Physical Quality Of Life Scores Research Articles

Psychosocial well-being assessment in women with breast cancer.

207 Background: A breast cancer (BC) diagnosis can affect psychosocial wellbeing. The goal of the current study is to identify the severity of and specific risk factors for depression, anxiety, and quality of life impairment in a sample of BC patients. Early identification of at risk individuals can expedite appropriate referrals and interventions. Methods: Data from 53 female BC patients referred to a Behavioral Medicine service at a large academic medical center in 2013-2015 by medical providers who identified distress at routine clinic visits were analyzed. Patients completed the Center for Epidemiology Studies Depression Scale, State Trait Anxiety Inventory, McGill Pain Questionnaire, and the Short Form 12 Quality of Life Inventory as part of their initial assessment following referral. Demographic factors, disease and treatment related factors were analyzed for correlation with psychosocial wellbeing. Results: Mean age was 52. The majority of the population were Caucasian (79%), and 53% were married. All stages of disease were represented. Significant depression, anxiety and psychological quality of life impairment were seen in 53%, 50%, and 39% of patients respectively. There was a trend towards a significant difference in higher anxiety scores in patients who were not on chemotherapy (M=44.2, SD 5.4) compared to those on chemotherapy at the time of assessment (M=38.54, SD 9.3; t (51) = -1.94 p=0.077). A positive correlation was seen between depression and pain scores (r 0.294, p=0.038). Depression and psychological quality of life scores were negatively correlated (r -0.632 p<0.001), as were pain and physical quality of life scores (r -.343, p 0.024). There was no correlation between higher rates of depression or anxiety with type of surgical intervention or stage of disease. Conclusions: Significant depression, anxiety and quality of life impairment were seen in a large percentage of BC patients referred to Behavioral Medicine for perceived distress, regardless of type of surgery and disease stage. Higher rates of anxiety were seen in patients referred while not on chemotherapy compared to patients who were on chemotherapy at the time of referral. Early referral is the key to proper identification and treatment of high risk individuals.

0350: Correlation between cardio-pulmonary exercise test variables and health-related quality of life among children with congenital heart diseases

peak oxygen uptake (VO2) correlates with health related quality of life (QoL) in adults with heart failure. Cardio-pulmonary exercise test (CPET) is recommended in the follow-up of adults with congenital heart diseases (CHD). Few data is available as regards correlation between CPET and QoL among children with CHD. 202 CHD children aged 8 to 18 performed a CPET (treadmill n=96, cycle-ergometer n=106). CHD severity was stratified into 4 groups. All children and parents filled out the Kidscreen QoL questionnaire. Peak VO2, anaerobic threshold (AT), oxygen pulse followed a downward significant trend with increasing CHD severity and conversely for VE/VCO2 slope. Self-reported and parent-reported physical well-being QoL scores correlated with peak VO2 (respectively r=0.27, p<0.0001 and r=0.43, p<0.0001), percentage of predicted peak VO2 (r=0.28, p=0.0001 and r=0.41, p<0.0001), and percentage of predicted VO2 at AT (r=0.22, p<0.01 and r=0.31, p<0.0001). Significant correlations were also observed between several QoL dimensions and VD/VT ratio, oxygen uptake efficiency slope (OUES), oxygen pulse but never with VE/VCO2 slope. The strongest correlations were observed in the treadmill group, especially between peak VO2 and physical well-being for parents (r=0.57, p<0.0001) and self (r=0.40, p<0.0001) reported QoL. peak VO2 and anaerobic threshold are the two CPET variables which best correlated with self and parents-reported QoL in this large pediatric cohort. If QoL is involved as a “patient related outcome” in a clinical trial in pediatric cardiology, we suggest to use parents related QoL scores. Clinical Trial Registration ClinicalTrials.gov (number NCT01202916).

Microsurgical Reconstructions for Head and Neck Cancers in Elderly Aged >80Years: An Analysis of Surgical Outcomes and Quality of Life.

The rising incidence of primary head and neck (H&N) cancers in the elderly presents a dilemma regarding the appropriateness of complex surgery in this assumed frail age group. With limited data on surgical morbidity, survival, and patient quality of life (QOL), this analysis aimed to broaden the understanding of safety and effectiveness of microsurgical treatment in very elderly H&N cancer patients. A prospective database analysis was used to evaluate surgical outcomes (morbidity, survival, and QOL) in all patients aged 80years and older undergoing microsurgical reconstruction for cutaneous and intra-oral H&N cancers between 2004 and 2014. Outcomes were assessed for their association with surgical, tumour, and patient variables. Comorbidities were categorized by the ACE27 index and postoperative morbidity by the Clavien-Dindo scoring system. QOL was analyzed using the UW-QOLv4. Of 720 microsurgical reconstructions, 96 patients were identified. Median survival was 25months. The ACE27 index was the only variable significantly associated with survival with a 5-year survival of 59.2% in the least comorbid group versus 19.7% in the most comorbid group (p 0.015). ACE-27 showed influence on socioemotional QoL scores. Physical QOL scores were influenced by tumour and operative factors. Patients were found to value physical QOL over socioemotional. Microsurgical reconstructions are well tolerated in the very elderly patients and should be considered predominantly based on comorbidity. Tumour stage, flap type, and cancer site should still form part of the preoperative counseling due to their implication on postoperative physical function.

Level of physical activity and quality of life: a comparative study among the elderly of rural and urban areas

Objective : To investigate if the relationship between physical activity level (PAL) and quality of life (QOL) is affected by living environment (rural or urban). Method : A quantitative, observational and cross-sectional study was performed. Of the 40 participants of both genders, 20 were residents of urban areas and 20 were residents of rural areas in the town of Pimenta Bueno (RO), Brazil. The WHOQOL BREF and IPAQ Long Version questionnaires were used to assess QOL and PAL, respectively. Mann Whitney and Fisher's Exact were used to statistically compare groups for QOL and PAL scores. The correlation between the two was tested by the Spearman test. A significance level of p&lt;0.05 was used. Results : No differences between the rural and urban areas for QOL or PAL were found. In the rural group a positive and significant correlation was found between PAL and the physical, psychological and complete QOL domains. In terms of PAL, elderly persons from the rural area who were regularly active had higher total QOL and physical domain scores than insufficiently active elderly individuals from the rural area. When place of residence was compared, insufficiently active elderly in the urban area had higher scores on the social component of QOL than insufficiently active elderly from the rural group. Among regularly active seniors, those living in the rural area had higher physical QOL scores. Conclusion : According to the results, level of physical activity exerts a differential influence on the QOL of elderly people from rural and urban areas.

Early lenalidomide treatment for low and intermediate-1 International Prognostic Scoring System risk myelodysplastic syndromes with del(5q) before transfusion dependence.

Lenalidomide is approved for the treatment of transfusion‐dependent (TD) del(5q) myelodysplastic syndromes (MDS). However, few data are available in patients with transfusion‐independent (TI) del(5q) MDS. In the first, observational, part of this 2‐part study, we assessed the impact of transfusion dependence on overall survival (OS) and non‐leukemic death in untreated del(5q) MDS patients who were TD (n = 136), TI with hemoglobin (Hb) ≥10 mg/dL (n = 88), or TI with Hb <10 mg/dL (n = 96). In the second, interventional, part we assessed the quality‐of‐life (QoL) benefits and clinical efficacy of lenalidomide (10 mg/day) in 12 patients with TI del(5q) MDS and Hb <10 mg/dL. In the untreated population, OS was significantly longer in TI than in TD patients (TI [Hb ≥10 g/dL], 108 months; TI [Hb <10 g/dL], 77 months; TD, 44 months). Transfusion dependence also negatively impacted non‐leukemic death rates. In the interventional part of the study, baseline Hb levels were found to correlate significantly with physical (R = 0.666, P = 0.035) and fatigue (R = 0.604, P = 0.049) QoL scores. Median physical QoL scores improved significantly after 12 weeks' treatment with lenalidomide (+12.5; P = 0.020). Evaluable TI patients experienced early increases in Hb levels, and all attained an erythroid response. Our findings suggest that TI patients with moderate anemia may benefit from early treatment with lenalidomide.

Pain, quality of life and activity in aged evacuees living in temporary housing after the Great East Japan earthquake of 11 March 2011: a cross-sectional study in Minamisoma City, Fukushima prefecture.

BackgroundThe aim of this study was to clarify pain, quality of life and activity in the aged evacuees living in temporary housing after the Great East Japan Earthquake on 11 March 2011.MethodsThe study was a cross-sectional study performed in Minamisoma City, Fukushima Prefecture 1 year and 6 months after the disaster. Inclusion criteria were the ability to walk independently and consent to answer questionnaires. Seventy-one evacuees who met the inclusion criteria were included in this study. There were 16 men and 55 women with a mean age of 75.9 years. Sixty evacuees were surveyed when they gathered at the assembly hall in the temporary housing (Assembled group) and 11 evacuees were surveyed through individual visits to their residences (Individual group). Evacuees in the Individual group agreed to participate in this study, but refused to visit the assembly hall to engage in exercise and recreation. Pain, quality of life (QOL) and level of activity were assessed with the Numeric Rating Scale (NRS), the MOS Short-Form 36 item Health Survey (SF-36) and a pedometer, respectively. Student’s t-test, Mann–Whitney U test, and Fisher’s exact test were used for statistical analysis.ResultsForty-four (62.0 %) residents had chronic pain with a mean NRS of 2.74. Twenty-one (29.6 %) of these residents had relatively severe pain rated 5 or above on the NRS. QOL was significantly lower for the subscales of “physical functioning,” “role physical”, “general health”, “social functioning”, “role emotional” and “mental health”, when compared with the national standard values. Values were also visibly lower for “physical component summary” in the summary score. On comparing the Assembled group and the Individual group, “physical function”, “role physical”, “social functioning” and “physical component summary” were found to be significantly lower in the Individual group. The mean daily number of steps was 1,892 in the Individual group and 4,579 in the Assembled group. The Individual group thus significantly took less mean daily number of steps compared with the Assembled group.ConclusionsThis study quantified the state of pain, QOL and activity of aged evacuees living in temporary housing after the Great East Japan Earthquake. The evacuees frequently had chronic pain and lower physical and mental QOL scores compared to the national standard values.

Quality of life after videoscopic left cardiac sympathetic denervation in patients with potentially life-threatening cardiac channelopathies/cardiomyopathies

Left cardiac sympathetic denervation (LCSD) provides an additive or potentially alternative treatment option for patients with life-threatening cardiac channelopathies/cardiomyopathies. We sought to examine the effects of LCSD on quality of life (QOL). From November 2005 to May 2013, 109 patients who underwent LCSD were subsequently sent postoperative QOL surveys. Of 109 patients, 8 (7%) could not be contacted. Of the remaining 101 patients, 62 returned surveys (response rate 61%). There were an average of 4.1 ± 1.8 self-reported side effects immediately after LCSD. The most common anticipated side effects included unilateral hand dryness, color or temperature variance between sides of the face, and abnormal sweating. Although parent-reported pediatric physical QOL scores were lower than national norms, there were no differences in psychosocial QOL or disability scores (P = .09 and .33, respectively). QOL scores for adult patients were not significantly different from a US normative sample. Adult LCSD patients reported less disability than a US normative sample (P < .01). There was no correlation between QOL scores and the presence of anticipated side effects. However, among the subset of pediatric patients who continued to receive ventricular fibrillation-terminating implantable cardioverter-defibrillator shocks after LCSD, there was a correlation between their disability scores and the number of reported shocks (Spearman correlation = 0.56). The majority of patients/parents reported that they were very or somewhat satisfied with their surgery (or their child's surgery) and would definitely or probably recommend LCSD to another patient. Despite the anticipated side effects associated with LCSD, patients are satisfied with their surgery and indicate that they would recommend the surgery to another patient.

Co-occurrence of anxiety and depressive symptoms following breast cancer surgery and its impact on quality of life

PurposeLittle is known about the prevalence of combined anxiety and depressive symptoms (CADS) in breast cancer patients. Purpose was to evaluate for differences in demographic and clinical characteristics and quality of life (QOL) prior to breast cancer surgery among women classified into one of four distinct anxiety and/or depressive symptom groups. MethodsA total of 335 patients completed measures of anxiety and depressive symptoms and QOL prior to and for 6 months following breast cancer surgery. Growth Mixture Modelling (GMM) was used to identify subgroups of women with distinct trajectories of anxiety and depressive symptoms. These results were used to create four distinct anxiety and/or depressive symptom groups. Differences in demographic, clinical, and symptom characteristics, among these groups were evaluated using analyses of variance and Chi square analyses. ResultsA total of 44.5% of patients were categorized with CADS. Women with CADS were younger, non-white, had lower performance status, received neoadjuvant or adjuvant chemotherapy, had greater difficulty dealing with their disease and treatment, and reported less support from others to meet their needs. These women had lower physical, psychological, social well-being, and total QOL scores. Higher levels of anxiety with or without subsyndromal depressive symptoms were associated with increased fears of recurrence, hopelessness, uncertainty, loss of control, and a decrease in life satisfaction. ConclusionsFindings suggest that CADS occurs in a high percentage of women following breast cancer surgery and results in a poorer QOL. Assessments of anxiety and depressive symptoms are warranted prior to surgery for breast cancer.

Randomized Clinical Trial of an Integrated Self-Care Intervention for Persons With Heart Failure and Diabetes: Quality of Life and Physical Functioning Outcomes

ObjectivesPersons with concomitant heart failure (HF) and diabetes mellitus (DM) have complicated, often competing, self-care expectations and treatment regimens that may reduce quality of life (QOL). This randomized controlled trial tested an integrated self-care intervention on outcomes of HF and DM QOL, physical function, and physical activity (PA). Methods and ResultsParticipants with HF and DM (n = 134; mean age 57.4 ± 11 years, 66% men, 69% minority) were randomized to usual care (control) or intervention. The control group received standard HF and DM educational brochures with follow-up telephone contact. The intervention group received education and counseling on combined HF and DM self-care (diet, medications, self-monitoring, symptoms, and PA) with follow-up home visit and telephone counseling. Measures included questionnaires for HF- and DM-specific and overall QOL, PA frequency, and physical function (6-min walk test [6MWT]) and were obtained at baseline and 3 and 6 months. Analysis included mixed models with a priori post hoc tests. Adjusting for age, body mass index, and comorbidity, the intervention group improved in HF total (P = .002) and physical (P < .001) QOL scores at 3 months with retention of improvements at 6 months, improved in emotional QOL scores compared with control at 3 months (P = .04), and improved in health status ratings (P = .04) at 6 months compared with baseline. The intervention group improved in 6MWT distance (924 ft to 952 ft; P = .03) whereas the control group declined (834 ft to 775 ft; F1,63 = 6.86; P = .01). The intervention group increased self-reported PA between baseline and 6 months (P = .01). ConclusionsAn integrated HF and DM self-care intervention improved perceived HF and general QOL but not DM QOL. Improved physical functioning and self-reported PA were also observed with the integrated self-care intervention. Further study of the HF and DM integrated self-care intervention on other outcomes, such as hospitalization and cost, is warranted.

Abstract 204: Cross-sectional Survey of Quality of Life and Workload Among Japanese Physicians Working in Stroke Care: The Nationwide Survey of Acute Stroke Care Capacity for Proper Designation of Comprehensive Stroke Center in Japan (J-ASPECT) Study

Objective: Approximately 40% of stroke physicians in Japan are in a state of burnout. The quality of life (QOL) of physicians working in stroke care is unclear. We aimed to compare health-related QOL (HRQOL) between physicians working in stroke care and the general population, and to evaluate personal and professional characteristics associated with HRQOL of physicians working in stroke care. Design: Cross-sectional survey. Setting and Participants: All board-certified members of the Japanese Neurosurgical Society and the Societas Neurologica Japonica working in Japan. Main outcome measure: Scores of HRQOL (physical and mental) as assessed by the Short-Form 8 (SF-8). Statistical analysis: We compared scores of physician’s HRQOL with standard values of the general population. Factors associated with HRQOL were identified by multivariable regression analysis with stepwise variable selection. Results: Of 11,211 stroke physicians who received the survey, 2279 (20.3%) completed the surveys. The mean physical QOL score was 49.4 points (95% CI: 49.1 to 49.7), which was similar to the population norm. However, the mean mental QOL score was below the population norm (46.1 points [95% CI: 45.7 to 46.4]), and 20.8% (475/2279) of stroke physicians had a score lower than one standard deviation below the population norm. The physical QOL score was lower in women than in men (coefficient = –1.66 [95% CI: –2.82 to –0.50]). An increase in nights on call per week was associated with a lower physical QOL (each additional 1 time per week = –0.39 [–0.53 to –0.25]), and an increase in mean sleep time was associated with a higher physical QOL score (each additional 1 hour = 0.87 [0.55 to 1.20]). Physicians who worked more than 40 hours per week had a lower mean mental QOL score than those who worked less than 40 hours per week (each additional 10 hour = –0.40 [–0.57 to –0.24]). A higher salary was associated with a higher mental QOL score (lower than $100 000 = reference; $100 000-149 000 = 0.08 [–1.10 to 1.27]; $150 000-199 000 = 0.68 [–0.61 to 1.97]; $200 000 or more = 1.90 [0.46 to 3.34]), and an increase of 1 day off per week was associated with an increase in mental QOL score (each additional 1 day = 0.88 [0.24 to 1.52]). Limitation: This study was based on a cross-sectional design and was thus unable to determine the causal effects of factors. Conclusion: Mental QOL scores of stroke physicians are significantly lower than those of the population norm. Work hours, salary, and numbers of days off are associated with the mental QOL score.

Determinants of Quality of Life After Lung Transplantation

Background: The purpose of this study was to examine clinical and non- clinical determinants of quality of life (QoL) in lung transplant recipients (LTR). Methods: QoL was measured cross-sectional in 152 LTR (4.5±3.2 years after lung transplantation (LTx); 95 (63%) double LTx; 80 (53%) female; age 50±11.9 years; 28 (18%) bronchiolitis obliterans syndrome (BOS) stage ≥ 1) using the SF-36, the Quality of Life Profile for Chronic Diseases Questionnaire as well as the St. GeorgesRespiratory Questionnaire. Gender, age, body mass index (BMI), time after LTx, procedure type, underlying disease, marital- and professional status and exercise capacity (6-minute walk test, 6MWT) were tested for their predictive value by non-parametric significance tests and ANOVA and ANCOVA. Results: There was a significant correlation with higher physical QoL scores for age < 48 years (p<0.05), a BMI of 21.0 - 25.2 kg/m 2 (p<0.05), a 6MWT≥ 430m (p<0.001), for cystic fibrosis patients (p<0.05) without BOS (p<0.05) and who go to work (p=0.018). Females boasted a superior social health (p=0.04) and less respiratory symptoms (p=0.023). Double LTx was a significant predictor for both, mental and physical health (p<0.05). Subsequent analysis of covariance revealed only BMI (p=0.024), BOS stage (p<0.001), underlying disease (p=0.01) and exercise capacity according to 6MWT (p<0.001) as significant predictors for QoL independent of age. Conclusion: The study results suggest that returning to normal BMI and improving exercise capacity seem to be important therapeutic approaches to enhance QoL after LTx. Future investigations should focus on prophylaxis and therapy of BOS to further optimize QoL after LTx.

How Are Select Chronic Pancreatitis Patients Selected for Total Pancreatectomy with Islet Autotransplantation? Are There Psychometric Predictors?

Selected patients with chronic pancreatitis can benefit from total pancreatectomy with islet autotransplantation. Patient selection is challenging and outcomes assessment is essential. A prospective database of total pancreatectomy with islet autotransplantation patients was reviewed. Attention was given to psychometric assessments, including Short Form-12 Quality of Life Survey (SF-12), Center for Epidemiologic Studies 10-Item Depression scale, and Current Opioid Misuse Measure in the preoperative period, and SF-12 in the postoperative period. One hundred and twenty-seven patients (76% women, mean age 40.5 years) underwent total pancreatectomy with islet autotransplantation. Preoperatively, the mean SF-12 physical quality of life score (physQOL) was 27.24 (SD 9.9) and the mean psychological QOL score (psychQOL) was 38.5 (SD 12.8), with a score of 50 representing the mean of a healthy population. Mean improvements in physQOL relative to baseline at 1 year, 2 years, and 3 years post surgery were 7.1, 5.8, and 7.8, respectively, which represented significant change (all p < 0.001). Mean improvements in psychQOL relative to baseline at 1 year, 2 years, and 3 years post surgery were 3.9, 4.9, and 6.6, which also represented significant improvement (all p < 0.001). The percentages of patients evidencing at least a 3-point improvement in physQOL at 1 year, 2 years, and 3 years post surgery were 65%, 60%, and 61%, respectively. The percentages of patients evidencing at least a 3-point improvement in psychQOL at 1 year, 2 years, and 3 years post surgery were 49%, 58%, and 66%, respectively. Exploratory regression analyses of SF-12, Current Opioid Misuse Measure, and Center for Epidemiologic Studies 10-Item Depression scale data revealed limited baseline predictability of surgical response; however, higher opioid misuse scores at baseline were significantly and positively related to physQOL improvement at 2 years (r[54] = 0.33, p = 0.02). Total pancreatectomy with islet autotransplantation improves QOL for selected patients with chronic pancreatitis. The physQOL improves quickly after surgery, and psychQOL improvements are more gradual. Opioid misuse can predict physQOL improvement.

A Comparison of Social Support, Depression, and Qualify of Life in Adults and Elders Who have Undergone Coronary Artery Bypass Surgery

Purpose: This study was done to compare social support, depression and quality of life (QoL) in adult (under 65) and elderly (over 65) patients who had coronary artery bypass surgery. Methods: Participants were 66 adult and 68 elderly patients who completed questionnaires on social support, depression and QoL. Data were collected from December, 2011 to January 2012 and analyzed using x 2 -test, t-test, and Pearson's correlation. Results: The adults’ physical QoL scores were significantly higher than those of the elders (t=2.58, p=.011). However, the average difference between physical and mental QoL based on age, after controlling for gender, showed that there was no significant difference in QoL between adults and elders. In adults, significant negative correlations were found between depression and social support (r=-.41, p<.001), physical QoL (r=-.48, p<.001), and mental QoL (r=-.56, p<.001), and significant positive correlation between social support and mental QoL (r=.25, p=.047). In elders, significant negative correlations were found between depression and social support (r=-.43, p<.001), physical QoL (r=-.45, p<.001), and mental QoL (r=-.56, p<.001), and significant positive correlation between social support and mental QoL (r=.28, p=.019). Conclusion: Age-differentiated nursing intervention programs should be developed, and studies should be conducted to verify effectiveness of programs.

Abstract 16939: Pediatric Quality of Life While Supported With a Ventricular Assist Device

Introduction: The Ventricular Assist Device (VAD) has emerged as an important treatment option for bridging pediatric patients with heart failure to transplant. VADs have been shown to improve survival; however, quality of life (QoL) while supported with a pediatric VAD is unknown. Methods: In this prospective study, pediatric patients, and their parents, who underwent VAD placement completed a generic PedsQL 4.0 biweekly until heart transplant or death. Data are reported at last follow-up with a VAD and compared to three previously reported groups: age-matched healthy controls, outpatients with severe heart disease and children after heart transplant. Results: From December 2007 to August 2013, 13 patients received VAD support for at least two weeks and completed a PedsQL. The mean age at implant was 10.0 ± 4.2 years with a median duration of support of 1.6 months (Table 1). Pre-implant INTERMACS profile was 1 for 3/13 (23%) and 2 for 10/13 (77%). Patients self-reported significantly (p&lt;0.05) reduced total and physical QoL scores when compared to each of the three comparison groups. Self-reported psychosocial QoL scores were significantly lower than healthy controls only. Parent proxy-reported scores were significantly lower than all three comparison groups for all three categories (Figure 1). Conclusion: A large deficit exists in the QoL of pediatric patients supported by a VAD compared to outpatient management of severe heart disease or post-heart transplant patients; however, VAD patients do represent a sicker group. Improvements in QoL must be made, as time spent with a VAD is expected to increase. Though a small sample, these data can serve as a baseline for future comparison.

Obesity Is Associated With Inferior General Health Following Live Kidney Donation Independent of Surgical Complications.

Background: Previous studies have reported reduced physical quality of life scores for living kidney donors with high BMI at donation though the impact of short-term surgical complications remains unclear. We hypothesized that donors with a BMI ≥30 kg/m2 and complications < 3 months from donation would be at increased risk for long-term poor general health. Methods: We surveyed the general health of 1,326 living kidney donors, >1 year from donation, on a scale ranging from “excellent” to “very good”, “good”, “fair” or “poor”. Using logistic regression, we analyzed BMI and the presence of complications <3 months from donation as a risk factor for inferior health ratings. Results: Time from donation to survey was 17.4 ± 11.2 years with an average age of 58.2 ± 12.6 years. Those with a baseline BMI >30 kg/m2 and who experienced a complication within the first 3 months were significantly older at the time of donation. There was no difference in race, relationship to the recipient or age at donation amongst the other groups. Donors with a BMI ≥30 kg/m2 and no complications <3 months had a 2.33 fold increased risk for reporting “good”, “fair”, or “poor” health outcomes (OR 2.33, p<0.01) compared to a 2.06 fold increased risk for those with short-term complications (OR 2.06, p=0.03). Those with a BMI <30 kg/m2 and <3 month complications were the only group with significantly increased odds for “fair” or “poor” health outcomes (OR 2.01, p<0.01) (Table 1). Table 1: Logistic Regression- Predictors of Inferior General Health.Table: No Caption available.Conclusion: Obese donors are at greater risk for reporting inferior general health many years from donation regardless whether they experienced post-surgical complications.

Health status recovery at one year in children injured in a road accident: A cohort study

Despite the frequency of traumatic injuries due to road accidents and potential importance of identifying children at risk of impaired recovery one year after a road accident, there is a lack of data on long-term recovery of health status, except in children with severe traumatic brain injury. The aim of the present study was to evaluate predictive factors of recovery in children one year after road traffic injuries. The prospective cohort study was composed of children aged <16 years, admitted to public or private sector hospitals in the Rhône administrative area of France following a road accident. Recovery of health status one year after the accident and information concerning quality of life and the consequences of the accident for the child or family 1 year after the accident were collected by questionnaire, usually completed by the parents. Victims were in majority male (64.6%) and had mild or moderate injuries (81.9% with Maximum Abbreviated Injury Scale (M-AIS) <3). One year after the accident, 75.0% of the mild-to-moderate and 34.8% of the severe cases estimated health status as fully recovered. After adjustment, severity score (M-AIS≥3) and lower limb injury (AIS>1) were associated with incomplete recovery of health status: weighted odds ratio (ORw), 4.3 [95% confidence interval (95% CI), 1.3–14.6] and ORw, 6.5 [95% CI, 1.9–21.7], respectively. Recovery status correlated significantly with quality of life physical scores (r=0.46), especially body pain (r=0.48) and role/social–physical (r=0.50) and, to a lesser extent, quality of life psychosocial scores (r=0.21). In a cohort of children injured in a road accident, those with high injury severity score and those with lower limb injuries are less likely to recover full health status by 1 year. Impaired health status was associated with a lower physical quality of life score at 1 year.

The relationship between psychological symptoms, lung function and quality of life in children and adolescents with non-cystic fibrosis bronchiectasis

ObjectivesThe aim of this study was to evaluate the relationship between psychological symptoms and quality of life (QOL) and clinical variables in a cohort of children and adolescents with non-cystic fibrosis (non-CF) bronchiectasis. MethodsSeventy-six patients (aged 8–17years) participated in this study. Questionnaires were used to evaluate the psychological status and QOL of the patients and healthy controls. The patient and control groups were divided into child and adolescent groups to exclude the effect of puberty on psychological status. ResultsNo significant difference was found between patient and control groups for mean depression and trait anxiety scores. Only the child-rated physical health QOL scores were significantly lower for patients than the controls. Also, excepting physical health scores in adolescent group, all of the parent-rated QOL scores were significantly lower in both group and total subjects. Regarding determinants of QOL, age of children and FEV1/FVC percent predicted had positive effects, while dyspnea severity and trait anxiety had negative effects, for the sample as a whole. ConclusionsNon-CF bronchiectasis is associated with poorer QOL in childhood. The impact of the disease on QOL occurs through both clinical and psychological variables.

Psychiatric Functioning and Quality of Life in Young Patients With Cardiac Rhythm Devices

Less is known about depression, anxiety and quality of life (QoL) in children and adolescents with pacemakers (PMs) and implantable cardioverter-defibrillators (ICDs) than is known in adults with these devices. A standardized psychiatric interview diagnosed anxiety/depressive disorders in a cross-sectional study. Self-report measures of anxiety, depression and post-traumatic stress disorder were obtained. Medical disease severity, family functioning and QoL data were collected. A total of 166 patients were enrolled (52 ICD, 114 PM; median age 15 years). Prevalence of current and lifetime psychiatric disorders was higher in patients with ICDs than PMs (Current: 27% vs. 11%, P = .02; Lifetime: 52% ICD vs. 34% PM, P = .01). Patients with ICDs had more anxiety than a healthy population (25% vs. 7%, P < .01). Patients with ICDs and PMs had similar levels of depression as a healthy population (ICD 10%, PM 4%, reference 4%, P = .29). In multivariate analysis including a medical disease score, demographics, exposure to beta-blockers, activity limitations, hospitalizations, shocks and procedures, the type of device (PM versus ICD) did not predict psychiatric diagnoses when age at implantation and the severity of medical disease were controlled for. Patients with ICDs and PMs had lower physical QoL scores (ICD 45, PM 47.5, Norm 53, P ≤ .03), but similar psychosocial functioning scores (ICD 49, PM 51, Norm 51, P ≥ .16) versus a normal reference population. Anxiety is highly prevalent in young patients with ICDs, but the higher rates can be attributed to medical disease severity and age at implantation instead of type of device.

Adherence to phosphate binders in hemodialysis patients: prevalence and determinants

Phosphate control is a crucial treatment goal in end-stage renal disease, but poor patient adherence to phosphate binder therapy remains a challenge. This study aimed to estimate the extent of phosphate binder adherence in hemodialysis patients and to identify potential determinants. Phosphate binder adherence was measured blindly in 135 hemodialysis patients for 2 months using the medication event monitoring system. Patient data, gathered at inclusion through medical records, ad hoc questionnaires and the short form (SF)-36 health survey, included: (1) demographics, (2) perceived side-effects, belief in benefit, self-reported adherence to the therapy, (3) knowledge about phosphate binder therapy, (4) social support, and (5) quality of life (SF-36). Phosphatemia data was collected from charts. 'Being adherent' was defined as missing <1 total daily dose/week and 'being totally adherent' as missing <1 total daily dose/week, every week. Mean age of patients was 67 years and 64 % of the sample was male. Over the 2 months, 78 % of the prescribed doses were taken. Every week, about half of patients were adherent. Over the entire 8-week period, 22 % of patients were totally adherent. Mean phosphatemia levels were 0.55 mg/dl lower in adherent than nonadherent patients (4.76 vs. 5.31 mg/dl). Determinants for being totally adherent were living with a partner, higher social support (both were interrelated) and higher physical quality of life. Experiencing intake-related inconvenience negatively affected adherence. The social support and quality of life physical score explained 26 % of the variance in adherence. Phosphate binder nonadherence remains a major problem. Interventions should aim, at least, to improve social support. With few associated factors found and yet low adherence, an individualized approach seems indicated.

Colchicine for prevention of atrial fibrillation recurrence after pulmonary vein isolation: Mid-term efficacy and effect on quality of life

Our group previously showed that colchicine treatment is associated with decreased early recurrence rate after ablation for atrial fibrillation (AF). The purpose of this study was to test the mid-term efficacy of colchicine in reducing AF recurrences after a single procedure of pulmonary vein isolation in patients with paroxysmal AF. Assessment of quality-of-life (QOL) changes was a secondary objective. Patients with paroxysmal AF who were scheduled for ablation were randomized to a 3-month course of colchicine 0.5 mg twice daily or placebo and were followed for a median of 15 months (with a 3-month blanking period). QOL was assessed with a general-purpose health-related QOL tool (26-item World Health Organization QOL questionnaire) at baseline and after 3 and 12 months. Two hundred twenty-three randomized patients underwent ablation, and 206 patients were available for analysis (144 male, age 62.2 ± 5.8 years). AF recurrence rate in the colchicine group was 31.1% (32/103) vs 49.5% (51/103) in the control group (P = .010), translated in a relative risk reduction of 37% (odds ratio 0.46, 95% confidence interval 0.26-0.81). The number needed to treat was 6 (95% confidence interval 3.2-19.8). Physical domain QOL scores at 12 months were 63.6 ± 13.8 in the colchicine group and 52.5 ± 18.1 in controls, whereas psychological domain scores were 56.1 ± 13.7 vs 44.7 ± 17.3, respectively (P <.001, for both). Colchicine treatment after pulmonary vein isolation for paroxysmal AF is associated with lower AF recurrence rates after a single procedure. This reduction is accompanied by corresponding improvements in physical and psychological health-related QOL scores.