Satisfactory Health-related Quality Of Life Research Articles

Loss of Renal Function Is Associated With Deterioration of Health-Related Quality of Life in Kidney Transplant Patients

Objective The evaluation of health-related quality of life (HRQOL) is becoming an important measure of the outcomes of kidney transplantation. The aim of this study was to evaluate whether deterioration of renal function was associated with a worse HRQOL in kidney transplant patients (KTP) compared with patients experiencing chronic native kidney insufficiency. Patients and Methods HRQOL was assessed in 128 stable KTP and 102 chronic kidney disease patients (CKDP) using the SF-36 health survey. The 2 groups were matched for age, sex, sociodemographic conditions, and renal function, the only difference being that KTP had experienced hemodialysis treatments before transplantation. Results Overall, KTP revealed a satisfactory HRQOL compared with CKDP. At variance with CKDP, KTP with estimated creatinine clearances >60 mL/min versus <60 mL/min showed higher scores among 7 of 8 SF-36 categories: physical function (PF), role physical (RP), bodily pain (BP), general health (GH), vitality (VT), role emotional (RE), and mental health (MH). Estimated creatinine clearance showed a significant positive correlation with PF ( P = .0004), RP ( P = .008), BP ( P = .01), GH ( P = .0001), VT ( P = .001), RE ( P = .03), and MH ( P = .02), but exclusively in KTP. Multiple regression analysis confirmed in KTP that the scale scores of PF, RP, GH, VT, and RE were significantly dependent on creatinine clearance. Conclusion Our data demonstrated that among KTP deterioration of renal function was associated with a worse HRQOL.

Assessing current outcomes of juvenile idiopathic arthritis: A cross‐sectional study in a tertiary center sample

To investigate the disease outcomes of a cross-sectional sample of children with longstanding juvenile idiopathic arthritis (JIA) seen between September 2002 and December 2006, and to provide a benchmarking of outcomes obtained with current treatment. All consecutive patients were included if they met the following criteria: diagnosis of JIA, disease duration > or = 5 years, and informed consent. Outcome assessments included disease activity, inactive disease, minimal disease activity, pain, physical function, health-related quality of life (HRQOL), auxometric measurements, and articular and extraarticular damage. A total of 310 patients were included. At study visit, patients had on average a low level of disease activity. However, only 21.8% met the criteria for inactive disease, and less than 50% met the definition of minimal disease activity. Additionally, 19.2% had moderate to severe Childhood Health Assessment Questionnaire disability and 3.6% were in Steinbrocker class III-IV. Approximately 10% had major impairment in HRQOL. A total of 34.2% had damage in > or = 1 joint or joint group and 26.1% showed extraarticular damage. Of the 125 patients who underwent a wrist radiograph, 35.2% had significant structural damage and 8.7% had growth retardation. Our patients had on average a low level of disease activity, little or no physical disability, and a satisfactory HRQOL. However, a sizable proportion of patients had persistently active disease, impaired function, and damage. These findings underscore the critical need for treatments and treatment strategies that have the ability to better control disease activity and to reduce the development of disease-related morbidities.

Effects of Long-term Regular Exercise on Cognitive Function, Lipid Profile and Atherogenic Biomarkers in Middle-aged Men

Effects of Long-term Regular Exercise on Cognitive Function, Lipid Profile and Atherogenic Biomarkers in Middle-aged Men Several studies on exercise and its effect on cognitive function in human and animal populations have documented the beneficial impact of regular physical activity on maintenance of good cognitive abilities and satisfactory health-related quality of life well into older age. The aim of the study was to evaluate the effects of long-term regular running on metabolic profile and cognitive function in middle-aged men. A total of 24 regularly exercising, middle-age men (Group A), all being members of the Runners Club, and 22 age-matched sedentary subjects (Group B), as the control group, were enrolled in this study. The control group included 8 non-overweight (BMI=23.5±5.2) individuals (Group C) and 14 overweight/obese (BMI=30.7±1.6) subjects (Group D). Serum lipid profile, glucose and homocysteine concentrations were assessed by routine laboratory methods. Subjects' cognitive function was evaluated based on Trail Making Test (TMT) and Digit Symbol Test (DST) scores. In a majority of runners (Group A), the BMI and the parameters of lipid profile (TC, HDL, LDL, TG, glycerol) were close to those recorded in non-overweight controls (Group C) and, in both groups, results were ideally within the reference ranges for healthy male subjects. However, as compared to the whole control group (Group B), which may be considered as an average population sample of sedentary middle-age men, significant differences were observed in BMI and concentrations of TC and LDL, as well as in the pro-atherogenic biomarkers (TC/HDL, LDL/HDL), which were lower in runners. A similar tendency was found in concentrations of TG (independent cardiovascular risk factor), glycerol and TG/HDL ratio (surrogate measure of insulin resistance), however the differences did not reach the level of significance. The level of homocysteine (pro-atherogenic biomarker) was comparable in all groups, and in most cases, within the reference range for male adults. Results of cognitive function tests did not reveal any significant between-group differences. The TMT score was found to be correlated positively (r=0.492, p&lt;0.05), whereas DST score was correlated negatively (r=-0.549, p&lt;0.005), with age. The DST performance, as evaluated in the group of runners (Group A), appeared to be strongly dependent (r=0.809, p&lt;0.005) on the educational level of the subject. These data provided evidence of beneficial effects of a long-term regular endurance running exercise on lipid profile and cardiovascular health in middle-aged men. However, we failed to confirm the findings of a favorable impact of regular physical activity on improvement in cognitive abilities.

Quality of life following emergency liver transplantation for acute liver failure

Liver transplantation is an accepted and successful therapy for both acute and chronic liver diseases (CLDs), with good survival outcomes. Whilst the study of health-related quality of life (HRQoL) post transplantation for CLDs have been well documented, there is little data measuring HRQoL following liver transplantation for acute liver failure (ALF) patients. Data were collected using between-method triangulation; however, only the quantitative element of the study is reported here. Measuring eight health domains, we distributed the short form 36 (SF-36) questionnaire by post to 96 acute and chronic transplant recipients. Differences between the groups were measured using both parametric and non-parametric t-tests. Overall, the patients showed a satisfactory HRQoL; there were no differences between either acute or chronic transplant groups in seven of the eight domains of quality of life. Among the patients transplanted for ALF, there were no differences in HRQoL between patients transplanted for paracetamol hepatotoxicity compared with other indications, and no variations in HRQoL related to recipient gender, employment or length of survival post transplantation. When compared with the UK SF-36 normal values to the ALF transplant recipients, there was a significantly lower physical functioning and role emotional scores. Regardless of aetiology, most of recipients transplanted for ALF have a HRQoL comparable with chronic transplant recipients.

Health-related quality of life in adults after repair of congenital diaphragmatic defects—a questionnaire study

Background and Aim Long-term respiratory, gastrointestinal, and vertebral sequelae are common after repair of congenital diaphragmatic defects (CDDs). The aim of this study was to assess the effect of these sequelae on the health-related quality of life (HRQoL) of adult survivors after CDD repair. Materials and Methods A questionnaire, including 36-Item Health Survey Form (SF-36), 36-item Gastrointestinal Quality of Life Index (GIQLI), 55-item Psychosocial Survey, 9-item survey for Respiratory Symptoms–Related Quality of Life Index, and a symptoms query, was sent to 94 adult survivors of CDD and to 400 healthy control subjects. One SD lower than the age-adjusted national average in the 36-Item Health Survey Form score for physical or mental health was considered as low HRQoL. Results Sixty-nine patients with CDD (72%) and 162 (41%) control subjects returned the questionnaire. The initial presentation was critical in less than 10% of patients with CDD. Forty-five patients with diaphragmatic hernia had primary closure; in 1 patient with diaphragmatic hernia, a patch was used. Twenty-four patients had plication of diaphragmatic eventration. The incidence of gastroesophageal reflux (20% vs 2%), recurrent intestinal obstruction (7% vs 0%), and recurrent abdominal pain (12% vs 2%) was significantly higher in patients with CDD than in control subjects, whereas no difference in the incidence of respiratory, musculoskeletal, or other health problems not associated with CDD was found. Scores in GIQLI, Psychosocial Survey, and Respiratory Symptoms–Related Quality of Life Index did not differ between patients with CDD and control subjects. Health-related quality of life was low in 17 (25%) of 69 patients with CDD, which exceeded 1.5 times the expected value. There was no correlation between the type or severity of the primary defect and HRQoL at the time of the study. Conclusion Most adults with repaired CDD have good or satisfactory HRQoL. Congenital diaphragmatic defect–associated symptoms with or without acquired diseases significantly impair HRQoL in one fourth of the patients.

Gesundheitsbezogene Lebensqualität

Treatment of severe acute respiratory distress syndrome (ARDS) with extracorporeal membrane oxygenation (ECMO) can be lifesaving but requires maximal use of intensive care resources over prolonged periods of time, resulting in high costs. Little is known about the health-related quality of life (HRQL) in long-term survivors. This case-controlled retrospective study was designed to assess the health-related quality of life in long-term survivors of ARDS and ECMO-therapy. 14 long-term survivors of ARDS (APACHE II score = 24, Lung Injury Score = 3.25, median values) treated using ECMO between 1992 and 1995 (median time interval between data collection and discharge from the ICU 16 months) and 14 ARDS-patients conventionally treated during the same period (group I) were identified and completed the SF-36 Health Status Questionnaire (Medical Outcome Trust, Boston, USA). 14 healthy subjects (group II) were drawn at random from a large data base generated to provide normal values for the SF-36 in a German population. All three groups were comparable with respect to sex and age. Long-term survivors of ECMO-therapy reported significant reductions in physical functioning when compared with patients treated by mechanical ventilation alone (group I, -12.5%, p < 0.05) and with healthy controls (group II, -50%, p < 0.05) and showed a higher incidence of chronic physical pain (+5% and +24%, respectively, p < 0.05). There were no differences with regard to the mental health dimensions of the SF-36 (e.g. vitality, mental health index or social functioning) between ECMO-patients and all controls. Nine patients (64.3%) from the ECMO group versus all patients treated conventionally (group I) had full-time employment (p = 0.46, Chi2 test). The majority of long-term survivors of ECMO-treatment show good physical and social functioning, including a high rate of employment. The more aggressive approach of ECMO-therapy and a possibly more severe underlying disease process may explain impairments in health-related quality of life outcomes after ECMO-treatment. Despite these limitations, long-term survivors of ECMO-therapy are able to reach a highly satisfactory health-related quality of life.