Risk Factor For Poor Quality Of Life Research Articles

Adult congenital heart diseases: systematic review/meta-analysis.

Congenital heart disease (CHD) is a gross structural abnormality of the heart that has functional significance. The impact of CHD on the patients' quality of life (QOL) is a topic of considerable interest and importance to both researchers and clinician. However, there is a lack of systematic reviews investigating and identifying the QOL of congenital heart disease patients. To assess the QOL of adult patients with congenital heart disease by reviewing the previous studies conducted on this subject. The PubMed and Google Scholar databases were explored for studies published between 2020 and 2022. The keywords used for the searching process included "QOL, Adults, CHD, Outcomes, Impact, Effects, Life of CHD Patients." The inclusion criteria were original English articles and full-text articles conducted on adult patients with congenital heart disease and reported quality of life. A total of 5455 articles were obtained, but only seven articles were eligible for the inclusion criteria. The included studies involved a total of 8549 participants; 104 were healthy, and 8445 were adult patients with congenital heart disease. The investigated items of the studies included quality of life, health-related QOL, including physical and psychological dimensions, sense of coherence, mental health, physical functioning, physiological wellbeing, psychological resilience, anxiety, depression, illness perception, and health status. Patients with congenital heart disease experience low QOL across all dimensions. The risk factors for poor QOL included age, depression, anxiety, and female gender.

Factors Associated with Poor Quality of Life in Breast Cancer Survivors: A 3-Year Follow-Up Study.

The purpose of this study was to identify subgroups of quality of life (QOL) changes in breast cancer survivors (BCSs), and to determine factors associated with subgroups of consistently low or deteriorated QOL. We enrolled 101 women recently diagnosed with breast cancer in South Korea and asked them to complete a questionnaire at baseline (within 1 month of diagnosis), 1 year later (Year 1), 2 years later (Year 2), and 3 years later (Year 3). We assessed QOL using the global QOL subscale from the EORTC QLQ-C30. We defined low QOL as a global QOL score 10 points below the mean score of the general population. Based on low QOL as defined in this study, we identified subgroups of QOL changes over 3 years. We identified four subgroups of QOL changes: improved (47.4%), stable (30%), continuously low (8.8%), and deteriorated (13.8%), and considered the last two categories (22.6%) poor QOL. Logistic regression analyses demonstrated that significant determinants of poor QOL were insomnia at Year 1, fatigue and anxiety at Year 2, and fatigue, depression, and comorbidity at Year 3. In conclusion, persistent symptoms of insomnia, fatigue, anxiety, depression, and comorbidity are potential risk factors for poor QOL in BCSs.

Mothers of Children With Special Health Care Needs: Exploring Caregiver Burden, Quality of Life, and Resiliency

This study aimed to explore caregiver burden, quality of life (QOL), and resilience in mothers of children with special health care needs (CSHCN), compare differences between mothers of CSHCN and healthy children, and differences between mothers of CSHCN on the basis of child severity. Mothers (n=106) with a child aged < 18 years were recruited. A cross-sectional design was used. Measures included the Caregiver Burden Inventory, Quality of Life Scale, and Brief Resilience Inventory. Pearson point-biserial correlations and independent t-tests were used to compare group differences. Caregiver burden and QOL were negatively correlated (p < .001). Mothers of CSHCN had greater burden (p < .001) and poorer QOL (p=.006). Child severity increased caregiver burden time (p=.003). Study findings expound on research indicating mothers of CSHCN experience greater burden and poorer QOL than their peers, and child severity increases burden via time commitment. Health care providers should assess risk factors for poor QOL and caregiver burden and provide appropriate resources.

Relationships Among Smartphone Use, Physical Activity, and Quality of Life in Chinese College Students.

This study aimed to investigate the correlations between smartphone use, physical activity, and quality of life (QOL) among Chinese college students. We enrolled 6323 students who were chosen from three Chinese universities. All participants completed the World Health Organization QOL Scale-Brief, Smartphone Addiction Index, and Physical Activity Questionnaire-Short Form. Smartphone addiction was negatively related to QOL (β = -1.375), whereas physical activity was positively related to QOL (β = .059). The presence of both smartphone addiction and insufficient physical activity decreased QOL scores when compared with the group with sufficient physical activity and non-smartphone addiction (β = -36.505). Physical activity and smartphone use are potentially modifiable risk factors for poor QOL in college students. Thus, interventions to decrease smartphone use and promote physical activity could be beneficial for improving QOL in this population.

Construction and Verification of Predictive Model for Influencing Factors of Quality of Life in Patients with Type 2 Diabetic Nephropathy: A Hospital-Based Retrospective Study.

The influencing factors of quality of life (QOL) in patients with type 2 diabetic nephropathy (T2DN) were explored, a practical risk prediction model was constructed and independent verification was conducted. The clinical data of 273 patients with T2DN in Tai'an Maternal and Child Health Care Center from February 2021 to February 2023 were used for retrospective analysis, and the patients were divided into modelling group (n = 173) and validation group (n = 100). According to 36-item short form health survey (SF-36) scores, the research subjects in the modelling group were divided further into poor group (n = 78) and good group (n = 95). Multivariate logistic regression was used in analysing the influencing factors of QOL and establishing a clinical prediction model based on the results. Then, a receiver operating characteristic (ROC) curve was used in evaluating the model's prediction efficiency. Remarkable differences in age, duration of diabetes, presence or absence of hypertension, education level, exercise frequency and family monthly income were found among the patients (p < 0.001). Multivariate logistic regression analysis suggested age ≥60 (odds ratio (OR) = 3.395, 95% CI = 1.269-9.083), duration of diabetes ≥3 years (OR = 4.574, 95% CI = 1.623-12.885), presence of hypertension (OR = 4.011, 95% CI = 1.490-10.796), education level of junior high school and below (OR = 7.318, 95% CI = 3.648-14.678), no or little exercise (OR = 3.948, 95% CI = 1.989-7.839) and family monthly income <3500 yuan (OR = 2.871, 95% CI = 1.089-7.573) are risk factors for poor QOL (p < 0.05). The regression model was logit (p) = -5.412 + 1.222X1 + 1.520X2 + 1.389X3 + 1.990X4 + 1.373X5 + 1.055X6 (X1 as age ≥60, X2 as duration of diabetes ≥3 years, X3 as presence of hypertension, X4 as education level of below junior high school, X5 as no or little exercise and X6 as family monthly income <3500 yuan). Based on this model, the ROC curve showed that the AUC value, standard error and 95% CI were 0.842, 0.043 and 0.758-0.926, respectively. An analysis was made on the re-included 100 patients, and the predictive sensitivity, specificity and Kappa coefficient of the constructed model were 82.10%, 86.90% and 0.703. Age ≥60, duration of diabetes ≥3 years, presence of hypertension, education level of junior high school and below, no or little exercise and family monthly income <3500 yuan were independent influencing factors for poor QOL in patients with T2DN. The use of this model has certain clinical application value.

Assessment of quality of life in asthmatic children and adolescents: A cross sectional study in West Bank, Palestine

Asthma is one of the most common chronic illnesses among children and adolescents. It can severely affect their quality of life (QoL). Our study assessed the QoL and analyzed potential risk factors for poor QoL among asthmatic children and adolescents. This was a cross-sectional comparative study. Pediatric Asthma Quality of Life Questionnaire (PAQLQ) was used to measure the QoL and Asthma Control Test (ACT) was used to evaluate asthma control. The Chi-square test and independent t-test were used to compare variables. We used Multivariate logistic regression to identify the association between determinants and outcomes. Statistical significance was set at p<0.05. We recruited 132 participants. We found that 47 patients (35.6%) had controlled Asthma and 85 patients (64.3%) had uncontrolled Asthma. When compared to uncontrolled asthma individuals, participants with controlled asthma had improved QoL and scored significantly higher in the symptom domain (P = 0.002), activity domain (P = 0.004), emotional domain (P = 0.002), and overall PAQoL scores (P = 0.002). Hospital admission affects significantly all domains of PAQOL (P<0.05). Poor QoL was significantly associated with hospitalization for asthma (OR = 3.4; CI: 2.77-3.94, P = 0.01), disease severity (OR = 3.0; CI: 2.41-3.61, P = 0.01), uncontrolled asthma (OR = 2.88; CI: 2.21-3.41, P = 0.019), and male gender (OR = 2.55; CI: 1.88-2.91, P = 0.02). The results of the present study showed that in children and adolescents, uncontrolled asthma, disease severity, and previously hospitalized patients were associated with poor QoL. These factors must be considered when planning a comprehensive care plan for a better quality of life.

Urinary incontinence and quality of life: A longitudinal analysis from the English Longitudinal Study of Ageing

ObjectivesTo explore the longitudinal association between urinary incontinence (UI) and quality of life (QoL) in the English Longitudinal Study on Ageing, a large study of older UK adults with ten years of follow-up. Study designCohort study. Main outcomes interestTo determine the presence of UI, participants reported whether they had lost urine beyond their control in the last 12 months. Participants also reported whether UI lasted more than one month, indicating a more chronic problem. QoL was measured using the CASP (control, autonomy, self-realisation and pleasure)-19, with higher values indicating a higher QoL. ResultsOf the 8028 participants (mean age: 65.2 years; 56.7% females) included, 1172 reported UI at baseline. No significant differences in CASP-19 score were found at baseline (p = 0.24). In people with UI, a significant decline in CASP-19 score (from 34.3 ± 14.0 at baseline to 30.9 ± 16.1 in wave 7) (p = 0.016) was observed. The results were stronger in men than in women and with a longer duration of UI. ConclusionUI was associated with poor QoL over ten years of follow-up in a large cohort of UK participants. Our findings further suggest the importance of UI as a potential risk factor for poor QoL.

Assessment of Pelvic Floor Function and Quality of Life in Patients Treated for Cervical Cancer: A Multicenter Retrospective Study

Objectives: Our study aimed to evaluate the quality of life (QoL) and pelvic floor function of cervical cancer (CC) patients after treatment. Design: This was a cross-sectional observational cohort study. Participants: The participants included in this study were CC patients who underwent radical hysterectomy (RH) from 2012 to 2018 at 18 medical centers across China. Methods: The validated versions of the Pelvic floor Distress Inventory-Short Form 20, Overactive Bladder Symptom Score, and Euro Qol Five-Dimension questionnaires were used to evaluate postoperative pelvic floor dysfunction (PFD) and QoL. Results: A total of 689 CC patients were enrolled. The incidence of stress urinary incontinence (SUI), incomplete urinary emptying, and constipation were 32.7, 27.7, and 28.6%, respectively. Multivariate analysis confirmed that laparoscopic RH (LRH) and vaginal wall resection greater than 3 cm were risk factors for lower urinary tract symptoms (LUTS). LRH and chemotherapy were risk factors for SUI. Chemoradiotherapy and LRH were risk factors for overactive bladder (OAB). A high body mass index and LRH were risk factors for more severe defecation symptoms. ARH and large amount of operative blood loss were risk factors for poor QoL. Conclusion: PFD is common in CC patients after treatment. LRH seems to increase the postoperative distress, including LUTS and defecation symptoms. Postoperative urinary incontinence and OAB are more bothersome for patients undergoing chemotherapy and radiotherapy. We recommend evaluating pelvic floor function as a standard assessment during follow-up.

Quality of life of families with celiac disease children in Eastern Province of Saudi Arabia

Objectives: The prevalence of Celiac Disease (CD) is increasing worldwide, and the kingdom of Saudi Arabia reports the highest seroprevalence rate. A strict Gluten-Free Diet (GFD) for lifetime is the only therapy to CD patients. It has been demonstrated that childhood CD negatively affects the health of parents. On the other hand, the emotional and social wellbeing of the parents has a great impact on the Quality Of Life (QOL) of CD children. However, limited literatures are available on the QOL of parents of CD children. This study aims to evaluate the QOL of families of celiac disease children on GFD treatment and identify modifiable risk factors for poor QOL. Methods: A total of 73 children with celiac disease living in different cities of the eastern province of the kingdom of Saudi Arabia were included in this descriptive, cross-sectional study. A modified version of the celiac disease-specific instrument measuring the QOL was used. Data analyses were done using descriptive statistics, correlation coefficient test and the Fisher’s exact test. Results: The mean QOL score was found to be 65.8 and the median was 64.0. Very few (5.48%) parents perceived their QOL to be good, while majority of them (78.08%) considered it as moderate; and the remaining parents (16.44%) regarded it as poor. Conclusions: We found that small-sized families, with young and educated mothers have a better QOL than others. Most of the emotional and psychosocial elements of QOL were related to the difficulties in availability of GFD in daily life.

Quality of life in children with tuberous sclerosis complex: A pediatric cohort study.

AimsTo evaluate the quality‐of‐life (QOL) impairment and identify the possible risk factors in patients with tuberous sclerosis complex (TSC) in China.MethodsThe parent proxy‐report PedsQL 4.0 Generic Core Scales were administered to 124 caregivers of children with TSC (aged 2‐18 years). For comparison, the survey was also conducted in a demographically group‐matched sample of healthy controls (HCs) (aged 2‐18 years).ResultsA total of 124 children with TSC and 206 HCs were recruited. The mean parent proxy‐report total scale score, physical health summary score, and psychosocial health summary score for children with TSC were 65.0 (SD 19.7), 77.6 (SD 22.9), and 58.0 (SD 21.3), respectively, compared with the HC values of 83.6 (SD 14.3), 87.2 (SD 16.9), and 82.8 (SD 15.9). There were statistically significant differences between the two groups (P < .0001). TSC2 mutation (P = .033), epilepsy (P = .011), seizure before 2 years old (P = .001), course of epilepsy (more than 2 years) (P = .001), high reported seizure frequency (more than once a month) (HRSF) (P = .007), multiple antiepileptic drugs (≥2) (P = .002), intellectual disability (ID) (mild and moderate ID, P < .0001, and severe and profound ID, P < .0001), and TANDs (P < .0001) (ADHD, P = .004; agoraphobia, P = .007; and social anxiety disorder, P < .0001) were closely related to lower QOL scores.ConclusionThis study is the first large cohort study on QOL in children with TSC in China. The results of the PedsQL 4.0 indicated that the QOL of children with TSC is significantly lower than that of HCs. TSC2 mutation, epilepsy, early onset, long disease course and HRSF, ID, and TANDs are risk factors for poor QOL.

Predictors of quality of life in bipolar disorder: A path analytical study

Quality of life (QoL) is an important outcome in psychiatric illnesses like bipolar disorder (BD). However, little is known about the variables that affect it, and therefore contribute to prognosis and treatment outcomes in these populations. This study aimed to explore QoL in BD and investigate its relationship with modifiable (cognitive reserve, cognitive ability, mood symptoms) and non-modifiable factors (diagnosis, previous suicide attempts, substance misuse, age). The WHOQOL-bref was administered to 121 control participants and 109 patients with BD, who also underwent clinical and neuropsychological assessments. Factor analysis was used to identify latent constructs underlying WHOQOL-bref domains, and structural equation models were used to examine predictors of each latent construct. Two latent constructs were identified in the WHOQOL-bref, and labeled ‘Personal’ and ‘Social’ QoL. Both were directly predicted by depression symptoms and a diagnosis of BD, and indirectly predicted by (hypo)manic symptoms. Cognitive reserve was a stronger predictor of social QoL than a diagnosis of BD. Our findings suggest that the management of depression symptoms and fostering of cognitive reserve may improve QoL in BD. A diagnosis of BD and/or substance use disorders were risk factors for poor QoL, and may signal the need for preventive interventions to promote well-being.

The impact of co-morbidity on the quality of life of people with dementia: findings from the IDEAL study.

BackgroundThe aim was to investigate the co-morbidity profile of people with dementia and examine the associations between severity of co-morbidity, health-related quality of life (HRQoL) and quality of life (QoL).MethodsThe improving the experience of Dementia and Enhancing Active Life (IDEAL) cohort consisted of 1,547 people diagnosed with dementia who provided information on the number and type of co-morbid conditions. Participants also provided ratings of their health-related and dementia-specific QoL.ResultsThe majority of the sample were living with more than one chronic condition. Hypertension was commonly reported and frequently combined with connective tissue disease, diabetes and depression. The number of co-morbid conditions was associated with low QoL scores, and those with severe co-morbidity (≥5 conditions) showed the greatest impact on their well-being.ConclusionsCo-morbidity is an important risk factor for poor QoL and health status in people with dementia. Greater recognition of the nature and impact of co-morbidity is needed to inform support and interventions for people with dementia and a multidisciplinary approach to care provision is recommended.

1684PD_PR - Physical activity (PA) and patterns of quality of life (QOL) after adjuvant chemotherapy (CT) for breast cancer (BC)

Background: We aimed to describe longitudinal patterns of QOL and the interplay between PA and risk of QOL deterioration among BC patients (pts). Methods: We used a French prospective longitudinal clinical study (CANTO, NCT01993498) to identify 2525 stage I-III BC pts treated with adjuvant CT from 2012-14. PA exposure (GPAQ 16) and QOL (EORTC QLQ C30/B23) were reported by pts before CT, and at 3-6 and 12 months after CT. Pts with levels of PA ≥ 10 MET-hours/week were considered physically active (as per WHO recommendations on PA). Poor QOL was defined by functional scores <60 and symptoms scores ≥40 (Giesinger, 2016). We used multivariate mixed models to assess patterns of QOL and group based trajectory models to identify clusters of pts with poor QOL and associated risk factors, adjusting for PA as time dependent covariate. Results: Mean age (Standard Deviation, SD) was 52 y (11). 57%, 62% and 63% pts were physically active before CT, 3-6 and 12 months after CT, respectively. QOL scores before CT were higher among physically active vs inactive pts, including (mean [SD]): global health status (GHS) (69 [1.4] vs 65 [1.4]), physical (90 [1.1] vs 87 [1.1]) and emotional function (65 [1.9] vs 62 [1.9]) (all adjusted p<.05). QOL significantly worsened after CT, but scores remained higher among active pts (p<.001). A cluster of 33% pts had high and persistent risk of poor GHS: associated factors included comorbidities vs no (adjusted odds ratio 1.4 [95% Confidence Interval 1.1-1.9]), low income vs high (1.6 [1.2-2.0]), smoking vs no (1.3 [1.1-1.6]), mastectomy vs partial surgery (1.2 [1.1-1.6]). A significant interaction between recommended levels of PA and risk of poor GHS was observed (p<.001). Consistent with GHS, we found clusters of pts with high risk of poor QOL across physical, emotional and multiple other QOL domains, with similar risk factors and significant interactions with recommended levels of PA. Conclusions: Among this large cohort of BC survivors, QOL significantly worsened after CT. We were able to group pts following distinct longitudinal patterns of QOL and to identify clinical, socio-economical, and treatment risk factors for poor QOL, including PA behavior. Interventional strategies that also promote PA may help prevent QOL deterioration after CT. Clinical trial identification: NCT01993498. Legal entity responsible for the study: UNICANCER. Funding: A. Di Meglio: Recipient of the 2017 ESMO Clinical Research Fellowship Award. I. Vaz-Luis: Research grants: Susan Komen for the Cure, and "Association pour la Recherche sur le Cancer (ARC)". Disclosure: All authors have declared no conflicts of interest.

A systematic review of factors related to children's quality of life and mental health after brain tumor

Brain tumor has been found to have a major impact on children's quality of life (QOL); yet, the subjective impact of the illness is still not well understood. This review aimed to investigate factors related to children's subjective well-being (SWB), or self-reported QOL and mental health after brain tumor. A further aim was to determine the consistency between child and parent-proxy ratings of children's SWB and common factors associated with both child and parent-proxy ratings. A systematic search of PsycINFO, MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Embase, and Scopus was conducted from 1980 to May 2018 to identify eligible studies. Methodological quality of these studies was assessed by 2 independent reviewers. Twenty studies investigated factors related to children's self-reported mental health or QOL. Fourteen studies examined these factors from the perspectives of both children and their parents. Overall, risk factors for poor QOL included infratentorial tumors, radiation, hydrocephalus, lower IQ, and behavioral problems. Only 5 studies examined mental health outcomes, the findings of which were mixed. Relatively few studies examined psychosocial variables related to children's SWB. Although several risk factors for poor QOL were identified, further research investigating mental health outcomes and the influence of psychosocial factors on children's SWB is needed to guide support interventions for pediatric brain tumor.

Combat exposure, emotional and physical role limitations, and substance use among male United States Army Reserve and National Guard soldiers

Combat-exposed soldiers are at an increased risk for health problems that diminish quality of life (QOL) and substance use. We explored the cross-sectional associations between combat exposure and two measures of QOL, and the effect of substance use on those associations. Data are from the baseline wave of Operation: SAFETY, an ongoing survey-based study of United States Army Reserve/National Guard (USAR/NG) soldiers and their partners. Our sample consisted of male USAR/NG soldiers with a history of deployment (N = 248). Limitations in usual activity due to physical and emotional problems were assessed using the 36-Item Short-Form Health Survey (SF-36). Greater combat exposure was independently associated with limitations in usual activity due to physical (regression coefficient = -0.35, 95% CI -0.55 to -0.16, R 2 = 0.09; p < 0.01) and emotional (regression coefficient = -0.32, 95% CI -0.56 to -0.09, R 2 = 0.09; p < 0.01) problems. Combat exposure had a significant interaction with frequent heavy drinking on physical role limitations (regression coefficient = -0.65, 95% CI -1.18 to -0.12, R 2 = 0.12; p < 0.05) and emotional role limitations (regression coefficient = -0.83, 95% CI -1.46 to -0.19, R 2 = 0.12; p < 0.05). Combat exposure also had a significant interaction with lifetime non-medical use of prescription drugs on physical role limitations (regression coefficient = 0.81, 95% CI 0.18-1.45, R 2 = 0.11; p < 0.05). Combat is an unmodifiable risk factor for poor QOL among soldiers; however, frequent heavy drinking and non-medical use of prescription drugs modifies the relationship between combat exposure and QOL. Therefore, substance use is a potential point of intervention to improve QOL among soldiers.

The impact of peer victimization and psychological symptoms on quality of life in children and adolescents with systemic lupus erythematosus.

There is no documentation about the association between peer victimization, psychological status, and quality of life (QOL) in children and adolescents with systemic lupus erythematosus (SLE). The aim of this study was to evaluate the association between peer victimization, psychological symptoms, and QOL in a cohort of children and adolescents with SLE. Forty-one patients (aged 9-18years) participated in this study. The control group (n=49) was composed of healthy children and adolescents from local community. Questionnaires were used to evaluate the peer victimization, psychological status, and QOL of children and adolescents with and without SLE. No significant difference was found between the study and control groups for peer victimization, depression, state and trait anxiety, and QOL scores. The peer victimization, depression, anxiety, and self-esteem scores were negatively correlated with psychosocial and total subscale scores of QOL in the study group. According to regression analyses, trait anxiety had a negative predictive effect on the physical health domain scores of QOL, whereas trait anxiety and peer victimization had a negative effect on the psychosocial domain and total scores of QOL in the SLE patients. This study suggests that trait anxiety and peer victimization are risk factors for poor QOL in adolescents with SLE.

Associations of self-neglect with quality of life in older people in rural China: a cross-sectional study.

Elder self-neglect (ESN) has become a public health issue globally. Limited studies have focused on ESN, as well as the relationship between ESN and quality of life (QoL) in developing countries. The study's objective is to explore the association between ESN and QoL among rural elderly in China. A cross-sectional study was conducted among 3,182 elder adults aged 60 years or older, using a cluster-sampling technique in one township in Dangtu, a county in Anhui province. All participants completed face-to-face interview in their household. QoL was assessed using a brief form of the World Health Organization's quality of life questionnaire (WHOQOL-BREF), and ESN was assessed using the Scale of the Elderly Self-neglect (SESN). Hierarchical linear regression models were used to analyze the associations between the ESN scores and QoL scores after adjusting for sociodemographic, social support, and physical and psychological variables. The scores of overall ESN and five domains were significantly correlated with the scores of four QoL domains (p < 0.001). After adjusting for sociodemographic characteristics, social support, and physical and psychological health characteristics, elders who reported higher overall self-neglect scores had significantly lower scores in the four QoL domains (p < 0.001). Education, economic level, physical health, ADL, depression, and cognitive function are consistent predictors across all QoL domains. ESN is an independent risk factor for poor QoL in elderly people in rural China. Understanding the role of ESN and its influence on QoL is important for the management of and intervention in ESN.

Anxiety-depressive Symptoms in Patients with Chronic Obstructive Pulmonary Disease (COPD) and Impact on Outcome

Objectives: Psychological distress and adversities are more common in Chronic obstructive pulmonary disease (COPD) patients compared with other chronic illnesses. In addition, anxiety and depressive symptoms have evident impacts on COPD patients outcome. The present study designated to investigate whether anxiety and depressive symptoms occur more common in patients with severe and very severe COPD than controls. Also, we assessed the relationship between anxiety-depressive symptoms and quality of life (QOL), functional status and impairment, exacerbations, re-hospitalization, length of stay (LOS) and mortality prediction. Methods: The study sample included 220 patients with severe and very severe COPD, and 220 non-COPD patients as controls. Anxiety-depressive symptoms were assessed in COPD and controls using the Hospital Anxiety and Depression scale (HAD). The COPD group is divided into two groups: the depressed and non-depressed groups. Both groups were followed up for 12 months. Results: The prevalence of anxiety-depressive symptoms was highly significant in severe and very severe COPD patients than non-COPD patients (44.5% compared with 14.5% in controls) When the results were adjusted, the risk was 3.5 times greater for patients. Anxiety-depressive symptoms were significantly associated with more mortality, longer LOS, failure of smoking cessation and worse Saint George Respiratory Questionnaire (SGRQ). Conclusion: Anxiety-depressive symptoms occur more common in patients with severe and very severe COPD than in controls. In addition, anxiety-depressive symptoms are important risk factor for poor QOL, poor functional status and impairment, more exacerbations, more re-hospitalizations, prolonged LOS, failure of smoking quitting and more mortality. Anxiety-depressive symptoms were risk factor independent of physiological measure of disease severity (e.g. FEV1).

Living with untreated prostate cancer

To summarize the literature on the predictors of quality of life (QoL) of patients with prostate cancer (PCa) on active surveillance and to highlight both risk factors of poor QoL and resilience factors that facilitate decision-making and promote adherence to active surveillance. Four main clusters of predicting variables have been highlighted: decision-making-related issues (patient's perception of the influence of physicians on the choice of active surveillance was related to higher decisional conflict; smaller amount of time to make a decision was predictive of poor QoL); demographic variable (such as marital status, age, and education level); psychological individual and interpersonal characteristics (neuroticism and impaired mental health were found to be associated with poor QoL, whereas positive outlook toward cancer was predictive of considering active surveillance as an effective management option for PCa); and patients' perceptions of cancer characteristics (prostate-specific antigen and number of positive cores). Men who choose active surveillance may present unique care needs. Identification of the most relevant risk factors for poor QoL can be useful to physicians who aim to target the psychosocial issues that patients and their families may need to address promptly. Predictive models could be used to identify active surveillance patients who present features of psychosocial vulnerability and to develop tailored psychoeducational interventions.

Impact of bile duct injury after laparoscopic cholecystectomy on quality of life: a longitudinal study after multidisciplinary treatment

Bile duct injury (BDI) is associated with increased morbidity and poor survival. The aim of the present study was to compare quality of life (QoL) between patients with BDI and those without after laparoscopic cholecystectomy. A longitudinal assessment was performed and risk factors for poor QoL were determined. In March 2005 a survey was performed of 403 eligible patients with BDI who were referred to a tertiary center for multidisciplinary treatment by gastroenterologists, radiologists, and surgeons. A longitudinal quality-of-life study was performed to determine changes in outcome after a mean of 5.5 and 11 years' follow-up. Of the eligible 403 patients with BDI, 278 (69 %) responded to the survey after a mean follow-up of 5.9 years. The quality-of-life outcome of injured patients was significantly lower in three of the eight domains compared to patients who underwent cholecystectomy without an injury ( P < 0.05). In seven of the eight QoL domains injured patients scored significantly worse than the healthy population norms ( P < 0.05). The longitudinal assessment after another 5.5 years of follow-up did not show improvement in QoL. Clinical characteristics such as the type of injury and the type of treatment did not affect outcome. Nineteen percent of the patients (n = 53) filed a malpractice claim after BDI. These patients reported better QoL (effect size = 0.6, P = 0.02) when the claim was resolved in their favor than when the claim was rejected. BDI has a detrimental effect on long-term QoL. QoL in patients with BDI is poor and does not improve during follow-up. The outcome of a malpractice litigation claim is associated with QoL.