Association Of Quality Of Life Research Articles

The associationof quality of life and the functioning in the chronic disease among patients after myocardial infarction

Abstract Background The importance of health-relatedquality of life (HRQoL) and improving functional status in reducing risk factors of myocardial infarction (MI) has also been increasingly recognized. Purpose This study aimed to examine the level of quality of life (QoL) in patients after myocardial infarction (MI) in relation to the degree of functioning in chronic disease. Methods This was a cross-sectional, single-centre study. The study was conducted among 231 patients who were hospitalized for myocardial infarction (MI) after percutaneous coronary intervention (PCI). The WHO Quality of Life Questionnaire (WHOQOL BREF) andthe Chronic Disease Functioning Scale(FCIS) were used. Results The Spearman's correlation coefficient showed a statistically significant correlation (coefficient value 0.5 < |r/rho| ≤ 0.7) between general functioning in chronic disease and the average QoL (rho = 0.56;p < 0.001)and somatic QoL levels(rho = 0.52;p < 0.001), as well as a moderately strong positive correlation with the QoL level on the psychological domain (rho = 0.50;p < 0.001), social domain (rho = 0.48;p < 0.001) and environmental domain (rho = 0.43;p < 0.001). Conclusion Identifying the chronic disease functioning indicator in post-MI patients in relation to HRQoL allows for targeted counseling and secondary prevention of ischemic heart disease (IHD), which translates into a reduced risk of further cardiovascular events and related rehospitalization.

Digital health literacy and quality of life association with perceptions about the disease COVID-19 in public health services

<b>Background: </b>Digital health literacy and quality of life association with perceptions about the disease COVID-19 in public health services<b> </b>may have been little studied to date to examine socio-demographic parameters.<br /> <b>Materials & methods:</b> This research was conducted using self-report about digital health literacy, and quality of life questionnaires to participants attending in the Hippocrates Hospital Athens Greece (n=167). Initially, participants were asked to answer questions regarding the impact of the COVID-19 pandemic. The data of the study were analyzed using SPSS 26 IBM.<br /> <b>Results:</b> Study’s findings from has to do with the role of age. People who are younger in age seem to be more likely to think that quality of life is just a flu-like illness and generally harmless. In addition, the stronger the perceived impact of the pandemic, the higher the digital health literacy of the participants.<br /> <b>Conclusions:</b> The findings of this study regarding the relationship between socio-demographic variables and the examined parameters are in line with previous literature. Moreover, this study highlights the central role of digital health literacy in relation to the perception of the severity of the situation during quality of life associated with pandemic.

Social determinants of health and neurocognitive and psychosocial outcomes in adult childhood cancer survivors: A report from the childhood cancer survivor study (CCSS).

12084 Background: Limited data exist on the impact of social determinants of health on neurocognitive, psychological, and quality of life (QOL) outcomes in adult childhood cancer survivors. Methods: We examined patient-reported outcomes (PROs) of neurocognitive function, psychological symptoms, and QOL in association with the Area Deprivation Index (ADI) and neighborhood ambient air quality in 5,131 survivors (52.1% female, mean [SD] age 29.9 [7.1], mean [SD] age at diagnosis 7.9 [6.2], 81.5% White, and 42.3% leukemia) from the Childhood Cancer Survivor Study. The ADI, which reflects neighborhood socioeconomic deprivation, was coded using survivors’ residential 9-digit ZIP codes; neighborhood ambient air quality was coded by the NASA Satellite-based pollution measures PM2.5 and NO2 by ZIP codes. Impairment on PROs was identified from scores on the Neurocognitive Questionnaire (≤10th%ile), the Brief Symptoms Inventory (BSI; ≥90th%ile), the pain survey (yes vs. no), and the Medical Outcomes Study Short Form-36 ( < 16th%ile). Multivariable logistic regression assessed associations between social determinants and PROs with odds ratios (OR) and 95% confidence intervals (CI), adjusting for demographic and treatment (chemotherapy and radiation) factors. Results: Among survivors, impaired neurocognitive function was reported in 26.5% for task efficiency, 25.4% memory, 15.4% emotional regulation, and 11.6% organization. For the BSI and pain survey, 56.7%, 11.3%, 8.3%, and 7.3% reported total pain, depression, somatization, and anxiety, respectively. Poor physical and mental domains of QOL were reported by 10.9% and 17.0% of survivors, respectively. Survivors with an ADI in the top deprived 20% neighborhoods (compared to the bottom 80% neighborhoods) reported worse neurocognitive function (task efficiency, OR 1.89, 95% CI 1.45-2.46; emotional regulation, OR 1.74, 95% CI 1.30-2.34; and memory, OR 1.67, 95% CI 1.29-2.17), more severe symptoms (pain, OR 1.34, 95% CI 1.05-1.70; somatization, OR 1.55, 95% CI 1.05-2.28; and depression, OR 1.70, 95% CI 1.19-2.44), and poorer QOL (physical, OR 1.75, 95% CI 1.28-2.38; mental, OR 1.79, 95% CI 1.35-2.36), controlling for treatment factors. Survivors from the 20% most deprived neighborhoods showed worse task efficiency (OR 1.50, 95% CI 1.03-2.17), adjusting for all confounders. PM2.5 and NO2 levels were not associated with impairment on PROs, adjusting for all confounders. Conclusions: Social determinants, particularly living in the top deprived neighborhoods, are adversely associated with neurocognitive, psychological, and QOL outcomes in adult childhood cancer survivors. These findings indicate the critical need of evaluating childhood cancer survivors’ area-level deprivation and tailoring support and interventions for survivors based on their social and structural contexts.

Life-space, frailty, and health-related quality of life

IntroductionLife-space and frailty are closely linked to health-related quality of life and understanding their inter-relationship could indicate potential intervention targets for improving quality of life. We set out to examine the relationship between frailty and life-space and their relative impact on quality of life measures.MethodsUsing cross-sectional data from a population-representative cohort of people aged ≥ 70 years, we assessed quality of life with the EuroQol Health Index tool (5-levels) (EQ-5D-5L). We also undertook a life-space assessment and derived a frailty index. Linear regression models estimated EQ-5D-5L scores (dependent variable) using life-space assessment, frailty index and interactions between them. All models were adjusted by age, sex, lifestyle, and social care factors.ResultsA higher EQ-5D Index was associated with higher life-space (0.02 per life-space assessment score, 95%CI: 0.01 to 0.03, p < 0.01) and decreasing frailty (-0.1 per SD, 95%CI: -0.1 to -0.1, p < 0.01). There was evidence of an interaction between life-space and frailty, where the steepest gradient for life-space and EQ-5D was in those with the highest frailty (interaction term = 0.02 per SD of frailty, 95%CI: 0.01 to 0.03, p < 0.01).ConclusionIndividuals with the highest frailty were twice as likely to have higher quality of life in association with a larger life-space. Interventions designed to improve quality of life in frail older people could focus on increasing a person’s life-space.

Cardiac structure and function and quality of life associations in HFpEF: An analysis from TOPCAT-Americas

BackgroundPatients with heart failure with preserved ejection fraction (HFpEF) have poor health-related quality of life (HR-QoL). However, the relationship between HR-QoL measures and the alterations of cardiac structure and function that are present in patients with HFpEF remains unknown. AimsTo study the associations between HR-QoL and echocardiographic parameters in HFpEF. MethodsRegression modelling in patients from TOPCAT-Americas who had both HR-QoL questionnaires and a baseline echocardiogram. ResultsA total of 631 patients (36% of the TOPCAT-Americas population) had both echocardiographic and HR-QoL at baseline. KCCQ-23 Overall Summary Score (OSS; 0–100 points) was negatively (higher echocardiographic values-poorer/lower HR-QoL scores) associated with left ventricular end-diastolic diameter (LVEDD: β = −3.56 [−7.00 to −0.13] points-per-1 cm, P = 0.042), interventricular septum thickness (β = −1.31 [−2.19 to −0.42] points-per-1 mm, P = 0.004), posterior wall thickness (β = −1.57 [−2.52 to −0.63] points-per-1 mm, P = 0.001 and left atrial width (β = −3.27 [−6.39 to −0.15], P = 0.040) points-per-1 cm, and positively (higher echocardiographic values-better/higher HR-QoL scores) associated with left ventricular end-diastolic volume index (LVEDVi: β = 0.23 [0.09 to 0.37] points-per-1 ml/m2, P = 0.002) and left ventricular end-systolic volume index (LVESVi: β = 0.41 [0.18 to 0.63] points-per-1 ml/m2, P < 0.001). Body mass index (BMI: β = −0.74 [−1.02 to −0.47] points-per-1Kg/m2, P < 0.001), diabetes (β = −6.01 [−10.05 to −1.97], P = 0.004), and asthma (β = −6.78 [−13.52 to −0.04], P = 0.049) were negatively associated with OSS. A similar pattern of associations was observed for KCCQ-23 Clinical Summary Score, EQ5D-VAS and NYHA class. ConclusionIn patients with HFpEF, HR-QoL measures were associated with cardiac structure and function alterations. Extra-cardiac factors were also associated with HR-QoL, which may influence HR-QoL results when testing cardiovascular drugs.

ASSESSMENT OF HEALTH-RELATED QUALITY OF LIFE AND RISK FACTORS ASSOCIATED WITH PANCREATITIS IN A TERTIARY CARE HOSPITAL

Objective: The objective of the study was to measure the health-related quality of life (HRQoL) in pancreatitis and to appraise the risk factors associated with the pancreatitis.&#x0D; Methods: A prospective observational study was performed with admitted cases of pancreatitis over 6 month’s period. A total of 150 patients were selected for the study. All data concerning risk factors were recorded and Short-Form-36 (SF-36) questionnaire was applied and quality of life (QOL) was analyzed in all patients with in study group.&#x0D; Results: All domains of (HRQoL) were assessed; it shows highest effect on role limitations due to physical health (36%), role limitations due to emotional problems (29%), role limitations due to physical health, and role limitations due to emotional problems (10%). Finally, our study revealed that there is a profound deterioration in physical components of QOL. The risk factors that majorly influence the QOL in association with disease were found to be alcohol consumption and smoking (70%).&#x0D; Conclusion: Pancreatitis remarkably diminishes the patient’s HRQoL which predominantly shows negative impact on physical health.

Immediate and 6-week after effects of a rehabilitation program for Ehlers-Danlos syndrome hypermobile type patients: A retrospective study.

Ehlers-Danlos syndromes (EDS) are a group of inherited connective tissue disorders with an impaired quality of life in association with fatigue, pain, and kinesiophobia. A retrospective evaluation of the effects of an outpatient rehabilitation program (RP) was performed in Ehlers-Danlos syndrome hypermobile type (hEDS) patients. The 6-minute walk test (6MWT) was used to evaluate functional capacity. Kinesiophobia, fatigue, pain, and quality of life were self-evaluated at the start, at the end, and 6 weeks after the end of the RP. The retrospective analysis of patients' records showed significant improvement for the walked distance during the 6MWT (491.8 ± 72.5 vs. 439.4 ± 100.9 m) maintained at 6-week follow-up (p = .001), significant improvement for kinesiophobia (p = .033) and the impact of fatigue on activity (p = .01), and significant increase for quality of life with in particular improvements of vitality (p = .001). This retrospective study showed encouraging results of a RP for hEDS patients on functional capacity and quality of life, and prospective studies with long-term follow-up are needed to confirm them.

The impact on functioning of second-generation antipsychotic medication side effects for patients with schizophrenia: a worldwide, cross-sectional, web-based survey

BackgroundIt is well established that the different antipsychotics used for schizophrenia symptoms differ substantially in their side effects. However, relatively little is known about the impact of these side effects on functioning from the patient’s perspective. We aimed to understand how key side effects of second-generation antipsychotics impact the functioning and quality of life (QoL) of patients with schizophrenia.MethodsThis is a cross-sectional, web-based survey of patient-reported side effect burden of antipsychotic drugs in adults with schizophrenia. The survey was deployed in the United States, Canada, Australia, Spain, Italy, Norway, and Denmark. It included sociodemographic and clinical questions, the Quality of Life Enjoyment and Satisfaction Questionnaire Short Form (Q-LES-Q-SF), and the Glasgow Antipsychotic Side-Effect Scale (GASS). Eight pre-defined key side effects classified as activating (“Shaky hands or arms,” “Restlessness,” and “Difficulty sleeping”), sedating (“Sleepy during the day”, “Feeling drugged or like a zombie,” and “Feeling dizzy/Fainted”) or other side effects (“Problems enjoying sex” and “Gaining weight”), and additional questions related to impacts on function and quality of life were asked.ResultsIn total, 435 participants (mean age: 38 years, 53.8% female) were included. The total Q-LES-Q-SF score indicated overall medium satisfaction with their quality of life (score of 44.3; possible range 14–70). The most prevalent side effects were “Sleepy during the day” (83.2%), “Difficulty sleeping” (74.7%), “Dry mouth” (63.9%), “Problems enjoying sex” (53.4%) and “Gaining weight” (52.4%). Women reported the side effects of “Sleepy during the day”, “Problems enjoying sex” and “Gaining weight” more frequently than men. Key side effects impacted physical, social, occupational and psychological aspects of functioning. Patients with key side effects often felt frustrated by their experiences. Total Q-LES-Q-SF score showed a significant inverse correlation with the score of pre-defined groups of side effects indicating worse QoL in association with more severe key side effects in these patients.ConclusionStable patients with schizophrenia taking second-generation antipsychotics live with many side effects, including activating and sedating side effects, sexual side effects, and weight gain. Presence of these side effects is associated with substantial impacts across all aspects of daily functioning and lower quality of life and satisfaction.

Nível insuficiente de atividade física se associa a menor qualidade de vida e ao estudo noturno em universitários do Distrito Federal

Physical activity (PA) practice is an essential issue for health and quality of life (QOL). ObjectiveWe analyzed the level of physical activity (LPA) and QOL in association with anthropometric and socioeconomics factors among undergraduate students from the Distrito Federal ‐ Brazil. MethodsWe randomly evaluated 392 volunteers (43.6% men). We employed the IPAQ+reported siting time (ST), and WHOQOL questionnaires. Logistic regression was used to evaluate LPA predictors. QOL was compared between sex, class period (day vs night), LPA and income. ResultsTwo hundred and one volunteers (51.4%) were insufficiently active (IA) and showed lower QOL than the active (AT) ones on physical (PHD) and psychological (PSD) domains (p<0.05). Lower LPA was associated with greater ST and with the night shift study. We found a high proportion of IA students that was associated with lower QOL on PHD and PSD, higher ST and nightshift study.

The impact of occupational stress on nurses' caring behaviors and their health related quality of life.

BackgroundNursing is perceived as a strenuous job. Although past research has documented that stress influences nurses’ health in association with quality of life, the relation between stress and caring behaviors remains relatively unexamined, especially in the Greek working environment, where it is the first time that this specific issue is being studied. The aim was to investigate and explore the correlation amidst occupational stress, caring behaviors and their quality of life in association to health.MethodsA correlational study of nurses (N = 246) who worked at public and private units was conducted in 2013 in Greece. The variables were operationalized using three research instruments: (1) the Expanded Nursing Stress Scale (ENSS), (2) the Health Survey SF-12 and (3) the Caring Behaviors Inventory (CBI). Univariate and multivariate analyses were performed.ResultsContact with death, patients and their families, conflicts with supervisors and uncertainty about the therapeutic effect caused significantly higher stress among participants. A significant negative correlation was observed amidst total stress and the four dimensions of CBI. Certain stress factors were significant and independent predictors of each CBI dimension. Conflicts with co-workers was revealed as an independent predicting factor for affirmation of human presence, professional knowledge and skills and patient respectfulness dimensions, conflicts with doctors for respect for patient, while conflicts with supervisors and uncertainty concerning treatment dimensions were an independent predictor for positive connectedness. Finally, discrimination stress factor was revealed as an independent predictor of quality of life related to physical health, while stress resulting from conflicts with supervisors was independently associated with mental health.ConclusionOccupational stress affects nurses’ health-related quality of life negatively, while it can also be considered as an influence on patient outcomes.

Health-related quality of life association with work-related stress and social support among female and male disabled employees

ABSTRACTFew studies have focused on adverse relations of job strain to health in disabled employees by gender. In this study, the author explores gender differences in work-related stress, social support, and health-related quality of life (HRQoL) among 106 disabled employees in an electronics manufacturing plant during 2012–2013, using questionnaire data on demographics, perceived work-related stress, the Beck Depression Inventory, the Chinese version of the Job Content Questionnaire (C-JCQ), and HRQoL. The prevalence of stress related to workload, colleagues, and supervisor were 26.4%, 14.1%, and 8.5%, respectively. Disabled females had higher scores for psychological job demand than male disabled employees (p = .0219). Increasing psychological job demand scores were adversely related to physical function scores (β = −1.6) in males, whereas increasing decision latitude scores were positively related to role-limitation due to physical function (β = 2.3), general health (β = 1.2), vitality (β = 1.3), role-limitation due to emotional health (β = 2.6), and mental health (β = 0.9) scores in females. These results provide a better understanding of the HRQoL in female and male disabled workers, allowing for the development of stress-prevention programs specific for gender in disabled laborers.

Family Home Caregivers for Old Persons in the Arab Region: Perceived Challenges and Policy Implications

The profound demographic changes that the Arab region has experienced during the past few decades have led to slow, albeit noteworthy increase in the proportion of older people, which will inevitably place heavy burdens on families who are assumed the responsibility in providing care for its older members. Although there has been much research about elderly caregiving issues in other regions around the world, less is known about aging family member caregiving, the challenges that family member caregivers face in the Arab region, and the facilities provided for family support to the elderly and to the caregivers themselves. Thus, the purposes of this study are to gain an overview of the current situation of ageing and elderly family member caregiving in the Arab region; to address the challenges family caregivers face, such as necessary skills and know- ledge, communication, cultural issues, health, financial burdens and enhancement of quality of life in association with their care-giving role. These challenges can negatively impact the quality of life for the caregiver and the care receiver. The importance of implementing research and policy intervention to meet these challenges for all concerned will be discussed.

Factors Affecting Breast Cancer Patient Quality of Life in Association With Radiation

Factors Affecting Breast Cancer Patient Quality of Life in Association With Radiation

Potential implications of adjuvant endocrine therapy for the oral health of postmenopausal women with breast cancer

Current adjuvant treatment modalities for breast cancer that express the estrogen receptor or progesterone receptor include adjuvant anti-estrogen therapies, and tamoxifen and aromatase inhibitors. Bone, including the jaw, is an endocrine-sensitive organ, as are other oral structures. This review examines the potential links between adjuvant anti-estrogen treatments in postmenopausal women with hormone receptor positive breast cancer and oral health. A search of PubMed, EMBASE, CENTRAL, and the Web of Knowledge was conducted using combinations of key terms "breast," "cancer," "neoplasm," "Tamoxifen," "Aromatase Inhibitor," "chemotherapy," "hormone therapy," "alveolar bone loss," "postmenopausal bone loss," "estrogen," "SERM," "hormone replacement therapy," and "quality of life." We selected articles published in peer-reviewed journals in the English. The authors found no studies reporting on periodontal diseases, alveolar bone loss, oral health, or oral health-related quality of life in association with anti-estrogen breast cancer treatments in postmenopausal women. Periodontal diseases, alveolar bone density, tooth loss, and conditions of the soft tissues of the mouth have all been associated with menopausal status supporting the hypothesis that the soft tissues and bone of the oral cavity could be negatively affected by anti-estrogen therapy. As a conclusion, the impact of adjuvant endocrine breast cancer therapy on the oral health of postmenopausal women is undefined. The structures of the oral cavity are influenced by estrogen; therefore, anti-estrogen therapies may carry the risk of oral toxicities. Oral health care for breast cancer patients is an important but understudied aspect of cancer survivorship.

P-1236 - Association between social functioning, quality of life and recovery status in schizophrenic patients - a longitudinal, naturalistic study

Symptomatic remission is an important outcome of schizophrenia however its association with social functioning (SF) and quality of life (QoL) hasn't been fully recognized. To assess SF and QoL in association with remission status according to Andreasen criteria. This was a study of a group 64 patients hospitalized for the first time between 1998 - 2002. They were assessed 1 month following discharge (T. 1), 12 months later (T. 2), 4 – 6 years after T.1 (T. 3) and 7–11 years after T.1 (T. 4). During the observation 17.2% were remitted (Group 1), 37.5% were remitted or non remitted (Group 2), and 45.3% were non remitted (Group 3). There were differences between the groups however SFS and QL didn't change. Remission status Time 1 (mean) Time 2 (mean) Time 3 (mean) Time 4 (mean) P value Group 1 recovered n=11 SFS 114.1 112.1 118.6 119.5 0.08 WHOQOL 92.7 92.4 94.4 93.9 0.99 Group 2 recovered/non-recovered n=24 SFS 103.9 105.4 110.5 111.2 0.18 WHOQOL 85.9 85.4 88.4 86.9 0.42 Group 3 non-recovered n=29 SFS 98.6 99.2 99.6 100.4 0.61 WHOQOL 77.8 78.7 75.6 77.1 0.96 [Table Social functioning and QoL] Close association between remission status and SF and QoL suggests that remission status may be a good indicator for SF and QoL in schizophrenia.

SF-36 summary and subscale scores are reliable outcomes of neuropsychiatric events in systemic lupus erythematosus

ObjectiveTo examine change in health-related quality of life in association with clinical outcomes of neuropsychiatric events in systemic lupus erythematosus (SLE).MethodsAn international study evaluated newly diagnosed SLE patients for neuropsychiatric...

Treatment of Narcolepsy and other Hypersomnias of Central Origin

The purpose of this paper is to summarize current knowledge about treatment of narcolepsy and other hypersomnias of central origin. The task force performed a systematic and comprehensive review of the relevant literature and graded the evidence using the Oxford grading system. This paper discusses the strengths and limitations of the available evidence regarding treatment of these conditions, and summarizes key information about safety of these medications. Our findings provide the foundation for development of evidence-based practice parameters on this topic by the Standards of Practice Committee of the American Academy of Sleep Medicine. The majority of recent papers in this field provide information about use of modafinil or sodium oxybate for treatment of sleepiness associated with narcolepsy. Several large randomized, placebo-controlled studies indicate that modafinil and sodium oxybate are effective for treatment of hypersomnia due to narcolepsy. We identified no studies that report direct comparison of these newer medications versus traditional stimulants, or that indicate what proportion of patients treated initially with these medications require transition to traditional stimulants or to combination therapy to achieve adequate alertness. As with the traditional stimulants, modafinil and sodium oxybate provide, at best, only moderate improvement in alertness rather than full restoration of alertness in patients with narcolepsy. Several large randomized placebo-controlled studies demonstrate that sodium oxybate is effective for treatment of cataplexy associated with narcolepsy, and earlier studies provide limited data to support the effectiveness of fluoxetine and tricyclic antidepressants for treatment of cataplexy. Our findings indicate that very few reports provide information regarding treatment of special populations such as children, older adults, and pregnant or breastfeeding women. The available literature provides a modest amount of information about improvement in quality of life in association with treatment, patient preferences among the different medications, or patient compliance. Several recent studies provide evidence that modafinil and sodium oxybate are effective for treatment of hypersomnia due to narcolepsy. No studies were identified that report direct comparison of these newer medications with traditional stimulants. Despite significant advances in understanding the pathophysiology of narcolepsy, we do not have an ideal treatment to restore full and sustained alertness. Future investigations should be directed toward development of more effective and better tolerated therapies, and primary prevention.

Acute Exacerbations of Chronic Bronchitis in Elderly Patients

Chronic bronchitis (CB) is a disorder that is characterised by chronic mucus production. This disorder is called chronic obstructive pulmonary disease (COPD) when airflow obstruction is present. The majority of patients with COPD, which often goes undiagnosed or inadequately treated in the elderly, have symptoms consistent with CB. The clinical course of CB is usually punctuated by periodic acute exacerbations linked to infections caused by viral and typical or atypical bacterial pathogens. Acute exacerbations of chronic bronchitis (AECB) often lead to a decline in lung function and poor quality of life in association with increased risk of mortality and a significant economic impact on the healthcare system and society because of the direct costs of hospitalisations. In elderly individuals with COPD, co-morbidities play a vital role as determinants of health status and prognosis. Failure to eradicate infecting pathogens contributes to persistence of infection and inflammation that requires repeated courses of therapy and hospitalisation. Stratifying patients with AECB according to symptoms, degree of pulmonary function impairment and risk factors for poor outcome can help clinicians choose empirical antimicrobial chemotherapy regimens that are most likely to result in treatment success. Failure to cover likely pathogens associated with episodes of AECB can lead to lengthy hospital admissions and significant declines in functional status for elderly patients. Fluoroquinolones may provide the best therapeutic option for elderly patients with COPD who have complicated underlying CB but who are sufficiently stable to be treated in the outpatient setting. Optimised treatment for stable outpatients with CB may diminish the frequency of AECB, and effective antimicrobial therapy for AECB episodes can significantly diminish healthcare costs and maintain quality of life in the elderly patient.

Correlates of health-related quality of life in type 2 diabetes

We assessed the impact of medical comorbidities, depression, and treatment intensity on quality of life in a large primary care cohort of patients with type 2 diabetes. We used the Health Utilities Index-III, an instrument that measures health-related quality of life based on community preferences in units of health utility (scaled from 0=death to 1.0=perfect health), in 909 primary care patients with type 2 diabetes. Demographic and clinical correlates of health-related quality of life were assessed. The median health utility score for this population was 0.70 (interquartile range 0.39-0.88). In univariate analyses, older age, female sex, low socioeconomic status, cardiovascular disease, microvascular complications, congestive heart failure, peripheral vascular disease, chronic lung disease, depression, insulin use and number of medications correlated with decreased quality of life, while obesity, hypertension and hypercholesterolaemia did not. In multiple regression analyses, microvascular complications, heart failure and depression were most strongly related to decreased health-related quality of life, independently of duration of diabetes; in these models, diabetes patients with depression had a utility of 0.59, while patients without symptomatic comorbidities did not have a significantly reduced quality of life. Treatment intensity remained a significant negative correlate of quality of life in multivariable models. Patients with type 2 diabetes have a substantially decreased quality of life in association with symptomatic complications. The data suggest that treatment of depression and prevention of complications have the greatest potential to improve health-related quality of life in type 2 diabetes.

Therapeutic progress. III: Diabetic nephropathy.

Diabetic nephropathy is a common cause of end stage renal failure. Patients ultimately require dialysis or transplantation and endure a poor quality of life in association with increased mortality. Due to the quantitative significance of this problem there is also a considerable financial burden. It has been generally accepted that once nephropathy is established it is irreversible although aggressive anti-hypertensive treatment can delay its progression. More recently there have been numerous reports proposing a specific renal protective role of certain drugs. In this article we review the current literature on the use of angiotensin converting enzyme inhibitors in diabetic nephropathy. There is strong evidence that the use of ACE inhibitors in diabetic nephropathy (in the presence or absence of hypertension) slows the progression of deterioration in renal function and may even arrest its progression if detected at the microproteinuric stage.