Physical Composite Summary Scores Research Articles

Abstract 1997: Health-related quality of life at diagnosis in survivors of adolescent and young adult cancer

Abstract Purpose: Data are lacking on the distribution, factors associated with, and long-term impact of diminished health-related quality of life (HRQoL) at diagnosis in adolescent and young adult (AYA) cancer survivors (≥2 years post cancer diagnosis). Our goal was to fill this gap in knowledge. Methods: A cohort of AYA (15y - 39y) cancer patients treated at MD Anderson between 2000-2016 who had survived at least 2 y was identified from our Institutional Tumor Registry. HRQoL was assessed at diagnosis with the SF12v1 questionnaire. Demographic and behavioral risk factors, tumor type, and vital status were ascertained. Physical composite summary (PCS) and mental composite summary (MCS) scores were generated from SF12 responses following mean-based normalization; PCS or MCS < 50 indicated “poor” HRQoL. Statistical tests included ANOVA, quantile regression, and multivariable Cox proportional hazards. Results: 2,609 AYA cancer survivors (75% diagnosed between age of 26-39 y; 67% White, 18% Hispanic and 9% Black) were included. Breast cancer was the most frequent diagnosis (25%), followed by sarcoma (12%) and Hodgkin lymphoma (10%). Median follow-up for participants was 10.5 y. Overall mean PCS and MCS scores at diagnosis were 45.3 (SD: 11.4) and 47.0 (SD: 10.5), respectively. Female AYA cancer patients had significantly higher PCS, yet lower MCS compared to their male counterparts (both P<0.001). A positive association between age at diagnosis and PCS was observed (P<0.001), in contrast to the inverse association with MCS (P<0.001). Differences in PCS (P<0.001) and MCS (P=0.001) were also evident by tumor type. For example, women with breast cancer reported the most favorable PCS (51.5) at diagnosis, yet among the lowest MCS (46.1) of the nine tumor types analyzed. The Black AYA population had a larger burden of poor PCS at diagnosis with 61% of patients reporting scores <50 compared to 55% of Hispanic and 51% of non-Hispanic whites. Significant predictors of diminished PCS in AYA cancer survivors in the bottom 25% of PCS scores were younger age at diagnosis (P=0.003), male gender (P<0.001), diagnosis of a hematologic malignancy versus solid tumor (P<0.001), smoking (P=0.003) and not consuming any alcohol currently (P<0.001). Overall, low PCS (<50) at diagnosis (HR=1.57, P<0.001), and diagnosis of a solid tumor compared to a hematologic malignancy (HR=2.33, P<0.001) were associated with lower survival. Conclusions: In this large, diverse AYA cancer survivor cohort, physical and mental HRQoL at diagnosis were impacted by AYA’s age at diagnosis, gender, tumor type, and smoking status. Low PCS at diagnosis was an independent predictor of diminished survival among AYA cancer survivors ≥2y post diagnosis. Our findings suggest that patient-reported poor physical well-being at diagnosis is a biomarker of poor prognosis for AYA cancers. Further studies are needed to identify interventions to improve outcomes for this population. Citation Format: Goldy C. George, Clark R. Andersen, Xiaohui Tang, John A. Livingston, Michael E. Roth, Michelle A. Hildebrandt. Health-related quality of life at diagnosis in survivors of adolescent and young adult cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 1997.

Association of a Perioperative Multicomponent Fall Prevention Intervention With Falls and Quality of Life After Elective Inpatient Surgical Procedures

Falls after elective inpatient surgical procedures are common and have physical, emotional, and financial consequences. Close interactions between patients and health care teams before and after surgical procedures may offer opportunities to address modifiable risk factors associated with falls. To assess whether a multicomponent intervention that incorporates education, home medication review, and home safety assessment is associated with reductions in the incidence of falls after elective inpatient surgical procedures. This prospective propensity score-matched cohort study was a prespecified secondary analysis of data from the Electroencephalography Guidance of Anesthesia to Alleviate Geriatric Syndromes (ENGAGES) randomized clinical trial, which was conducted at a single academic medical center between January 16, 2015, and May 7, 2018. Patients in the intervention group of the present study were enrolled in either arm of the ENGAGES clinical trial. Patients in the control group were selected from the Systematic Assessment and Targeted Improvement of Services Following Yearly Surgical Outcomes Surveys prospective observational cohort study, which created a registry of patient-reported postoperative outcomes at the same single center. The propensity score-matched cohort in the present study included 1396 patients (698 pairs) selected from a pool of 2013 eligible patients. All patients underwent elective surgical procedures with general anesthesia and had a hospital stay of 2 or more days. Data were analyzed from January 2, 2020, to January 11, 2022. The multicomponent safety intervention (offered to all patients in the ENGAGES clinical trial) included patient education on fall prevention techniques, home medication review by a geriatric psychiatrist (with communication of recommended changes to the surgeon), a self-administered home safety assessment, and targeted occupational therapy home visits with home hazard removal (offered to patients with a preoperative history of falls). The primary outcome was patient-reported falls within 1 year after an elective inpatient surgical procedure. The secondary outcome was quality of life 1 year after an elective surgical procedure, which was measured using the physical and mental composite summary scores on the Veterans RAND 12-item health survey (score range, 0-100 points, with 0 indicating lowest quality of life and 100 indicating highest quality of life). Among 1396 patients, the median age was 69 years (IQR, 64-75 years), and 739 patients (52.9%) were male. With regard to race, 5 patients (0.4%) were Asian, 97 (6.9%) were Black or African American, 2 (0.1%) were Native Hawaiian or Pacific Islander, 1237 (88.6%) were White, 3 (0.2%) were of other race, and 52 (3.7%) were of unknown race; with regard to ethnicity, 12 patients (0.9%) were Hispanic or Latino, 1335 (95.6%) were non-Hispanic or non-Latino, and 49 (3.5%) were of unknown ethnicity. Adherence to individual intervention components was modest (from 22.9% for completion of the self-administered home safety assessment to 28.2% for implementation of the geriatric psychiatrist's recommended medication changes). Falls within 1 year after surgical procedures were reported by 228 of 698 patients (32.7%) in the intervention group and 225 of 698 patients (32.2%) in the control group. No significant difference was found in falls between the 2 groups (standardized risk difference, 0.4%; 95% CI, -4.5% to 5.3%). After adjusting for preoperative quality of life, patients in the intervention group had higher physical composite summary scores (3.8 points; 95% CI, 2.4-5.1 points) and higher mental composite summary scores (5.7 points; 95% CI, 4.7-6.7 points) at 1 year compared with patients in the control group. In this cohort study, a multicomponent safety intervention was not associated with reductions in falls within the first year after an elective surgical procedure; however, an increase in quality of life at 1 year was observed. These results suggest a need for other interventions, such as those designed to increase adherence, to lower the incidence of falls after surgical procedures.

Assessing health-related quality of life and health utilities in patients with chronic hepatitis B-related diseases in China: a cross-sectional study

ObjectivesThe health-related quality of life (HRQoL) and utilities of patients with chronic hepatitis B (CHB) virus infection, including compensated cirrhosis (CC), decompensated cirrhosis (DC) and different stages of hepatocellular carcinoma...

Quality of Life and Its Determinants in Patients With Adrenal Insufficiency: A Survey Study From Three Tertiary Centers in the United States

Context: Quality of life (QoL) is impaired in patients with chronic adrenal insufficiency (AI) despite standard glucocorticoid (GC) replacement therapy. Current evidence on the determinants of QoL is scarce and limited in very few European countries, and how it relates to AI subtypes remains underexplored. Objective: We conducted the first survey study in patients with AI in the USA to determine the correlations between clinical parameters, adverse outcomes, patient education, socioeconomic factors, and QoL in different subtypes of AI. Design, Setting and Participants: Cross-sectional survey study of 529 patients with AI between 2015 and 2020, at three tertiary centers in the USA. Intervention: Patient-centered questionnaires. Main Outcome Measures: QoL scores using Short-Form 36. Results: Of 529 participants, 223 (42.2%) had primary AI (PAI), 190 (35.9%) had secondary AI (SAI), and 116 (21.9%) had glucocorticoid induced AI (GIAI). Median age at the time of survey was 58 years (IQR: 43–68), 342 (64.8%) were women and 483 (91.3%) were Caucasians. Median duration of AI was 6 years (IQR: 3–14.5), longest in patients with PAI (11 vs 4 years in SAI and GIAI, p=0.0001). Overall, Physical Composite Summary (PCS) score was lower than the Mental Composite Summary (MCS) (38.1±12.9 vs 46.5±11.8). Across the eight dimensions, each individual decade- and sex-adjusted Z-score (using the normative data of USA population) in patients with PAI was significantly higher than that of the other two AI subtypes (all p<0.05), although all Z-scores were still below 0. In multivariate analyses, patients were more likely to report a worse PCS score (<40) if they were women (OR: 3.3, CI 95%: 1.8–6.0), had SAI or GIAI (OR: 2.5, CI 95%: 1.4–4.3), had shorter duration of AI (<6 years) (OR: 2.0, CI 95%: 1.1–3.6), were treated with >25 mg hydrocortisone equivalent daily (OR: 2.3, CI 95%: 1.2–4.6), had more comorbidities related to GC excess (OR: 2.3, CI 95%: 1.3–4.0), reported higher financial burden due to AI (OR: 2.1, CI 95%: 1.3–3.6), and reported difficulties with AI management (OR: 2.5, CI 95%: 1.2–5.2). Women (OR: 2.1, CI 95%: 1.08–4.0), shorter duration of AI (OR: 2.4, CI 95%: 1.4–4.3), higher financial burden due to AI (OR: 2.3, CI 95%: 1.3–4.0), reporting difficulties with AI management (OR: 2.6, CI 95%: 1.4–4.9), and lack of family support during adrenal crisis (OR: 9.1, CI 95%: 2.3–33.3), were predictors of a worse MCS score (<40). Conclusions: Patients with AI have substantially impaired QoL despite GC replacement therapy. Certain determinants of QoL are modifiable and achievable, such as avoiding GC over-replacement, offering detailed hands-on education in self-management, more comprehensive insurance coverage, and more robust domestic support. Our study calls for a multidimensional effort from patients, clinicians, and society to improve QoL in this vulnerable patient population.

Quantifying heterogeneity of physical and mental health-related quality of life in chronic obstructive pulmonary disease patients in the United States

ABSTRACT Background Chronic obstructive pulmonary disease (COPD) is a heterogenous condition. This study aims to quantify the heterogeneity of Health-related Quality of Life (HRQoL), and identify subgroups with the lowest HRQoL, in COPD patients in the United States (US). Methods Data from 2008–2015 Medical Expenditure Panel Survey were used to examine the heterogeneity of HRQoL between different COPD subgroups using mixed-effects modeling and G-computation. The Physical Composite Summary (PCS) and Mental Composite Summary (MCS) scores from the Short-Form-12 questionnaire were utilized. We also compared the heterogeneity of HRQoL in our COPD cohort against that in a matched non-COPD cohort. Results The final sample consisted of 1,866 (weighted = 19,952,143) COPD patients with a mean age of 63.2 years (Standard error (SE):0.38), mean MCS score of 46.84 (SE:0.35), and mean PCS score of 35.65 (SE:0.32). The adjusted MCS and PCS scores ranged from 36.19 to 53.06, and from 25.52 to 48.27, respectively, for COPD subgroups. COPD patients had statistically significantly lower MCS and PCS scores by 4.61, and 5.86 points, respectively, compared to the matched non-COPD cohort, and MCS scores showed a wider variability in the COPD cohort. Conclusion Our study quantifies substantial heterogeneity of HRQoL in COPD in the US and provides evidence for prioritizing COPD subgroups with the lowest HRQoL for targeted interventions.

P1465DEPRESSION AND HEALTH RELATED QUALITY OF LIFE AMONG ELDERLY HAEMODIALYSIS PATIENTS

Abstract Background and Aims The reported prevalence of depression is around 20-30% among dialysis patients according to the literature. Previous studies have shown a strong negative correlation between depression and kidney disease related quality of life (KDQOL) scores in ESRD patients. In this study we examined the relationship between depression and KDQOL scores of a racially diverse cohort of elderly haemodialysis (HD) patients. Additionally we investigated the predictors of depression among this cohort. Method Prevalent HD patients aged 65 years and above who were dialyzing in our institution were included in this cross-sectional study. The Geriatric depression scale (GDS-15) and KDQOL-SFTM version 1.3 were the instruments used to derive depression and KDQOL domain scores respectively. The predictor variable was depression status based on a cut-off of 5 and patients were categorized into 2 groups – depression (Yes)-GDS≥5 and depression (No)–GDS&amp;lt;5. The impact of socio-demographic factors and lab parameters was compared using chi square test for categorical variables and Independent T test/Mann Whitney U test for continuous variables. The 3 main KDQOL domains – physical composite summary (PCS) score, mental composite summary (MCS) score and Kidney disease composite summary (KDCS) score were compared using Independent T test among the depression status groups. Multivariate logistic regression was used to determine the predictors of depression among this elderly HD cohort. Results A total of 1034 elderly HD patients (mean age 72.1±5.6 years, 55.9% male, 65.7% Chinese, 65.8% diabetic and mean vintage of 5.8±5.6 years) were included in the study. The prevalence of depression was 18.1% among this elderly HD cohort. The patients with depressive symptoms were predominantly non-ambulant, with high medical dependency and increased hospital admissions in the past year compared to the non-depressed group. There were no statistically significant differences in the age, race, gender, diabetic status and dialysis vintage between the groups with and without depression. The group with depression had significantly lower PCS, MCS and KDCS domain scores compared to the group without depression (p&amp;lt;0.001). Mobility status was identified as an independent predictor of depression - ambulant patients were 53% (OR-0.47, 95%CI 0.31-0.70, p&amp;lt;0.001) less likely to be depressed compared to non-ambulant HD patients (p&amp;lt;0.001). Mean scores for KDQOL dimensions like sleep and social support were significantly lower among patients with depression (p&amp;lt;0.001). Conclusion Elderly haemodialysis patients with depression had significantly lower mean health related quality of life scores compared to patients without depression. Mobility status was an important predictor of depression among our elderly cohort. Regular screening and management of depression should be part of the routine care of the elderly HD patients so as to improve their quality of life and dialysis outcomes.

Health-related quality of life among patients with comorbid diabetes and kidney disease attending a codesigned integrated model of care: a longitudinal study

ObjectiveTo evaluate the impact of an integrated diabetes and kidney disease model of care on health-related quality of life (HRQOL) of patients with comorbid diabetes and chronic kidney disease (CKD).Research...

Relationship between blood flow rate and quality of life in patients undergoing hemodialysis

Background: A low quality of life (QoL) score in patients undergoing hemodialysis (HD) is associated with an increased risk of mortality. However, no study has evaluated a direct relationship between the blood flow rate (BFR) and QoL in patients undergoing twice-weekly HD. Materials and Methods: This cross-sectional study was conducted on patients undergoing HD (twice weekly) at the HD Unit in Cipto Mangunkusumo Hospital, Jakarta. The patients were divided into two groups: those with a BFR of >250 ml/min and those with a BFR of ≤250 ml/min. QoL was assessed using the Kidney Disease QoL-Short Form questionnaire, which is divided into physical composite summary (PCS), mental composite summary, and kidney disease composite summary (KDCS) scores. The relationship between the BFR and QoL scores was analyzed using the Chi-square test and logistic regression analysis to determine the adjusted prevalence ratio (PR). Results: In total, 132 patients were included in the analysis. Patients with a BFR of >250 ml/min were more likely to have a higher PCS score (PR, 1.86; 95% confidence interval [CI], 1.15–2.99) and KDCS score (PR, 1.41; 95% CI, 1.03–1.92) than those with a BFR of ≤250 ml/min. After the multivariate analysis, the BFR was still associated with the PCS score (adjusted PR, 1.75; 95% CI, 1.12–2.36) and KDCS score (adjusted PR, 1.31; 95% CI, 1.04–1.49). Conclusion: Higher BFR values were significantly associated with higher PCS and KDCS scores in patients undergoing twice-weekly HD.

Patient reporting of complications after surgery: what impact does documenting postoperative problems from the perspective of the patient using telephone interview and postal questionnaires have on the identification of complications after surgery?

ObjectivesTo identify the frequency of postoperative complications, including problems identified by patients and complications occurring after discharge from hospital. To identify how these impact on quality of life (QoL) and...

Abstract 990: Patterns of racial disparities in health-related quality of life among colorectal cancer patients and relationship with survival

Abstract Distinct racial disparities are evident in CRC prognosis with Black patients experiencing worse outcomes than Hispanics and Whites. In a prior study of Health Related Quality of Life (HR-QoL) in a cohort of CRC patients, we observed that racial minority patients experienced lower HR-QoL scores compared to White CRC patients. Therefore, in this study, we focused on the identification of patterns of racial disparities in HR-QoL scores and relationship to differences in prognosis. White (N=450), Hispanic (N=366), and Black (N=316) CRC patients within 1 year of diagnosis at MD Anderson Cancer Center completed the SF-12 quality of life questionnaire to determine Mental Composite Summary (MCS) and Physical Composite Summary (PCS) scores. Participants also completed a questionnaire to collect epidemiology and sociodemographic variables. Vital status and histology information was obtained from the institutional tumor registry. Racial disparities were reported in HR-QoL with both Black and Hispanic patients reporting lower mean PCS and MCS scores compared to White patients, suggesting poorer HR-QoL in these populations. We observed differences in patterns of association between epidemiology and sociodemographic variables and poor HR-QoL by race. Hispanics who never married were at higher risk of poor physical HR-QoL (OR: 2.55(1.15-5.67), P=0.021) compared to married patients, which was not observed for White or Black CRC patients. Similarly, CRC patients with some college education was associated with a decreased risk of poor PCS, but only in Hispanics (OR: 0.26(0.13-0.52), P&amp;lt;0.0001). White females have about two-fold risk of poor PCS (P=2.00 x 10-4) and MCS (P=2.21 x 10-4) scores compared to White males. This relationship was also observed for Black females OR: 2.28(1.35-3.84), but not Hispanic females. Among CRC patients reporting poor PCS (&amp;lt;50), significant differences in median survival times (MSTs) were observed by race. Hispanic patients had the highest MST at 85.4 months followed by Blacks (47.8 months) and Whites (43.2 months). A similar relationship was observed for poor MCS (&amp;lt;50) stratified by race with MST times of 81.9 months for Hispanics, 40.8 months for Blacks, and 54.1 months for Whites. In conclusion, we identified patterns of racial disparities in epidemiology and sociodemographic factors that correspond to poor baseline HR-QoL in CRC patients. We also demonstrated that a prognostic correlation exists between baseline HR-QoL and patient overall survival, and that this relationship is influenced by race. The patterns of racial disparity identified in this study can be an important tool for assessing the underlying mediators of HR-QoL in CRC patients and to further identify those who are particularly at risk for poor prognosis. Citation Format: Michelle A. T. Hildebrandt, Alem A. Belachew, Monica E. Reyes, Yuanqing Ye, Xifeng Wu. Patterns of racial disparities in health-related quality of life among colorectal cancer patients and relationship with survival [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 990. doi:10.1158/1538-7445.AM2017-990

Physical Functioning Among Older Adults New to Long-Term Services and Supports.

To identify determinants of self-reported physical functioning (PF) among older adults new to long-term services and supports (LTSS). Using the International Classification of Function, Disability, and Health (ICF) framework, we conducted a secondary analysis of self-reported data on symptoms, basic/instrumental activities of daily living, quality of life, assistive devices, physical therapy needs, prior healthcare utilization, health status, and demographics from 470 older adults new to LTSS (Home/Community-Based n = 156; Assisted Living n = 156; Nursing Home n = 158). Multiple linear regression was used to identify associations between ICF constructs and self-reported PF (SF-12 Physical Composite Summary score [SF12PCS], lower scores indicate worse PF). LTSS recipients were mostly female (71%) and over age 80 (Mean: 80.9 years, SD: 8.7). LTSS recipients' mean SF12PCS score was 37.3 (SD 11.0), indicating overall low self-reported PF. LTSS recipients living in their homes (b = -3.35, p = .003) or assisted living facilities (b = -2.93, p = .012) had significantly lower mean scores compared to recipients in nursing homes. Higher SF12PCS scores were associated with fewer activities of daily living deficits (p < .001), and better quality of life (p < .001). Lower scores were associated with more symptoms (p < .001), poorer nutrition (p = .013), ambulation aid use (p < .001), and physical therapy (p < .026). Diverse health, activity, and environmental factors may facilitate early identification of new LTSS recipients most in need of interventions to optimize self-reported PF. Several health conditions may be targets for such interventions. Additional research is needed to evaluate and compare PF trajectories among older adults receiving LTSS in diverse settings.

Predictors of Health-Related Quality-of-Life After Complex Adult Spinal Deformity Surgery: A Scoli-RISK-1 Secondary Analysis

Study DesignLongitudinal cohort. ObjectivesTo identify variables that predict 2-year Short Form-36 Physical Composite Summary Score (SF-36PCS) and the Scoliosis Research Society-22R (SRS22-R) Total score after surgery for complex adult spinal deformity. Summary of Background DataIncreasingly, treatment effectiveness is assessed by the extent to which the procedure improves a patient's health-related quality of life (HRQOL). This is especially true in patients with complex adult spinal deformity. MethodsThe data set from the Scoli-Risk-1 study was queried for patients with complete 2-year SF-36 and SRS-22R. Regression analysis was performed to determine predictors of 2-year SF-36PCS and SRS-22R Total scores. Factors included were sex, age, smoking status, body mass index, American Society of Anesthesiologists (ASA) grade, Lower Extremity Motor Score improvement, indication for surgery, preoperative and 2-year maximum coronal Cobb angles, number of prior spine surgeries, number of three-column osteotomies, number of surgical levels, number of surgical stages, lowest instrumented level, presence and type of neurologic complication, and number of reported serious adverse events. ResultsOf 272 cases enrolled, 206 (76%) cases were included in this analysis, 143 (69%) females, and mean age of 57.69 years. Factors that were significantly associated with of 2-year SF-36PCS were age (p < .001), ASA grade (p < .001), maximum preoperative Cobb angle (p = .007), number of three-column osteotomies (p = .049) and type of neurologic complication (p = .068). Factors predictive of 2-year SRS-22R Total scores were maximum preoperative Cobb angle (p = .001) and the number of serious adverse events (p = .071). ConclusionsFactors predictive of lower 2-year HRQOLs after surgery for complex adult spinal deformity were older age, higher ASA grade, larger preoperative Cobb angle, larger numbers of three-column osteotomies, and the occurrence of both neurologic and nonneurologic complications. Most of these factors are beyond the control of surgeons. Still, surgeons should medically optimize a patient prior to surgery to minimize the risk of complications and offer the best chance of improving a patient's quality of life. Level of EvidenceLevel II. Prospective cohort.

Assessment of health-related quality of life and its determinants in patients with chronic kidney disease.

Health-related quality of life is an important, yet neglected aspect of chronic kidney disease (CKD) care. We evaluated the quality of life and its determinants across CKD 3 to 5D using a kidney disease specific tool (Kidney Disease Quality of Life-SF™) in an underprivileged, predominantly rural population with high rates of illiteracy and unemployment. The scores of individual domains were summarized to three composite scores – physical composite summary (PCS), mental composite summary (MCS), and kidney disease component summary score (KDCS). A total number of 204 participants were recruited from nephrology outpatient clinics. About 68.1% of participants were males. The mean age of the study population was 49.14 ± 13.63 years. There was a high proportion of illiteracy (36.3%) and unemployment (80.9%). KDCS showed a significant decline (P = 0.01) from CKD 3 to CKD 5D whereas MCS and PCS showed a nonsignificant decrease. There was no difference in KDCS, PCS, or MCS scores between patients treated by hemodialysis and CAPD. Illiteracy and unemployment were associated with significantly lower KDCS, PCS, and MCS scores. Age ≥50 years was associated with poor PCS (29.49 ± 8.20 vs. 34.17 ± 9.99; P < 0.001). Hemoglobin <10 g/dL was associated with poor KDCS (58.93 ± 13.09 vs. 65.55 ± 13.38; P < 0.001) and PCS (29.56 ± 8.13 vs. 33.37 ± 9.82; P < 0.001). The presence of comorbidities such as diabetes and hypertension had no impact on the composite scores. KDCS, MCS, or PCS scores did not vary among patients having high serum phosphorus (≥4.5 mg/dL), low albumin (<3.5 g/dL), and elevated parathyroid hormone (≥150 pg/ml). On multiple linear regression analysis, the predictors of KDCS were unemployment (P < 0.001) and illiteracy (P = 0.03). Unemployment (P < 0.001) and age (P < 0.001) were predictors of PCS whereas literacy level (P < 0.001) was predictive of MCS.

Outcomes and revision rates in normal, overweight, and obese patients 5 years after lumbar fusion

Background ContextObesity is a growing problem in health care. Studies have demonstrated similar functional outcomes but higher complication rates after spine surgery in obese patients. PurposeThis study aimed to compare patient-reported outcomes and revision rates 5 years after instrumented posterior lumbar fusion between normal, overweight, and obese patients. Study designPropensity matched case control. Patient samplePatients who had posterior instrumented lumbar spinal fusion from 2001 to 2008 from a single spine specialty center with complete preoperative and 5-year postoperative outcome measures were identified. Outcome measuresOswestry Disability Index (ODI), Back Pain (0–10) and Leg Pain (0–10) Numeric Rating Scales, and Short Form-36 Physical Composite Summary Scores (SF-36 PCS). MethodsThree comparison groups, one with body mass index (BMI) ≥20–25 kg/m2 (normal), another with ≥25–<30 kg/m2 (overweight), and another with ≥30–40 kg/m2 (obese) were created using propensity matching techniques based on demographics, baseline clinical outcome measures, and surgical characteristics. Five-year postoperative outcome measures and revision rates in the three groups were compared. One-way analysis of variance was used to compare continuous variables, and Fisher exact test was used to compare categorical variables between the groups. Significance was set at p<.01. ResultsThere were 82 cases matched in each cohort. Estimated blood loss (440 cc vs. 702 cc vs. 798 cc, p=.000) and operative time (234 minutes vs. 263 minutes vs. 275 minutes, p=.003) were significantly greater in the overweight and obese patients. Improvements in ODI (14.2 vs. 9.6 vs. 10.4, p=.226), SF-36 PCS (5.9 vs. 2.9 vs. 3.5, p=.361), back pain (3.0 vs. 2.0 vs. 2.1, p=.028), and leg pain (3.0 vs. 2.3 vs. 2.3, p=.311) scores were similar among the groups. Revision rates (14 vs. 15 vs. 13, p=.917), and time between index and revision surgery (p=.990) were similar among the three groups as well. ConclusionWhen considering a subset of patient-reported outcomes and revision surgery after 5 years, patients with an elevated BMI >25 at baseline did not appear to have worse outcomes than those with a normal BMI of 20–25 when undergoing posterior lumbar fusion surgery. Obesity should not be considered a contraindication to surgery in patients with appropriate surgical indications.

Consumption of soft drinks and health-related quality of life in the adult population.

Despite the accumulated evidence on the health risks associated with sugar-sweetened beverages (SSB), the industry has funded mass communication strategies promoting the idea that soft drinks, including SSB, may represent a source of well-being. This study assessed the association between consumption of soft drinks and health-related quality of life (HRQL), as a proxy of well-being, in the adult population of Spain. The cohort was established in 2008-2010 with 8417 individuals representative of the Spanish population aged 18-60 years. Habitual soft drink consumption was assessed with a validated diet history at baseline. HRQL was measured using the SF-12 questionnaire at baseline and in a subsample of 2132 study participants in 2012. The analyses were performed using linear regression and adjusted for the main confounders. In cross-sectional analyses at baseline, those who drank ⩾1 serving/day of SSB had a lower (worse) score on the physical composite summary (PCS) of the SF-12 (adjusted linear regression coefficient: -1.08; 95% confidence interval (CI): -1.60 to -0.54) than those who drank <1 serving/week. Results were similar among individuals younger than 35 years (-1.06; 95% CI: -1.79 to -0.32), those who were not dieting (-1.21; 95% CI: -1.80 to -0.62), those who did not lose >5 kg in the previous 4 years (-0.79; 95% CI: -1.87 to 0.29), and in those without morbidity (-1.18; 95% CI: -1.91 to -0.46). Neither SSBs nor artificially sweetened beverages (ASBs) showed an association with the mental composite summary (MCS) of the SF-12. In the prospective analyses, no association was observed between baseline consumption of SSBs or ASBs and the changes in the PCS and MCS score from 2008/2010 to 2012. No evidence was found that soft drink consumption has a beneficial effect on either the physical or mental dimensions of HRQL.

Racial Differences in Chronic Pain and Quality of Life among Adolescents and Young Adults with Moderate or Severe Hemophilia.

Background and ObjectiveWe explored racial differences in adherence to recommended clotting factor treatment regimens, chronic pain, and quality of life (QoL) among adolescents and young adults (AYAs) diagnosed with moderate or severe hemophilia.MethodsA convenience sample of hemophilia patients aged 13–25 years completed an online cross-sectional survey in 2012. Chronic pain was measured using the revised Faces Pain Scale (FPS-R) and dichotomized as high (FPS-R ≥ 4) or low (FPS-R < 4). QoL was measured with the SF-36.ResultsOf 80 AYA participants (79 male), most had severe disease (91 %) and hemophilia A (91 %). Most were white (76 %) and non-Hispanic (88 %). At the univariate level, compared to whites, non-whites were more likely to have produced an inhibitor against clotting factor treatment (74 vs 38 %, p < .01), less likely to have commercial health insurance (16 vs 63 %, p < .001), more likely to report high levels of chronic pain (FPS-R ≥ 4) (63 vs 26 %, p < .01), and had lower SF-36 physical composite summary (PCS) scores. Adjusted logistic and quantile regression modeling, respectively, revealed that non-whites were 5.31 (95 % CI 1.62, 17.4; p < .01) times more likely to report high chronic pain and had median PCS scores that were 26.0 (95 % CI 11.0, 40.9; p < .01) points lower than whites.ConclusionsTargeted efforts to prevent and manage chronic pain among non-white AYAs with moderate or severe hemophilia are necessary. After accounting for demographic and clinical differences, there were no racial differences in adherence to recommended clotting factor treatment regimens; however, non-whites were more than five times more likely to report high levels of chronic pain, which predicted worse overall physical QoL, bodily pain, physical and social functioning, and greater role limitations due to physical health.

Habitual Yogurt Consumption and Health-Related Quality of Life: A Prospective Cohort Study

BackgroundHealth-related quality of life (HRQL) is a global indicator of perceived health status, which includes physical and mental domains. Several biological mechanisms might support an association between consumption of yogurt and better HRQL. ObjectiveOur aim was to assess the association between habitual yogurt consumption and HRQL in the general adult population. DesignWe conducted a prospective study with 4,445 individuals aged 18 years and older who were recruited in 2008 to 2010 and were followed up to 2012. Habitual yogurt consumption was assessed at baseline with a validated diet history. HRQL was measured with the Physical Composite Summary and the Mental Composite Summary of the Spanish version of the SF-12 Health Survey. The analysis of the association between baseline yogurt consumption and HRQL at 2012 was performed with linear regression and adjusted for the main confounders, including baseline HRQL. ResultsMean follow-up was 3.5 years (standard deviation=0.6 years). Compared with nonconsumers of yogurt, the Physical Composite Summary scores were similar in habitual consumers of ≤6 servings/week (β=.40; P=0.20) and in consumers of ≥1 serving/day (β=.25; P=0.45). A suggestion of tendency toward a lower Mental Composite Summary score was found among daily yogurt consumers (β=−.65; P=0.09; P for trend across categories=0.07). Results were similar among individuals without morbidity, never smokers, and individuals with higher adherence to the Mediterranean diet. ConclusionsHabitual yogurt consumption did not show an association with improved HRQL.

Factors Associated with Quality of Life among Hemodialysis Patients in Malaysia

Although hemodialysis treatment has greatly increased the life expectancy of end stage renal disease patients, low quality of life among hemodialysis patients is frequently reported. This cross-sectional study aimed to determine the relationship between medical history, hemodialysis treatment and nutritional status with the mental and physical components of quality of life in hemodialysis patients. Respondents (n=90) were recruited from Hospital Kuala Lumpur and dialysis centres of the National Kidney Foundation of Malaysia. Data obtained included socio-demography, medical history, hemodialysis treatment and nutritional status. Mental and physical quality of life were measured using the Mental Composite Summary (MCS) and Physical Composite Summary (PCS) of the Short-Form Health Survey 36-items, a generic core of the Kidney Disease Quality of Life Short Form. Two summary measures and total SF-36 was scored as 0–100, with a higher score indicating better quality of life. Approximately 26 (30%) of respondents achieved the body mass index (24 kg/m2) and more than 80% (n=77) achieved serum albumin level (>35.0 mg/dL) recommended for hemodialysis patients. The majority of respondents did not meet the energy (n=72, 80%) and protein (n=68,75%) recommendations. The total score of SF-36 was 54.1±19.2, while the score for the mental and physical components were 45.0±8.6 and 39.6±8.6, respectively. Factors associated with a higher MCS score were absence of diabetes mellitus (p=0.000) and lower serum calcium (p=0.004), while higher blood flow (p=0.000), higher serum creatinine (p=0.000) and lower protein intake (p=0.006) were associated with a higher PCS score. To improve the overall quality of life of hemodialysis patients, a multidisciplinary intervention that includes medical, dietetic and psychosocial strategies that address factors associated with mental and physical quality of life are warranted to reduce further health complications and to improve quality of life.

The association of PTSD with physical and mental health functioning and disability (VA Cooperative Study #569: the course and consequences of posttraumatic stress disorder in Vietnam-era Veteran twins)

To assess the relationship of posttraumatic stress disorder (PTSD) with health functioning and disability in Vietnam-era Veterans. A cross-sectional study of functioning and disability in male Vietnam-era Veteran twins. PTSD was measured by theComposite International Diagnostic Interview; health functioning and disability were assessed using the Veterans RAND 36-Item Health Survey (VR-36) and the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0). All data collection took place between 2010 and 2012. Average age of the 5,574 participating Veterans (2,102 Vietnam theater and 3,472 non-theater) was 61.0years. Veterans with PTSD had poorer health functioning across all domains of VR-36 and increased disability for all subscales of WHODAS 2.0 (all p<.001) compared with Veterans without PTSD. Veterans with PTSD were in poorer overall health on the VR-36 physical composite summary (PCS) (effect size=0.31 in theater and 0.47 in non-theater Veterans; p<.001 for both) and mental composite summary (MCS) (effect size=0.99 in theater and 0.78 in non-theater Veterans; p<.001 for both) and had increased disability on the WHODAS 2.0 summary score (effect size=1.02 in theater and 0.96 in non-theater Veterans; p<.001 for both). Combat exposure, independent of PTSD status, was associated with lower PCS and MCS scores and increased disability (all p<.05, for trend). Within-pair analyses in twins discordant for PTSD produced consistent findings. Vietnam-era Veterans with PTSD have diminished functioning and increased disability. The poor functional status of aging combat-exposed Veterans is of particular concern.

The Association between Alzheimer's Disease Severity as measured by RMBPC and Caregiver-reported Outcomes

The objective was to describe the self-reported attributes and outcomes for caregivers of patients with Alzheimer's disease (AD) and quantify the association of patient severity with caregiving hours per week reported by caregiver. From a 2009 survey of 1079 AD caregivers, responses from unpaid primary caregivers of community-dwelling AD patients were selected. Patient severity was calculated from responses to the Revised Memory and Behavioral Problem Checklist (RMBPC) as a continuous (0-4) variable. Caregiver attributes and outcomes were described for three cohorts based on RMBPC; Mild (RMBPC < 1.25), Moderate (1.25 ≤ RMBPC < 2.25), and Severe (RMBPC ≥ 2.25) and compared using chi-square tests for categorical variables and ANOVA for continuous variables. A generalized linear regression model with a negative binomial distribution was constructed for ‘caregiving hours per week' with RMBPC, age, gender, marital status, relation to patient, living situation, employment and income as covariates. Of the 849 caregivers meeting study criteria, 18.8% were caring for persons categorized as Mild (n=160), 52.4% as Moderate (n=445) and 26.4% as Severe (n=244). Significant differences (p<0.05) were observed among the severity groups in attributes such as age, relation to AD patient, diagnosed depression and diagnosed anxiety and in caregiver outcomes such as Zarit Caregiver Burden Scale, Desire to Institutionalize Scale, SF-12 Mental and Physical Composite Summary Scores, work days per month missed due to caregiving and caregiving hours per week (Mild=43.6 hours, Moderate= 47.9 hours, Severe= 55.1 hours). A positive relationship between RMBPC and caregiving hours was seen in the multivariate analysis, with a 1 point change in RMBPC associated with a 10% change in hours (p=0.005). Two factors associated with less time caregiving were household income greater than $50,000 (p=0.013) and living apart from the AD patient (p<0.001). In this survey of unpaid caregivers of AD patients living in the community, differences in caregiver characteristics and outcomes were quantified among those caring for Mild, Moderate and Severe AD patients. The findings of this study suggest that higher patient severity is associated with increased burden on caregivers in terms of caregiving time, lost work time and quality of life.Tabled 1Caregiver Attributes and Outcomes by Patient SeverityTotal (N=849)Severity by RMBPC ScoreP ValueMild (N=160)Moderate (N=445)Severe (N=244)Caregiver AttributesAge (Mean ± SD)51.09 ± 13.4353.07 ± 14.6951.86 ± 13.2048.39 ± 12.63<.001Gender (Female)69.61%65.00%70.79%70.49%0.370Relationship to Alzheimer's Disease Patient0.007Spouse/significant other15.55%20.63%16.85%9.84%Daughter/Son/In-Law61.96%61.25%62.70%61.07%Grandchild15.43%12.50%13.03%21.72%Other7.07%5.63%7.42%7.38%Caregiver Employment0.838Full-Time, Part-Time, or Self Employed55.12%56.25%54.16%56.15%Not Employed44.88%43.75%45.84%43.85%Diagnosed with Anxiety28.15%10.00%29.44%37.70%<.001Diagnosed with Depression31.21%11.25%30.34%45.90%<.001Caregiver OutcomesZarit Caregiver Burden Scale (Mean ± SD)37.45 ± 16.9025.53 ± 14.2637.67 ± 15.5244.86 ± 16.56<.001Desire To Institutionalize Scale (Mean ± SD)2.50 ± 2.031.28 ± 1.522.56 ± 2.013.18 ± 2.02<.001SF-12v2: Mental Component Summary (Mean ± SD)42.43 ± 11.8748.41 ± 10.6742.58 ± 11.5338.25 ± 11.55<.001SF-12v2: Physical Component Summary (Mean ± SD)47.81 ± 11.2549.76 ± 9.6647.95 ± 11.2246.29 ± 12.070.009Work Days Missed Due to Caregiving (Mean ± SD)5.95 ± 15.131.39 ± 3.095.48 ± 12.499.75 ± 21.76<.001Hours per Week Providing Care (Mean ± SD)49.12 ± 37.3643.64 ± 34.5547.86 ± 37.6355.06 ± 38.000.013 Open table in a new tab