Predictors Of Health-related Quality Of Life Research Articles

Self-reported depression in cancer survivors versus the general population: a population-based propensity score-matching analysis.

The purpose of the study was to evaluate health-related quality of life (HRQoL) and depression in community-dwelling cancer survivors using structured questionnaires and propensity score matching (PSM). Subjects (age ≥ 30years) who participated in the Sixth Korean National Health and Nutritional Exam Survey completed the EuroQoL5 Dimensions (EQ-5D) and Patient Health Questionnaire (PHQ-9). For the analysis, participants were divided into a cancer survivor group and a group consisting of the general cancer-free population. We compared PHQ-9 and EQ-5D Utility Index scores between the two groups, while controlling for underlying baseline demographic and clinical differences between groups using PSM. Additionally, we divided cancer survivors into two group (< 5 vs. ≥ 5years since cancer diagnosis), and we evaluated whether the cancer prevalence period was associated with the EQ-5D Utility Index score. Of all 4124 subjects, 208 cancer survivors were matched with 624 controls using PSM. PHQ-9 and EQ-5D scores in cancer survivors were not different from the general population. In unadjustedsubgroup analyses, PHQ-9 scores and EQ-5D proportion of subjects with anxiety/depression (23.3% vs. 7.6%) were higher in cancer survivors with < 5years since cancer diagnosis compared to those with ≥ 5years. In multivariate analyses,predictors of depression in cancer survivors included household income and employment status, and predictors of HRQoL-included household income and subjective perceived health status. Period since the cancer diagnosis was not a predictor of either depression or HRQoL. Depression and HRQoL in cancer survivors were similar to that experienced by the general population, and household income, perceived subjective health status and employment status were the main factors affecting depression and HRQoL in cancer survivors.

Health-related quality of life and its socio-economic and cultural predictors among advanced cancer patients: evidence from the APPROACH cross-sectional survey in Hyderabad-India

BackgroundPatients with advanced cancer often experience poor health-related quality-of-life (HRQoL) due to cancer and treatment-related side-effects. With India’s palliative care landscape in its infancy, there is a concern that advanced cancer patients, especially individuals who are from disadvantaged populations experience poor HRQoL outcomes. We aim to assess HRQoL of advanced cancer patients in terms of general well-being (physical, functional, emotional, and social/family well-being), pain experiences, psychological state, and spiritual well-being, and determine the relationship between belonging to a disadvantaged group and HRQoL outcomes. We hypothesize that patients from disadvantaged or minority backgrounds, identified in this paper as financially distressed, female, lower years of education, lower social/family support, minority religions, and Non-General Castes, would be associated with worse HRQoL outcomes compared to those who are not from a disadvantaged group.MethodsWe administered a cross-sectional survey to 210 advanced cancer patients in a regional cancer center in India. The questionnaire included standardized instruments for general well-being (FACT-G), pain experiences (BPI), psychological state (HADS), spiritual well-being (FACT-SP); socio-economic and demographic characteristics.ResultsParticipants reported significantly lower general well-being (mean ± SD) (FACT-G = 62.4 ± 10.0) and spiritual well-being (FACT-SP = 32.7 ± 5.5) compared to a reference population of cancer patients in the U.S. Patients reported mild to moderate pain severity (3.2 ± 1.8) and interference (4.0 ± 1.6), normal anxiety (5.6 ± 3.1) and borderline depressive symptoms (9.7 ± 3.3). Higher financial difficulty scores predicted most of the HRQoL domains (p ≤ 0.01), and being from a minority religion predicted lower physical well-being (p ≤ 0.05) and higher pain severity (p ≤ 0.05). Married women reported lower social/family well-being (p ≤ 0.05). Pain severity and interference were significant predictors of most HRQoL domains.ConclusionsAdvanced cancer patients, especially those with lower financial well-being and belonging to minority religions, reported low physical, functional, emotional, social/family, and spiritual well-being, and borderline depressive symptoms. Future studies should be directed at developing effective interventions supporting vulnerable groups such as those with financial distress, and those belonging to minority religions.

Predictors of health-related quality of life after non-catastrophic injury sustained in a road traffic crash.

Health-related quality of life (HRQoL) is an important patient-reported outcome that warrants greater attention in individuals who sustained a non-catastrophic injury in a road traffic crash. Additional robust data on HRQoL outcomes after a non-catastrophic injury are needed to effectively identify potential targets for studies of tertiary prevention of poor recovery after a crash. We assessed the association between non-catastrophic road traffic crash injuries and HRQoL and factors that independently affect long-term HRQoL. In this inception cohort study, injured participants (≥17years old) were identified from various sources including hospital emergency departments by a medical examination by a registered healthcare professional in New South Wales (Australia) and followed up after 12months. HRQoL was measured by the European Quality of Life-5 Dimensions (EQ-5D-3L) and Medical Outcomes Survey Short Form 12 items (SF-12). A range of socio-demographic, pre-injury health, psychological, and injury-related factors were considered potential predictors of HRQoL in regression analyses. Among 2019individuals identified, 1201 (59.5%) were followed up after 12months. HRQoL significantly improved between baseline and 12-month follow-up: EQ-5D-3L summary score (0.41-unit difference); SF-12 physical component summary score (PCS; 13.6-unit difference) and mental component summary score (MCS; 3.5-unit difference). Over 12months, HRQoL score was lower for people claiming compensation than others (P<0.0001). Key predictors of better 12-month EQ-5D-3L summary score and visual analogue scale score for pain were age, not claiming compensation, reduced body mass index, less pain severity, less pain-related disability, and less general psychological distress. Significant predictors of SF-12 PCS score were injury to the neck (P=0.02) or head or face (P=0.01), being a driver or passenger at the time of the crash (P<0.0001), hospital admission (P<0.0001) and pain severity (P<0.0001). Baseline variables associated with 12-month SF-12 MCS scores were head or face injury (P=0.02), pre-injury health (P=0.04), pre-injury psychological conditions (P=0.04), trauma-related distress (P=0.0002) and general psychological distress (P<0.0001). A wide spectrum of biopsychosocial factors contribute to HRQoL after a road traffic crash injury. These epidemiological data are potentially important because they could identify potential targets for studies of tertiary prevention of persistently poor HRQoL after such an injury.

Factors influencing the quality of life in persons living with human immunodeficiency virus infection in Almaty, Kazakhstan

The study purpose was to determine the factors associated with health-related quality of life (HRQoL) among people living with HIV (PLHIV) in Kazakhstan. A convenience sample of 531 adult PLHIV registered at the Almaty City AIDS Center was used for this cross-sectional study. HRQoL data were collected with the World Health Organization’s Quality of Life HIV brief questionnaire, depression – with Patient Health Questionnaire-9, and clinical data were retrieved from medical records. Multivariate logistic and Tobit censored regressions were used to examine the relationship of socio-demographic, behavioral, and clinical factors with HRQoL and the six specific HRQoL domains: 35.8% of participants did not report good HRQoL. The following variables were identified as independent predictors of poor HRQoL: probable depression (adjusted odds ratio [AOR] 13.42, 95% confidence interval [CI]: 4.56–39.52); history of injecting drug use (AOR 2.10, 95% CI: 1.40–3.14); CD4+ T-cell count <200 cells/mm3 (AOR 2.17, 95% CI: 1.30–3.62); previously married status (AOR 2.23, 95% CI: 1.16–4.28); and co-infection with tuberculosis, syphilis, toxoplasmosis, Chlamydia, herpes simplex, or cytomegalovirus (AOR 1.59, 95% CI: 1.06–2.39). HRQoL of PLHIV in Almaty was independently influenced by several factors. An interdisciplinary approach is needed in planning healthcare and social services addressing improvement of HRQoL among PLHIV.

PRS60 IMPACT OF SLEEP DISTURBANCE ON HEALTH-RELATED QUALITY OF LIFE IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD): WHAT DO WE KNOW SO FAR?

Extrapulmonary impacts of chronic obstructive pulmonary disease (COPD) often include sleep disturbance, poor sleep quality, and daytime sleepiness resulting in detrimental impact on patients' overall health-related quality of life (HRQoL). This study evaluated the impact of sleep disturbance on HRQoL in patients with COPD. Literature searches were performed in biomedical databases until March 2019. Specific search terms identified observational studies assessing HRQoL in COPD that included sleep as a patient-reported outcome (PRO) endpoint. Only full text articles published in English were included. Out of total 1247 abstracts identified for initial screening, 177 were selected for full text review. Based on the inclusion criteria, PRO-related information from 36 studies are analyzed. Sleep disturbances and poor sleep quality was on average prevalent in more than one-third, ranging from 27%-100% of COPD patients. Sleep measures such as the Pittsburgh Sleep Quality Index (PSQI), PROMIS-sleep disturbance domain, Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISI), and COPD and Asthma Sleep Impact Scale (CASIS) showed significant correlations (all p<0.05) with HRQoL [determined by COPD Assessment Test (CAT), 36-Item Short Form Health Survey (SF-36), the Nottingham Health Profile (NHP) and the St George's Respiratory Questionnaire (SGRQ)]. Univariate and multivariate analyses showed that sleep quality (evaluated by PSQI) is an important determinant for HRQoL in COPD. Furthermore, HRQoL is an important predictor of sleep quality, thereby establishing bidirectional relationship. “Good sleepers” (PSQI<5) have better HRQoL compared to “poor sleepers” (PSQI≥5). Increased sleep disturbance is associated with emotional impact. Both significant (all p<0.05) and non-significant (all p>0.05) results were seen for associations of sleep with disease severity. Overall, there is a bidirectional relationship of sleep quality and HRQoL in COPD. Sleep quality is an independent significant predictor of HRQoL in COPD. Hence, sleep should be considered an important HRQoL component when evaluating the health status of COPD patients.

Clinically Significant Fatigue: Prevalence, Predictors, and Health-Related Quality of Life in Adult Leukemia Patients

Background: Cancer-related fatigue (CRF) is a common distressing symptom in leukemia patients. CRF becomes clinically significant (clinically significant fatigue-CSF) when adversely affects healthrelated quality of life (HRQoL) and warrants further workup, referrals, and treatment. We aimed to assess the prevalence and predictors of CSF and assess its impact on HRQoL in adult leukemia patients. Methods: Analysis was performed on 168 leukemia patients. The primary study outcomes were CSF (score ≥4) as measured by the fatigue numerical rating scale and HRQoL using a validated Functional Assessment of Cancer Therapy-Leukemia (FACT-Leu) scale. Univariate and multivariate regression analyses were conducted to identify independent predictors of CSF and HRQoL. Findings: A total of 168 leukemia patients were included in the study with a mean age of 43.99±19.20 years. The prevalence of CSF was 89 (53%) and 130 (77.4%) for CRF. The mean CSF score was 6.66±2.02. The ROC curves for the FACT-Leu scale indicated the score of ≥126 out of 176 as the optimal cut-off score for good HRQoL. About 106 (63.1%) of leukemia patient had poor HRQoL (102.61±23.50). Overall, FACT-Leu mean score indicated that study participants had poor HRQoL (114.70±29.67). There was a statistically significant difference in HRQoL between the patients with CSF 104.89±28.82 and Non-CSF 125.76±26.71, p<0.001. Poor appetite 3.02 [1.33-6.85] was statistically significant predictors (p<0.010) of CSF. Dependence on caregiver (odd ratio: 3.31 [95% CI: 0.41-0.75]) and having non-CSF (odd ratio: 5.22 [95% CI: 2.44- 11.19]) were found statistically significant predictors of good HRQoL. Interpretations: CSF is prevalent among leukemia patients, and adversely affects their HRQoL. The findings reported by patients are based on a patient-centered approach survey. Holistic assessment and supportive care are needed to reduce the burden of CSF and improve leukemia patients HRQoL. Funding Statement: The authors have stated: None. Declaration of Interests: The authors have no competing conflict of interest. Ethics Approval Statement: Approval for the study was granted from the institutional review board at KFMC. Written informed consent was obtained prior to patients’ participation in the study.

The association of resilience with health-related quality of life (HRQoL) in adolescent students.

Identifying the factors associated with HRQoL in adolescents is a prerequisite of interventions aimed at improving the overall quality of life and health status among them. Studies have identified many factors associated with HRQoL in different populations; however, very little is known about the role of resilience on HRQoL in adolescent students. This cross-sectional study was conducted on 1500 high school students (750 boys and 750 girls) in Tehran. The subjects were selected through the cluster and multistage sampling methods. The data collection tool included three questionnaires; a demographic information questionnaire, the Health-Related Quality of Life Questionnaire (KIDSCREEN-27), and the Children and Youth Resilience Measurement (CYRM-28). Data were analyzed with SPSS 23 software. Regression analysis was performed to determine the association of resilience with HRQoL. The mean score of overall health-related quality of life and overall resilience were 57.51 ± 15.03 and 98.35 ± 16.48, respectively. Individual sub-scale (β = 0.402, p < 0.001), caregiver sub-scale (β = 0.279, p < 0.001) and context sub-scale (β = 0.122, p < 0.001) of resilience were, respectively, the positive and significant predictors of HRQoL in students. The resilience sub-scales explained 49% of the total variance of HRQoL, and the individual sub-scale was the strongest predictive factor for HRQoL in students. It is recommended to incorporate resilience training programs into the regular school education in order to improve the quality of life and health of students in all high schools and educational centers of the country.

Relation Between Clinical Oral Health Status, Oral Health Related Quality of Life, Denture Material Type and Self-perceived General Health, in a General Population

The purpose of the current study was to assess the oral health related quality of life (OHRQoL), general health related quality of life (HRQoL), clinical oral and denture status, as well as their interrelation, within a hospitalized general population. The Romanian versions of the Oral Health Impact Profile-49 (OHIP-49Ro), SF-36 questionnaires, together with an additional set of oral health assessment questions, were administered under the interview format to 170 patients, hospitalized in the Second Medical Clinic of Internal Medicine, Cluj-Napoca, Romania. The patients also underwent clinical examination, based on which the DMFT was calculated. Denture status, was as well, registered, together with the denture material. Each patient provided informed consent, prior to any examination. Questionnaire scores were calculated and used for the univariate descriptive statistics, reflecting oral health, OHRQoL and HRQoL sample tendencies. Successively, multiple regression analysis was applied, with the purpose of investigating the relationship between: the clinical oral health status, OHRQoL and HRQoL. In the first model, OHRQoL, while in the second model the dependent variable was represented by the HRQoL, each having a set of established predictors. Additionally, for denture wearing patients, OHRQoL variations in respect to the denture material were assessed, using one-way ANOVA. The mean OHIP-49Ro overall score was 31.90. The mean SF-36 subscales score was 60.66. The mean DMFT score was 18.47. For both regression analyses, all the regression models were significant. For the first model, the predictors accounted for 48.5% of variance in OHRQoL. For the second model, the highest percent of variance, explained by the predictors, was registered for the Mental Health subscale (22.8%). DMFT, as a clinical measure, was a statistically significant predictor rather for the perception in general health. However, OHRQoL was a good predictor for HRQoL, as an integrated part of it. Moreover, the one-way ANOVA indicated statistically significant differences in OHRQoL perception, in respect to the denture material F(2, 82) = 3.253, p = 0.044. The current study indicated complex relations between the patients� clinical status, the OHRQoL and HRQoL. The clinical determinants presented direct impact on both OHRQoL and HRQoL. More balanced HRQoL scores suggested that patients focused more on the perception of general health outcomes.

Health-related quality of life and depressive symptoms in Friedreich ataxia.

Friedreich ataxia (FRDA) is a chronic, progressive and highly disabling cerebellar degenerative disease. Despite this, little attention has been paid to the health-related quality of life (HRQOL) in this disease. The aim of the present study was to assess FRDA patients' perception of HRQOL and to determine the influence of depression, and demographic and clinical variables. The sample consisted of 62 patients with genetically confirmed FRDA. The SF-36 Health Survey was used to assess HRQOL. Depressive symptoms were evaluated with the Beck Depression Inventory-II. FRDA patients' mean scores were significantly lower than the values for the Spanish population in all SF36 dimensions. Average z scores ranged from - 5.5 in physical functioning to - 0.48 in mental health. Age and clinical variables were significant predictors of HRQOL in only several dimensions, whereas BDI scores were able to predict a significant percentage of variance in all SF36 dimensions, except physical functioning. Our study demonstrates the high impact of Friedreich ataxia on quality of life. This impact does not only occur in those aspects most related to motor disability but it is also present in non-motor dimensions. Depressive symptomatology is the most relevant variable for predicting quality of life.

Health-related quality of life in patients with compensated and decompensated liver cirrhosis

BackgroundCompensated (Child-Pugh [CP] A) and decompensated (CP B/C) liver cirrhosis significantly differs in terms of impairment of health-related quality of life (HRQoL). However, sufficient data on potentially treatable factors associated with HRQoL in both stages of the disease are still lacking. Consequently, aims of this study were to determine differences in HRQoL between patients with compensated and decompensated liver cirrhosis and to identify potentially treatable factors associated with HRQoL. Methods218 patients with liver cirrhosis were enrolled into this study. Chronic Liver Disease Questionnaire (CLDQ) was used to assess HRQoL. Covert hepatic encephalopathy (CHE) was diagnosed according to a combination of Psychometric Hepatic Encephalopathy Score and Critical Flicker Frequency. Frailty was assessed by Clinical Frailty Scale (CFS). ResultsHRQoL differed between patients with CP A (n = 133) and CP B/C (n = 85) liver cirrhosis (CLDQ total score: 5.6 vs. 4.8, p < 0.001). Multivariate analysis identified a history of falls in the recent year, presence of CHE, female gender, active smoking, higher CFS, and higher serum levels of CRP as independent predictors of impaired HRQoL (all p < 0.05) in patients with CP A liver cirrhosis. In patients with CP B/C liver cirrhosis, female gender, a history of overt hepatic encephalopathy, and lower hemoglobin were independently associated with impaired HRQoL (all p < 0.05). ConclusionsPredictors of impaired HRQoL differ in patients with CP A or CP B/C liver cirrhosis. Focusing on treatable factors in routine clinical practice may improve HRQoL in all stages of liver cirrhosis.

Liver transplant candidates have impaired quality of life across health domains as assessed by computerized testing

Introduction and objectivesLiver transplantation candidates are among the most comorbid patients awaiting lifesaving intervention. Health related quality of life (HRQOL) measured by instruments that incorporate dynamic computerized adaptive testing, could improve their assessment. We aimed to determine the feasibility of administration of the Patient-Reported Outcomes Measurement Information System (PROMIS-CAT) in liver transplant candidates. Materials and methodsLiver transplantation candidates were prospectively enrolled following a review of their available medical history. Subjects were given a tablet computer (iPad) to access the pre-loaded PROMIS CAT. Results109 candidates with mean age 55.6±8.6 years were enrolled in this pilot study. Mean MELD-Na score was 16.3±6.3; 92.6% had decompensated liver disease. Leading etiologies of cirrhosis included hepatitis C (34.8%), nonalcoholic steatohepatitis (25.7%) and alcohol (21.1%). Subjects with MELD-Na score>20 had the most significant impairment in HRQOL (anxiety/fear+5.9±2.7, p=0.0289, depression+5.1±2.5, p=0.0428, fatigue+4.3±2.6, p=0.0973) and physical impairment (−7.8±2.5, p=0.0022). Stage of cirrhosis and decompensated liver disease were predictive of impaired HRQOL but Child–Pugh Turcotte score was not. Hepatic encephalopathy was the strongest independent predictor of impaired HRQOL, with significant impairment across all domains of health. ConclusionsLiver transplant candidates have significantly impaired HRQOL across multiple domains of health as measured by PROMIS-CAT. HRQOL impairment parallels disease severity. Future study is needed to determine how best HRQOL could be systematically included in liver transplantation listing policy, especially in those candidates with hepatic encephalopathy.

Socioeconomic status, social support, oral health beliefs, psychosocial factors, health behaviours and health-related quality of life in adolescents.

This study assessed the relationships between socioecononic status (SES), social support, oral health beliefs, psychosocial factors, health-related behaviours and health-related quality of life (HRQoL) in adolescents. A school-based follow-up study involving 376 12-year-old adolescents was conducted in Manaus, Brazil. Baseline data included sociodemographic characteristics (sex, parental schooling, family income, household overcrowding and number of goods), social support (SSA questionnaire), oral health beliefs and psychosocial factors (Sense of Coherence [SOC-13 scale] and self-esteem [Rosenberg Self-Esteem Scale]). Health-related behaviours (toothbrushing frequency, sedentary behaviour, smoking and sugar consumption) and HRQoL [KINDL questionnaire] were assessed at 6-month follow-up. Structural Equation Modelling assessed the relationships between variables. Greater social support (β = 0.30), higher SOC (β = 0.23), higher self-esteem (β = 0.23), higher toothbrushing frequency (β = 0.14) and less smoking (β = - 0.14) were directly linked with better HRQoL. SES (β = 0.05), social support (β = 0.26), oral health beliefs (β = - 0.02) were indirectly linked to HRQoL. Higher SES directly predicted higher toothbrushing frequency (β = 0.14) and less smoking (β = - 0.22). Greater social support also directly predicted higher SOC (β = 0.55), positive oral health beliefs (β = - 0.31) and higher self-esteem (β = 0.58). Greater social support indirectly predicted less smoking via oral health beliefs (β = - 0.05) and less sugar consumption via SOC (β = - 0.07). Socioeconomic status, social support, oral health beliefs and psychosocial factors were important predictors of adolescent's health behaviours and HRQoL over 6-month period through direct and indirect mechanisms. Health behaviours also directly influenced HRQoL.

Depressive symptoms, physical symptoms, and health-related quality of life among older adults with HIV.

In the United States, approximately 45% of persons living with HIV (PLHIV) are ≥ 50years of age. Many older PLHIV have multi-morbidities that complicate HIV infection and/or interfere with, or are exacerbated by, antiretroviral treatment. Physical health symptoms and psychiatric disorders, particularly depression, can worsen life quality in older PLHIV. This study assessed associations among physical symptoms, indicators of HIV-related health status (i.e., time since diagnosis; ever diagnosed with AIDS; having attained viral suppression), depressive symptoms, and health-related quality of life (HRQoL) in older PLHIV. Regression analyses examined data from 296 PLHIV ≥ 50years of age living in Cincinnati, OH, Columbus, OH, and New York City. Depressive symptoms and physical symptoms, particularly those related to appearance and sexual functioning, most strongly predicted HRQoL. Indicators of HIV health status did not significantly predict HRQoL. Depressive symptoms were a particularly robust predictor of HRQoL, even when accounting for physical health symptoms. Findings suggest that symptom management is critical to HRQoL in older PLHIV, and symptoms related to physical appearance and sexual functioning should not be overlooked in this growing population.

Direct and Indirect Effects of Trait and State Gratitude on Health-Related Quality of Life in a Prospective Design.

Gratitude has been consistently linked to well-being, but its influence on health-related functioning is not well understood. Furthermore, research suggests the need to differentiate between-person and within-person effects of personality characteristics, and research on gratitude and health has not typically done so. This prospective study aimed to (1) differentiate the unique effects of trait and state gratitude on health-related quality of life (HRQoL) and (2) test state gratitude as a mediator between baseline trait gratitude and subsequent HRQoL. Undergraduate participants (N = 141) completed a trait gratitude measure at baseline and then repeated measures of weekly state gratitude and HRQoL over eight weeks. Multilevel models examined baseline trait gratitude, state gratitude averaged across the study (person aggregate) as between-person individual differences, and within-person variability in state gratitude (person-centered) as predictors of HRQoL, as well as the indirect effect of trait gratitude on HRQoL via state gratitude. Greater aggregate and person-centered state gratitude each predicted higher HRQoL. Baseline trait gratitude did not have a significant direct effect but prospectively predicted higher HRQoL via higher weekly state gratitude. Results suggest that understanding effects of gratitude on health-related perceptions requires accounting for both between-person individual differences and within-person fluctuation in state gratitude.

Exploring health-related quality of life of Spanish domestic adult adoptees: sociodemographic characteristics, chronic medical conditions, and gender differences.

The main objective is to study the health-related quality of life (HRQoL) as a positive approach to health in adult adoptees. We will also consider comparison with population norms, relation to chronic medical conditions, the role of sociodemographic variables, and gender differences among the variables in this study. This was a cross-sectional study of 179 adult domestic adoptees from Spain aged between 18 and 44. They were recruited from a longitudinal study, which was on its third wave. They answered an interview and the self-report measure Health Survey Short Form (SF-12). ANOVAs and t test analyses to compare groups, and multiple regression to determine predictors of HRQoL, were performed. Adoptees are not different from the general population in terms of perceived physical health (PH) and mental health (MH). Both PH and MH are related to different variables (e.g., current age is negatively associated with PH, as is the number of chronic medical conditions with MH). Despite the absence of gender differences in MH perception, there were common and different predictor variables for males and females. The number of chronic medical conditions predicts HRQoL regardless of gender. For women, employment is also a predictor, and for men, other variables are being in a romantic relationship, having children, and low income. Adult adoptees are comparable to general population in terms of HRQoL, but there are associated variables (chronic medical conditions and gender) that should be considered. Post-adoption services should promote health and support in life transitions for this group.

Impaired heart rate recovery as a predictor for poor health-related quality in patients with transient ischemic attack.

We aimed to investigate heart rate recovery (HRR) in patients with transient ischemic attack (TIA) and the relationship between HRR and health-related quality of life (HRQOL).All available patients were enrolled during the enrollment period. A total of 120 patients with TIA and 120 healthy controls were included in this study. A treadmill stress test was performed to calculate the HRR. The HRR were calculated as follows: HRR 1, 2, 3, and 5 minutes = heart rate at peak during exercise − heart rate at 1, 2, 3, and 5 minutes at rest. All patients enrolled were asked to fill in the Short Form 36 Health Survey to calculate HRQOL.We found that the maximum heart rate of TIA patients was significantly higher than that of healthy controls (166 ± 11 vs. 162 ± 14 beats/min, P = .015). Similarly, maximum systolic blood pressure (SBP) and diastolic blood pressure (DBP) were higher in TIA group compared with healthy control group (SBP: 172 ± 15 vs. 165 ± 14 mm Hg, P < .001; DBP: 102 ± 12 vs. 93 ± 16 mm Hg, P < .001). The HRR were significantly lower in TIA group compared with control group (TIA vs. controls, HRR1: 17 ± 7 vs. 30 ± 8 beats/min, HRR2: 32 ± 11 vs. 49 ± 9 beats/min, HRR3: 43 ± 13 vs. 63 ± 12 beats/min, HRR5: 54 ± 16 vs. 73 ± 15 beats/min, all P < .001). Multivariate analysis showed that older age (P = .03) and high BMI (P = .04) were risk factors associated with abnormal HRR in patients with TIA. With regard to HRQOL, we found that role limitations due to physical problems, general health, vitality, and role limitations due to emotional problems were significantly lower in patients with abnormal HRR compared with patients with normal HRR. Multivariate analysis showed that older age (P = .04) and abnormal HRR (P = .03) were predictors for poor HRQOL in TIA patients.HRR was impaired in patients with TIA. In addition, TIA patients with abnormal HRR suffered from a significantly poorer HRQOL. Hence, given the prognostic value of HRR, patients with TIA should be monitored to prevent cardiovascular events and to improve HRQOL.

The Relationship of Psychological Factors and Asthma Control to Health-Related Quality of Life

Psychological variables (anxiety, depression, and coping strategies) and asthma control (assessed from the patient's perspective or from the physician's perspective) affect health-related quality of life (HRQoL) in asthmatic patients. However, no study has simultaneously evaluated these variables to understand the independent contribution of each one of these factors to HRQoL. To determine the impact of anxiety, depression, coping strategies, and asthma control on HRQoL, and to compare the impact of asthma control on HRQoL when it is established by the physician versus when it is considered by the patient. A total of 373 asthmatics completed the Hospital Anxiety and Depression Scale, Coping Orientations to Problems Experienced Inventory, 36-Item Short-Form Health Survey, and St. George Respiratory Questionnaire. Asthma control was measured by the patient with Asthma Control Test and by the physician with the classification asthma control of Global Initiative for Asthma. Demographic and clinical characteristics were also collected. Anxiety, depression, and poor patient-rated asthma control status were associated with worse HRQoL in all dimensions (except Mental Health for asthma control). Physician-rated asthma control was related to worse HRQoL in physical generic and specific dimensions. Among coping strategies, only avoidant coping impacted HRQoL in a few dimensions. Anxiety, depression, and asthma control (especially patient-rated asthma control) were important independent predictors of asthma HRQoL, and all of them should therefore be considered in interventions to improve HRQoL in asthmatic patients.

Health-Related Quality of Life of Ex-Prisoners of War Affected by Posttraumatic Stress Disorder 25 Years After Captivity.

War captivity is one of the most difficult human experiences and can cause long-lasting effects on mental and physical health. Posttraumatic Stress Disorder (PTSD), as one of the frequent consequences of war trauma, is often associated with the psychiatric and/or somatic comorbidity. Therefore, PTSD results in impaired Health-Related Quality of Life (HRQoL). This study aimed to investigate the HRQoL in the Croatian Homeland War ex-POWs affected by PTSD, regarding the intensity of PTSD symptoms, sociodemographic characteristics and somatic comorbidity, and to identify predictors of poor HRQoL. The study sample consisted of two groups (45 participants each) based on whether they were POWs or not (control group). All study participants were diagnosed with PTSD according to the ICD-10 criteria and had combat experience as active participants in defence of the Republic of Croatia during the Homeland War. The subjects were evaluated using the sociodemographic questionnaire, PTSD self-report checklist (PCL-5) and Short Form (SF-36) Health Survey questionnaire. The data on participants' physical diseases were collected from medical anamnesis and medical records in the last five years. In relation to ex-POWs, the control group had significantly smaller number of retirees, more unemployed persons, smaller number of married subjects, and higher number of divorced persons. Low socioeconomic status and intensity of PTSD symptoms has been confirmed as a significant predictor of impaired HRQoL in both subject groups. The most commonly PTSD associated physical diseases were musculosceletal, cardiovascular, and gastrointestinal diseases. Endocrine and metabolic diseases were more frequent in the ex-POWs' group. PTSD was associated with the HRQoL, whether the veterans were ex-POWs or not. The hypothesis that exposure of ex-POWs to the trauma of captivity experience impaired HRQoL to a greater extent, compared to the non-detained veterans, was not confirmed. Low socioeconomic status has proved to be the most significant predictor of poorer HRQoL.

SAT-246 CHRONIC KIDNEY DISEASE IMPACTS HEALTH-RELATED QUALITY OF LIFE OF CHILDREN IN UGANDA, EAST AFRICA

Limited data exists about the epidemiology of kidney disease in sub-Saharan East African children or impact of chronic kidney disease (CKD) on health-related quality of life (HRQoL). Our objective was to describe types of renal disease, compare HRQoL in Ugandan children with CKD and children with benign or resolving renal disease (non-CKD), and assess for predictors of HRQoL. This cross-sectional study of children aged 0-18 years assessed demographic, socioeconomic and clinical data and surveyed HRQoL using the Pediatric Quality of Life Core ScaleTM (PedsQL) (scoring scale 0-100) for 4 domains (physical, emotional, social and school) and overall HRQoL. CKD and non-CKD participant scores were compared using unpaired t-test. Predictors of HRQoL were evaluated using linear and logistic regression analyses. A total of 149 children were enrolled (71 in CKD group; 78 in non-CKD group; median age 9 years; male 63%). Primary renal diseases included nephrotic syndrome 83 (56%), glomerulonephritis 25 (17%), obstructive uropathy 22 (15%), cystic kidney disease 6 (3.7%), acute kidney injury 2 (1.3%), hypertension 2 (1.3%), human immunodeficiency virus-associated nephropathy 1 (0.7%), and unknown renal disease 8 (5%). Congenital anomalies of the kidney and urinary tract (CAKUT) accounted for 39% (28/71) of CKD etiologies. In the CKD group, 46% were at stage 5 with 10%, 14%, 16%, and 14% at stages 4, 3, 2 and 1, respectively. Among school-eligible children, 34% (19/56) with CKD did not attend school whereas all non-CKD did (p<0.0001); CKD children enrolled in school missed on average 14 days per month. CKD children had significantly lower HRQoL domain scores. Mean overall HRQoL score by child report was 57 for CKD vs. 86 for non-CKD (p<0.0001), similar to caregiver report 63 for CKD vs. 86 for non-CKD (p<0.0001). Predictors of lower HRQoL among CKD children were advanced CKD stages, primary caregiver other than child’s parent, low hemoglobin, and vitamin D deficiency. As in other parts of the world, CAKUT was the main cause of CKD in Ugandan children. The majority of children presented at late CKD stages. HRQoL in CKD was much lower than in non-CKD children. Only two thirds of school-eligible CKD children actually attended school. Low hemoglobin and vitamin D deficiency were potentially modifiable factors associated with low HRQoL. Simple interventions with iron, erythropoietin stimulating agent, and vitamin D supplementation might lead to improved HRQoL.

The Effect of Gastrostomy Placement on Health-Related Quality of Life in Children

Background and purposeA gastrostomy placement (GP) aims to improve nutritional status and health-related quality of life (HRQoL) in children who require long-term enteral tube feeding. We evaluated the effect of GP on HRQoL. MethodsA prospective, longitudinal cohort study was performed including patients referred for laparoscopic GP. Children and/or caregivers were asked to fill out the validated PedsQL™ questionnaire before and 3 months after surgery. The aim was to compare preoperative with postoperative HRQoL and to identify predictors of HRQoL. ResultsFifty patients were included with a median age of 3.4 years (interquartile range 1.4–5.6). After GP, total HRQoL did not significantly increase (p = 0.30). However, psychosocial health significantly increased: 55.8 (standard deviation ±20.8) to 61.2 (±19.6; p = 0.03) on a 100-point scale. This was mainly owing to an increase in social HRQoL: 58.2 (±32.3) to 68.3 (±27.9; p = 0.04). HRQoL both before and after GP was significantly lower in children with neurologic impairment (p < 0.0005). However, neurologic impairment did not influence the effect of surgery on HRQoL (p = 0.66). Low preoperative body mass index was a predictor for improvement in HRQoL after GP. ConclusionsAfter GP in children, psychosocial HRQoL improved significantly. This was mainly owing to an improvement in social HRQoL. Level of evidenceIV