Significant Decrease In Quality Of Life Research Articles

Assessment of quality of life in patients with female pattern hair loss in a tertiary care hospital in India

Background: Female pattern hair loss (FPHL) is the most common cause of hair loss in women. Although it is a mild dermatological disorder, psychologists and dermatologists have observed that even clinically imperceptible hair loss is capable of damaging the quality of life (QoL) of patients due to the loss of self-image and diminished self-esteem. Methods: After obtaining consent from patients 66 females filling in inclusion criteria were selected for study. Data was collected from OPD case papers once and a fifteen-minute interview regarding the illness and symptoms was conducted as per the questionnaires (Hairdex, VAS, DLQI) to evaluate the QoL. Results: The QoL subscales results showed the younger age group (≤30 years) was more affected in all Hairdex subscales. They fared significantly poorly with higher scores than older patients (>30 years) as far as symptom score and stigmatization were concerned (p<0.05). Even DLQI scores was highest in patients less than 20 years of age. Mean dermatology life quality index (DQLI) score of younger subjects was significantly higher than older subjects (p<0.05). Conclusions: Our study showed that there is statistically significant decrease in QoL in patients with FPHL more so in younger patients. Younger patients seem to be more stigmatized, have poor functioning and emotional stability.

Predictors of futility outcomes after TAVI: insights from the France TAVI Registry

Abstract Background Transcatheter aortic valve implantation (TAVI) has revolutionized the treatment of aortic stenosis and provides a significant symptom relief and mortality reduction. However, a substantial group of patients fail to derive a benefit from TAVI, whether in terms of mortality, quality of life (QoL) or functional benefit. Objectives The aim of the present analysis was to report factors associated with a futility outcome one year after TAVI, in a national real-life registry. Methods This prospectively designed France TAVI-QoL substudy included patients from the national France TAVI registry between February the 12th 2018 and February the 12th 2019. Patient’s QoL was assessed at baseline and one year after TAVI using the EuroQol 5-Dimension 5-Level (EQ-5D-5L) questionnaire. Vital status was collected from the SNDS ("Systeme Natiobal des donnees de sante"). Factors associated with a futility outcome, defined by death or significant degradation of QoL one-year after a TAVI, were analyzed through a multivariable logistic regression. Results The mean age of the 3159 included patients was of 83 years old, and 51,1% were male. At follow-up, a total of 1055 patients (33.4%) met the primary outcome of procedure futility: 596 (18.9%) died and 459 (14.5%) had a significant decrease in QoL. The independent factors associated with procedure futility were general conditions (diabetes under insulin (RR 1.7, 95CI[1.2-2.3]; p=0.001), estimated glomerular filtration rate (odds-ratio [OR] 0.9 per 1 ml/min increase, 95CI[0.9-1.0]; p<0.001), chronic pulmonary disease (OR 1.6, 95CI[1.2-1.9]; p<0.001)), geriatric values (severe reduction in mobility (OR 1.5, 95CI[1.1-2.1]; p=0.003)), cardiologic values (supraventricular arrhythmia (OR 1.5, 95CI[1.2-1.8]; p<0.001), anticoagulation therapy at discharge (OR 1.3, 95CI[1.1-1.6]; p=0.01)), and procedural features (immediate complications (OR 1.5, 95CI[1.2-1.7]; p<0.001), and time to discharge (OR 1.1, 95CI[1.1-1.1]; p<0.001)). Conclusion One third of patients treated in the TAVI Qol Substudy presented with a futility outcome. Certain risk factors are potentially reversible (e.g. severe reduction in mobility or supraventricular arrhythmia), and their management might attenuate the risk of treatment futility and improve TAVI outcomes. Futility outcomes should be assessed with the growing number of patients with aortic stenosis and increasing concerns in the allocation of resources.

Quality of life among adolescents with idiopathic scoliosis in Tunisia.

our study aimed to assess the quality of life (QOL) among adolescents with adolescent idiopathic scoliosis (AIS) receiving nonoperative treatment, and to identify the demographic and clinical factors associated with poor QOL. this is a cross-sectional study. We included adolescents followed in the Department of Physical Medicine and Rehabilitation at Taher Sfar Hospital (Mahdia - Tunisia). The Quality-of-Life Profile for Spine Deformities (QLPSD), the Scoliosis Research Society 22 questionnaire (SRS-22) and the visual analogue scale objectifying the QOL (EVA QOL) were used. Correlations between the QOL domains and selected characteristics were performed. a total of 48 adolescents with AIS were included, with a mean age of 14.2 ± 2.1 years and a sex ratio (M/F) of 0.77. Adolescents who underwent rehabilitation treatment only had significantly better quality of life (QOL) scores than those with braces, as measured by three scales. Among brace wearers, we found a correlation between QOL and the degree of correction achieved by the brace, as measured by the EVA-QOL. We observed significant relationships between psychosocial status and age, correction angle, and treatment duration among braced patients, as measured by the QLPSD. Additionally, we found that dorsal flexibility was correlated with the correction angle and the treatment duration. According to the SRS-22, the overall QOL score of braced adolescents was significantly correlated with the correction obtained by the brace. wearing a brace in adolescent with AIS leads to a significant decrease in QOL according to the three QOL assessment scales.

Living on the Edge: Comparing the Quality of Life Transformation of Local Communities Induced by New Town Development in Different Peri-Urban Areas

Peri-urban development has both potential and consequences. It has consequences in terms of changes in the condition of livelihood assets and quality of life (QoL) of local communities, while it has benefits because it generates new urban activities. In theory, these impacts vary in significance for peri-urban with diverse characteristics. Therefore, this research aims to investigate and compare the impact of new town development on local communities in various peri-urban areas. Ample attention is given to two new town development projects: Metro Tanjung Bunga (MTB) in a coastal area and Kota Baru Parahyangan (KBP) in an inland area of Indonesia. There were 150 respondents involved from 13 kampungs (enclaves). The research begins with a qualitative descriptive analysis to determine the impact of development and continues with a t-test to validate and compare the magnitude of the impact in the two peri-urban areas. The findings show that the development of the new towns has resulted in a decrease in livelihood assets and community QoL levels. An intriguing finding also demonstrates that the two peri-urban areas have significantly different development impacts: coastal peri-urban communities experienced a more significant decrease in QoL than non-coastal peri-urban communities. This research would enrich the discussions about peri-urban transformation, effects of the process on local communities and sustainability of these effects in developing countries.

Long-term quality of life and acceptance of implantable cardioverter-defibrillator therapy: results of the European Heart Rhythm Association survey.

Implantable cardioverter-defibrillator (ICD) may impact patients' life significantly. The aim of this survey was to analyse the impact of the ICD on quality of life (QoL) metrics from the patient's perspective. 'Living with an ICD' was a prospective, multicentre study with an online questionnaire submitted to the European Heart Rhythm Association (EHRA) Research Network centres as well as patient associations from 10 European countries; it was filled-in directly and personally by the patients that were invited to participate, with a minimal interaction or influence from the healthcare professionals. Overall, the questionnaire was completed by 1809 patients (624 women, 34.5%). Patients in their 60s and 70s and from Western Europe were the most represented. The median time from first ICD implantation was 5 years (IQR 2-10). Device-related complications were reported by 505 patients (22.4%), including one or more inappropriate shocks (n = 209, 11.6%). Almost half the respondents reported improved QoL, with a more favourable impact for those receiving cardiac resynchronization therapy-defibrillator (CRT-D), and only a 10th experienced a significant decrease in QoL. The occurrence of complications remained a major predictor of deteriorated QoL (odds ratio 2.1, 95% confidence interval 1.4-3.0, P < 0.001). In conclusion, most patients have a globally positive view and acceptance of ICD therapy, reporting preserved to improved QoL after device implantation. Complications, namely inappropriate shocks, affect the expectation of living a normal life post-implant and are associated with a significant decrease in QoL. Our findings also highlight the importance of a detailed informed consent process and the involvement of the patient in the decision-making process.

Outcome Following Percutaneous Transhepatic Biliary Drainage (PTBD) in Carcinoma Gallbladder: a Prospective Observational Study.

Percutaneous biliary drainage (PTBD) is required as palliation and optimization for surgery or chemotherapy in carcinoma gallbladder (GBC) but may be associated with complications. We aimed to study the outcomes, complications, and changes in quality of life in patients with GBC undergoing PTBD. A prospective study from July 2018 to December 2019 in patients of GBC presenting with obstructive jaundice was done. Patients planned for PTBD were included in the study. The progression of the disease, complications of PTBD, reinterventions, effects on initiation or completion of chemotherapy, surgical resection or intervention, and overall survival were recorded. Quality of life (QoL) was assessed using the SF-36 questionnaire before and after 4-6weeks of intervention. Of 160 patients assessed for inclusion, 60 (mean age 53.7 ± 10.95years, 27 (45%) males) were eventually included. Eleven patients (18.3%) had metastatic disease at presentation. Of 60 patients undergoing PTBD, none had immediate procedure-related complications, 41 (68%) patients had at least one, and 18 (30%) patients had more than one complication. The most common complication was peri-catheter bile leak (41.6%), followed by catheter dislodgement (30%), blockage (23.3%), and bleeding (10%). Reintervention was required in 32 (53%) patients. There was a significant decrease in QoL after PTBD (P < 0.0001). Median survival after PTBD was 12weeks. The high technical success of PTBD does not translate into the improvement of QoL.

Compensatory Pelvic Retro-Rotation Associated with a Decreased Quality of Life in Patients with Normal Sagittal Balance.

Study DesignCross-sectional observational study.PurposeTo examine whether pelvic rotation as a compensatory mechanism for sagittal imbalance is related to quality of life (QOL).Overview of LiteraturePoor sagittal alignment is associated with compensatory pelvic retroversion and decreased QOL. Whether the compensatory pelvic tilt (PT) influences QOL is unclear.MethodsOverall, 134 subjects aged ≥20 years with lower back pain were included (104 females; mean age, 70±9.8 years). Sagittal vertical alignment (SVA) and PT were analyzed radiographically. Patients were stratified into three groups based on SVA values: good alignment (group G), intermediate alignment (group I), and poor sagittal alignment (group P). Patients in group I were further categorized into two groups: low PT and high PT. The Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) was used for clinical assessment, and the scores were compared between groups.ResultsAs SVA increased, PT and lumbar lordosis (LL) increased and decreased, respectively. PT and LL differed significantly between groups G and P (p<0.01 for each comparison). Within group I, there was no significant difference in SVA between the high PT and low PT groups, suggesting that the high PT group had acquired a compensated sagittal balance. Importantly, all domains in the JOABPEQ (except for lower back pain) were significantly lower in the high PT group than in the low PT group (p<0.05 for every comparison).ConclusionsThis study showed that focusing solely on SVA as a single indicator can cause important losses in QOL to be overlooked in patients with lumbar disorders. Although pelvic retroversion can compensate for sagittal balance, it is associated with a significant decrease in QOL. To improve the assessment of patients with lumbar disorders, PT should be considered besides SVA.

Quality of life and its determinants in patients with drug resistant focal epilepsy

Objective: to determine the factors influencing quality of life (QoL) in patients with drug-resistant focal epilepsy (DRFE). Material and methods. 111 adult patients with DRFE were included in the study. Quality of life was measured using the Quality Of Life In Patients with Epilepsy – 31 questionnaire (QOLIE-31). The severity of the disease (frequency and subjective assessment of the severity of seizures), the effect of pharmacotherapy (drug load and composition of the treatment regimen), the social status of patients, comorbid conditions (anxiety and depressive disorders, pathological fatigue) were assessed. Results. In the studied sample, a pronounced decrease in QoL was shown, the median of the final QOLIE-31 score was 65.4 points (interquartile range 53.0–72.6 points). A statistically significant decrease in QoL was found in subgroups of patients with seizures during the previous three months; taking carbamazepine or benzobarbital; with anxiety and depressive disorders; with pathological fatigue; and in unemployed patients. A multiple linear regression model (R2=0.66) was developed, which included the following determinants: Fatigue Severity Scale, Liverpool Seizure Severity Scale, and the risk of depression according to the NDDI-E questionnaire. Conclusion. In patients with drug-resistant focal epilepsy, there is a pronounced decrease in the quality of life due to combination of factors associated with the characteristics of the disease, treatment, comorbidities, and social status. The key QoL determinants in patients with DRFE are pathological fatigue, anxiety and depression, and subjective severity of epileptic seizures; employment is a positive factor. The role of epileptic seizures frequency in QoL formation in these patients requires further research.

Hemodiyaliz Hastalarında Fibromiyalji Sendromu Prevalansı ve Yaşam Kalitesine Etkisi

Objective: We evaluated the prevalence of fibromyalgia syndrome (FM) in hemodialysis patients and whether this syndrome was associated with gender, age, duration of hemodialysis, or other laboratory parameters. Methods: The study included 248 patients with chronic kidney disease (CKD) undergoing hemodialysis. The patients were stratified into two groups: patients with FM based on the 2010 American College of Rheumatology diagnostic criteria and patients not meeting these criteria without FM. Quality of life (QOL) was assessed using the Short Form-36 (SF-36) and Kidney Disease Quality of Life-36 (KDQOL-36) questionnaires. Sociodemographic data, laboratory parameters and a marker for adequacy of hemodialysis (Kt/V) were recorded. Results: FM was detected in 33/248 (13.3%) of patients included. All patients diagnosed as FM were female. When all sub-parameters of SF-36 and KDQOL-36 were compared, QOL was lower in the FM group compared to patients without FM (p&amp;lt;0.05). When laboratory parameters, dialysis duration, Kt/V, marital status and BMI were compared, no difference was detected between groups (p&amp;gt;0.05). FM frequency was higher in cases of advanced age, presence of systemic disease and/or hepatitis B and C infection in patients undergoing hemodialysis (p&amp;lt;0.05). In addition, FM frequency was inversely proportional to education level (p&amp;lt;0.05). Conclusion: FM, associated with a significant decrease in QOL, is more commonly seen in CKD patients undergoing dialysis compared to the general population. Thus, it will be helpful to keep FM in mind and to improve QOL in these patients by early diagnosis and treatment.

Treatment of post-prostatectomy urinary incontinence and erectile dysfunction: there is insufficient utilisation of care in German cancer survivors

PurposeTreatment of post-prostatectomy urinary incontinence (UI) and erectile dysfunction (ED) increases quality of life (QoL). Aim of our study was to evaluate the utilisation of care among patients with post-prostatectomy UI and ED in Germany.MethodsThe HAROW study documented treatment of patients with localised prostate cancer (≤ T2c) in Germany. 1260 patients underwent radical prostatectomy (RP). Patients answered validated questionnaires after a median follow-up of 6.3 years. Response rate was 76.8%.ResultsMedian age at RP was 65 (IQR 60–69) years. 14% (134/936) used more than one pad per day for UI. 25% (26/104, 30 missing) of UI patients underwent surgery to improve continence. Of patients without surgery, 41% (31/75) reported a moderate-to-severe issue concerning their incontinence with worse mental health and QoL. 81% (755/936) patients were unable to have an erection firm enough for sexual intercourse. Of all ED patients, 40% (319/793) used ED treatment regularly or tried it at least once. 49% (243/499) of patients with interest in sex never tried ED treatment. In multivariate analysis, patients not using ED treatments were older (≥ 70 years OR 4.1), and more often had preoperative ED (OR 2.3) and less interest in sex (OR 2.2). Nevertheless, 30% (73/240) of these patients had moderate-to-severe issues with their ED reporting worse mental health and QoL.ConclusionAlmost half of the patients without post-prostatectomy UI and ED treatment reported moderate-to-severe issues with a significant decrease in QoL. This indicates an insufficient utilisation of care in Germany.

Longitudinal Health-related Quality of Life among Individuals Considering Treatment for Stage I Non–Small-Cell Lung Cancer

Rationale: Because of improvements in screening, there is an increasing number of patients with early-stage non-small-cell lung cancer (NSCLC) who are making treatment decisions.Objectives: Among patients with suspected stage I NSCLC, we evaluated longitudinal patient-centered outcomes (PCOs) and the association of changes in PCOs with treatment modality, stereotactic body radiotherapy (SBRT) compared with surgical resection.Methods: We conducted a multisite, prospective, observational cohort study at seven medical institutions. We evaluated minimum clinically important differences of PCOs at four time points (during treatment, 4-6 wk after treatment, 6 mo after treatment, and 12 mo after treatment) compared with pretreatment values using validated instruments. We used adjusted linear mixed models to examine whether the association between treatment and European Organization for Research and Treatment of Cancer global and physical quality-of-life (QOL) scales differed over time.Results: We included 127 individuals with stage I NSCLC (53 surgery, 74 SBRT). At 12 months, approximately 30% of patients remaining in each group demonstrated a clinical deterioration on global QOL from baseline. There was a significant difference in slopes between treatment groups on global QOL (-12.86; 95% confidence interval [CI], -13.34 to -12.37) and physical QOL (-28.71; 95% CI, -29.13 to -28.29) between baseline and during treatment, with the steeper decline observed among those who underwent surgery. Differences in slopes between treatment groups were not significant at all other time points.Conclusions: Approximately 30% of patients with stage I NSCLC have a clinically significant decrease in QOL 1 year after SBRT or surgical resection. Surgical resection was associated with steeper declines in QOL immediately after treatment compared with SBRT; however, these declines were not lasting and resolved within a year for most patients. Our results may facilitate treatment option discussions for patients receiving treatment for early-stage NSCLC.

Quality of life of agricultural workers with gastroesophageal refl ux disease

According to the frequency and prevalence of gastroesophageal refl ux disease (GERD) ranks fi rst in a number of gastroenterological diseases. GERD can lead to serious complications and a signifi cant reduction in the quality of life (QL). Agricultural workers (AW) are at risk for the development of GERD, as their typical working and living conditions are provoking and/or aggravating risk factors for the development of this disease.The aim of the study is to study the impact of GERD on the quality of life of agricultural workers.The study included 98 patients with GERD and 140 conditionally healthy individuals. To assess the quality of life, a nonspecifi c SF–36 questionnaire was used.As a result of a one-time study found that workers AW statistically signifi cantly lower indicators of «General health» (GH), «pain index» (PI), «life activity» (LA) and «mental health» (MH) compared with the data of representatives of working professions who live in the city.With increasing age, there is a decrease in QL, especially GH and PI, while the indicator of «social functioning» (SF) reaches the maximum values in the age group from 51 to 60 years.Comparison of QL indices in the groups of patients with GERD and conditionally healthy AW workers allowed to establish a statistically signifi cant diff erence in all parameters characterizing mental health, as well as in the indicators of GH and «physical functioning» (PF). It is characteristic that the indicators of the Russian Federation and the PI had no statistically signifi cant diff erence between the groups of observations. Statistically signifi cant strong correlation was revealed between the age of AW workers, patients with GERD, and indicators of PI and LA, statistically signifi cant moderate correlation — between the age and indicators of GH, PF, «role functioning» (RF) and «emotional state» (ES).For healthy workers of AW is characterized by a signifi cant decrease in QL compared with workers living in the city, while in patients with GERD decrease in QL is accompanied mainly by a violation of the mental subsphere. When studying the quality of life of patients should take into account the infl uence of not only the studied disease, but also medical and social factors.

THE PECULIARITIES OF THE QUALITY OF LIFE OF PATIENTS, SUFFERED FROM ANEURYSMAL SUBARACHNOID HAEMORRHAGE

The analysis of data from a number of scientific sources shows that even those patients, with favorable outcomes after suffering from aneurysmal subarachnoid hemorrhage (aSAH), may often experience a decline in quality of life (QoL), both at the physical and psychosocial levels. The influence of functional dependence on the patient’s quality of life remains controversial, because among the number of patients, who save the ability of self-care, there exists a part of those, who are not able to return to their previous lifestyle, kind of activity, they have difficulties in their relationships and emotional disorders.&#x0D; The aim of study was to assess the quality of life of patients in recovery and residual periods of aSAH.&#x0D; Material and methods. We examined 114 patients (64.91 % - males, 35.09 % - females). The patients’ quality of life was studied by using the questionnaire SF-36. The control group consisted of 20 healthy participants, matched by age and gender.&#x0D; Results. The significant decrease in QoL of patients was observed in all scales, with the exception of physical functioning, vital activity and social functioning. It should be noted, that "mental health" scale rates correlated with the level of anxiety (r = -0,55) and depression (r = -0,61). In the different age groups, the QoL indicators were almost identical, with the exception of "physical functioning" component, because older patients received a lower score for this scale (p&lt;0.01). Patients with a moderate level of disability were observed with a decline in all QoL categories of the scale SF-36. Patients, who were totally independent, had also a significant decline in all QoL scale components, with the exception of physical functioning. &#x0D; Conclusions. We found the decrease in QoL of patients in recovery and residual periods of aSAH, which does not depend on one’s level of functional dependence. The influence of anxiety (r = -0,55) and depression (r = -0,61) on the subscale "mental health" was established.

THE PECULIARITIES OF THE QUALITY OF LIFE OF PATIENTS, SUFFERED FROM ANEURYSMAL SUBARACHNOID HAEMORRHAGE

The analysis of data from a number of scientific sources shows that even those patients, with favorable outcomes after suffering from aneurysmal subarachnoid hemorrhage (aSAH), may often experience a decline in quality of life (QoL), both at the physical and psychosocial levels. The influence of functional dependence on the patient’s quality of life remains controversial, because among the number of patients, who save the ability of self-care, there exists a part of those, who are not able to return to their previous lifestyle, kind of activity, they have difficulties in their relationships and emotional disorders.&#x0D; The aim of study was to assess the quality of life of patients in recovery and residual periods of aSAH.&#x0D; Material and methods. We examined 114 patients (64.91 % - males, 35.09 % - females). The patients’ quality of life was studied by using the questionnaire SF-36. The control group consisted of 20 healthy participants, matched by age and gender.&#x0D; Results. The significant decrease in QoL of patients was observed in all scales, with the exception of physical functioning, vital activity and social functioning. It should be noted, that "mental health" scale rates correlated with the level of anxiety (r = -0,55) and depression (r = -0,61). In the different age groups, the QoL indicators were almost identical, with the exception of "physical functioning" component, because older patients received a lower score for this scale (p&lt;0.01). Patients with a moderate level of disability were observed with a decline in all QoL categories of the scale SF-36. Patients, who were totally independent, had also a significant decline in all QoL scale components, with the exception of physical functioning. &#x0D; Conclusions. We found the decrease in QoL of patients in recovery and residual periods of aSAH, which does not depend on one’s level of functional dependence. The influence of anxiety (r = -0,55) and depression (r = -0,61) on the subscale "mental health" was established.

QUALITY OF LIFE IN PATIENTS WITH PRIOR OSTEOPOROTIC VERTEBRAL FRACTURE

Objective : to analyze the dynamics of quality of life (QOL) in patients with prior osteoporotic vertebral compression fracture during an 18-month follow-up study. Subjects and methods . The investigation enrolled 219 patients (mean age, 67.6 years) with vertebral fracture from seven centers of the Russian Federation. QOL was assessed four times using the EQ-5D (EuroQoL-5D) and TTO (Time Trade-Off) questionnaires during an 18-month prospective follow-up study. The work was done within the framework of the International Multicenter Study ICUROS (The International Costs and Utilities Related to Osteoporotic Fractures Study) organized by the International Osteoporosis Foundation (www.icuros.org). Results and discussion . The patients with vertebral compression fracture showed a statistically significant decrease in QOL throughout the follow-up period. Immediately after the fracture, there was a dramatic decrease in the total EQ-5D score, followed by its gradual increase. However, the emerging trend in QOL recovery proved to be unstable, and by the end of the 18th month, it was significantly lower than that before the fracture. On the contrary, the TTO questionnaire showed that QOL drastically decreased immediately after fracture, but at month 4 it reached the level that was before the fracture, and remained stable until the end of the follow-up period. Conclusion . The performed investigation enabled us to obtain data on QOL using the EQ-5D (QOL assessment from the social point of view) and TTO (individual QOL assessment) in the population of residents of the Russian Federation, in men and women aged 50 years and older with osteoporotic vertebral compression fracture.

Patient-reported health-related quality of life for men treated with low-dose-rate prostate brachytherapy as monotherapy with 125-iodine, 103-palladium, or 131-cesium: Results of a prospective phase II study

PurposeTo compare quality of life (QoL) after brachytherapy with one of the three approved radioactive isotopes. Methods and MaterialsPatients with mostly favorable intermediate-risk prostate cancer were treated on this prospective phase II trial with brachytherapy as monotherapy, without hormonal therapy. QoL was recorded at baseline and each follow-up by using the Expanded Prostate Cancer Index Composite instrument. The minimal clinically important difference was defined as half the standard deviation of the baseline score for each domain. Mixed effect models were used to compare the different isotopes, and time-driven activity-based costing was used to compute costs. ResultsFrom 2006 to 2013, 300 patients were treated with iodine-125 (I-125, n = 98, prescribed dose [PD] = 145 Gy), palladium-103 (Pd-103, n = 102, PD = 125 Gy), or cesium-131 (Cs-131, n = 100, PD = 115 Gy). Median age was 64.9 years. Median follow-up time was 5.1 years for the entire cohort, and 7.1, 4.8 and 3.3 years for I-125, Pd-103, and Cs-131 groups, respectively. All three isotope groups showed an initial drop in QoL at first follow-up, which gradually improved over the first 2 years for urinary and bowel domains. QoL profiles were similar between I-125 and Pd-103, whereas Cs-131 showed a statistically significant decrease in QoL regarding bowel and sexual function at 12 months compared with Pd-103. However, these differences did not reach the minimal clinically important difference. Compared with I-125, the use of Pd-103 or Cs-131 resulted in cost increases of 18% and 34% respectively. ConclusionsThe three different isotopes produced a similar QoL profile. Statistically significant differences favored Pd-103/I-125 over Cs-131 for bowel and sexual QoL, but this did not reach clinical significance.

Quality of life and impact of pain in women treated with aromatase inhibitors for breast cancer. A multicenter cohort study.

Women with hormone-dependent breast cancer are treated with aromatase inhibitors (AI) to slow disease progression by decreasing estrogen levels. However, AI have adverse effects, including pain, with potentially serious impact on quality of life (QOL) and treatment compliance. We evaluated quality of life during the first year of AI treatment, focusing particularly on the impact of pain. In a multicenter cohort study of 135 women with early-stage breast cancer, free of pain at the initiation of AI treatment, quality of life (by the EORTC QLQ-BR23), somatic and psychic symptoms, psychological characters, temperament and coping strategies were assessed at baseline and at each follow-up visit (1, 3, 6 and 12 months). The impact of treatment-induced pain on quality of life during follow-up was determined with repeated-measures regression models. These models were constructed to assess the effects of pain and pain type on quality of life during follow-up, taking into account predictors associated with quality of life at baseline. Prior ganglion resection, taxane treatment and chemotherapy, a high amplification score on the pain catastrophizing scale, and a high harm avoidance score on the personality questionnaire were associated with a significantly lower baseline QOL. Fifty-seven percent of women developed pain of five different types: upper or lower limb joint pain, diffuse pain, neuropathic pain, tendon pain and mixed pain. A significant decrease in QOL was noted in the women with pain, particularly for body image, sexual functioning and future perspectives. Moreover, the impact of pain on QOL depended on the type of pain experienced. In conclusion, women treated with aromatase inhibitors display changes in quality of life and the degree of change in quality of life depends mostly on the type of pain experienced. Oncologists and patients should be aware of painful adverse effects of AI and encouraged to provide or receive earlier and more appropriate management of these effects.

Impact of orthopedic treatment on the quality of life of adolescents with idiopathic scoliosis: A cross-sectional study

The idiopathic scoliosis (IS) corset could have physical and psychological effect especially in adolescents. The aims of our study were to determine the influence of the Chêneau corset on the quality of life (QOL) of adolescents with an IS and to seek for a correlation between the QOL of adolescents treated with brace and age, Risser Index, correction percentage and corset treatment duration. This was a six-month (September 2016–February 2017) cross-sectional study including 48 adolescents with IS divided into two groups. The first group (G1) included treated with brace and rehabilitated adolescents. The second one (G2) included only those who were reeducated (corset being made, non-evolutive scoliosis or Risser > 4). QOL was assessed by Quality of Life Profile for Spine Deformities (QLPSD), SRS-22 and QOL Visual Analog Scale (VAS). We collected 27 girls (56%) and 21 boys (44%), with a mean age of 14 years ± 2 years (10–18 years). QOL was better in adolescents treated only by rehabilitation with a significant difference ( P < 0.05). According to the QOL VAS, we objectified a correlation between the QOL and correction percentage. According to QLPSD scale, the overall QOL score of patients wearing the corset was significantly correlated with the percentage of correction and the age. We noted that psychosocial status was significantly correlated with age, percentage correction and duration of treatment with corset. We found a correlation between body image and the correction angle. Dorsal flexibility was correlated with percentage correction and duration of treatment. According to SRS-22, the overall QOL score of the patients wearing the corset was significantly correlated with the correction percentage. We noted a correlation between the psychosocial status and the correction percentage. Satisfaction was correlated with percentage correction and duration of treatment. Orthopedic treatment in teenagers with IS results in a significant decrease in QOL regardless of the scales. This study shows that a multidisciplinary care should be carried out in order to improve the aesthetics, the pain and the acceptance of the corset and to insist in treatment adherence.

Is repeat Botulinum Toxin A injection valuable for neurogenic detrusor overactivity-A systematic review and meta-analysis.

To investigate the value of repeat botulinum toxin A (BTX-A) injections in patients with neurogenic detrusor overactivity (NDO). We searched the PubMed, EMBASE, and EBSCO databases for articles published until June 2016. Studies that reported the efficacy and safety of repeat BTX-A injections for adult patients with NDO were eligible. The effect size for each outcome was calculated as the standardized mean difference ± standard error and 95% confidence interval, and was graded as small, >0.2; moderate, >0.5; or large, >0.8. The outcomes included maximum cystometric capacity (MCC), maximum detrusor pressure (MDP), reflex volume (RV), bladder compliance (BC), quality of life (QOL), and injection interval. Descriptive reviews were performed for urinary incontinence (UI) and adverse events (AEs). Eighteen studies involving 1533 patients whose level of evidence ranged from 3 to 4 were included in this study. We noted non-significant changes in MCC, MDP, RV, and BC between the first and last injections. Patients who had received ≤4 injections were found to have stable QOL improvements after the first and last injections, whereas patients who had received ≥5 injections were found to have a significant decrease in QOL after the last injection. No significant differences in injection intervals were noted after repeat BTX-A injections, and the repeat injection failure rate was low. Our study demonstrated that repeat BTX-A injections allow sustained improvements in patients with NDO. The rate of AEs was stable and low. However, additional high-quality, large-scale, and long-term trials are necessary to establish the efficacy and safety of ≥5 repeat BTX-A injections.

Factors associated with impaired quality of life in French patients with chronic idiopathic constipation: a cross-sectional study.

Chronic idiopathic constipation can impact the health-related quality of life (QoL). We aimed to evaluate QoL in French patients with different clinical types of chronic constipation. In this cross-sectional study, 338 general practitioners included 1710 consecutive adult patients who fulfilled the Rome III criteria for constipation and agreed to complete Patient-Assessment of Constipation Quality of Life and Symptom questionnaires. Sociodemographic and medical data were collected. Multivariate analyses enabled identification of factors associated with poor QoL using odds ratios (ORs) with 95% confidence intervals (95% CIs). Overall, 1673 patients were eligible for analyses; 32% had infrequent evacuation (IE) of feces, 24% had difficult evacuation (DE) of feces, and 44% had both (IE+DE). The mean global Patient-Assessment of Constipation Quality of Life score was 1.9 (95% CI: 1.9-2.0), with a significantly worse QoL for IE+DE patients (mean 2.0; 95% CI: 2.0-2.1); 23% of patients reported a poor QoL, that is, a more than 2.4 (29% in IE+DE group, P<0.0001). Poor QoL was significantly associated with psychosocial parameters, associated digestive symptoms, but the main factors were the use of rectal treatment (OR 2.5; 95% CI: 1.9-3.3), one or less defecation/week (OR 3.5; 95% CI: 2.2-5.7), and weak/null perceived treatment efficiency (OR 4.3; 95% CI: 2.8-6.5). Chronic constipation is associated with a significant decrease in QoL, especially in patients suffering from both infrequent and DE of feces and feeling unsatisfied by their treatments.