Physical Dimension Of Health-related Quality Of Life Research Articles

Does opioid therapy enhance quality of life in patients suffering from chronic non-malignant pain? A systematic review and meta-analysis

Background and objective Chronic pain is associated with a poor health-related quality of life (HRQL). Whereas the prescription rate of opioids increased during the last decades, their use in chronic non-malignant pain remains unclear. However, there is currently no clinical consensus or evidence-based guidelines that consider the long-term effects of opioid therapy on HRQL in patients with chronic non-cancer pain. This systematic review aims to address the question of whether opioid therapy improves HRQL in patients with chronic non-malignant pain and provide some guidance to practitioners. Databases and data treatment PubMed, EMBASE and CENTRAL were searched in June 2020 for double-blind, randomized trials (RCTs), comparing opioid therapy to placebo and assessed a HRQL questionnaire. The review comprises a qualitative vote counting approach and a meta-analysis of the Short Form Health Survey (SF-36), EQ-5D questionnaire and the pain interference scale of the Brief pain inventory (BPI). Results 35 RCTs were included, of which the majority reported a positive effect of opioids for the EQ-5D, the BPI and the physical component score (PCS) of the SF-36 compared to placebo. The meta-analysis of the PCS showed a mean difference of 1.82 [confidence interval: 1.32, 2.32], the meta-analysis of the EQ-5D proved a significant advantage of 0.06 [0.00, 0.12]. In the qualitative analysis of the mental component score (MCS) of the SF-36, no positive or negative trend was seen. No significant differences were seen in the MCS (MD: 0.65 [-0.43, 1.73]). A slightly higher premature dropout rate was found in the opioid group (risk difference: 0.04 [0.00, 0.07], p = .07). The body of evidence is graded as low to medium. Conclusion Opioids have a statistically significant, but small and clinical not relevant effect on the physical dimensions of HRQL, whereas there is no effect on mental dimensions of HRQL in patients with chronic non-malignant pain during the initial months of treatment. In clinical practice, opioid prescriptions for chronic non-cancer pain should be individually assessed as their broad efficacy in improving quality of life is not confirmed. The duration of opioid treatment should be determined carefully, as this review primarily focuses on the initial months of therapy.

Abstract 16166: Self-Care Self-Efficacy Predicts Long-Term Health-Related Quality of Life in Patients With Heart Failure

Introduction: Health-related quality of life (HRQOL) influences prognosis in heart failure (HF). Self-care and self-care self-efficacy are important in improving HRQOL; however, their effect on long-term HRQOL is yet to be elucidated. Aims: To determine the effect of self-care and self-care self-efficacy on long-term HRQOL in patients with HF. Methods: This longitudinal study enrolled outpatients with HF, who were followed-up at 3, 6, and 12 months. Self-care and self-care self-efficacy were assessed using the Self-Care of Heart Failure Index ver.7.2 and the Self-care Self-Efficacy scale, respectively. HRQOL was assessed using the Patient-Reported Outcomes Measurement Information System. Linear regression analysis was conducted to determine the association between baseline self-care and self-care self-efficacy and physical and mental dimensions of HRQOL at each time period. Adjusted variables were age, sex, body mass index, HF severity, comorbidities, activities of daily living, marital status, education level, and depressive symptoms. Results: This study analyzed 315 patients (mean age, 73±13 years, 72% male). The physical dimensions of HRQOL at all time points were associated with baseline self-care self-efficacy (baseline, 3, 6, and 12 months: p < 0.001, p < 0.001, p < 0.001, and p < 0.001, respectively) but not with baseline self-care maintenance (p = 0.057, p = 0.108, p = 0.101, and p = 0.153), symptom perception (p = 0.111, p = 0.101, p = 0.662, and p = 0.944), and self-care management (p = 0.737, p = 0.229, p = 0.387, and p = 0.167). The mental dimension of HRQOL at all time points were associated with self-care self-efficacy (baseline, 3, 6, and 12 months: p < 0.001, p < 0.001, p < 0.001, and p < 0.001, respectively). Multivariate linear regression analysis revealed that high scores on the physical and mental dimensions of HRQOL at all time points were significantly associated with high baseline self-care self-efficacy despite adjustment for all variables (physical and mental dimensions: baseline, p < 0.001 and p < 0.001; 3 months, p < 0.001 and p < 0.001; 6 months, p < 0.001 and p < 0.001; 12 months, p < 0.001 and p < 0.001). Conclusion: Improving self-care self-efficacy is important for maintaining long-term HRQOL in patients with HF.

The overall and domain-specific quality of life of Chinese community-dwelling older adults: the role of intrinsic capacity and disease burden.

This study aimed to investigate the impact of the different domains of intrinsic capacity (IC) and chronic disease burden on health-related quality of life (HRQoL) and domain-specific HRQoL in Chinese community-dwelling older adults. A cross-sectional observational study of a community-based cohort. We evaluated Chinese older adults (n = 429, mean age, 72.91 ± 7.014 years; female proportion, 57.30%). IC contains five domains, namely locomotion, vitality, cognition, psychological, and sensory capacity. Locomotion dysfunction was defined as grip and/or gait decline. Vitality decline was defined if two of the following three parameters were present: fatigue, physical inactivity, and weight loss or overweight. Cognition was classified into normal cognition, pre-mild cognitive impairment (pre-MCI), and MCI according to the normative z-scores of the neuropsychological test battery. Psychological dysfunction was diagnosed based on depressive symptoms. Sensory dysfunction was defined as hearing and/or vision impairment. HRQoL was assessed using the AQoL-8D scale, which comprised physical (including independent living, senses, and pain) and psychosocial (including mental health, happiness, self-worth, coping, and relationships) dimensions. Low HRQoL (HRQoL score or subscores in the highest quintile) was used as a dependent variable in logistic regression analyses adjusted for demographic, health-related, and psychological confounders. Sensory impairment was an independent determinant of senses, and locomotion impairment was significantly associated with overall HRQoL, independent living, and pain in the physical dimension of HRQoL. Cognition was an independent determinant of the senses. Vitality was independently associated with overall HRQoL, senses, and pain in the physical dimension and mental health and relationships in the psychological dimension of HRQoL. The psychological domain of IC was independently associated with overall and domain-specific HRQoL apart from senses after adjustment for all confounders. The number of multimorbidities mainly had a significant impact on independent living after adjustment for all confounders. IC domains and chronic disease burden had heterogeneous influences on overall and domain-specific HRQoL. The impairment of sensory and locomotion domains had a synergistic impact on the overall and physical dimensions of HRQoL. The vitality and psychological domains of IC had more profound effects on HRQoL. Older people with high morbidity might have a higher risk of poor independent living.

Age-Related Hearing Loss With Tinnitus and Physical Frailty Influence the Overall and Domain-Specific Quality of Life of Chinese Community-Dwelling Older Adults.

Objective: To investigate the impact of the severity of age-related hearing loss (ARHL) and tinnitus, presence of ARHL and/or tinnitus, and physical frailty on the health-related quality of life (HRQoL) and domain-specific HRQoL in Chinese community-dwelling older adults.Design: This was a cross-sectional study of a community-based cohort.Participants: We evaluated Chinese older adults (n = 429, 183 men and 246 women) aged ≥ 58years.Measurements: The severity of HL and tinnitus were measured using pure-tone audiometry and the Tinnitus Handicap Inventory (THI), respectively. Physical frailty was measured using the five-item Fried scale. HRQoL was assessed using the Assessment of Quality of Life-8-Dimension (AQoL-8D) multi-attribute utility instrument (35 HRQoL items and eight domain-specific HRQoL subcategories). Low HRQoL (HRQoL score or subscores in the highest quintile) was used as a dependent variable in logistic regression analyses adjusted for demographic (Model 1) and health-related (Model 2) and psychosocial (Model 3) confounders.Results: Age-related hearing loss severity was an independent determinant of senses in the physical dimension of HRQoL after adjusting for all covariates. Tinnitus severity was significantly associated with HRQoL and with independent living, senses, and pain in the physical dimension after adjusting for demographic and health-related covariates and was still associated with independent living and senses after adjusting for all covariates. The presence of ARHL and/or tinnitus was significantly associated with independent living and senses in the physical dimension after adjusting for all the covariates. Physical frailty was an independent determinant of HRQoL, independent living, and pain in the physical dimension and with mental health, happiness, and coping in the psychosocial dimension after adjusting for demographic and health-related covariates. The association with HRQoL, independent living, and pain in the physical dimension, and with happiness and coping in the psychosocial dimension remained significant after adjusting for the covariates. Depressive symptoms, social dysfunction, and a number of comorbidities were critical determinants of psychosocial HRQoL.Conclusion: Physical frailty has a stronger and more profound effect on HRQoL, particularly on independent living and pain in the physical dimension and on happiness and coping in the psychosocial dimension. Domain-specific HRQoL should be considered in the management of patients with ARHL with tinnitus and physical frailty.Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT2017K020.

Health-related quality of life in men and women who experienced cardiovascular diseases: Tehran Lipid and Glucose Study

BackgroundCardiovascular diseases (CVDs) are among the most common causes of death worldwide, including in Iran. Considering the adverse effects of CVDs on physical and psychosocial health; this study aims to investigate the association between experience of CVDs and health-related quality of life (HRQoL) in adult participants of the Tehran Lipid and Glucose Study (TLGS).MethodsThe participants of this cross-sectional study were 7009 adults (≥ 20 years) who participated in the TLGS during 2014–2017. Demographic information and HRQoL data was collected through validated questionnaires by trained interviewers. HRQoL was assessed by the Iranian version of the SF-12 questionnaire. Data was analyzed using the SPSS software.ResultsThe mean age of participants was 46.8 ± 14.6 years and 46.1% of them were men. A total of 9.0% of men and 4.4% of women had CVDs. In men, the mean physical HRQoL summary score was significantly lower in those with CVDs compared to those without CVDs (46.6 ± 0.8 vs. 48.5 ± 0.7, p > 0.001). In women, the mean mental HRQoL summary scores was significantly lower in those with CVDs compared to those without CVDs (42.8 ± 1.0 vs. 45.2 ± 0.5, p = 0.009). In adjusted models, men with CVDs were more likely to report poor physical HRQoL compared to men without CVDs (OR(95%CI): 1.93(1.32–2.84), p = 0.001); whereas for women, the chance of reporting poor mental HRQoL was 68% higher in those with CVDs than those without CVDs (OR(95%CI): 1.68(1.11–2.54), p = 0.015).ConclusionThe findings of the current study indicate poorer HRQoL in those who experienced CVDs compared to their healthy counterparts with a sex specific pattern. While for men, CVDs were associated with more significant impairment in the physical dimension of HRQoL, women experienced a similar impairment in the mental dimension of HRQoL.

Health-Related Quality of Life among Elderly Population of Bangladesh

Introduction: Elderly population in Bangladesh is one of the largest in the world in term of absolute number and ageing is an emerging problem. Elderly are at risk from non-communicable diseases as well as mental problems and health-related quality of life (HRQoL) affects in urban and rural elderly.
 Objective: To find out and compare HRQoL in urban and rural elderly population of Bangladesh.
 Materials and Methods:A comparative cross-sectional study was carried out to compare HRQoL in urban and rural elderly. This was a two samples study; 130 each from urban and rural. Total 260 elderly were selected conveniently. Data were collected through face to face interview using a pre-tested semi structured questionnaire of SF-36 v2 HRQoL survey. This study was carried in urban elderly residing in Ward number 3, Race Course, Cumilla City Corporation and in rural elderly residing in Noapuskuni Village of Babutipara Union, Muradnager Upazila, Cumilla. This one-year study was conducted from 15 July 2017 to 14 June 2018.
 Results: Majority of the elderly were Muslim (91.5%), female (53.5%), married (59.6%) and from joint family (91%). The mean ± SD age of elderly was 69.26±6.337 years and mean ± SD monthly family income was Tk. 16561.54±9192.076. SF- 36 v2 HRQoL scale; a licensed software-based survey tool was used measure the health-related quality of life of elderly. Most of the elderly were found with average physical component summary (PCS) (53.1%) and mental component summary (MCS) (50.8%) of HRQoL. Age had significant negative correlation with PCS (p<0.001) and MCS (p<0.001) in urban and rural elderly. Education level of urban and rural elderly had significant positive correlation with PCS (p<0.01) and MCS (p<0.01). Marital status of urban and rural elderly had significant negative correlation with PCS (p<0.001) and MCS (p<0.001) of HRQoL. Among the rural respondents, the mean ± SD of PCS of male was 43.79±5.766 and female was 41.14±6.860. The difference was statistically significant (p<0.05). Mean score of PCS of urban and rural respondents were 45.68±6.366 and 42.43±6.467 respectively. This difference was statistically significant (p<0.001). Mean scores of MCS of urban and rural respondents were 43.96±4.921 and 42.56±7.028 respectively. This difference was not statistically significant (p>0.05).
 Conclusion: Most of the elderly had average level of health-related quality life. Rural female elderly had significantly lower physical health of HRQoL than that of rural male elderly. Physical dimension of HRQoL of rural elderly was significantly lower than that of urban elderly.
 JAFMC Bangladesh. Vol 15, No 2 (December) 2019: 161-164

Association between gross motor competence and health-related quality of life in (pre)schoolchildren: the mediating role of cardiorespiratory fitness

ABSTRACT Background: Motor competence, defined as a person’s ability to execute different motor skills, is directly associated with children’s physical, mental, and social development and may be essential in encouraging an active lifestyle in childhood. Although health-related quality of life (HRQoL) in children has been described as an individual’s subjective perception of the impact of health status on physical, psychological and social functioning, in very young children, a HRQoL parent-proxy report is needed since (pre)schoolchildren have problems expressing their feelings and understanding items on HRQoL instruments. In addition, the influence of motor competence on fitness levels has strong empirical support, so it seems reasonable to hypothesize that cardiorespiratory fitness might play a crucial role in the association between motor competence and HRQoL in children. Objectives: This study examined the association between gross motor competence (G-MC) and HRQoL in typically developing children, and whether this association between G-MC and HRQoL was mediated by cardiorespiratory fitness. Methods: An observational cross-sectional study with 1088 (pre)schoolchildren (51.84% boys, 48.16% girls) aged between 4 and 7 years (5.32 ± 0.60) belonging to 21 schools in the Spanish provinces of Cuenca and Ciudad Real were included. G-MC was evaluated using the MABC-2 battery, HRQoL was assessed using the KINDL-R questionnaire and cardiorespiratory fitness using the 20m-shuttle-run-test. Partial correlations, covariance models and mediation analyses were conducted. Results: The mean scores of HRQoL (physical well-being, self-esteem, friends, school and global score index) were significantly higher (p < 0.05) in children with higher G-MC. When cardiorespiratory fitness was added as a covariate, all the results remained unchanged (p < 0.05), except for physical well-being for the total sample as well as emotional well-being and the global score index for girls. Simple mediation analyses showed that cardiorespiratory fitness acted as a mediator between G-MC and physical well-being (Indirect Effect = 0.04 [95% CI = 0.01; 0.07]) for the total sample. For boys, it acted as a mediator between G-MC and physical well-being (Indirect Effect = 0.04 [95% CI = 0.00; 0.08]) and school (Indirect Effect = 0.05 [95% CI = 0.01; 0.09]), and, for girls, between G-MC and emotional well-being (Indirect Effect = 0.04 [95% CI = 0.01; 0.08]) and the global score index (Indirect Effect = 0.02 [95% CI = 0.00; 0.05]). Conclusions: The results of this study suggest that good G-MC levels are associated with better HRQoL, mainly in global score index of HRQoL and self-esteem, friends, and school dimensions in typically developing children. Further, cardiorespiratory fitness mediates the association between G-MC and the physical dimension of HRQoL in (pre)schoolchildren. Additionally, physical and academic dimensions are mediated by cardiorespiratory fitness for boys and the emotional and global score indices of HRQoL are mediated by cardiorespiratory fitness for girls. These findings provide scientific evidence that improving motor competence and cardiorespiratory fitness might be a practical strategy to increase HRQoL in children. Thus, families and the educational community should promote effective interventions and incorporate opportunities inside and outside school that aim to jointly improve motor competence and cardiorespiratory fitness.

Health-Related Quality of Life in Patients with Non-Small Cell Lung Cancer before and after Surgery - a Comparison between Thoracotomy and Video-Assisted Thoracoscopic Surgery

Earlier studies have proven that in patients with non-small cell lung cancer video-assisted thoracoscopic surgery is functionally superior to thoracotomy in terms of perioperative and postoperative complications. The objective of this work was to determine whether there is a difference in health-related quality of life (HRQoL) of patients with non-small cell lung cancer - compared to the German normal population - before and after surgery. Moreover, HRQoL after thoracotomy was compared to HRQoL after video-assisted thoracoscopic surgery (VATS). Based on retrospective data generated during a 7-year period (2010 - 2017), 327 patients with non-small cell lung cancer who underwent therapy were examined. Patients either underwent thoracotomy or video-assisted thoracoscopic surgery. 456 of short form 12 questionnaires were analysed. Via norm-based scoring, and physical and mental component summaries (PCS and MCS) were calculated before and 6, 12, and 24 months after treatment. Using t tests, potential differences in physical and mental component summaries were evaluated between patients and the German normal population as well as between patients after thoractomy and after VATS. Up to 24 months after surgery, the physical dimension of HRQoL is significantly reduced, while the mental component summary does not significantly differ from the German population. Moreover, thoracotomy and VATS gave equivalent values for health-related quality of life. With respect to health-related quality of life, thoracotomy and video-assisted thorascopic surgery are equivalent in the long term. But there was a trend to improvement with both summary scores that might indicate superiority of video-assisted thoracoscopic surgery.

Religious and Psychosocial Covariates of Health-Related Quality of Life in People Living with HIV/AIDS.

HIV/AIDS is a chronic, highly stigmatized illness that requires significant lifestyle adjustments, including consistent adherence to Antiretroviral Therapy (ART) in order for People Living With HIV/AIDS (PLWH) to survive and maintain good immune health. PLWH often report poor or moderate Health-Related Quality of Life (HRQoL) that is worse than the general population. This may be related to the psychological and physiological demands of HIV disease and the sociodemographic stressors associated with it. The role of religious coping, religiosity, and social support in the mental and physical dimensions of HRQoL is less known, although recent studies highlight that PLWH rely on spirituality/religion to cope with HIV-associated stressors. This study examined the effects of religious coping, religiosity, depressive symptoms, medication adherence, and social support satisfaction in various dimensions of Health- Related Quality of Life (HRQoL) in a sample of 292 PLWH. Majority of participants were African-American (90.1%) and 56.2% were male. Mean age was 45 years and, on average, participants lived with HIV for nearly 11 years. Descriptive statistics, correlations, Analysis of Variance (ANOVA), and hierarchical multiple linear regression were used to analyze the data. Income, sex (β= .14), age (β= −.14), depressive symptoms (β= −.27), and social support satisfaction (β= .17) significantly predicted physical HRQoL. Results indicate that income (β= .13), sex (β= .14), medication adherence (β= .13), negative religious coping (β= −.18), religious attendance (β= .13), religiousness (β= .16), and social support satisfaction (β= .27) significantly predicted mental HRQoL. Depressive symptoms (β= −.38), positive religious coping (β= .24), and social support satisfaction (β= .16) significantly predicted general HRQoL. Participants, who were female, prayed less than daily, attended religious services less than weekly or who were non/less religious had significantly poorer HRQoL. The findings confirm the importance of religion, mental health, medication adherence and social support in the HRQoL of PLWH, which should all be routinely assessed by clinicians.

Analysis of selected determinants of health-related quality of life in persons with spinal cord injury

AbstractThe aim of the study was the analysis of factors determining health-related quality of life (HRQoL) in persons with spinal cord injury (SCI).The study involved 100 persons with SCI dependent on using a wheelchair in everyday life, including 22 females and 78 males. Study conducted using the SF-36 questionnaire used to assess HRQoL.Based on the statistical analysis of the collected research material it has been shown highly significant correlations between the physical and mental dimensions of HRQoL and age at the day of injury and age at the day of the survey. There were also highly significant differences in the physical dimension of HRQoL due to the following variables: clinical pattern of injury, marital status, level of education and participation/non-participation in the active rehabilitation camp. In the case of the mental dimension of the HRQoL there was a significant variation due to the same variables with the exception of clinical pattern of SCI.Based on the undertaken research it was shown that people with higher levels of HRQoL are characterized by: lower age at the time of the study, lower age at the time of injury, long time since injury, paraplegia, marital status – single, secondary/higher level of education and participation in the active rehabilitation camps in the past.

Social capital, socioeconomic status, and health-related quality of life among older adults in Bogotá (Colombia).

The main goal of this study was to evaluate the relationship between levels of cognitive social capital and health-related quality of life (HRQOL). A multilevel, cross-sectional study was conducted in 2007 in Bogotá Colombia. A total of 1,907 older adults completed the Spanish version of the Short Form of Health Survey (SF-8) to assess HRQOL. Cognitive dimension of social capital was assessed. Hierarchical linear regressions were conducted to determine the associations between social capital variables and HRQOL. Only 20% to 25% of the population reported trust in others and shared values. A total of 93% percent reported that people in their neighborhood would try to take advantage of them if given a chance. Higher social capital indicators were positively associated with the mental and physical dimensions of HRQOL. Results from this study support evidence on the disintegration of the Colombian society, which may be influenced by high levels of social inequality.

Quality of life along the diabetes continuum: a cross-sectional view of health-related quality of life and general health status in middle-aged and older Finns

To examine the general health status and health-related quality of life (HRQOL) along the diabetes continuum of middle-aged and older Finns, and to determine the glucose metabolism stage by which the HRQOL has decreased noticeably. The cross-sectional sample consisted of 920 persons aged 51-75 from the general population in a single municipality in a rural area of Eastern Finland. Data were adjusted for age, sex, smoking history, current alcohol consumption, employment and marital status. The HRQOL and health status were evaluated using two preference-based HRQOL instruments, 15D and SF-6D, and one health profile instrument, 36-Item Short Form Health Survey (SF-36). Individuals with impaired glucose tolerance (IGT) and type 2 diabetes had noticeably low mean SF-6D, 15D and general health status. The decrease in overall HRQOL was mainly due to a decline in the physical dimensions of HRQOL. The adjusted odds ratios (95% CI) for having noticeably low HRQOL on SF-6D, 15D and general health dimension of SF-36 associated with IGT were 1.95 (1.18-3.25), 1.35 (0.84-2.18) and 2.00 (1.21-3.29), respectively. The progression along the diabetes continuum was significantly associated with a decrease in HRQOL and health status. Furthermore, the data indicate that when a person is detected to have IGT, the HRQOL and general health status have already diminished noticeably. The prevailing evidence suggests that detection and intervention before a patient develops IGT is essential in order to minimize the loss of quality of life and quality-adjusted life years.

Evaluating health‐related quality of life in patients with polycystic liver disease and determining the impact of symptoms and liver volume

Polycystic liver disease (PLD) follows a progressive course ultimately leading to severe hepatomegaly and mechanical complaints in a subset of patients. It is still unknown to what extent this compromises health-related quality of life (HRQL). Our aim was to determine HRQL in PLD patients and investigate its association with concurrent abdominal symptoms and liver volume. Pooled data of 92 severe PLD patients from two randomized clinical trials were used for our cross-sectional analysis. HRQL was assessed using the generic short-form health survey (SF-36) resulting in eight scale scores and the summarizing physical (PCS) and mental component score (MCS). Subsequently, these were compared with the general population. Abdominal symptoms were measured with a standardized, 7-point scale questionnaire in 54 patients. We dichotomized symptoms for absence or presence and compared them with the component scores. Finally, a possible correlation between liver volume and HRQL was explored. Demographics showed severe polycystic livers (mean 4906 ± 2315 ml). PCS was significantly lower compared with the general population (P < 0.001), in contrast with a similar MCS (P = 0.82). PLD patients had statistically significant (P < 0.05) diminished physical functioning, role physical, general health, vitality and social functioning scores. Upper- and lower abdominal pain and dyspnoea were significantly associated with a reduced PCS (P < 0.01). No correlation was found between liver volume and HRQL. Polycystic liver disease patients had significantly lower HRQL in the physical dimension compared with the general population. Abdominal pain and dyspnoea had a significant impact on this physical dimension of HRQL.

Smoking habit profile and health-related quality of life.

Few studies have investigated the relationship between smoking and health-related quality of life (HRQOL), and the results are not consistent. The aim of this study is to explore the association between smoking and HRQOL. Cross-sectional study of 714 Spanish adults (44.7% never smokers and 55.3% smokers) without diagnosis of physical or mental disorder. Each participant provided information about different sociodemographic variables and data on HRQOL. Smokers also reported smoking-related information about smoking-related variables. Nicotine dependence was not associated with the physical dimension of HRQOL, but in the mental component, nicotine dependent smokers showed worse HRQOL than never smokers (p = 0.004) and than non-nicotine dependent smokers (p = 0.014). There were no differences between no-nicotine dependent smokers and never smokers. Smoking status (non smokers vs. smokers), number of cigarettes smoked per day, stage of change, quit attempts in the past year or age of smoking onset were not related to HRQOL. In subjects without physical or mental diseases, only nicotine dependent smokers showed a significant impairment in the mental component of HRQOL. Therefore, it is important to consider nicotine dependence in the relationship between smoking and HRQOL.

Use of different subjective health indicators to assess health inequalities in an urban immigrant population in north-western Italy: a cross-sectional study

BackgroundDespite the steady growth of the immigrant population in Italy, data on the health status of immigrants are scarce. Our main goals were to measure Health-Related Quality of Life (HRQoL), Self-Rated Health (SRH) and morbidity among immigrants in Genoa. We aimed to assess the relative contribution of some social, structural and behavioral determinants to “within-group” health disparities.MethodsWe enrolled 502 subjects by means of snowball sampling. The SF-12 questionnaire, integrated with socio-demographic and health-related items, was used. Multivariate logistic and Poisson regression models were applied in order to identify characteristics associated with poor SRH, lower SF-12 scores and prevalence of self-reported morbidities.ResultsSubjects showed relatively moderate levels of HRQoL (median physical and mental scores of 51.6 and 47.3, respectively) and about 15% of them rated their health as fair or poor. Lower scores in the physical dimension of HRQoL were associated with the presence of morbidities and immigration for work and religious reasons, while those who had migrated for religious and family reasons displayed a lower probability of lower scores in the mental dimension of HRQoL. Poor SRH was associated with female gender, overweight/obesity and presence of morbidities. Moreover, compared with immigrants from countries with a low human development index, immigrants from highly developed societies showed significantly lower odds of reporting poor SRH. About one-third of respondents reported at least one medical condition, while the prevalence of multi-morbidity was 10%. Females, over 45-year-olds, overweight and long-term immigrants had a higher prevalence of medical conditions.ConclusionsOur study confirms the presence of health inequalities within a heterogeneous immigrant population. HRQoL, SRH and morbidity are valid, relatively rapid and cheap tools for measuring health inequalities, though they do so in different ways. These indicators should be used with caution and, if possible, simultaneously, as they could help to identify and to monitor more vulnerable subjects among immigrants.

Physical activity and health-related quality of life among adult women in Cali, Colombia: a cross-sectional study

To examine the associations of leisure-time physical activity (LTPA) and walking for transportation (WT) with the physical and mental dimensions of health-related quality of life (HR-QOL) among women. A cross-sectional study was carried out in 2009 among 1,263 women ages 18-59years living in neighborhoods with low and middle-low socioeconomic status in the urban area of Cali. HR-QOL was assessed using the Short Form 8 (SF-8). LTPA and WT were measured using the long version of the International Physical Activity Questionnaire (IPAQ). Associations were assessed using linear regression models adjusting for potential confounders. Low (10-149min) and medium-high (at least 150min) levels of WT were negatively associated with the mental and physical dimensions of HR-QOL. Low (10-149min of moderate intensity PA, or 10-74min of vigorous intensity PA) and medium-high (at least 150 or 75min of moderate or vigorous intensity PA, respectively) levels of LTPA were positively associated with both dimensions. Significant interactions were observed between education level and perceived safety from traffic. This study found that WT and LTPA were associated with HR-QOL both in the physical and mental dimensions; however, the direction and magnitude of the association varied by domain. These results highlight the need to better understand the links between PA and HR-QOL in urban contexts from Latin America.

The effectiveness of secondary and tertiary care lifestyle intervention in morbidly obese patients: a 1-year non-randomized controlled pragmatic clinical trial.

In this non-randomized clinical pragmatic trial, we aimed to compare the effectiveness of an outpatient intensive lifestyle intervention (ILI) programme conducted in a tertiary care obesity rehabilitation centre with an outpatient moderate lifestyle intervention (MLI) programme at a secondary care obesity centre. Effectiveness was measured in terms of the 1-year effect each programme had on body weight, physical activity and health-related quality of life (HRQL). A total of 232 morbidly obese subjects were recruited to the ILI group and 140 to the MLI group, with retention rates of 78% and 44%, respectively. The ILI group had a significantly larger mean (95% confidence interval [CI]) weight loss than the MLI group, 11% (9%, 12%) vs. 2% (1%, 6%), P < 0.001, and a larger proportion of completers attaining ≥5% weight loss (71% vs. 33%), P < 0.001. Compared with the MLI group, the ILI group achieved a significant larger mean (95% CI) increase in the physical dimension of HRQL 6.9 (4.4, 9.3), P < 0.001, the mental dimension of HRQL 4.4 (1.4, 7.4), P = 0.018 and in the emotional dimension of HRQL 17.8 (12.8, 22.6), P < 0.001. There were no significant differences in terms of changes in physical activity. Compared with MLI, ILI was associated with significantly larger weight loss and better HRQL.

Health-related quality of life in family members of patients with an advanced cancer diagnosis: A one-year prospective study

BackgroundReceiving a cancer diagnosis affects family members as well as the person diagnosed. Family members often provide support for the sick person in daily life out of duty and love, and may not always think of their own vulnerability to illness. To individualise support for them, family members who are most at risk for becoming ill must be identified.The aim of this study was to investigate health-related quality of life (HRQOL) in family members of patients with advanced lung or gastrointestinal cancer 3 to 15 months after diagnosis.MethodsData on mental and physical dimensions of HRQOL were collected from family members of these patients in this prospective quantitative study. Five assessments using the Short Form 36 Health Survey (SF-36) and EuroQol (EQ-5D) were conducted during a 1-year period starting 3 months after diagnosis. Thirty-six family members completed the study, i.e. participated in all five data collections.ResultsNo statistically significant changes in physical or mental HRQOL within the study group appeared over the 1-year follow-up. Compared with norm-based scores, family members had significantly poorer mental HRQOL scores throughout the year as measured by the SF-36. Family members also scored statistically significantly worse on the EQ-5D VAS in all five assessments compared to the norm-based score. Findings showed that older family members and partners were at higher risk for decreased physical HRQOL throughout the 1-year period, and younger family members were at higher risk for poorer mental HRQOL.ConclusionsIt is well known that ill health is associated with poor HRQOL. By identifying family members with poor HRQOL, those at risk of ill health can be identified and supported. Future large-scale research that verifies our findings is needed before making recommendations for individualised support and creating interventions best tailored to family members at risk for illness.

Health-related quality of life in different clinical subgroups with typical AFL who have undergone cavo-tricuspid isthmus ablation

BackgroundTo evaluate changes in health-related quality of life (HRQOL) in different sub-groups of a cohort of patients with typical atrial flutter (AFL) treated with cavotricuspid isthmus (CTI) radiofrequency catheter ablation.Methods95 consecutive patients due to undergo CTI ablation were enrolled in a study involving their completion of two SF-36 HRQOL questionnaires, before ablation and at one-year follow-up.Results88 of the initial 95 patients finished the study. Regardless of whether patients experienced atrial fibrillation (AF) during follow-up, a statistically significant improvement in HRQOL was observed, compared with pre-ablation scores and in all dimensions except Bodily Pain. However, patients without AF during follow-up had significantly higher absolute HRQOL scores in most dimensions. No differences were seen in most HRQOL dimensions, with respect to AFL type (paroxysmal, persistent) or duration, whether AFL was first-episode or recurrent, Class I-III drug dependent, sex, or presence of structural heart disease or tachycardiomyopathy. Patients with persistent AFL showed the greatest improvement in HRQOL when they also had a ventricular cycle length ≤500 ms. The combination of recurrent AFL, ventricular cycle length ≤500 ms and structural heart disease led to a significantly greater improvement in physical HRQOL dimensions than did first-episode AFL, no structural heart disease and ventricular cycle >500 ms. The only independent factor associated with a greater improvement was structural cardiopathy.ConclusionsCTI-ablation treatment leads to a significant improvement in HRQOL in patients with typical AFL. Patients with AF during follow-up show a significantly lower HRQOL at one-year post-ablation. The only independent risk factor found to be associated with a greater improvement in the physical summary component was structural cardiopathy.

Health-Related Quality of Life Among Young Adults with Multiple Sclerosis

Multiple sclerosis (MS) is an unpredictable disease that can have physical, psychological, and social impacts, reducing health-related quality of life (HRQOL). The objective of this study was to identify factors associated with HRQOL among young adults with MS. Survey data were collected from 100 people with MS aged 18 to 31 years, with 93 participants providing all data needed for analyses of our regression models. The survey cohort was recruited from the North American Research Committee on Multiple Sclerosis (NARCOMS) Registry (now the NARCOMS/Global Patient Registry). Multiple linear regression models were used to analyze the data, with the Physical Component Summary and the Mental Component Summary of the 8-item Short Form Health Status Survey serving as dependent variables. Independent variables were other survey responses, including demographic, disease, and treatment characteristics. The results indicated that full-time employment, relapsing-remitting course of MS, and satisfaction with access to MS-focused care were associated with better physical dimensions of HRQOL. Conversely, MS symptoms that interfered with daily life and perceptions of not having as good a social life as other people of comparable age were linked to poorer physical dimensions of HRQOL. Worsening MS symptoms, not having as good a social life as other people of comparable age, and seeing a mental health professional in the previous 12 months were associated with poorer mental dimensions of HRQOL. Our study highlights the association of MS-focused care with better physical dimensions of HRQOL among young adults with MS.