Objective Quality Of Life Research Articles

‘Freedom From Fear and Want’ and Our Psychological Response to Environmental Changes

Freedom from fear and freedom from want are two of the fundamental freedoms and likely related to changes in the environment. It has usually been assumed that our subjective feelings should change accordingly with changes in the objective environment. However, two counterintuitive effects reviewed in this article imply a rather complex psychological mechanism behind how people respond to environmental changes and strive for the freedom from fear and want. The first is the ‘psychological typhoon eye’ effect, in which the closer people are to hazards, the calmer they feel. Several possible explanations have been proposed, but the mechanism behind this effect remains unclear. The findings are important for future post-disaster interventions and helpful for policy makers in risk management and researchers in risk studies. The second effect is the ‘town dislocation’ effect, wherein although inhabitants’ objective quality of life is improved during the urbanisation process, the projected endorsement and rated social ambience of town residents is lower than that of residents in the country and in the city; this effect is mediated by social support. The findings have implications for how to better assess the urbanisation process and how to improve people's affective appraisals of their living environment.

Surgery for Chronic Otitis Media Causes Greater Taste Disturbance Than Surgery for Otosclerosis.

Patients with otosclerosis more often complain about postoperative taste disturbance than patients with chronic otitis media, which seems paradoxical. We aim to investigate if and potentially why this seems to be the case, since the chorda tympani nerve (CTN) is thought to be severely traumatized less frequently during surgery in the former than in the latter. Prospective cohort study. Department of Otorhinolaryngology at Hospital of Vastmanland, Vasteras, Sweden. Sixty-five adults undergoing primary middle ear surgery were included. Thirty-seven were operated on for chronic suppurative otitis media with or without cholesteatoma (CSOM) and 28 for otosclerosis. Middle ear surgery due to otosclerosis or CSOM. Subjective and objective taste measurements and quality of life (QoL) questionnaire. Taste was assessed using electrogustometry (EGM) and the filter paper disc (FPD) method before and up to 1 year after surgery. Questionnaires on taste disturbance, including a visual analogue scale (VAS), and QoL were completed before and up to 1 year after surgery. Subjective taste disturbance anytime during the 1-year follow-up were reported by 62 and 46%, respectively. The difference in EGM 1 week after surgery compared with preoperative EGM was significantly greater among CSOM patients than otosclerosis. One year postoperatively, the difference is non-significant. Surgery for CSOM causes greater initial and more long-lasting taste disturbances as compared with surgery for otosclerosis. One-year postoperative taste normalizes for both CSOM and otosclerosis patients according to VAS and EGM measurements. No real change in QoL was seen 1-year postoperatively. Level 2 evidence is prospective observational research with an experimental design.

Profiles of Relationships Between Subjective and Objective Cognition in Schizophrenia: Associations With Quality of Life, Stigmatization, and Mood Factors

Justification: Recent studies showed that neurocognitive insight difficulties occur in subjects with schizophrenia. However, little is known about the different profiles of neurocognitive insight, their relations with neurocognitive functioning, and their specific links with mood factors and outcomes. Aim: The study explored profiles of relationships between objective and subjective cognition in persons with schizophrenia spectrum disorders (SSD) and associations with quality of life (QoL), stigmatization, and mood factors. Method: Participants were 69 outpatients with an SSD. Cluster analysis (Ward method) was performed to explore profiles of interactions between subjective complaints and objective cognitive performances. Analyses of variance (ANOVAs) were then conducted to compare groups on anxiety and depression levels, stigmatization, and QoL. Results: Cluster analysis produced 3 groups: high cognitive impairment/moderate cognitive complaints (N = 26), good cognitive functioning/moderate cognitive complaints (N = 22), and moderate cognitive impairment/high cognitive complaints (N = 21). The second group has higher objective QoL, and the third group has higher levels of anxiety, depression, and stigmatization. Our results show that (a) not all patients with SSD have neurocognitive insight difficulties, (b) relation between objective and subjective cognition is not linear, and (c) differences between profiles may have theoretical and clinical implications.

P3.02c-015 Phase II Trial of S-1/Cisplatin Combined with Bevacizumab for Advanced Non-Squamous Non-Small Cell Lung Cancer: TCOG LC-1202: Topic: Targeted Therapy

S-1 plus cisplatin is a standard chemotherapy regimen for advanced non-small cell lung cancer (NSCLC) (Ann. Oncol. 2015; 26:1401-8). The addition of bevacizumab significantly improved overall survival (OS) in patients with advanced non-squamous (non-SQ) NSCLC who received carboplatin plus paclitaxel but failed to show an OS advantage in patients who received cisplatin plus gemcitabine. Few studies of bevacizumab have evaluated quality of life (QOL) in patients with non-SQ NSCLC. Chemotherapy-naïve patients with stage IIIB, IV, or recurrent non-SQ NSCLC, Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0–1, age 20–74 years, and measurable lesions were treated with a 3-week cycle of S-1 40 mg/m2 twice a day on days 1–14, cisplatin 60 mg/m2 on day 8, and bevacizumab 15 mg/kg on day 8, for 4–6 cycles. Patients without progressive disease received maintenance bevacizumab 15 mg/kg on day 1 with a 3-week cycle and S-1 40 mg/m2 twice a day every other day. The primary endpoint was progression-free survival (PFS). Secondary endpoints were objective response rate (ORR), OS, toxicity profile, and QOL. From June 2013 to January 2015, 39 evaluable patients were enrolled from 8 institutions: 10 women and 29 men; median age 65 (range, 38–74) years; epidermal growth factor receptor positive/anaplastic lymphoma kinase positive: two patients/two patients; performance status 0/1: 22/17; stage IIIB/IV/recurrence: 1/35/3; adeno/large cell/other: 35/1/3. Thirty one patients (80%) completed 4 cycles of induction chemotherapy, and 23 patients (59%) were started on maintenance chemotherapy. Median PFS, OS, and ORR were 7.3 months (95% confidence interval (CI): 5.9–8.7), 21.4 months (95% CI: 14.7–not reached), and 64%, respectively. The worst hematologic and non-hematologic adverse events were as follows (%): grade 3/4 leukopenia: 13/0; neutropenia: 18/5; thrombocytopenia: 0/0; anemia: 0/0; neutropenic fever: 3/0; and hypertension: 28/0; diarrhea: 3/0. QOL data will be presented at the meeting. S-1 plus cisplatin in combination with bevacizumab met the primary endpoint in patients with advanced non-SQ NSCLC in the present trial. Additionally, the response rate is anticipated to be high, and the regimen was well tolerated. Clinical trial information: UMIN000009476.

Differentiate Patterns of Individually Perceived Quality of Life in Big Cities, Towns and Rural Areas

Quality of Life (QoL) in local place is one of the most important factors of place competitiveness and thus is pushed to the working agendas of scientists as well as practitioners in the local governance. Generally, it is agreed that QoL differ in diverse local places. Explanation of these differences still is complex and challenging problem. Most often living place related QoL is researched and predicted by investigating social indicators that reflect averaged objective living conditions in some certain place: country, city, town or region. Scientific research on empirically observed relationships among objective living conditions in local places and individuals’ subjectively perceived QoL had concluded that impacts of socio-economic circumstances in local places (measured by common social indicators) on subjectively perceived individual QoL are not direct, but complex, versatile and diverse. To explore and structure this diversity some conceptual assumptions were made and respective research was conducted. It is assumed that range of intermediate personal characteristics – individual objective and subjective QoL factors – leverage over individual subjectively perceived QoL. On the other hand, objective differences of socio-economic factors in local places suggest that personal characteristics and other objective and subjective QoL factors specific to particular individuals could form some common patterns that are able to disclose differences in individually perceived QoL in different socio-economic conditions, diverse local places, e.g. cities, towns and rural areas. The research aims at investigating differences in patterns of individual subjectively perceived QoL in different local places. The differences of considered local places are reasoned by indicators of objective socio-economic conditions in cities, towns and rural areas. The tested presumption is that common patterns of individual subjectively perceived QoL differ respecting objective socio-economic factors in the local places; e.g. residents of higher income regions value income factor less than residents of lower average income regions, etc… The research concludes with finding and discussing statistical regression models for predicting individual subjectively perceived QoL in towns, big cities and rural areas. Residents’ attitude to social environment, their abilities to deal with important problems in life, household total income, and age are used as predictors to explain differences of individual subjectively perceived QoL. The case of Lithuania is investigated. European Social Survey (round 6, 2013) data is used. DOI: http://dx.doi.org/10.5755/j01.ee.27.5.14640

The Use of Multi-Criteria Taxonomy in the Study of Objective Quality of Life in Polish Voivodeships

Abstract The article attempts to compare the living conditions of the population living in rural communities of West Pomeranian Voivodeship. The analysis used data for 159 indicators in the following areas of life: natural environment, demographics, social aspects, municipal infrastructure and housing, economic aspects, education and schooling, culture and tourism, and transport. The application of a multi-criteria taxonomy method allowed the author to take into account all the spheres of life altogether and to differentiate a group of voivodeships that are similar in terms of the examined phenomenon. On the basis of the conducted study it was found that Poland’s regions demonstrate a high degree of differences in terms of the objective quality of life.

Bénéfice d’un programme d’éducation thérapeutique agréé sur la qualité de vie et le bien-être psychologique de sujets souffrant de schizophrénie

IntroductionIn schizophrenic disorders, supportive psychosocial therapies have been used as adjuncts to pharmacotherapy to help alleviate residual symptoms and to improve social functioning and quality of life. Among these therapies, psychoeducational therapies showed a significant efficacy on improving drug adherence and on reducing relapses. However, according to the French Health Agency, fewer than 10% of psychiatric structures in France offer registered psychoeducation programs. Caregiver apprehension of patients’ depressive reactions to the awareness of the disease could underlie the underuse of psychoeducation therapies. Indeed, the psychoeducation programs’ impact on objective and subjective quality of life is discussed among the literature. In this context, we conducted a retrospective, monocentric, open-labelled and non-controlled pilot study to measure the impact of a registered psychoeducation program on objective and subjective quality of life of patients suffering from schizophrenia. Secondary objectives included measures of the effects on drug observance and awareness of the disease. MethodsWe included stabilized patients over the age of eighteen suffering from schizophrenia. Referent psychiatrics were asked to inform the patient of the diagnosis and to prescribe psychoeducation therapy. From 2011 to 2014, we offered three ambulatory programs, each program including fifteen two-hour group sessions. The groups were opened for three to six patients and managed by two caregivers. Themes discussed during the sessions included: schizophrenic disease, treatments, relationships to family, diet, social issues, toxics, relaxation. Objective and subjective quality of life were evaluated one month before and one month after the program using respectively the global assessment functioning (GAF) and the subjective quality of life (SQoL) scales. The Medical Adherence Rating Scale (MARS) and the French IQ8 scale evaluated respectively drug adherence and awareness of the disease. All patients gave their written consent for the study. Based on medical records and scales, we compared data before and after the program using the Wilcoxon test, adapted for small samples. ResultsFourteen patients, with a mean age of 37.6 years, were included. All patients had a chronic antipsychotic treatment and four benefitted from a bitherapy with a mood stabilizer. The mean length of disease was 15.3 years, with a mean number of 3.4 hospitalizations before inclusion. The participation rate was nearly twelve sessions out of fifteen. Mean GAF score before the program was 48/100. After the program, mean GAF score was significantly increased to 54/100 (P=0.008). As to SQoL score, we found a significant difference of the sub item psychological well-being from 3.2/5 before the program to 3.8/5 after the program (P=0.03). Global SQoL score and other sub items (self-esteem, resilience, and physical well-being) showed a slight but not significant improvement. The sub items family relationships and sentimental life were diminished, non-significantly. Concerning the drug adherence, the mean MARS score was significantly increased from 6.1 to 6.4/8 (P=0.03). Comparison of the insight IQ8 scale showed a slight but non-significant increase. When asked to note the program, patients were globally very satisfied, with a mean rate of 8.6/10. Of fourteen patients, one needed to be hospitalized three years after program. DiscussionThis retrospective study on a small sample of patients suffering from schizophrenic disorder pointed out a significant improvement on drug adherence, objective quality of life and psychological well-being, after an eight-month registered program of psychoeducational therapy. These results are in line with a recent report from the Cochrane group who reported a significant raise of GAF associated with psychoeducational therapies. The literature data for subjective quality of life are more contradictory. Despite the small sample and evaluation means that need to be corrected in further studies, we reproduced the results described in the literature regarding the improvement on drug adherence. However, the stability of these effects should be checked in the medium and long term. ConclusionAdjunctive psychoeducation therapy has a positive impact on reducing relapses in schizophrenia. In this study, we showed a significant benefit on drug adherence, objective quality of life and psychological well-being on a small sample of patients and provide arguments for the development of psychoeducation programs which are currently underrepresented in France. Our results encourage conducting a further prospective multicenter controlled study on a larger sample to clarify the benefit of psychoeducational therapy on objective and subjective quality of life in schizophrenia.

Suicide Attempt Status and Quality of Life Disparity Among Individuals with Schizophrenia: A Longitudinal Analysis

AbstractObjective: Survivors of a suicide attempt are at greater risk for future suicide than those who have no history of such attempts (i.e., non-attempters), particularly in the context of schizophrenia. Although disparity between attempt survivors and non-attempters in quality of life (QoL) can potentially influence suicide risk disparity over time, no known longitudinal work has focused on QoL disparities between these groups. This study examined 2 types of QoL differences between attempt survivors and non-attempters over a 3-year period: (a) differences in levels of QoL (i.e., chronic disparity), and (b) differences in QoL change (i.e., change disparity). Method: In a sample of 166 adults with schizophrenia entering community-based psychosocial rehabilitation, 2-level hierarchical linear models were used to compare attempt survivors and non-attempters on objective and subjective QoL domains over 7 waves. Results: Chronic disparity in subjective QoL between groups was observed in work (b = −0.51; 95%...

Asperger syndrome in males over two decades: Quality of life in relation to diagnostic stability and psychiatric comorbidity.

This study examined objective quality of life (work, academic success, living situation, relationships, support system) and subjective quality of life (Sense of Coherence and Short-Form Health Survey-36) in an adult sample of males ( n = 50, mean age: 30 years) with Asperger syndrome diagnosed in childhood and followed prospectively over two decades. The association between long-term diagnostic stability of an autism spectrum disorder and/or comorbid psychiatric disorders with quality of life was also examined. The results showed great variability as regards quality of life. The subsample that no longer fulfilled an autism spectrum disorder had full-time jobs or studies (10/11), independent living (100%), and reported having two or more friends (100%). In the stable autism spectrum disorder group, 41% had full-time job or studies, 51% lived independently, and 33% reported two or more friends, and a significant minority had specialized employments, lived with support from the government, or had no friends. Academic success was positively correlated with IQ. A majority of the total group scored average Sense of Coherence scores, and the mean for Short-Form Health Survey-36 was above average regarding psychical health and below average regarding mental health. Stability of autism spectrum disorder diagnosis was associated with objective but not subjective quality of life, while psychiatric comorbidity was associated with subjective but not objective quality of life.

Characterizing Objective Quality of Life and Normative Outcomes in Adults with Autism Spectrum Disorder: An Exploratory Latent Class Analysis.

This study aims to extend the definition of quality of life (QoL) for adults with autism spectrum disorder (ASD, n = 180, ages 23-60) by: (1) characterizing the heterogeneity of normative outcomes (employment, independent living, social engagement) and objective QoL (physical health, neighborhood quality, family contact, mental health issues); and (2) identifying predictors of positive normative outcomes and good objective QoL. Findings of an exploratory latent class analysis identified three groups of adults with ASD-Greater Dependence, Good Physical and Mental Health, and Greater Independence. Findings indicate that better daily living skills, better executive function, and more maternal warmth are associated with assignment to better outcome groups. Findings have implications for interventions designed to enhance achievement of normative outcomes and objective QoL.

Comparing how co-morbid depression affects individual domains of functioning and life satisfaction in schizophrenia

ObjectiveDepression in schizophrenia is often associated with reduced life satisfaction. Yet, it is not clear how depression influences different functioning domains. The relative impact across objective and subjective quality of life (QOL) has also not been clearly compared. This study sought to examine the differences in individual QOL indicators between schizophrenia patients with and without co-morbid depression. This was completed separately for objective and subjective QOL. Method57 patients with schizophrenia/schizoaffective disorder were classified into groups with (DP: N=31, M=45.81, SD=10.29) and without depression (NDP: N=26, M=40.54, SD=11.00) using MADRS scores. Objective and subjective QOL was assessed using Lehman's (1988) QOL Interview using five domains: daily activities and functioning, family relations, social relations, safety and health. z-scores were created for these domains (objective and subjective) based on responses from 44 healthy controls (M=39.80, SD=13.94). ResultsObjectively, DP patients had significantly reduced social interaction frequency compared to HCs. Subjectively, DP patients had significantly poorer scores than HCs on all five domains, and additionally reported poorer satisfaction with daily activities and health compared with the NDP group. ConclusionsPresence of depression in schizophrenia results in reduced self-reported life satisfaction across a broad spectrum of QOL domains. Objectively, depression resulted in decreased interactions with friends and peers, i.e. greater social isolation. The findings support the need to continue developing and implementing peer support groups in schizophrenia, a challenging task especially in the face of depression. More broadly, the assessment of depression in other illnesses is recommended.

NETTER-1 phase III: Progression-free survival, radiographic response, and preliminary overall survival results in patients with midgut neuroendocrine tumors treated with 177-Lu-Dotatate.

194 Background: Currently, there are limited therapeutic options for patients with advanced midgut neuroendocrine tumors progressing on first-line somatostatin analog therapy. Methods: NETTER-1 is the first Phase III multicentric, randomized, controlled trial evaluating 177Lu-DOTA0-Tyr3-Octreotate (Lutathera) in patients with inoperable, progressive, somatostatin receptor positive midgut NETs. 230 patients with Grade 1-2 metastatic midgut NETs were randomized to receive Lutathera 7.4 GBq every 8 weeks (x4 administrations) versus Octreotide LAR 60 mg every 4-weeks. The primary endpoint was PFS per RECIST 1.1 criteria, with objective tumor assessment performed by an independent reading center every 12 weeks. Secondary objectives included objective response rate, overall survival, toxicity, and health-related quality of life. Results: Enrolment was completed in February 2015, with a target of 230 patients randomized (1:1) in 36 European and 15 sites in the United States. At the time of statistical analysis, the number of centrally confirmed disease progressions or deaths was 23 in the Lutathera group and 67 in the Octreotide LAR 60 mg group. The median PFS was not reached for Lutathera and was 8.4 months with 60 mg Octreotide LAR [95% CI: 5.8-11.0 months], p < 0.0001, with a hazard ratio of 0.21 [95% CI: 0.13-0.34]. Within the current evaluable patient dataset for tumor responses (n = 201), the number of CR+PR was 19 (18.8%) in the Lutathera group and 3 (3.0%) in the Octreotide LAR 60 mg group (p < 0.0004). Although the OS data were not mature enough for a definitive analysis, the number of deaths was 13 in the Lutathera group and 22 in the Octreotide LAR 60 mg group (p < 0.019 at interim analysis) which suggests an improvement in overall survival. Conclusions: The Phase III NETTER-1 trial provides evidence for a clinically meaningful and statistically significant increase in PFS and ORR, and also suggests a survival benefit in patients with advanced midgut NETs treated with Lutathera. Clinical trial information: NCT01578239.

Quality of Life in Fit Elderly Patients with Chronic Lymphocytic Leukemia (CLL) Receiving Oral Fludarabine-Based Regimens As First Line Therapy: Australasian Leukaemia and Lymphoma Group (ALLG) CLL5 Trial

BackgroundThe diagnosis and treatment of CLL may have a great impact on the quality of life (QoL) due to a variety of reasons including disease-related symptoms, infection, effects of therapy and the emotional, socio-economic, and functional effects of living with an 'incurable' illness. The main aim of any treatment is to maximize QoL by inducing remission with minimal short- and long-term toxicity. Balancing disease and symptom control with QoL in elderly patients receiving CLL therapy regimens can be challenging. There is little published QoL data in elderly CLL patients receiving the FCR (fludarabine, cyclophosphamide, rituximab) immunochemotherapy regimen. Our prior study showed no significant difference in health related QoL for first-line therapy of CLL with monotherapy between chlorambucil, fludarabine and cladribine (Mulligan, SP et al. Leuk Lymphoma, 2014).AimWe report the QoL assessments of CLL patients enrolled in the ALLG clinical trial CLL5, a randomised, 3-arm, dose de-escalation study of the FCR regimen.MethodsThe treatment schedule has been described with fit elderly patients randomly assigned to one of three treatment regimens: FR5, FCR3, and FCR5 (Mulligan SP et al. iwCLL Abstract, 2015). Treatment was repeated every 28 days for a planned total of 6 cycles. Importantly, an early stopping rule mandating cessation of therapy was included for any patient having grade 3 or 4 toxicity lasting >2 weeks.QoL assessments using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) were measured at 8 time points: before commencement of therapy, at the end of the 3rd and 6th cycles of treatment, at the final staging and thereafter every 3 months for 12 months.ResultsOf the 116 evaluable in the study, 2 patients had no QoL data, 6 patients had only baseline QoL data, and 4 patients had no baseline QoL data, therefore the number of patients included in the QoL analysis was 104. There appeared to be a trend towards improved global health (figure 1), physical functioning (figure 2) and role functioning with full dose (FCR5) towards the end of the follow-up period compared to commencement of therapy. Comparison of cognitive functioning (figure 3) between the three arms showed a statistically significant improvement with FCR5. However, on multivariate analysis there was no statistical significant difference.ConclusionsDespite a trend favouring full-dose FCR, there were no definitively significant differences in the QoL domains following treatment with FCR-based immunochemotherapy between the three different groups. QoL continues to be a neglected issue, particularly for the typical elderly CLL patient. This study highlights the need for objective QoL assessment as part of all CLL trials, especially those targeted in the typical elderly patient. [Display omitted] [Display omitted] [Display omitted] DisclosuresGill:Roche: Research Funding; Sanofi Aventis: Research Funding; AbbVie: Honoraria; Roche: Honoraria. Turner:Roche: Research Funding; Sanofi Aventis: Research Funding. Renwick:Sanofi Aventis: Research Funding; Roche: Research Funding. Latimer:Sanofi Aventis: Research Funding; Roche: Research Funding. Mackinlay:Sanofi Aventis: Research Funding; Roche: Research Funding. Berkahn:Sanofi Aventis: Research Funding; Roche: Research Funding. Simpson:Janssen-Cilag: Honoraria; Celgene: Honoraria; Onyx Pharmaceuticals: Research Funding; Roche: Honoraria. Forsyth:Sanofi Aventis: Research Funding; Roche: Research Funding. Cull:Janssen-Cilag: Membership on an entity's Board of Directors or advisory committees; Amgen: Other: Travel. Harrup:Roche: Research Funding; Sanofi Aventis: Research Funding. Kuss:Sanofi Aventis: Research Funding; Roche: Research Funding. Mulligan:Sanofi Aventis: Research Funding; Janssen: Consultancy, Honoraria, Speakers Bureau; Celgene: Consultancy, Honoraria; Roche: Consultancy, Honoraria, Research Funding, Speakers Bureau.

Insular Gray Matter Volume and Objective Quality of Life in Schizophrenia.

Improving quality of life has been recognized as an important outcome for schizophrenia treatment, although the fundamental determinants are not well understood. In this study, we investigated the association between brain structural abnormalities and objective quality of life in schizophrenia patients. Thirty-three schizophrenia patients and 42 age-, sex-, and education-matched healthy participants underwent magnetic resonance imaging. The Quality of Life Scale was used to measure objective quality of life in schizophrenia patients. Voxel-based morphometry was performed to identify regional brain alterations that correlate with Quality of Life Scale score in the patient group. Schizophrenia patients showed gray matter reductions in the frontal, temporal, limbic, and subcortical regions. We then performed voxel-based multiple regression analysis in these regions to identify any correlations between regional gray matter volume and Quality of Life Scale scores. We found that among four subcategories of the scale, the Instrumental Role category score correlated with gray matter volume in the right anterior insula in schizophrenia patients. In addition, this correlation was shown to be mediated by negative symptoms. Our findings suggest that the neural basis of objective quality of life might differ topographically from that of subjective QOL in schizophrenia.

Bridging the Gap: Overcoming Data Difficulties During 40 Years of Measuring Well-Being in The Netherlands

For more than 40 years the Netherlands Institute for Social Research|SCP has studied the quality of life of the Dutch population. A characteristic element of that research is the use of time series. However, maintaining a time series over such a long period is not easy. All manner of problems arise, such as indicators no longer being relevant (who still has a black and white television?) or the changing importance that is attached to particular topics (sport is more important today than it was in 1974). The method of data collection can also change. In this article we take the perspective of a specific measurement to look at the changes that have taken place over the last 40 years and how those changes have been accommodated. We do this using the SCP Life Situation Index, which measures the objective quality of life of Dutch citizens. The conclusion is that it is possible to construct a long-term time series, but that it is not always possible to interpret changes from year to year: the perspective has to focus primarily on long-term developments.

Fibromyalgia therapy

Although we do not often consider chronic amplified pain syndromes as important in children, the incidence of these is surprisingly high. As many as 2%-6% of children, for example, may meet the criteria for fibromyalgia. Despite this, there are very few guidelines on the management of fibromyalgia in children. This is unfortunate in that some children may be very seriously involved and compromised by the condition. There is little evidence that medications play a useful role in the management of childhood fibromyalgia. A group in Philadelphia has developed an intense program of physical and occupational therapy for children with another pain syndrome, complex regional pain syndrome. In this issue of The Journal, Sherry et al from this program describe a similar approach in 64 children with fibromyalgia. The report is particularly useful, as it presents 1-year follow-up data in this chronic condition. The data in this report are optimistic. Children generally showed improvement in several objective measures, including pain, function, and quality of life. These improvements occurred in the context of no medications. The program is very resource-intense, involving up to 8 hours of therapy daily. It will be very interesting to see the degree to which this experience can be replicated in other centers. In any case, it is most encouraging to see these results in such a disabling condition. Article page 731▶ The Treatment of Juvenile Fibromyalgia with an Intensive Physical and Psychosocial ProgramThe Journal of PediatricsVol. 167Issue 3PreviewTo assess the short-term and 1-year outcomes of children with fibromyalgia treated with intensive physical and occupational therapy (PT/OT) and psychotherapy. Full-Text PDF Open Access

Subjective and objective quality of life at first presentation with psychosis.

Quality of life (QOL) in first-episode psychosis (FEP) is impaired when compared to non-clinical controls and several clinical factors including symptoms and untreated psychosis have been linked with poorer QOL. Measurement methods are varied, however, resulting in inconsistent findings and there is a need to simultaneously combine subjective and objective measures of QOL. We examined both subjective (n = 128) and objective QOL (n = 178) in a catchment area cohort of individuals with FEP (n = 222) to determine correspondence between patient satisfaction and clinician-rated functional domains. We also examined the contribution of sociodemographic and clinical characteristics to both subjective and objective QOL. There were complex relationships between subjective and objective QOL domains in that patient's assessments of health status (psychological well-being, symptoms/outlook, physical health) were not correlated with clinicians but there were strong correlations between social functioning domains (occupation, social relations, financial status and activities of daily living) assessed by patients and clinicians. Longer duration of untreated psychosis, being treated as an inpatient, higher positive symptoms and poorer social functioning in client-rated QOL domains predicted poorer objective QOL. We found that both subjective and objective assessments of QOL displayed a degree of clinical utility demonstrated by relationships between clinical factors and both QOL perspectives. Moreover, the lack of association between patient characteristics and QOL shows some potential malleability of QOL outcomes through intervention as there were several clinical factors linked with both subjective and objective QOL.

Living With a Personality Disorder: Its Impact on Life Balance

Abstract Date Presented 4/17/2015 Little is known about the life balance of women with Clusters B and C personality disorders. This study compared subjective and objective life balance in women with and without personality disorders. It also examined relationships among subjective and objective life balance, stress, and quality of life.

Sleep Patterns During Hospitalization Following Hematopoietic Stem Cell Transplantation.

To characterize patient-reported and objective sleep assessments and provide a preliminary examination of the relationships among sleep, quality of life, and demographic or treatment factors. A secondary data analysis using a descriptive-correlational design. University of Illinois Hospital and Health Sciences System. 40 patients undergoing a hematopoietic stem cell transplantation (HCT) hospitalized for the conditioning regimen, stem cell infusion, and immediate recovery period. Each patient wore a wrist actigraph continuously from the fourth day following HCT to the eighth day to objectively assess sleep patterns (total sleep time, sleep onset latency, sleep efficiency, wake after sleep onset, and number of awakenings). At the end of the five-day period, patients completed measures of sleep disturbance and quality of life. Objective sleep (total sleep time, sleep onset latency, sleep efficiency, wake after sleep onset, and number of awakenings), subjective sleep (sleep disturbance), and quality of life. The mean total nighttime sleep (objectively obtained) was 232 minutes (SD = 71 minutes), with 14 patients (35%) sleeping less than three consecutive hours during one or more study days. Age was negatively correlated with patient-reported sleep disturbance. Patient-reported sleep disturbance was significantly associated with length of hospital stay. No correlations were found between patient-reported and objective sleep assessments. This study objectively documents inadequate and irregular sleep in hospitalized patients undergoing HCT. Sole reliance on patient-reported sleep assessments may not represent the full extent of the problem. Attempts to streamline care during the night by not waking patients for routine care unless indicated by the patient's condition (as advocated by the American Academy of Nursing) and providing supportive care for symptoms (such as diarrhea) during the night may reduce the number of awakenings and possibly improve overall sleep quality.

Quality of Life and Functioning One Year After Experiencing Accumulated Coercive Events During Psychiatric Admission.

The study aimed to determine the number of accumulated coercive events experienced by patients during inpatient admission, the patients' functioning and quality of life (QOL) one year after discharge, and associations between these variables and patient characteristics and between follow-up outcomes and number of accumulated coercive events. A prospective cohort study was undertaken at three community services and an independent hospital in Ireland (N=162). Accumulated coercive events scores were based on patients' legal status, perceived coercion, and exposure to physical restraint, seclusion, or forced medication. Most (68%) experienced at least one coercive event. Lower functioning predicted more coercive events. At follow-up, the mean subjective QOL score was 63% of the highest possible score, objective QOL improved for 15% of participants, and functioning improved for 70%. Accumulated coercive events did not predict these outcomes. Coercive events during psychiatric admission appeared unrelated to functioning and QOL at follow-up.