Ratings Of Overall Health Research Articles

Muscle assessment in brachial plexus injury: A reliability study

PurposeMotor outcome following a brachial plexus injury is frequently measured to evaluate the success of surgical interventions. We aimed to identify whether the manual muscle testing using the Medical Research Council (MRC) method in adults with C5/6/7 motor weakness was reliable and whether its results correlated with functional recovery. MethodsTwo experienced clinicians examined 30 adults with C5/6/7 weakness following proximal nerve injury. The examination included using the modified MRC to assess motor outcome in the upper limb. Kappa statistics were calculated to evaluate inter-tester reliability. Correlation coefficients was calculated to explore the correlation between the MRC and the Disabilities of the Arm Shoulder and Hand (DASH) score and each EQ5D domain. ResultsWe found that grades 3–5 of the modified and unmodified MRC motor rating scales have poor inter-rater reliability when assessing C5/6/7 innervated muscles in adults with a proximal nerve injury. The Deltoid Posterior and the Extensor Carpi Radialis Longus were the only muscles (using the modified MRC) to achieve a Kappa over 0.6 indicating substantial reliability. Higher combined MRC scores correlated significantly with a lower DASH and vice versa. Similarly, higher combined scores of MRC correlated significantly with a higher rating of overall health on the EQ5D VAS. ConclusionsThis study demonstrates that the MRC motor rating scale has poor inter-rater reliability when assessing C5/C6/C7 innervated muscles in adults following proximal nerve injury. Other methods of assessing motor outcome following proximal nerve injury need to be considered.

Quality of Life Assessment With European Organisation for Research and Treatment of Cancer Questionnaire (Head and Neck Module 43) and Its Clinicopathological Correlation Among Patients Treated for Oral Squamous Cell Carcinoma: An Exploratory Study.

Introduction Oral cancer has a great impact on quality of life (QOL). Many risk factors influence the overall QOL. Our study was performed to evaluate the QOL among patients with oral cancer and to correlate it with age, gender, tobacco usage, and clinicopathological details. Methods We have used the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Head and Neck Module (EORTC QLQ-HN43) and the Quality of Life Questionnaires for Core 30 (QLQ-C30) among the patients diagnosed with oral cancer after reporting to our institution. The Gpower calculation based on differences between two independent means reported by Meera et al. had a total sample size of 28 with an actual power of 0.9616. Thirty-five patients were included in the present study. Ethical clearance for this study was obtained, and there were no gender or age limits for enrollment. The patient demographic details and case history with relevant treatment information were collected from the DIAS (Dental Information Archival Software) of Saveetha Dental College, Chennai. After obtaining informed consent from the patients, the EORTC QLQ-HN43 and QLQ-C30 questionnaires were given to them. It was used both in Tamil and English. Various domains such as pain, appearance, and oral function were documented. The findings were correlated with clinical and histopathological findings. The collected data were tabulated and statistically analyzed with IBM Statistical Package for the Social Sciences (SPSS) version 20 (IBM Corp., USA). The mean ± SD were calculated for continuous variables, and frequency with percentage was determined for categorical parameters. Results The study included both men (57%) and women (43%)in the age range of 30-70 years, with a mean age of 50 years. Study samples included tobacco users (82%) and non-tobacco users (18%). Out of the 35 patients, 15 patients had lesions involving the buccal mucosa (42%) and 10 involving the tongue (28%). Oral squamous cell carcinoma (OSCC) was the most common type of lesion, and it was mostly treated surgically with resection and excision (82%), or just excision (18%). Seventy percent of our patients underwent reconstruction, while primary closure was done in only 30% of cases. All of the patients underwent neck dissection, including supraomohyoid neck dissection (52%), modified radial neck dissection (40%), and radial neck dissection (8%). Histopathology revealed that 49% had well-differentiated squamous cell carcinoma, 23% had moderately differentiated squamous cell carcinoma, and 28% had poorly differentiated squamous cell carcinoma. Out of the 35 included cases, five patients had died (14%). The primary site was buccal mucosa in all five cases, and surprisingly, three patients also had recurrences post-surgery or post-radiotherapy. We observed that the average rating of overall health and overall QOL at the time of diagnosis was 5.4. After one year of follow-up, the average rating of overall health and overall QOL was found to be 3.4. Conclusion The administration of EORTC QLQ-HN43 was found to be efficacious in our study on patients with OSCC. We could identify baseline data regarding the QOL of our patients treated for OSCC. We have identified critical domains of oral function that need to be focused upon to improve the overall QOL of OSCC patients through adjunctive therapies. We have also identified higher mortality and overall poorer QOL in patients with OSCC involving the buccal mucosa.

Client and service factors associated with changes in health-related quality of life following community rehabilitation

Purpose To identify client and service factors associated with changes in health-related quality of life following community rehabilitation. Methods We conducted a retrospective observational cohort study within a community rehabilitation program. Health-related quality of life was measured using the EuroQol five Dimensions, five response level version (EQ-5D-5L). Our primary outcome was the Visual Analogue Scale (VAS) rating of overall health. Analyses were stratified by diagnostic group: traumatic orthopaedic, elective orthopaedic, neurological, medical, and other. The association between client and service factors and discharge VAS scores, adjusted for baseline scores were determined using multivariable regression. Results EQ-5D-5L data were available for 981 of 1350 participants. Treatment intensity was associated with a seven-point increase (β = 7.22, 95%CI 2.28–12.2, p = 0.004) in VAS scores for traumatic orthopaedic participants. For neurological participants, there was a positive interaction between comorbidities and intensity of therapy (β = 7.9, 95%CI 2.75–13.1, p = 0.003), indicating that greater therapy intensity in those with higher comorbidity scores was associated with an improvement in VAS scores. Age was negatively associated with VAS scores for traumatic orthopaedic participants and socioeconomic status was positively associated with VAS scores for elective orthopaedic participants. Conclusions Treatment intensity is a modifiable service factor that may positively influence health-related quality of life. Implications for rehabilitation In addition to providing information on client progress towards attainment of individual treatment goals, routine collection of patient reported outcome measures within a community rehabilitation program can elicit information that can inform rehabilitation service improvement. Clients of a community rehabilitation program with a neurological or medical condition demonstrate the least improvement in overall health profile and may require additional rehabilitation or supports. Across all diagnostic groups, problems with anxiety and depression were least likely to improve following receipt of community rehabilitation. Improving access to psychological services and associated referral pathways in community rehabilitation services could improve these outcomes. Initiatives aimed at increasing intensity of therapy such as targeted triage and resource allocation, may improve health-related quality of life for clients of a community rehabilitation program with traumatic orthopaedic conditions. For clients with a neurological condition, initiatives aimed at increasing intensity of therapy may improve health-related quality of life in more complex patients with comorbid health conditions.

Social Contact and Wellness Outcomes for Older Adults in Different Residential Settings

More frequent social contact with others has been shown to be associated with positive well-being outcomes for older adults, who may be at increased risk of loneliness or isolation. The current study investigates whether the potential benefits of social contact might vary by social contact medium and by residence type (senior living (SL) settings vs. the broader community). 5,148 older adults residing in SL communities completed surveys on health and well-being. Data were combined with responses from 1,000 demographically similar older adults residing outside SL settings who participated in a similar study. Participants in both studies reported their frequency of social contact with friends (4 types: in-person meet-ups, speaking by phone, writing or emailing, and communicating via social media), subjective overall health, and life satisfaction. Results of multilevel regression analyses revealed that more frequent in-person social contact with friends was associated with more positive ratings of overall health only for participants in non-SL settings, but not those in SL. More frequent in-person social contact was also associated with higher life satisfaction, and this effect was stronger for non-SL participants. More frequent contact by phone and written letters/emails was associated with better ratings of overall health, regardless of residence type. In contrast, more frequent social media use was associated with lower ratings of overall health. Analyses controlled for age, gender, education, marital status, income, chronic health conditions, and depressive symptoms. The observed patterns of results speak to the possible protective benefits of social engagement for older adults in different residence settings.

Qualitative patient interviews on symptoms and impacts in metastatic synovial sarcoma (mSS).

e23576 Background: Synovial sarcoma (SS), a soft tissue sarcoma, is a rare and aggressive malignancy, with significant morbidity and mortality associated with mSS. There are currently no patient-reported outcome (PRO) instruments specific to mSS patients and little qualitative research to understand impacts on mSS patients’ health-related quality of life (QoL). The objective of this study was to characterize the symptoms and impacts experienced by mSS patients to inform the selection of content-valid PRO instruments for use in investigational trials in mSS patients. Methods: This was a non-interventional, qualitative interview study of adult participants in the United States (US) with physician-confirmed mSS. Participants were consented from a large private practice in the US. Six semistructured concept elicitation interviews (60–90m by telephone) were conducted by trained interviewers. Participants were asked to describe their mSS symptoms and their impact on functioning in an open-ended fashion with follow-up probes. Verbatim transcripts were analyzed using thematic analysis methods and Atlas.Ti software. Socio-demographics and clinical characteristics were collected by the site. The study received Institutional Review Board (IRB) approval from Western IRB. Results: Among the 6 participants, average age was 45y (range 21–61y) and 2 were female. All 6 participants had pulmonary metastasis, 1 participant had a liver metastasis, and 1 participant had a mediastinal mass. The most common symptoms participants spontaneously identified were pain (n = 6), fatigue (n = 6), coughing (n = 5, with 2 upon probing), shortness of breath (n = 4), phlegm/mucus in the lungs (n = 3), coughing up blood (n = 2), and gastrointestinal complications (n = 2). Nerve/shooting/burning pain (n = 5) was mentioned upon probing. Participants also reported impacts of their disease on sleep (quantity and quality) (n = 6), physical activity (n = 6), social life (n = 6), daily activities (n = 5), emotions (n = 5), loss of appetite (n = 3), and finances (n = 1). Although not spontaneously reported, global ratings of overall health and QoL were considered relevant by all participants. Conclusions: This is the first study to identify patient-relevant symptoms and impacts associated with mSS. Further interviews with additional participants are ongoing, and we will analyze these data to identify appropriate PRO instruments for use in investigational trials in mSS patients. Funding: GlaxoSmithKline (209386).

Perceived versus Actual Risk of Cardiovascular Disease in College Students

ABSTRACTBackground: College wellness interventions have potential to reduce the growing burden of cardiovascular disease (CVD) by guiding students to establish behaviors for lifetime CVD risk reduction. Yet, some students may not see CVD prevention as a relevant issue during young adulthood. Purpose: We examined perceived risk of CVD amongst 148 college students and compared perceived risk to demographic characteristics and traditional risk markers. Methods: Survey data on perceived CVD risk and student characteristics were linked to biochemical lab values from a cholesterol screening program. Results: Only 39.2% of students had been previously screened for dyslipidemia. Mean perceived CVD risk was highest amongst students with age ≥21 years, BMI ≥30, a family history of CVD, and a fair or poor rating of overall health. Perceived risk was not higher amongst students with total cholesterol values outside of the normal range. Discussion: While some students were aware they may possess an elevated CVD risk, we identified others who were unaware of a potential risk. Translation to Health Education Practice: These variations in perceived risk indicate that individualized intervention approaches may be necessary to engage college students in behaviors for lifelong CVD prevention.

Sleep, stress, or social support?: Exploring the mechanisms that explain the relationship between student recreation center use and well-being

Objective: The current study explores the role of health-related mechanisms (i.e. sleep, social support, and stress) in accounting for the impact of student recreation center (SRC) use on college-student well-being. Participants: Students (N = 540; Mage =23.67, SD = 7.10; 65.6% female) with membership to the SRC were recruited to complete an online survey. Method: The survey was implemented in Spring 2017 and included questions on SRC use (e.g. hours spent, facilities used), mental well-being (e.g. anxiety, depressive symptoms), physical well-being (e.g. height, weight, somatic symptoms), and the health-related mechanisms. Results: SRC frequency was associated with reduced somatic symptoms and ratings of overall health, though not mental health outcomes. Sleep was the most robust mechanism explaining the link between SRC use and physical health. Conclusion: Given the importance of sleep, educational institutions can promote student well-being by supporting SRC use and sleep quality.

Comparative Effectiveness of Two Walking Interventions on Participation, Step Counts, and Health.

To (1) compare the effects of two worksite-based walking interventions on employee participation rates; (2) compare average daily step counts between conditions, and; (3) examine the effects of increases in average daily step counts on biometric and psychologic outcomes. We conducted a cluster-randomized trial in which six employer groups were randomly selected and randomly assigned to condition. Four manufacturing worksites and two office-based worksite served as the setting. A total of 474 employees from six employer groups were included. A standard walking program was compared to an enhanced program that included incentives, feedback, competitive challenges, and monthly wellness workshops. Walking was measured by self-reported daily step counts. Survey measures and biometric screenings were administered at baseline and 3, 6, and 9 months after baseline. Analysis used linear mixed models with repeated measures. During 9 months, participants in the enhanced condition averaged 726 more steps per day compared with those in the standard condition (p < .001). A 1000-step increase in average daily steps was associated with significant weight loss for both men (-3.8 lbs.) and women (-2.1 lbs.), and reductions in body mass index (-0.41 men, -0.31 women). Higher step counts were also associated with improvements in mood, having more energy, and higher ratings of overall health. An enhanced walking program significantly increases participation rates and daily step counts, which were associated with weight loss and reductions in body mass index.

Australian Indigenous youth's participation in sport and associated health outcomes: Empirical analysis and implications

Analysis of the 2012 Mission Australia Youth Survey (MAYS) finds that among Indigenous youth aged 15–19 years there is a positive relationship between self-reported participation in sport and two health outcomes: rating of overall health and risk of mental health disorder. We find that Indigenous youth who participate in sport are 3.5 times more likely to report good general health and 1.6 times more likely to have no probable serious mental illness. The significance of these findings is discussed in relation to potential future research and policy. In terms of research, the analysis illustrates the utility of brief and cost-effective measures of health outcomes that could be used in future evaluations of specific programs targeting Indigenous youth participation in sport. We also discuss the potential ramifications, for practitioners and management professionals, of the particular policy paths needed to address the current gaps in service delivery to Indigenous communities, and for the development of grassroots, evidence-based, well resourced, culturally sensitive, inclusive and community-led programs. This can, in part, be achieved by ensuring youth sport development programs are shaped by Indigenous youth themselves.

Self-rated health and associated factors among older South Africans: evidence from the study on global ageing and adult health

Background: Population ageing has become significant in South African society, increasing the need to improve understandings of health and well-being among the aged.Objective: To describe the self-reported ratings of overall health and functioning, and to identify factors associated with self-rated health among older South Africans.Design: A national population-based cross-sectional survey, with a sample of 3,840 individuals aged 50 years and older, was completed in South Africa in 2008. Self-reported ratings of overall health and functioning were measured using a single self-reported health state covering nine health domains (used to generate the Study on Global Ageing and Adult Health (SAGE) composite health state score). Disability was measured using the World Health Organization Disability Assessment Schedule II (WHODAS-II) activities of daily living (ADLs), instrumental activities of daily living (IADLs), perceptions of well-being, and the World Health Organization Quality of Life index/metric (WHOQoL).Results: Overall, more than three quarters (76.8%) of adults rated their health as moderate or good. On balance, men reported very good or good health more often than women (p<0.001). Older people (aged 70 years and above) reported significantly poorer health status than those aged 50–59 (adjusted odds ratio (AOR) 1.52; 95% confidence interval (CI) 1.00–2.30). Indians and Blacks were significantly more likely to report poorer health status at (AOR = 4.01; 95% CI 1.27–12.70) and (AOR = 0.42; 95% CI 0.18_0.98; 30 p < 0.045), respectively, compared to Whites. Respondents with primary education (AOR = 1.83; 95% CI 1.19–2.80) and less than primary education (AOR = 1.94; 95% CI 1.37–2.76) were more likely to report poorer health compared to those with secondary education. In terms of wealth status, those in low wealth quintile (AOR = 2.02; 95% CI 1.14–3.57) and medium wealth quintile (AOR = 1.47; 95% CI 1.01–2.13) were more likely to report poorer health status than those in high wealth quintile. Overall, the mean WHODAS-II score was 20%, suggesting a low level of disability. The mean WHOQoL score for females (Mean = 51.5; SD = 12.2) was comparable to that of males (Mean = 49.1; SD = 12.6).Conclusion: The depreciation in health and daily functioning with increasing age is likely to increase demand for health care and other services as people grow older. There is a need for regular monitoring of the health status of older people to provide public health agencies with the data they need to assess, protect, and promote the health and well-being of older people.

Measuring Health Status: Self-, Interviewer, and Physician Reports of Overall Health

This study examines and compares respondent, interviewer, and physician ratings of overall health. Data are from the 2006 Social Environment and Biomarkers of Aging Study, a nationally representative survey of older adults in Taiwan. Ordered probit models are used to examine factors associated with self- and external assessments of health and discordant health ratings. Our results suggest similarities and differences in factors influencing health ratings across evaluators but a high level of interevaluator disagreement in ratings. Discrepancies in ratings between physicians and both respondents and interviewers are associated with the greater weight given to functional limitations and psychological well-being in interviewer and respondent ratings and to the importance of clinical measures or risk factors of illness and mortality in physician assessments. Interviewer and physician assessments may be complementary to self-assessed health measures. The importance and implications of these findings for future research are discussed.

Differences in the Use of Pain Coping Strategies Between Oncology Inpatients with Mild vs. Moderate to Severe Pain

The purposes of this study were to determine a clinically significant cutpoint for worst pain and to evaluate for differences in the use of pain coping strategies between oncology inpatients with mild (i.e., worst pain intensity scores of ≤4) compared with moderate to severe (i.e., worst pain intensity scores of >4) pain based on results of the cutpoint analysis. Oncology inpatients in pain ( n = 224) completed the Coping Strategies Questionnaire (CSQ), the Brief Pain Inventory, and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). Fifty-six percent had moderate to severe pain. Patients in the moderate to severe pain group had significantly poorer Karnofsky Performance Status scores ( P = 0.04) and significantly lower ratings of overall health ( P < 0.0001). No differences were found between the two pain groups on any of the subscales of the CSQ, except catastrophizing ( P < 0.0001). Compared with the mild pain group, patients in the moderate to severe group scored significantly higher on this subscale. In addition, patients in the moderate to severe group used more passive coping strategies ( P = 0.02). Except for catastrophizing, the number and types of pain coping strategies used by this sample of hospitalized patients do not appear to be influenced by their pain intensity scores. Finally, when the CSQ scores of these hospitalized oncology patients were compared with those found in previous studies of oncology outpatients and patients with chronic noncancer pain, the scores were similar.

Adolescents with asthma: predictors of quality of life

This paper is a report of a study to determine the demographic, personal, interpersonal and illness factors associated with asthma quality of life (QOL), as self-reported by adolescents from the United States of America (USA) and Iceland. Asthma affects 12% of children in the USA and an estimated 9% in Iceland. Limited research has addressed asthma QOL for adolescents. This cross-sectional exploratory study included adolescents with asthma (n = 15 from the USA; n = 15 from Iceland), aged 13-17 years, primarily recruited from paediatric practices in central Kentucky, USA and Reykjavik, Iceland. Data were collected in 2006. Adolescents in the USA (47% male) had a mean age of 14.1 years (sd = 1.5); Icelandic adolescents (73% male) had a mean age of 15.1 years (sd = 1.4). Participants completed questionnaires measuring sociodemographic and asthma characteristics, degree of limitations due to asthma, self-rated health, depressive symptoms and asthma QOL. Multiple regression was used to determine predictors of asthma QOL. Gender was statistically significantly associated with QOL. The difference in QOL between adolescents in the USA and Iceland was not statistically significant. Statistically significant predictors of higher asthma QOL were a better rating of overall health (P < 0.01), not having had a severe asthma attack in the last 6 months (P < 0.01), and lower depressive symptoms (P < 0.05). Interventions designed to decrease depression and prevent asthma exacerbations may improve QOL for adolescents with asthma.

Distress and breast cancer anxiety (BCA) among BRCA mutation carriers participating in MRI-based screening

20001 Background: MRI has consistently been shown to be a more sensitive screening tool than mammography (M) but its lower specificity could have negative psychological effects. In a pilot study (SABCS 2004) no adverse psychological effects of MRI screening were found. A larger study was then done to look particularly at the impact of imaging recalls and biopsies. Methods: BRCA mutation carriers having breast screening with annual M, MRI, and ultrasound (US) + 6monthly clinical breast examination (CBE) were asked to complete questionnaires: 1 - 2 wks pre, 4 - 6 weeks after, and 6 months after their imaging. Questionnaires included the hospital anxiety and depression scale (HADS), a modified Kash breast cancer anxiety scale (BCAS), the monitor/blunter scale, a rating of overall health on a linear analog scale, a 4 category rating of anxiety related to each screening modality, and a description of any recent life altering events. Results: 54 women (29 BRCA1, 25 BRCA2) completed at least 2 questionnaires (median 3, range 2–5). Mean age was 44 (range 28–64). 26% were surveyed during their 1st round of screening. There was a very strong correlation between the BCAS and HADS anxiety with 19 (35%) having baseline BCA of whom 15 (79%) were monitors compared to 60% monitors among the patients without BCA. At baseline 41 (76%) indicated moderate/high MRI related anxiety compared to 61%, 46%, and 43% for M, U/S and CBE. Of the 16 patients (30%) who had recalls ± biopsy (n = 5) while on this study, 10 (63%) had elevated BCA and 3(19%) increased depression at baseline. In all but 2 women whose anxiety increased due to life events, no scores changed significantly after recall or biopsy. Only 1 cancer was diagnosed during the study period. In the other 38 women scores changed significantly only as a result of life events. Conclusions: Despite a high false positive rate, MRI-based screening had no detectable adverse psychological effects on BRCA mutation carriers in this study. No significant financial relationships to disclose.

Expectations of recovery from revision knee replacement

To evaluate outcome expectations of patients undergoing revision total knee replacement (TKR) and to examine personal factors, patient functioning, previous experiences with knee replacement surgery, concerns about surgery, and general health as predictors of expectations. Revision TKR patients (n = 184, 54% women; mean age 69 years) completed a questionnaire up to 2 weeks before surgery. This included demographics, experience with previous knee surgery, concerns about surgery, the Life Orientation Test (LOT), the Arthritis Helplessness Scale, the Western Ontario and McMaster Universities Osteoarthritis Index, and a rating of overall health. Outcome expectations were evaluated as 5 questions assessing global benefit; relief of pain; ease of disability; expectations of having complications; and whether the person expected to be fully recovered from surgery in <6 months, 6-12 months, >12 months, or did not expect to recover. Predictors of each of the 5 outcome expectations were evaluated using univariable and multivariable regression analyses. Expectations are a multidimensional construct (Cronbach's alpha = 0.63). Expectation of global benefit of surgery was high, but was lower for benefits related to ease of pain and improved function. Concerns about surgery were a consistent predictor of all expectation outcomes in multivariable modeling. When concerns about surgery and general health were entered into the model as an interaction with expectation of recovery time as the outcome, past experience (P = 0.05), pain (P = 0.03), LOT (P = 0.03), and interaction between concerns about surgery and general health were significant predictors. Clinicians need to understand and help patients shape appropriate expectations for recovery from revision TKR.

Prospective assessment of quality of life in ovarian cancer patients receiving whole abdomen hyperthermia and liposomal doxorubicin

Purpose: Prospective assessment of quality of life (QoL) in patients with refractory, residual or recurrent ovarian cancer receiving whole abdomen hyperthermia and intravenous liposomal doxorubicin chemotherapy.Methods: Treatment consisted of six cycles of intravenous liposomal doxorubicin at 40 mg m2 followed by whole abdomen hyperthermia with each cycle delivered every 4 weeks. QoL assessment was performed at baseline, prior to each cycle of chemotherapy and every 3 months during follow-up using self-administered questionnaires. Global QoL was rated on a seven-point scale and specific domains of QoL, disease related symptoms and treatment related toxicity were rated on a four-point scale.Results: Thirty-two patients were enrolled on the study and 129 QoL questionnaires were completed. Average age was 57.9 (range 45–76); nine patients had persistent and 23 recurrent disease. Ten patients completed six cycles of therapy. Three patients returned follow-up surveys. Subjects rated their overall QoL and health at baseline as above average with mean scores 5.10 (95% CI = 4.62−5.58) and 4.66 (95% CI = 4.23−5.08), respectively. No significant change in overall QoL was found between baseline and cycles 4–6 of therapy. Mean ratings of overall health and subject reported differences in QoL between cycles were not significantly changed during therapy. Limited follow-up data were available, but scores suggest possible improvement in QoL for patients completing all therapy. Subjects rated the greatest negative impact on QoL in areas of role functioning and social functioning, where the mean (SD) over all cycles was 2.00 (0.67) and 1.98 (0.70), respectively. For physical symptoms, fatigue and sleep disturbance had the most negative impact on QoL with means (SD) of 2.26 (0.62) and 1.91 (0.70). The moderate treatment related toxicity seen in this study did not significantly impact patients reported QoL.Conclusions: Patients with unfavourable ovarian cancer responding to intravenous liposomal doxorubicin and whole abdomen hyperthermia maintained above average QoL during therapy. Limited data on patients completing protocol therapy demonstrated possible improvement in QoL.

Health of children in title XXI: should we worry?

Health of children in title XXI: should we worry?

Effects of a Contemporary, Exercise-Based Rehabilitation and Cardiovascular Risk-Reduction Program on Coronary Patients With Abnormal Baseline Risk Factors

Phase II cardiac rehabilitation programs are associated with improvements in exercise tolerance, coronary risk factors, and psychosocial well-being. Nevertheless, previous reports have generally evaluated the global effectiveness of these programs (ie, on all subjects, collectively), which may serve to camouflage or attenuate the impact of these interventions on specific patient subsets. In this study, we investigated the effectiveness of a contemporary, exercise-based cardiac rehabilitation program that included a cardiovascular risk-reduction intervention, using a computerized database on 117 patients (average age, 66.5 years; 68% men; 96% white) who completed pre-phase II and post-phase II evaluations. Exercise training involved three 45- to 60-min sessions per week at minimum of 40 to 50% to a maximum of 75% oxygen uptake for 6 to 8 weeks. The effectiveness of the exercise training program was substantiated by significant (p <or= 0.05) reductions in heart rate (- 8 beats/min), systolic BP (- 11 mm Hg), and rating of perceived exertion (- 2, 6 to 20 scale) at a standard submaximal workload. Initial and follow-up ratings of overall health were improved: excellent (2.6 to 4.3%) and very good (20.7 to 35.7%). Average changes (p <or= 0.05 unless otherwise indicated) for all participants and those with abnormal baseline risk factors were as follows: systolic BP (- 4 mm Hg and - 16 mm Hg); diastolic BP (- 5 mm Hg and - 18 mm Hg); total cholesterol (- 19 mg/dL and - 75 mg/dL); low-density lipoprotein cholesterol (- 17 mg/dL and - 61 mg/dL); high-density lipoprotein cholesterol (- 1 mg/dL [not significant] and + 11 mg/dL); and triglycerides (- 5 mg/dL [not significant] and - 82 mg/dL), respectively. The present findings suggest that a positive correlation generally characterizes the change in coronary risk factors subsequent to a contemporary phase II cardiac rehabilitation program. Patients with the worst coronary risk factor profiles at baseline demonstrated the greatest improvements.

Primary care, self-rated health, and reductions in social disparities in health.

To examine the extent to which good primary-care experience attenuates the adverse association of income inequality with self-reported health. Data for the study were drawn from the Robert Wood Johnson Foundation sponsored 1996-1997 Community Tracking Study (CTS) Household Survey and state indicators of income inequality and primary care. Cross-sectional, mixed-level analysis on individuals with a primary-care physician as their usual source of care. The analyses were weighted to represent the civilian noninstitutionalized population of the continental United States. Principal component factor analysis was used to explore the stricture of the primary-care indicators and examine their construct validity. Income inequality for the state in which the community is located was measured by the Gini coefficient, calculated using income distribution data from the 1996 current population survey. Stratified analyses compared proportion of individuals reporting had health and feeling depressed with those with good and bad primary-care experiences for each of the four income-inequality strata. A set of logistic regressions were performed to examine the relation between primary-care experience, income inequality, and self-rated health. Good primary-care experience, in particular enhanced accessibility and continuity, was associated with better self-reported health both generally and mentally. Good primary-care experience was able to reduce the adverse association of income inequality with general health although not with mental health, and was especially beneficial in areas with highest income inequality. Socioeconomic status attenuated, but did not eliminate, the effect of primary-care experience on health. In conclusion, good primary-care experience is associated not only with improved self-rated overall and mental health but also with reductions in disparities between more- and less-disadvantaged communities in ratings of overall health.

Patient-centered processes of care and long-term outcomes of myocardial infarction

To examine whether patients' experiences with nontechnical aspects of care such as patient education and discharge planning are associated with long-term outcomes. Observational cohort study. Twenty-three New Hampshire hospitals during 1996 and 1997. Acute myocardial infarction (AMI) patients (N=2,272) enrolled prior to discharge. Surveys asking about problems with care and health were mailed to patients 1, 3, and 12 months after discharge. Patients were stratified into "worse" or "better" care groups on the basis of their hospital care problem score. Outcomes included self-reported overall health, physical health, mental health, chest pain, and shortness of breath. Other clinical measures were obtained from hospital discharge abstracts. The 1-, 3-, and 12-month surveys were returned by 1,346 (59.2%), 1,046 (46%), and 964 (42.4%) enrolled patients, respectively. The primary analytic cohort consisted of the 762 patients who completed both the 1- and 12-month surveys. After adjustment for postdischarge health status and other clinical factors, patients experiencing worse hospital care had lower ratings of overall health (48.4 vs 52.5 on 100-point scale; P=.02) and physical health (59.7 vs 68.4; P <.001), and were more likely to have chest pain (odds ratio [OR], 1.6; confidence interval [CI], 1.0 to 2.4; P=.04) 12 months after their AMI than other patients. However, differences in reports of chest pain were reduced if patients reporting worse hospital care had better experiences with subsequent ambulatory care. Patients' experiences with nontechnical processes of AMI hospital care are associated with long-term outcomes; however the association between a negative hospital experience and subsequent chest pain may be offset by more positive outpatient experiences.