Poorer Physical Health-related Quality Of Life Research Articles

Psychoemotional and Quality of Life Response to Mitral Operations in Patients With Mitral Regurgitation: A Prospective Study

Severe mitral regurgitation (MR) is associated with frequent alteration of psychoemotional status (PES), with anxiety and stress symptoms related to health-related quality of life (HR-QOL). Yet, it is unknown whether surgical correction of MR leads to improvement or deterioration in PES and HR-QOL. We prospectively performed comprehensive MR assessment and administered questionnaires assessing PES and HR-QOL in 131 patients (aged 60 years; 75% men) before and 6 months after operation for organic MR and compared them to 62 patients who did not undergo operation for mitral disease and 36 normal controls of similar age assessed with the same methods. Baseline PES was poorer preoperatively in patients undergoing mitral operation compared with patients who did not undergo mitral operation and normal controls (anxiety and posttraumatic stress [PTS]; both p < 0.01) with poorer physical HR-QOL (p < 0.01). Six months later, all these psychoemotional variables improved (all p ≤ 0.02) in the patients who underwent mitral operation, whereas no change was observed in the other 2 groups (all p > 0.1). Improvement after mitral repair resulted in postoperative normalization of emotional and physical well-being, with similar scores among all groups (all p ≥ 0.4). At 6-month follow-up, no difference in improvement in PES and HR-QOL was noted according to the surgical approach (robotic versus sternotomy, all p ≥ 0.2). Patients with severe organic MR present with frequent psychoemotional alterations and HR-QOL deterioration, in contrast to patients who do not undergo mitral operation and normal controls. After mitral operation, notable improvement results in normalization of emotional and physical well-being. Quantification ofemotional and physical well-being provides important outcome measures in patients with organic MR and uncovers important benefits provided by surgical correction of MR.

Is neck pain associated with worse health-related quality of life 6 months later? A population-based cohort study

Background contextCurrent evidence suggests that neck pain is negatively associated with health-related quality of life (HRQoL). However, these studies are cross-sectional and do not inform the association between neck pain and future HRQoL. PurposeThe purpose of this study was to investigate the association between increasing grades of neck pain severity and HRQoL 6 months later. In addition, this longitudinal study examines the crude association between the course of neck pain and HRQoL. Study designThis is a population-based cohort study. Patient sampleEleven hundred randomly sampled Saskatchewan adults were included. Outcome measuresOutcome measures were the mental component summary (MCS) and physical component summary (PCS) of the Short-Form-36 (SF-36) questionnaire. MethodsWe formed a cohort of 1,100 randomly sampled Saskatchewan adults in September 1995. We used the Chronic Pain Questionnaire to measure neck pain and its related disability. The SF-36 questionnaire was used to measure physical and mental HRQoL 6 months later. Multivariable linear regression was used to measure the association between graded neck pain and HRQoL while controlling for confounding. Analysis of variance and t tests were used to measure the crude association among four possible courses of neck pain and HRQoL at 6 months. The neck pain trajectories over 6 months were no or mild neck pain, improving neck pain, worsening neck pain, and persistent neck pain. Finally, analysis of variance was used to examine changes in baseline to 6-month PCS and MCS scores among the four neck pain trajectory groups. ResultsThe 6-month follow-up rate was 74.9%. We found an exposure-response relationship between neck pain and physical HRQoL after adjusting for age, education, arthritis, low back pain, and depressive symptomatology. Compared with participants without neck pain at baseline, those with mild (β=−1.53, 95% confidence interval [CI]=–2.83, –0.24), intense (β=−3.60, 95% CI=–5.76, –1.44), or disabling (β=−8.55, 95% CI=–11.68, –5.42) neck pain had worse physical HRQoL 6 months later. We did not find an association between neck pain and mental HRQoL. A worsening course of neck pain and persistent neck pain were associated with worse physical HRQoL. ConclusionsWe found that neck pain was negatively associated with physical but not mental HRQoL. Our analysis suggests that neck pain may be a contributor of future poor physical HRQoL in the population. Raising awareness of the possible future impact of neck pain on physical HRQoL is important for health-care providers and policy makers with respect to the management of neck pain in populations.

Mediating effects on health-related quality of life in adults with osteoporosis: a structural equation modeling.

Participants with physical limitation and high degree of pain had poor mental and physical health-related quality of life. In addition, the more support and exercise that the participants had, the more likely they were to report better health-related quality of life. Osteoporosis is a public health threat worldwide. The aim of this study is to examine the effects of individual demographics, disease characteristics, and social support on health-related quality of life (HrQoL) of adults with osteoporosis. Most psychosocial studies focused on the relationships but not the specific construct of social support on HrQoL. In a correlational design, face-to-face, structured interviews were employed to collect information. Study questionnaires included a demographic sheet, the modified Social Support Inventory, and the Short-Form 36 scales on a convenience sample of 161 individuals recruited from four outpatient centers. Using the structural equation modeling approach, all relationships among factors, mediators, and HrQoL were analyzed. The mean duration of osteoporosis was longer than 5 years. Participants who exercised more than three times per week had greater HrQoL than individuals who exercised less frequently. Participants with physical limitation and high degree of pain had poor mental and physical HrQoL. The more support that the participants perceived, the more likely they were to report better HrQoL. The best fitted structural equation modeling (SEM) model included individual demographics and physical function, and social support as significant predictors on HrQoL, with informational support and physical function acting as mediators in those relationships. Moreover, this structural model explained 35, 42, and 40 % of the variance on activity of daily living (ADL), physical, and mental health-related quality of life. The more informational support that individuals have, the more likely they were to report better HrQoL. Individuals with osteoporosis who have lower pain and more exercise are considered having better HrQoL. Further longitudinal research will help clarify the direction of these relationships.

Relationship between depression and physical activity, disability, burden, and health-related quality of life among patients with arthritis.

This study purports to examine the relationship of depression with physical activity, disability, arthritis-attributable burden (joint limitation, work limitation, social activity limitation, and joint pain), and health-related quality of life (HRQOL) among arthritis patients. Data from the 2011 Behavioral Risk Factor Surveillance System, a nationally representative sample of noninstitutionalized adults in the United States, was used for the purpose of this study. Multivariable logistic regression was employed to address the study objectives. The final study sample included 167,068 arthritis patients, 45,459 of whom had comorbid depression. Arthritis patients with depression had lower odds of engaging in physical activity (odds ratio [OR]=1.070, confidence interval [CI] 1.006-1.139) and higher odds of being disabled (OR=1.411, CI 1.306-1.524). Arthritis patients with depression also had greater odds of arthritis-attributable joint limitations (OR=1.551, CI 1.460-1.648), work limitations (OR=1.506, CI 1.414-1.604), social activity limitations (OR=1.647, CI 1.557-1.742), and pain (OR=1.438, CI 1.364-1.517) as compared to those without depression. Arthritis patients with versus without depression had greater odds of poor general health status (OR=1.698, CI 1.586-1.819), physical HRQOL (OR=1.592, CI 1.486-1.704), mental HRQOL (OR=6.225, CI 5.768-6.718), and activity limitations (OR=2.345, CI 2.168-2.537). Study results indicate toward a negative functional impact of depression among arthritis patients. Policy makers should consider incorporating screening and management of depression into routine clinical care of arthritis patients.

Weight and health-related quality of life: The moderating role of weight discrimination and internalized weight bias

ObjectivesObesity is an increasingly prevalent public health concern, with associated medical comorbidities and impairment in health-related quality of life (HRQoL). Obese women are frequently victims of weight-related discrimination. The HRQoL impairments among obese people could be related to this discrimination and to internalized weight bias.DesignWe examined the potential moderating role of discrimination (from others) and self-directed (internalized) weight-based discrimination in the association between body mass index (BMI) and HRQoL. MethodsEighty-one women (mean age=41.1years; mean BMI=43.40kg/m2, 97% Caucasian) completed valid and reliable measures of weight bias internalization (weight bias internalization scale), perceived discrimination by others (everyday discrimination scale) and both physical and mental HRQoL (SF-36 Health Survey). Multiple regression analysis was used to test whether internalized weight bias or discrimination moderated the association between BMI and the summary scores for physical and mental HRQoL, controlling for age. ResultsSignificant associations were found between BMI and discrimination (r=.36, p=.002), between internalized weight bias and both mental (r=.61, p<.001) and physical HRQoL (r=.45, p<.001), and between discrimination and physical HRQoL (r=.29, p=.014). A statistically significant interaction was found between BMI and internalized weight bias (b=−.21, SE=.10, p<0.05) in accounting for the variance in physical HRQoL. ConclusionsThe association between higher BMI and poorer physical HRQoL was found only in individuals reporting high levels of internalized weight bias. Self-discrimination among overweight individuals may be a critical factor in their physical health impairment.

Skeletal, neuromuscular and fitness impairments among children with newly diagnosed acute lymphoblastic leukemia

This study describes skeletal, neuromuscular and fitness impairments among 109 children (median age 10 [range 4–18] years, 65.1% male, 63.3% white) with acute lymphoblastic leukemia (ALL). Outcomes were measured 7–10 days after diagnosis and compared to age- and sex-specific expected values. Associations between function and health-related quality of life (HRQL) were evaluated with logistic regression. Children with ALL had sub-optimal bone mineral density (BMD) Z-score/height (mean ± standard error: − 0.53 ± 0.16 vs. 0.00 ± 0.14, p < 0.01), body mass index percentile (57.6 ± 3.15 vs. 50.0 ± 3.27%, p = 0.02), quadriceps strength (201.9 ± 8.3 vs. 236.1 ± 5.4 N, p < 0.01), 6 min walk distance (385.0 ± 13.1 vs. 628.2 ± 7.1 m, p < 0.001) and Bruininks–Oseretsky Test of Motor Proficiency scores (23 ± 2.5 vs. 50 ± 3.4%, p < 0.01). Quadriceps weakness was associated with a 20.9-fold (95% confidence interval 2.5–173.3) increase in poor physical HRQL. Children with newly diagnosed ALL have weakness and poor endurance and may benefit from early rehabilitation that includes strengthening and aerobic conditioning.

Predictors of health-related quality of life over time among adolescents and young adults with sickle cell disease.

Little is known about what factors affect the health-related quality of life (HRQoL) of adolescents and young adults (AYAs) with sickle cell disease (SCD), and how their HRQoL changes over time. This retrospective study included 87 AYAs attending a SCD Adolescent Clinic who completed a measure of HRQoL at each visit over the course of approximately 1.3years. Results suggested that the following were associated with poorer physical HRQoL: being female, more healthcare utilization events, and presence of internalizing symptoms. Internalizing and externalizing symptoms were the only factors correlated with poorer psychosocial HRQoL. Generalized linear mixed models indicated that physical and psychosocial HRQoL improved among all participants during the assessment period, and those with externalizing behaviors reported faster improvement in physical HRQoL over time. AYAs with SCD may benefit from early mental health screening and intervention to optimize clinical care.

Metabolic syndrome and health-related quality of life in reproductive age and post-menopausal women: Tehran Lipid and Glucose Study.

Given the lack of data clarifying the manner in which women with metabolic syndrome (MetS) in different eras of their life perceive their health-related quality of life (HRQoL), this study aimed at investigating the association between MetS and HRQoL in reproductive age and post menopausal women. This was a cross-sectional study conducted within the framework of Tehran Lipid and Glucose Study (TLGS). Metabolic syndrome was defined according to the Joint Interim Statement (JIS) and HRQoL was assessed using the Short Form Health Survey (SF-36). Logistic regression analysis was used to estimate the odds ratio (OR) of poor HRQoL with 95% confidence intervals (CIs) for reproductive age and post-menopausal women separately and adjusted for confounding variables. All 603 participants with (n = 340) and without (n = 263) MetS were studied. Overall, in both physical and mental domains, those without MetS had higher scores in all subscales of SF-36 except for vitality, role emotional and mental component summary. Unadjusted odds ratios (95% CI) for poor physical HRQoL were 2.8 (1.7-4.6); (P < 0.001) and 1.5 (0.7-3.4) for the reproductive age and post-menopausal groups, respectively. Compared to the post-menopausal group, the odds ratio of reporting poor HRQoL for reproductive age women was significantly higher, even after adjusting for age (OR: 1.7, 95% CI: 1.0-3.0, P < 0.05). The results indicate that MetS is associated with poor HRQoL in reproductive age, but not in post-menopausal women, and the association is observed mainly in relation to physical rather than mental health.

Predictors of future health-related quality of life in survivors of adolescent cancer

The purpose of this study was to identify characteristics associated with health-related quality of life (HRQOL) among long-term survivors of adolescent cancer enrolled in the Childhood Cancer Survivor Study. Thirty percent of survivors reported poor physical and/or mental HRQOL. Race/ethnicity, education, and head/neck disfigurement were significantly associated with poor mental HRQOL, while sex, age, household income, obesity, alkylating agents, pelvic radiation, head/neck or limb disfigurement, and walking with a limp were associated with poor physical HRQOL. Identification of high-risk adolescent cancer patients may facilitate timely intervention to attempt to minimize the impact of cancer and treatment on subsequent quality of life.

More than just body weight: The role of body image in psychological and physical functioning

The current study examined BMI and body image dissatisfaction as predictors of physical and mental health-related quality of life (HRQL) and psychosocial functioning in a sample of 414 undergraduate students (mean age=21.5, SD=4.9; mean BMI=23.6, SD=5.2). In men and women, higher BMI was correlated with body image dissatisfaction and physical HRQL, but not with any measures of psychosocial functioning, whereas higher body image dissatisfaction was associated with poorer physical HRQL and psychosocial functioning. Furthermore, body image dissatisfaction was observed to mediate the relationship between BMI and physical HRQL in men and women. Interestingly, in this model, higher BMI predicted increased self-esteem. These findings suggest that body image dissatisfaction may be an important target for health interventions.

Effects of depressive symptoms and family satisfaction on health related quality of life: the Hong Kong FAMILY study.

ObjectiveTo examine the effect of depressive symptoms and satisfaction with family support (FS) on physical and mental Health Related Quality of Life (HRQoL).MethodsData were obtained from the Hong Kong FAMILY Project baseline survey in 2009–2011, which included 16,039 community residents (age ≥20). The FS was measured using the Family Adaptation, Partnership, Growth, Affection, Resolve (APGAR, range 0–10) Questionnaire. HRQoL were assessed using the SF-12 version 2. Depressive symptoms were recorded using the Patient Health Questionnaire-9 (PHQ-9). Demographic and lifestyle variables, stressful life events, perceived neighborhood cohesion were also assessed.ResultsIn a multilevel regression model, socio-demographic and behavioral variables explained 21% and 19% of the variance in physical and mental HRQoL. The presence of depressive symptoms (PHQ-9 score ≥10, standardized coefficients, β of −1.73) and high FS (APGAR score 7–10, 1.15) were associated with mental HRQoL, after adjustment for age, education, household monthly income, drinking status, physical activity, chronic conditions, life stress and neighborhood cohesion. Not FS but the presence of depressive symptoms (β of −0.88) was associated with physical HRQoL. The presence of depressive symptoms in women than men were more associated with a poorer physical HRQoL (p<0.01) while depressive symptoms in men were associated with a decrease in mental HRQoL (p<0.001). The interaction between FS and depressive symptoms was nonsignificant in relation to HRQoL. Among those with depressive symptoms, high FS was associated with a better mental HRQoL (41.1 vs. 37.9, p<0.001) in women but not contribute to variance in men.ConclusionsHigher FS and presence of depressive symptoms were significantly associated with HRQoL in general population in Hong Kong. Among those with depressive symptoms, high FS was associated with a favorable mental HRQoL in women but not men.

Association Between Health-Related Quality of Life and Colorectal Cancer Screening

Conflicting information currently exists about the role played by health-related quality of life (HRQOL) in influencing colorectal cancer screening. The current study aimed to determine the relationship between HRQOL and colorectal cancer screening, using nationally representative public data from the Behavioral Risk Factor Surveillance System (BRFSS). The 2010 BRFSS data were used for this study. Individuals younger than age 50 years were excluded from the study. Missing data were imputed using the multiple imputation technique. Multiple multivariate logistic regression models were fitted to the data to determine the association between different components of HRQOL (physical HRQOL, mental HRQOL, activity limitation caused by poor mental or physical HRQOL, and general health status) and receipt of colorectal cancer screening tests (fecal occult blood testing [FOBT] in the past year, sigmoidoscopy in the past 5 years, and colonoscopy in the past 10 years). The study sample comprised 301,488 individuals. Approximately 12% of the respondents had received FOBT in the past year, 62.6% had received sigmoidoscopy in the past 5 years, or colonoscopy in the past 10 years, and 65.4% had received either of the screening tests within appropriate time frames. After controlling for demographic and health-related covariates, an inverse relationship was observed between HRQOL and colorectal cancer screening with the exception of mental HRQOL and FOBT. The relationship between mental HRQOL and FOBT was found to be nonsignificant. Policy makers should consider including HRQOL as an important parameter when designing interventions aimed at improving colorectal cancer screening rates.

Journal Digest

Journal Digest

Illness appraisals and health-related quality of life in adolescents and young adults with allergies and asthma

The current study sought to: 1) assess differences in levels of physical and mental health-related quality of life (HRQOL), illness uncertainty, and intrusiveness in adolescents and young adults (AYAs) with allergies and asthma, as well as 2) examine the effect of illness appraisals on HRQOL. Participants were undergraduate students with self-reported allergies (n=74) and asthma (n=74) who completed the Mishel Uncertainty in Illness Scale (MUIS), the Illness Intrusiveness Scale (IIS), and the SF-36 Health Survey Questionnaire. Paired t-tests indicated that AYAs with allergies reported higher levels of illness uncertainty and poorer mental HRQOL than AYAs with asthma; the groups did not differ on reported levels of illness intrusiveness or physical HRQOL. Hierarchical regressions were conducted to examine the relationship between illness appraisals and HRQOL. Results revealed that poorer mental HRQOL was associated with higher illness uncertainty in AYAs with allergies and higher illness intrusiveness in AYAs with asthma. Poorer physical HRQOL was associated with higher illness uncertainty in AYAs with asthma and higher illness intrusiveness in AYAs with allergies and asthma. The current examination suggests that illness appraisals may be differentially related to HRQOL in AYAs with allergies compared to those with asthma.

Poorer physical health-related quality of life among Aboriginals and injection drug users treated with highly active antiretroviral therapy.

We compared the health-related quality of life (HRQL) of Aboriginal and non-Aboriginal HIV patients after they started highly active antiretroviral therapy (HAART) in Edmonton, Alberta and investigated whether clinical status (CD4 cell count and viral load) might explain any observed differences. In 2006-2007, eligible patients who started HAART in 1997-2005 completed the MOS-HIV to measure HRQL. Using multiple linear regression models, we compared physical (PHS) and mental (MHS) health summary scores across four groups: Aboriginals infected with HIV via injection drug use (AB/IDUs); Aboriginal non-IDUs (AB/non-IDUs); non-Aboriginal IDUs (non-AB/IDUs); and non-Aboriginal non-IDUs (non-AB/non-IDUs). To assess whether clinical status could explain any observed group differences, we fitted a model adjusting for socio-demographics (age and sex) and years since starting HAART only and then additionally adjusted for current clinical status. Ninety-six patients were eligible (35% Aboriginal, 42% IDU). Adjusting for socio-demographics and years since starting HAART, AB/IDUs (p=0.008), AB/non-IDUs (p=0.002), and non-AB/IDUs (p=0.002) had lower PHS scores than non-AB/non-IDUs. After additionally adjusting for clinical status, these relationships remained significant for AB/non-IDUs (p=0.027) and non-AB/IDUs (p=0.048) but not for AB/IDUs (p=0.12). AB/IDUs and non-AB/IDUs tended to have worse MHS scores than non-AB/non-IDUs, but these relationships were not statistically significant and weakened after adjusting for current clinical status. AB/IDU, AB/non-IDUs, and non-AB/IDUs had significantly poorer physical HRQL than non-AB/non-IDUs. These differences appear to be partially explained by poorer clinical status, especially for AB/IDUs, which suggests that observed inequalities in physical HRQL may be diminished by improving patients' clinical status; for example, through improved adherence to HAART.

Mental and Physical Health–Related Quality of Life among U.S. Cancer Survivors: Population Estimates from the 2010 National Health Interview Survey

Despite extensive data on health-related quality of life (HRQOL) among cancer survivors, we do not yet have an estimate of the percentage of survivors with poor mental and physical HRQOL compared with population norms. HRQOL population means for adult-onset cancer survivors of all ages and across the survivorship trajectory also have not been published. Survivors (N = 1,822) and adults with no cancer history (N = 24,804) were identified from the 2010 National Health Interview Survey. The PROMIS® Global Health Scale was used to assess HRQOL. Poor HRQOL was defined as 1 SD or more below the PROMIS® population norm. Poor physical and mental HRQOL were reported by 24.5% and 10.1% of survivors, respectively, compared with 10.2% and 5.9% of adults without cancer (both P < 0.0001). This represents a population of approximately 3.3 million and 1.4 million U.S. survivors with poor physical and mental HRQOL. Adjusted mean mental and physical HRQOL scores were similar for breast, prostate, and melanoma survivors compared with adults without cancer. Survivors of cervical, colorectal, hematologic, short-survival, and other cancers had worse physical HRQOL; cervical and short-survival cancer survivors reported worse mental HRQOL. These data elucidate the burden of cancer diagnosis and treatment among U.S. survivors and can be used to monitor the impact of national efforts to improve survivorship care and outcomes. We present novel data on the number of U.S. survivors with poor HRQOL. Interventions for high-risk groups that can be easily implemented are needed to improve survivor health at a population level.

Health-Related Quality of Life and Healthcare Resource Utilization in Taiwanese Women With Menopausal Symptoms

Menopausal experience differs among women with different cultural and ethnic backgrounds and may impact quality of life. Some women with severe menopausal symptoms seek medical help to alleviate menopause-related symptoms. This study examined the demographic characteristics and health-related quality of life (HRQOL) of Taiwanese women experiencing menopausal symptoms and examined associations between menopausal symptoms and, respectively, poor HRQOL and healthcare resource utilization. This cross-sectional study used data from the 2005 National Health Interview Survey in Taiwan, which used a multistaged stratified systematic sampling scheme. A total of 4,437 women aged 35-64 years were analyzed. We used multivariable logistic regression models to identify variables significantly and independently associated with the presence of menopausal symptoms. We also used the model to assess the odds of poor HRQOL and healthcare resource utilization in women with menopausal symptoms compared with those without. Eight hundred and forty-six women (19.1%) reported experiencing menopausal symptoms. Age, religion, smoking, exercise, and comorbidity were independently associated with the presence of such symptoms. The propensity score-adjusted odds ratio of poor physical HRQOL, poor mental HRQOL, use of outpatient, traditional Chinese medicine and emergency room services, and hospitalization for women with menopausal symptoms were 1.85 (95% CI [1.54, 2.21]), 1.66 (95% CI [1.40, 1.97]), 1.39 (95% CI [1.18, 1.63]), 1.73 (95% CI [1.37, 2.18]), 1.44 (95% CI [1.15, 1.81]), and 1.36 (95% CI [1.02, 1.81]), respectively, compared with those without symptoms. Nearly one fifth of women aged 35-64 years in Taiwan experience menopausal symptoms. The presence of menopausal symptoms increases the likelihood of poor HRQOL and healthcare resource utilization even after controlling for possible confounders.

Adverse Psychosocial Working Conditions and Poor Quality of Life among Financial Service Employees in Brazil

Workers in the financial services sector are exposed to great stress at work. This study investigates whether exposure to adverse psychosocial work conditions is independently associated with poor health-related physical and mental quality of life among financial services workers. We studied a nationwide representative sample of 2,054 workers of a large Brazilian state bank in 2008. Adverse psychosocial work conditions were investigated by the Effort-reward imbalance (ERI) scale and the Job content questionnaire (JCQ). Health-related quality of life (HRQL) was assessed using the Medical Outcomes Study Short-Form General Health Survey (SF-12). Poor mental and physical HRQL was defined by the lowest quartiles of the SF-12 final score distributions. Associations were investigated using multiple logistic regression analysis. In the multivariate analysis, exposures to low control and lack of social support at work (JCQ) were associated with poor HRQL in the physical domain. Increasing effort-reward imbalance and overcommitment (ERI), on the other hand, were associated with poor HRQL in the mental domain, with a significant statistical trend. Overcommitment was also associated with poor physical HRQL. The results suggest that exposure to adverse psychosocial work conditions has a negative impact on both domains of HRQL among financial service workers. They also indicate that ERI and DC models capture different aspects of job strain.

Cognition and Physical Disability in Predicting Health-Related Quality of Life in Multiple Sclerosis

Many studies have shown that multiple sclerosis (MS) has a significant impact on patient health-related quality of life (HRQOL), but the relative contributions of physical versus cognitive disability are not well established. Most studies have relied on HRQOL outcomes that depend largely on patient mood, life satisfaction, and personal happiness. The Sickness Impact Profile (SIP) is a measure of HRQOL known for its relatively strong emphasis on task completion and activities of daily living. As such, the SIP may be less influenced by depression. We sought to determine the relative influence of physical disability and cognition, above and beyond demographic and disease variables, in predicting HRQOL. Patients (n = 132) and healthy controls (n = 26) underwent complete neuropsychological evaluation using the Minimal Assessment of Cognitive Function in MS (MACFIMS) battery and a series of self-report measures assessing depression, fatigue, and HRQOL. The SIP was also administered. Correlation analysis and group comparisons revealed significant associations between cognition and HRQOL outcomes. Logistic regression models comparing the Expanded Disability Status Scale (EDSS) and cognitive tests in predicting poor physical HRQOL retained both EDSS and Symbol Digit Modalities Test (SDMT) performance, while models predicting poor psychosocial and poor overall HRQOL retained only the SDMT. These findings support cognition as a significant predictor of overall HRQOL, psychosocial HRQOL, and, interestingly, physical HRQOL.

Excess Weight and Physical Health-Related Quality of Life in Postmenopausal Women of Diverse Racial/Ethnic Backgrounds

Studies of weight and health-related quality of life (HRQOL) generally focus on white populations. This analysis examines the association between clinical weight categories and physical HRQOL in five racial/ethnic groups of older women and determines the extent to which emotional/psychological (social support, caregiver burden) and physical health (diabetes, osteoarthritis) factors modify this relationship. The cross-sectional analysis, completed in 2007, used baseline data from postmenopausal women enrolled in the Women's Health Initiative (WHI) during the 5-year recruitment period (1993-1998). Of 161,393 women, 83% were non-Hispanic white, 9% were African American, 4% were Hispanic/Latina, 3% were Asian/Pacific Islander, and <1% were American Indian/Alaska Native. Obesity (body mass index [BMI] > or =30 kg/m(2)) was most common in non-Asian minority groups. Regression modeling showed higher odds of poor physical HRQOL with increasing weight category in all groups. In the total sample, these odds were at least 6 times as high in women with class 3 obesity as in women of normal weight and were only mildly attenuated after the analysis adjusted for emotional/psychological factors. Further adjustment for physical health factors made odds ratio (OR) estimates drop from 2.36 to 1.59 for class 1 obesity and from 6.96 to 3.71 for class 3 obesity. This pattern generally persisted within each racial/ethnic group. Heavier weight negatively affects physical HRQOL in postmenopausal women across diverse racial/ethnic backgrounds. Weight-relevant physical health factors have a greater impact on this weight-HRQOL association than do emotional/psychological factors.