all health care systems. Our local results in Qatar resonate with this MA and raise the attention needed to clinical communication practice.

Impaired insight in schizophrenia: impact on patient-reported and physician-reported outcome measures in a randomized controlled trial

BackgroundImpaired insight poses a challenge in the treatment of patients with schizophrenia because of its potential to jeopardize therapeutic engagement and medication adherence. This study explored how insight impairment, graded from none to extreme, is related to patient-reported mental health status, depression, and neurocognition in schizophrenia.MethodsIn a post hoc analysis of the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study (NCT00014001), insight was measured using the Positive and Negative Syndrome Scale (PANSS) Item G12 (lack of insight). Additional assessments for this analysis included the 12-Item Short-Form Health Survey (SF-12) Mental Component Summary (MCS), physician- and patient-reported Clinical Global Impression–Severity (CGI-S), MATRICS Consensus Cognitive Battery, and Calgary Depression Scale for Schizophrenia. Relationships between patient-reported outcomes and PANSS total and Item G12 ratings were evaluated.ResultsAmong 1431 CATIE study participants in this analysis, increasingly impaired insight at baseline was significantly associated with better patient-reported quality of life (QoL), lower baseline depression, and greater divergence between physician- and patient-reported illness severity. Patients with more severely impaired insight reported milder illness compared with physician reports, particularly those with moderate-severe to extreme impairment (PANSS Item G12 rating ≥ 5), approximately 10% (138/1431) of CATIE participants. For the 90% of patients with PANSS Item G12 ratings < 5, patient-reported QoL decreased with increasing symptoms. SF-12 MCS scores were linearly related to baseline PANSS total score only in patients with PANSS total score < 90 (moderately ill or better), and better symptom scores were associated with higher QoL. No significant relationship between insight and neurocognition was observed.ConclusionsIn the small subgroup (10%) of CATIE study patients with schizophrenia and PANSS Item G12 ratings ≥5, moderate-severe–severe/extreme insight impairment was associated with significantly more positive perception of QoL and illness severity by the patient versus the treating physician. This was not observed in the remaining 90% of patients with normal to moderately impaired insight, suggesting that poor insight as a threat to the validity of self-report is uncommon.

Quality of life in patients with heart failure and improved ejection fraction: one-year changes and prognosis.

The criteria for patients with heart failure (HF) and improved ejection fraction (HFimpEF) are a baseline left ventricular ejection fraction (LVEF) ≤40%, a ≥10-point increase from baseline LVEF, and a second LVEF measurement >40%. We aimed to (i) assess patients with HF and reduced LVEF (HFrEF) at baseline and compare quality of life (QoL) changes between those that fulfilled and those that did not fulfil the HFimpEF criteria 1year later and (ii) assess the prognostic role of QoL in patients with HFimpEF. We reviewed data from a prospective registry of real-world outpatients with HF that were assessed for LVEF and QoL at a first visit to the HF clinic and 1year later. QoL was evaluated with the Minnesota Living with Heart Failure Questionnaire (MLWHFQ). The primary prognostic endpoint was the composite of all-cause death or HF hospitalization. Baseline and 1-year LVEF and MLWFQ scores were available for 1040 patients with an initial LVEF ≤40% (mean age, 65.2±11.7years; 75.9% men). The main aetiology was ischaemic heart disease (52.9%), and patients were mostly in New York heart Association Classes II (71.1%) and III (21.6%). At baseline, the mean LVEF was 28.5%±7.3, and the mean MLWHFQ score was 30.2±19.5. After 1year, the mean LVEF increased to 38.0%±12.2, and the MLWHFQ scores improved to 17.4±16.0. In 361 patients that fulfilled the HFimpEF criteria (34.7%), significant improvements were observed in both LVEF (from 28.7%±6.6 to 50.9%±7.6, P<0.001) and QoL (from 32.9±20.6 to 16.9±16.0, P<0.001). Patients that did not fulfil the HFimpEF criteria also showed significant improvements in LVEF (from 28.4%±7.6 to 31.1%±7.9, P<0.001) and QoL (from 28.7±18.8 to 17.6±15.9, P<0.001). However, the QoL improvement was significantly higher in the HFimpEF group (-16.0±23.8 vs. -11.1±20.3, P=0.001), despite the worse mean baseline MLWHFQ score, compared with the non-HFimpEF group (P=0.001). The 1-year QoL was similar between groups (P=0.50). The 1-year MLWHFQ score was independently associated with outcomes; the hazard ratio for the composite endpoint was 1.02 (95% CI: 1.01-1.03, P=0.006). In contrast, the QoL improvement (with a cut-off ≥5 points) was not independently associated with the composite outcome. Patients with HFrEF showed improved QoL after 1year, regardless of whether they met the HFimpEF criteria. The similar 1-year QoL perception between groups suggested that factors other than LVEF influenced QoL perception. The 1-year QoL was superior to the QoL change from baseline for predicting prognosis in patients with HFimpEF.

The association between weight loss and long term development in quality-of-life among children living with obesity: a pragmatic descriptive intervention study

BackgroundChildhood obesity is associated with impaired Quality-of-Life (QoL), increased stigmatization and higher risk of development of depression compared to their peers. This report describes the long-term development in QoL for cohort of children with obesity after a sustainable weight reduction.MethodsThis pragmatic descriptive intervention study enrolled 120 children with obesity, age 5–17 years, in a multifactorial lifestyle intervention. The intervention was an across sectors collaboration between a department of pediatrics and community health care workers. QoL was assessed yearly throughout the intervention and evaluated by a 6-item Visual Analogue Scale (VAS). For analyzing changes in VAS, as function BMI-SDS, regression models were used, while ANOVA and Wilcoxon test were applied for normal and not-normal distributed data. 95% confidence interval not containing 0 and p-value < 0.05 was considered statistically significant.ResultsAfter 26.4 months (13.9 SD) an overall decrease in bullying (0.6 vs. 0.0 median) and motivation (10.0 vs. 9.6) was observed. QoL increased in children with a BMI-SDS reduction (0.65 (2.49 SD)) opposite children with no-change or increasing BMI-SDS who reported reduced QoL (-0.36 (1.55 SD) and -0.96 (2.27 SD)). A significant inverse relationship was observed for Joy of Life, QoL and body perception as a function of BMI-SDS per year.ConclusionWeight reduction causes improvement in QoL for children with obesity and an inverse relationship for QoL and changing BMI-SDS / year was establish.

Effect of an oral probiotic formula on scalp and facial skin condition, glucose, and lipid metabolism

Objective: We conducted this study to explore the effect of oral probiotic supplementation on hair density as a primary outcome in subjects with hair loss and at high risk of metabolic syndrome. The secondary objectives were to assess probiotic effects on skin barrier function,metabolic health and stress responses.Methods: We supplemented the diets of Chinese adults presenting with hair loss and high risk of metabolic syndrome (n = 26, male gender 38.5%, age = 33.6 ± 4.5 years) with a multi-strain probiotic formula at a dosage of 18.1 billion colony forming units (CFU) twice daily for 12 weeks. We compared the hair density, hair loss, anthropometrics measures, blood biochemistry markers, skin biophysical characteristics and stress-associated responses between baseline and the end of the trial.Results: After 12 weeks of probiotic supplementation, 96.2% of the study participants had improvement in hair density (median density level increased: 1; interquartile range: 1-2). Participants reported reduced hair loss both quantitatively and qualitatively. The majority (73.1%) of the participants reported apparent relief of scalp itching. Stratum corneum hydration and pH increased, while transepidermal water loss and sebum decreased on both scalp and facial skin. Body weight and body mass index decreased following probiotic consumption. Most components of glucose metabolism and the lipid profile were significantly better, with increases in high-density lipoprotein cholesterol and reductions in glucose, homeostasis model assessment-estimated insulin resistance, total cholesterol, non-high-density lipoprotein cholesterol and triglycerides. Inflammation and oxidative stress markers improved with increases in interferon-γ and superoxide dismutase, and reductions in high-sensitivity C-reactive protein, interleukin-6, interleukin-31 and malondialdehyde. No changes were observed in glycated hemoglobin, insulin, immunoglobulin E and interleukin-10 levels. Besides, perceived stress relieved in participants accompanied with improved sleep quality as well as better overall perception of life quality and health.Conclusion: Twice-daily supplementation with the test probiotic formula over a 12-weeks period may exert profound beneficial effects on hair growth, skin condition, glucose and lipid metabolism, and stress-associated psychological and physiological responses in participants presenting with hair loss and high risk of metabolic syndrome. This study has been registered at Chinese Clinical Trial Registry (ChiCTR2100050498).Keywords: hair density, hair loss, metabolic syndrome, oral probiotic supplementation

Self-care and quality of life among men with chronic heart failure.

IntroductionChronic Heart Failure (CHF) involves a complex regimen of daily self-care behaviors: pharmacological therapy, symptom monitoring and lifestyle modifications. Patients with CHF may have a reduced health related quality of life (HRQoL) due to various physical and emotional symptoms. HRQoL may be improved through the use of self-care interventions.PurposeTo assess the level of self-care and quality of life among men with chronic heart failure.MethodsThe study was conducted among 80 men diagnosed with CHF (mean age 58 years). The study was cross-sectional. A self-administered questionnaire and analysis of medical records were used to collect baseline sociodemographic and clinical data. Self-care was assessed using the standardized European Heart Failure Self-care Behavior Scale- EHFScBS-9 and quality of life was assessed using the World Health Organization Quality of Life Bref.ResultsThe Patients in NYHA class II constituted the vast majority (71.25%), mean LVEF in the study group was 43.5%, and mean disease duration was 3 years. The most common comorbidities were ischemic heart disease (72.5%), hypertension (70%) and diabetes mellitus (60%). The most commonly reported non-pharmacological treatments for NS were fluid restriction (45%), moderate physical activity (42.50%) and daily weight control (41.25%). The EHFSc-9 questionnaire score averaged 50.31 points out of 100 possible (SD = 26.52). The mean score regarding perception of QoL was 2.78 points (SD = 0.91), and 40% of patients indicating poor perception of QoL. The mean score for self-rated Analysis of the results of the individual domains of the WHOQoL BREF questionnaire showed that patients rated their QoL best in the environmental domain (M = 13.28; SD = 3.11), then in the social domain (M = 12.81; SD = 2.71), and in the psychological domain (M = 12.8; SD = 3.2). In contrast, QoL in the physical domain was rated the lowest (M = 10.44; SD = 2.85). There was no significant correlation between quality of life and self-care (p > 0.05).ConclusionsMen with CHF have unsatisfactory self-care outcomes and low quality of life scores and are dissatisfied with their health. Strategies to improve selfcare and quality of life in this group are indicated.