Significant Difference In Health Status Research Articles

위드 코로나 상황에서 지역사회 주민의 코로나19로 인한 염려 및 어려움, 지각된 스트레스가 우울에 미치는 영향

This study aimed to investigate the anxieties and difficulties caused by COVID-19, perceived stress on depression of the community residents in the With-COVID era. The participants comprised 198 community residents in G City. Data were collected from August 7 to September 8, 2022. Data analyses were conducted using independent t-test, one-way ANOVA, Pearson correlation coefficients, and multiple regressions analysis in IBM SPSS Statistics version 25.0. The mean score of the was anxieties and difficulties caused by COVID-19 45.03±14.740, perceived stress 20.31±4.89 and depression 15.35±9.17. The anxieties and difficulties caused by COVID-19 according to the general characteristics of the subjects were gender(t=5.23, p=.02), age(F=2.52, p=.04), and health status(F=8.74, p<.001). It was found that there was a statistically significant difference. Perceived stress showed a significant difference in age(F=2.84, p=.03). And depression showed a statistically significant difference in health status(F=7.43, p<.001). Depression had a statistically significant negative correlation with state of health(r=-.269, p<.001) and a positive correlation with anxieties and difficulties caused by COVID-19(r=.428, p=.041) and perceived stress(r=.275, p<.001). As a result of multiple regression analysis, the factors influencing the depression of residents in the G-city community were state of health(β=-.214, p=.025), anxieties and difficulties caused by COVID-19(β=.340, p<.001) and perceived stress(β=.142, p<.001). And the regression analysis indicated an explanatory power of 20.9%(F=13.607, p<.001). Therefore, it is required to develop various programs suitable for community residents who can alleviate these negative mental health problems such as stress and depression, and prevent and manage infectious diseases. In addition, it is necessary above all else to develop and apply programs that can be of practical help by considering the age group, education level, and job type of community residents.

Effect of socioeconomic status on the physical and mental health of the elderly: the mediating effect of social participation

BackgroundPrevious studies have demonstrated the effect of socioeconomic status on the health status of the elderly. Nevertheless, the specific dimensions of the effect and the mechanism await further investigation. In this study, socioeconomic status was divided into three dimensions and we used social participation as the mediation variable to investigate the specific path of effect.MethodsUsing the 2018 Waves of Chinese Longitudinal Healthy Longevity Survey (CLHLS) dataset, a total of 10,197 effective samples of the elderly over 65 years old were screened out. Socioeconomic status included income, education level, and main occupation before retirement. The physical health and mental health of the elderly was measured by the Instrumental Activities of Daily Living Scale and the Minimum Mental State Examination, respectively. The social participation of the elderly was the mediation variable, including group exercise, organized social activities and interacting with friends. Omnibus mediation effect analysis was adopted to examine the mediation effect and mediation analysis was completed using the SPSS PROCESS program.ResultsFirst, the results showed that when the income gap between the elderly reached a certain level, there was a significant difference in health status. Significant differences existed in health status amongst with different education levels. There was no sufficient evidence to show that occupation has a significant effect on the physical health. But when the dependent variable was mental health, the effect was significant. Second, group exercise mediated 64.11% (aib = 0.24, 95% CI [0.17,0.3]) and up to 20.44% (aib = 0.12, 95% CI [0.07,0.17]) of the disparity in physical and mental health due to income gap, respectively. And it could mediate the effect up to 56.30% (aib = 0.62, 95% CI [0.52,0.73]) and 17.87% (aib = 0.50, 95% CI [0.4,0.61]) of education on physical and mental health status, respectively. The proportion of relative mediation effect of occupation was up to 28.74% (aib = 0.19, 95% CI [0.13,0.25]) on mental health. Interacting with friends mediated only on the path that the education affected the health status of the elderly. The proportion was up to 33.72% (aib = 0.29, 95% CI [0.16,0.44]). The relative mediation effect of organized social activities on the health gap caused by income or education level gap was significant at some levels. The proportion was up to 21.20% (aib = 0.33, 95% CI [0.26,0.4]).ConclusionThe SES of the elderly including relatively large income gap, different education levels and occupational categories could indeed have a significant effect on health status of the elderly, and the reason why this effect existed could be partly explained by the mediation effect of social participation. Policymakers should pay more attention to the social participation of the elderly.

Quality of Life and Health Status of Jordanian Women Users of Various Contraceptive Methods and Associated Factors: Implications for Contraceptive Policies.

AimThe study aimed at investigating the differences in health status of women users and non-users of contraceptive methods and assess differences in contraception quality of life (CQoL) according to method used.MethodsAcross sectional study with 372 women between the ages of 18 and 49 years old were recruited. Participants completed the health status and the CQoL questionnaire, which was validated using factor analysis combining three factor loading measures with a good Cronbach's alpha reliability coefficient.ResultsResults showed that there were no significant differences in health status between users and non-users. There was a significant difference in QoL according to the method used at the p <0.05 level for the three conditions F (2193) = 6.0 and p = 0.003. Post hoc analysis indicated that the total CQoL was significantly higher in IUD users (M = 55.7, SD = 9.6) than users of natural methods (M = 50, SD = 9.0, p < 0.01). In addition, the total CQoL was significantly higher among women from the southern region (M = 56.7, SD = 9.0) than from the northern and mid-regions (M = 49.5, SD = 0.07 and M = 52, SD = 10, respectively, p < 0.01).ConclusionThe physiological changes of women’s QoL was affected by the use of the IUD method with significantly lower QoL scores than those who used oral contraceptives and non-hormonal methods. In addition, there was no significant difference in health status between users and non-users of contraceptive methods.ImplicationsThe study has implications for contraceptive counselling on quality of life of women users of IUD and women from the south region and provides opportunities for the advancement of the reproductive health services in Jordan.

Comparative study of single dose preoperative antibiotic versus five days antibiotic course in preventing surgical site infection for pediatric inguinal herniotomy

To compare single dose preoperative antibiotic versus five days antibiotic course in preventing surgical site infection for the pediatric inguinal herniotomy.The present study was conducted on 100 patients of elective inguinal herniotomy from January 2019 to April 2020 and compared on the basis of single dose preoperative antibiotic versus five days antibiotic course. All the patients were evaluated on the 3rd, 7th and 28th post-operative period and instructions were given to the guardians about wound care and to attend for early follow up if any signs &amp; symptoms of wound infection appear.50% of the patients were treated with prophylactic single dose antibiotic, i.e. inj. Ceftriaxone (30 mg/kg/dose) at the time of induction only and rest 50% were treated with inj. Ceftriaxone(30mg/kg/dose) at the time of induction as well as postoperatively at night followed by four days of oral antibiotic with Syr/Tablet. Cephalexin (25mg/kg/day) three times daily for another 4 days.Surgical Site Infection (SSI) in Group-B (4.0%) was higher than that of Group-A (2.0%) on day 3 but it was not significant (p=0.40). There was no significant difference in health status of the patients of the two groups when compared on post-operative day 7 and day 28 (p=0.99, p=0.99 respectively).Implementation of single dose antibiotic prophylaxis regimes tailored to the prevalent organisms in the institution can result in enormous savings, as the study shows significant reduction in hospital stay with no significant increase in incidence of SSI.

Health assessment of important tributaries of Three Georges Reservoir based on the benthic index of biotic integrity

China’s Three Gorges Reservoir (TGR) is the largest water conservancy project in the world, and plays a significant role in flood control and water transport. To study the health status of the tributaries of TGR, we set up 175 sampling sites, including 15 reference sites and 160 impaired sites on 36 important tributaries of TGR, and collected zoobenthos at these sampling sites. We selected 26 candidate metrics, analyzed them in terms of the distribution range, discriminant ability and correlation. Eight core metrics (i.e., total taxa, ephemerida + trichoptera + plecoptera taxa, diptera taxa, ephemerida%, trichoptera%, Shannon–Wiener diversity index, dominant species% and filter%) were identified, and then the benthic indexes of biological integrity (B-IBI) was established. The B-IBI was then used to evaluate the ecological status of 36 tributaries of TGR. Among all the sampling sites, “excellent”, “good”, “fair”, “poor” and “very poor” accounted for 5.14%, 13.14%, 28.00%, 44.57%, and 9.14%, respectively. Among all streams and rivers, “excellent”, “good” “fair”, “poor” and “very poor” accounted for 5.56%, 41.67%, 50.00%, 2.78%, and 0%, respectively, showing a general good condition for all tributaries. There was a significant difference in health status between tributaries in the TGR dam and those in its upper reaches. The B-IBI established in this study can capture the health status of 36 important tributaries of TGR. This study does not only enrich the practice of health assessment using B-IBI, but also provides some reference for the evaluation of similar rivers across the world.

Quality of Life and not Health Status Improves After Major Amputation in the Elderly Critical Limb Ischaemia Patient

A patient-oriented appraisal of treatment has become extremely important, particularly in elderly patients with critical limb ischaemia (CLI). Quality of life (QoL) is an important patient-reported outcome in vascular surgery. Frequently, the physical domain of QoL questionnaires represents an 'objective' evaluation of performing activities, which is expected to be impaired after major limb amputation. However, an objective appraisal of physical function is an assessment of health status (HS) and not of QoL. Little is known about the subjective appraisal of physical health (QoL). The goal of this study was to evaluate, prospectively, QoL in relation to HS in elderly CLI patients undergoing major limb amputation. Patients suffering from CLI aged 70 years or older were included in a prospective observational cohort study with a follow-up period of 1 year. Patients were divided according to having had an amputation or not. The World Health Organization Quality Of Life-BREF (WHOQOL-BREF) was used to asses QoL. The 12-Item Short Form Health Survey (SF-12) was used to measure HS. These self-reported questionnaires were completed five times during follow-up. Two-hundred patients were included of whom 46 underwent a major limb amputation within one year. Amputees had a statistically significant improvement of their physical QoL after six months (14.0 vs. 9.0 (95% CI -7.84;-1.45),p=0.005) and after a one-year follow-up (14.0 vs. 9.0 (95% CI -9.58;-1.46),p=0.008). They did not however show any statistically significant difference in HS. For non-amputees, both physical QoL and HS improved. An instant statistically significant improvement of the physical QoL appeared 1 week after inclusion (12.0 vs. 10.9 (95% CI -1.57;-0.63),p<0.001). Similarly, statistically significant improvement in the physical HS first occurred at 1 week follow-up (29.0 vs. 28.9 (95% CI -5.78;-2.23),p=0.003). There is a clear difference between patients' functioning (HS) and the patients' appraisal of functioning (QoL). In elderly CLI patients, this study clearly suggests a discrepancy between the physical QoL (WHOQOL-BREF) and HS (SF-12) measurements in vascular amputees. This raises the question, which outcome measurement is the most relevant for elderly CLI patients. Individual treatment goals should be kept in mind when assessing the HS or QoL outcome of patients undergoing hospital care. With respect to shared decision making, distinctive and subjective QoL questionnaires, like the WHOQOL-BREF, provide a very important outcome measurement and should be used in future research.

Relationship between changing patient-reported outcomes and subsequent clinical events in patients with chronic heart failure: insights from HF-ACTION.

A 5-point change in the Kansas City Cardiomyopathy Questionnaire (KCCQ) is commonly considered to be a clinically significant difference in health status in patients with heart failure. We evaluated how the magnitude of change relates to subsequent clinical outcomes. Using data from the HF-ACTION trial of exercise training in chronic heart failure (n = 2331), we used multivariable Cox regression with piecewise linear splines to examine the relationship between change in KCCQ overall summary score from baseline to 3 months (range 0-100; higher scores reflect better health status) and subsequent all-cause mortality/hospitalization. Among 2038 patients with KCCQ data at the 3-month visit, KCCQ scores increased from baseline by ≥5 points for 45%, scores decreased by ≥5 points for 23%, and scores changed by <5 points for the remaining 32% of patients. There was a non-linear relationship between change in KCCQ and outcomes. Worsening health status was associated with increased all-cause mortality/hospitalization (adjusted hazard ratio 1.07 per 5-point KCCQ decline; 95% confidence interval 1.03-1.12; P < 0.001). In contrast, improving health status, up to an 8-point increase in KCCQ, was associated with decreased all-cause mortality/hospitalization (adjusted hazard ratio 0.93 per 5-point increase; 95% confidence interval 0.90-0.97; P < 0.001). Additional improvements in health status beyond an 8-point increase in KCCQ was not associated with all-cause death or hospitalization (P = 0.42). In patients with heart failure, small changes in KCCQ are associated with changing future risk, but more research will be necessary to understand how different magnitudes of improving health status affect outcomes.

Abstract 091: The Association of Invasive Treatment on Health Status Outcomes in Patients with Non-ST Elevation Myocardial Infarction and Pre-infarct Angina

Introduction: Pre-infarct angina (PIA) in patients with non-ST elevation myocardial infarction (NSTEMI) is associated with better outcomes. However, the association of invasive strategy, as compared with ischemia-guided strategy, on health status outcomes for patients with PIA is not well studied. Methods: TRIUMPH and PREMIER are prospective myocardial infarction registries that collected the Seattle Angina Questionnaire (SAQ) at baseline, 1, 6 and 12 months. PIA was defined as a score of &lt;100 on the SAQ Angina Frequency score at the time of patients’ acute myocardial infarction admission. Invasive strategy was defined as undergoing coronary angiography within 72 hours of admission without a preceding stress test. Propensity-adjusted mixed effect multivariable models were used to compare follow-up health status in patients with and without PIA based on treatment strategy. Results: Among 3,544 patients with NSTEMI, 1,839 (52%) had PIA, of whom 1,230 (67%) had an invasive strategy of whom 75% underwent revascularization. While patients who underwent invasive strategy had better health status at baseline than those who underwent ischemia-guided strategy, after propensity adjustment, patients’ comorbidities and characteristics were well balanced (all standardized differences &lt;10%). An invasive strategy was associated with an improvement in SAQ angina frequency and SAQ summary score at 1 month only among patients with PIA (mean difference of 4 and 4.4 points, respectively, p &lt;0.005), but this difference was not sustained at 6 or 12 months (Figure). However, among patients with no PIA, there was no significant difference in health status among patients who underwent an invasive or conservative strategy at all time points (mean difference at 1 month of 0.4 and 0.5 points on SAQ angina frequency and summary score, respectively, p &gt;0.5 ). Conclusion: An invasive strategy for NSTEMI was associated with significantly better 30-day health status among patients with PIA, but not in those without. No health status benefits of an invasive strategy were observed at 6 or 12 months, regardless of PIA status.

Evaluation of the Health and Physical Activity Characteristics of Undergraduate Paramedic and Nursing Students

Introduction Levels of physical activity and health status are substantially influenced during the early adulthood years. The purpose of this research was to evaluate the health and physical activity characteristics of undergraduate paramedic and nursing students. Methods This research comprised a descriptive and inter-discipline survey of a sample of university students enrolled in healthcare programs. The health status and physical activity patterns of paramedic and nursing undergraduate students were assessed using the 36-item Short Form Health Survey (SF-36) and the International Physical Activity Questionnaire (IPAQ), respectively. Statistical comparisons for health status — total, eight health dimensions and weekly metabolic equivalent were performed. Results A total of 226 undergraduate students were surveyed with 66.4% enrolled in the paramedic, 17.7% in the nursing, and 15.9% enrolled in the double degree nursing/paramedic Bachelor programs. Results for the SF-36 total show a significant difference in health status between the undergraduate programs (p=0.001). Reduced health dimensions were also revealed among first year students. Results for the IPAQ shows a significant difference in physical activity between the programs (p=0.03). Comparison between IPAQ and year of study show a significant difference between groups (p=0.03). Conclusion Substantially reduced health status and physical activity patterns were shown in nursing students compared to paramedic students and among first year university undergraduates. This research highlights the need to further investigate the health status and physical activity patterns within university healthcare students.

The Association Between Health Changes and Cessation of Alcohol Consumption.

AimsTo assess whether health changes affect cessation of alcohol consumption and to compare the health status of former drinkers and abstainers.MethodsCohort data from 9001 Korean participants aged 40–69 years old were analyzed. Alcohol consumption was assessed every 2 years for 10 years. Participant age, sex, marital status, education level, employment status, smoking, chronic disease, perceived health and changes in these variables were analyzed to identify factors associated with quitting alcohol drinking. The number of diseases and perceived health of former drinkers and people who at baseline were lifetime abstainers were compared.ResultsAmong 4037 drinkers at baseline, 673 (16.7%) were classed as quitters and 3364 (83.3%) were classed as non-quitters. Sex, age and worsened perception of health were significantly associated with cessation of drinking. Women and individuals >60 years were more likely to cease drinking. There was a significant association between disease onset or treatment and alcohol cessation for cancer cases, but not for cardiovascular disease or chronic disease cases. There was no significant difference in number of diseases or perceived health between former drinkers and people who at baseline were lifetime abstainers.ConclusionsThe effect of disease onset or treatment on alcohol consumption cessation depended on disease type. Former drinkers did not show significantly worse health than people who at baseline were lifetime abstainers. Further studies of alcohol consumption and its effects on health are needed to consider disease occurrence and changes in alcohol consumption.Short summaryDisease onset or treatment significantly affected alcohol consumption cessation for cancer cases, but not for cardiovascular disease or other chronic disease cases. There was no significant difference in health status between former drinkers and lifetime abstainers.

간호대학생의 임상실습 만족도와 임상수행능력과의 관계

본 연구는 간호대학생의 임상실습 후 임상실습 만족도와 임상수행능력을 파악하기 위한 서술적 조사 연구이다. 연구대상자는 A대 간호학과 학생으로 임상실습을 경험한 3, 4학년 학생 전수인 118명 이었다. 수집된 자료는 SPSS/PC+ ver. 21을 이용하여 빈도, 평균, 표준편차, t-test, ANOVA, Scheffe test, Pearson's Correlation Coefficients로 분석하였다. 연구결과로, 대상자의 임상실습 만족도는 5점 만점에 3.36점, 임상수행능력은 5점 만점에 3.42점으로 나타났다. 임상실습 만족도의 하위영역은 교과만족이 가장 높고, 임상수행능력의 하위영역은 교육/협력관계가 가장 높게 나타났다. 대상자 특성에 따른 임상실습 만족도는 건강상태(F=3.896, p=.023), 대학생활 만족도(F=8.164, p<.001), 간호학 전공만족도(F=4.652, p=.011), 임상실습 여건만족도(F=11.889, p<.001), 임상실습량에 대한 만족도(F=13.504, p<.001)에서 유의한 차이가 있었다. 대상자의 특성에 따른 임상수행능력은 종교(t=6.682 p=.011), 대학생활 만족도(F=3.440, p=.035)에서 유의한 차이가 있었다. 간호 대학생의 임상실습 만족도와 임상수행능력(r=.297, p=.001) 간에는 양의 상관관계를 나타냈다. The purpose of this descriptive study was to investigate satisfaction with clinical practice and clinical performance ability for 118 of third and fourth year nursing students. The collected data were analyzed by using the SPSS/PC+ver. 21 program which determined frequency, percentage, mean, standard deviation, t-test, one-way ANOVA, Scheffe test, and Pearson's correlation coefficients. The results of this study were as follows : The satisfaction with clinical practice was 3.36 point out of 5 and the clinical performance ability was 3.42 point out of 5. In satisfaction with clinical practice, satisfaction of the curriculum was the highest and in clinical ability performance, education partnerships was the highest. Clinical practice satisfaction according to the general characteristic of the subjects was significant difference in health status(F=3.896, p=.023), satisfaction with college life(F=8.164, p<.001), nursing department(F=4.652, p=.011), conditions in clinical practice(F=11.889, p<.001), and practice workload(F=13.504, p<.001). Clinical performance ability according to the general characteristic of the subjects was significant difference in religion(t=6.682 p=.011) and satisfaction with college life(F=3.440, p=.035). The relationship between clinical practice satisfaction and clinical performance ability was positive correlation(r=.297, p=.001).

Non-functioning pituitary macroadenomas: Benefit from early growth hormone substitution after surgery

PurposeData suggests that substitution of GH in GH-deficient patients may improve quality-of-life and reduce insufficiency-associated-symptoms. Unlike in corticotroph, thyreotroph, or gonadotroph-insufficiency, GH-substitution is usually not started within the first 6–12months after surgery. We aimed to investigate the effect of early-GH-substitution on body-composition, metabolic and pituitary-laboratory-tests, and quality-of-life. MethodsData was reviewed from 21 adult-patients who were diagnosed with insufficiency of GH-axis using insulin–hypoglycemia-test. We retrospectively assessed body-composition, metabolic and pituitary-laboratory-tests and quality-of-life for a period of 52-weeks after pituitary-surgery in patients with early GH-substitution (= treated-group, 11-patients) and no GH-substitution (= untreated group, 10-patients). ResultsFollow-up-IGF-I-levels of the treated-group stayed within the normal range and differed significantly from the untreated-group. Bioelectrical-impedance-analysis showed a significant decrease of impedance, a significant increase of lean-body-mass and a significant difference in health status in the treated group (p<0.05). Average increase in HDL-level was 2.1mg/dl in the untreated compared to an average decrease of 0.2mg/dl in the treated-group. Lp(a)-levels were reduced by 4.1mg/dl in the treated and by 2.7mg/dl in the untreated-group.Both groups showed an initial-mean-life-satisfaction below average (−0.9 and −1.2). Within one year after surgery mean-health-status improved in both groups. The difference in health-status after 1-year compared to the health-status of the previous year was statistically different between both groups with a greater benefit in the treated-group.Finally there was a trend detectably pointing towards an improvement in pituitary-function (LH- and FSH-recovery) if GH was substituted. ConclusionEarly GH-substitution leads to a significant improvement in quality-of-life and body-composition after pituitary-surgery. It is possible that pituitary-function recovers more with early-GH-substitution.

Physical Activity and Structured Exercise for Patients With Stable Ischemic Heart Disease

EXERCISE WAS RECENTLY DESCRIBED AS “A MIRACLE drug” that can benefit every part of the body and substantially extend lifespan.” The authors suggested that the cardioprotective and systemic health benefits of regular exercise are underestimated by many clinicians, who often fail to emphasize the importance of regular physical activity, as well as the harms of physical inactivity, even though they routinely counsel patients about other modifiable cardiovascular risk factors, such as cigarette smoking, elevated cholesterol levels, and hypertension. If exercise is a central and indispensible component of a comprehensive strategy for the primary prevention of coronary artery disease, the mantra “exercise is medicine” may be even more valid and is too often undervalued as a critical element in secondary prevention. However, many patients with heart disease who qualify for and require exercise training as an essential part of their recovery process are not receiving this therapy, often because of a lack of awareness by patients, health care professionals, and payers of the necessity, appropriateness, and effectiveness of this intervention. This gap between scientific evidence and clinical practice is the focus of this Viewpoint, which discusses the importance of structured exercise and increased physical activity for patients with stable ischemic heart disease and the need to highlight the poor prognosis associated with being in the least fit, least active cohort (bottom 20%) for the 12 to 13 million US residents who comprise this population. One of the most puzzling aspects of the medical community’s failure to recommend regular exercise for patients with stable ischemic heart disease may be the fundamental simplicity and affordability of this intervention, particularly compared with other widely accepted preventive measures. For instance, the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial showed no difference in clinical outcomes in patients with stable ischemic heart disease (eg, death, myocardial infarction, hospitalization for unstable angina) during a mean 55-month follow-up between those who underwent percutaneous coronary intervention (PCI) and optimal medical therapy (including both risk-reducing and symptom-reducing therapies) and those treated with optimal medical therapy and lifestyle modification. Anginal symptoms were reduced in both groups, and there was no significant difference in health status between the groups, demonstrating that optimal control of risk factors could favorably affect outcomes. Despite clinical guideline recommendations that, among patients with stable ischemic heart disease, revascularization may be deferred until the effects of optimal medical therapy and lifestyle modification have been assessed and validated, more than half of the 1.3 million annual PCI procedures in the United States are performed electively for patients with stable ischemic heart disease, and only about 45% of these patients receive optimal medical therapy prior to their procedure. Equally concerning is that many of these patients do not participate in medically supervised or home-based exercise training programs, even after revascularization. Increased exercise or physical activity and cardiorespiratory fitness appear to mitigate cardiovascular disease progression. Exercise has antiatherosclerotic, antithrombotic, anti-ischemic, antiarrhythmic, and positive psychological effects, and secondary prevention exercise training regimens in conjunction with optimal medical therapy have been shown to reduce total mortality by 20%, cardiac mortality by 26%, and nonfatal myocardial infarction by 21%. Cardiorespiratory fitness may be expressed as metabolic equivalents (METs), for which 1 MET isapproximately 3.5 mL of oxygen per kilogram of body weight per minute (mL/kg/ min), which is equivalent to the energy requirement for basal homeostasis. Multiples of this value are often used to quantify relative levels of energy expenditure. Each 1-MET increase in exercise capacity is associated with an 8% to 35% (median, 16%) reduction in mortality, which compares favorably with the survival benefit conferred by low-dose aspirin, statins, -blockers, and angiotensin-converting enzyme inhibitors after acute myocardial infarction. Current guidelines recommend 30to 60 minutes of moderate-intensity aerobic activity at least 5 days a week for patients with stable ischemic heart disease to augment peak oxygen uptake and modify cardiovascular risk factors, as well as complementary resistance training at least 2 days a week to increase weight-carrying tolerance and skeletal muscle strength. Resistance training also attenuates the rate-

Patient satisfaction with GP-led melanoma follow-up: a randomised controlled trial

Background:There are no universally accepted guidelines for the follow-up of individuals with cutaneous melanoma. Furthermore, to date, there have been no randomised controlled trials of different models of melanoma follow-up care. This randomised controlled trial was conducted to evaluate the effects of GP-led melanoma follow-up on patient satisfaction, follow-up guideline compliance, anxiety and depression, as well as health status.Methods:A randomised controlled trial of GP-led follow-up of cutaneous melanoma was conducted over a period of 1 year with assessment by self-completed questionnaires and review of general practice-held medical records at baseline and 12 months later. It took place in 35 general practices in North-east Scotland. Subjects were 142 individuals (51.4% women 48.6% men; mean (s.d.) age 59.2 (15.2) years previously treated for cutaneous melanoma and free of recurrent disease. The intervention consisted of protocol-driven melanoma reviews in primary care, conducted by trained GPs and supported by centralised recall, rapid access pathway to secondary care and a patient information booklet. The main outcome measure was patient satisfaction measured by questionnaire. Secondary outcomes were adherence to guidelines, health status measured by Short Form-36 and the Hospital Anxiety and Depression Scale.Results:There were significant improvements in 5 out of 15 aspects of patient satisfaction during the study year in those receiving GP-led melanoma follow-up (all P⩽0.01). The intervention group was significantly more satisfied with 7 out of 15 aspects of care at follow-up after adjustment for potential confounders. There was significantly greater adherence to guidelines in the intervention group during the study year. There was no significant difference in health status or anxiety and depression between intervention and control groups at either baseline or outcome.Conclusions:GP-led follow-up is feasible, engenders greater satisfaction in those patients who receive it, permits closer adherence to guidelines and does not result in adverse effects on health status or anxiety and depression when compared with traditional hospital-based follow-up for melanoma.

Co-active coaching as an intervention for obesity among female university students

Purpose:The purpose of this study was to assess the impact of Co-active coaching on obese female university students’ body mass index (BMI), waist circumference (WC), functional health status and self-esteem, and conjointly to identify the coaching skills and primary agenda topics that facilitate coaching’s efficacy as an intervention for obesity.Design:A multiple-baseline, single-subject research design was utilized.Methods:Two certified coaches provided an average of nine, 35-minute, one-on-one sessions with five students whose BMI≥30kg/m2(obesity threshold). Measures included BMI, WC, the Short-Form 36 (SF-36) Health Survey, and the Rosenberg Self-Esteem Scale. Visual inspection was used to analyze changes in BMI and WC. Statistical interpretations, supplemented with qualitative information from post-intervention interviews, were used to determine whether a clinically significant difference in health status and/or self-esteem was achieved. Inductive content analysis was conducted on the interview transcripts and on 50 per cent of each participant’s coaching session transcripts.Results:Visual inspection revealed no change in BMI for three, a decrease for one, and a slight increase for one participant. WC decreased for three participants and remained stable for two. Collectively, the effect sizes and qualitative statements indicated clinically significant improvements in participants’ self-esteem and physical, mental, and overall health statuses upon completion of the intervention. Powerful questions and acknowledgements were the most frequently used coaching skills.Conclusions:Coaching and particular coaching skills were associated with a trend towards a decrease in WC and clinically significant increases in participants’ self-esteem and their mental, physical, and overall health statuses.

Effect of PCI on Quality of Life in Patients with Stable Coronary Disease

Conclusions: In patients with stable angina, those treated with percutaneous coronary intervention (PCI) and optimal medical management, and those treated with optimal medical management both have marked improvement in quality of life during follow-up. Initially, those treated with PCI have a small incremental benefit vs those treated with medical management alone. After 36 months there is no difference in health status between the two groups. Summary: Up to one-third of PCIs have been performed in patients with stable angina. This is despite the fact that patients with chronic coronary disease do not have a reduction in major cardiovascular events when treated with PCI vs best medical management. The argument has been made that PCI reduces angina symptoms more effectively than best medical management and therefore improves quality of life. In this study the authors analyzed quality of life data to determine whether quality of life was enhanced by a strategy of PCI in patients with chronic coronary artery disease. This was a randomized, not blinded, multicenter trial that took place in 50 centers in the United States and Canada, with sponsorship and oversight of the trial provided by the Department of Veterans' Affairs Cooperative Studies Program. The study randomly assigned 2287 patients with stable coronary artery disease to optimum medical therapy alone, or PCI plus optimal medical therapy. Angina-specific health status was assessed using the Seattle Angina Questionnaire. Scores ranged from 0 to 100, with highest scores indicating better health status. The RAND 36-Item Health Survey was used to assess overall physical and mental function. Upon entering the trial, 22% of the patients were free of angina. After 3 months, 42% in the medical therapy group alone and 53% of the PCI patients were angina-free (P < .001). The mean ± SD Seattle Angina Questionnaire scores at baseline were 66 ± 25 for physical limitations, 54 ± 32 for angina stability, 69 ± 26 for angina frequency, 87 ± 16 for treatment satisfaction, and 51 for quality of life. By 3 months these baseline scores increased more in the PCI group compared with the medical therapy group: 76 ± 24 vs 72 ± 23 for physical limitation (P = .004), 77 ± 28 vs 73 ± 27 for anginal stability (P = .002), 85 ± 22 vs 80 ± 23 for angina frequency (P <.001), 92 ± 12 vs 90 ± 14 for treatment satisfaction (P < .001), and 73 ± 22 vs 68 ± 23 for quality of life (P < .001). Overall, incremental benefit for PCI was present for 6 to 24 months, and patients with more severe angina had greater benefit from PCI. Similar results occurred in the PCI group in some, but not all, RAND-36 domains. At 36 months there was no significant difference in health status between the two groups. Comment: This was not a “head to head” trial of medical therapy vs PCI. The trial, in fact, compared a strategy of initial PCI plus optimal medical therapy vs optical medical therapy alone initially. Eventually 21% of the patients in the medical therapy alone group crossed over and received PCI. Therefore, what this trial tells us is that in patients with stable coronary disease, initial management should be optimal medical therapy, and if this is ineffective, patients should then be treated with coronary intervention.

Effect of PCI on Quality of Life in Patients with Stable Coronary Disease

It has not been clearly established whether percutaneous coronary intervention (PCI) can provide an incremental benefit in quality of life over that provided by optimal medical therapy among patients with chronic coronary artery disease. We randomly assigned 2287 patients with stable coronary disease to PCI plus optimal medical therapy or to optimal medical therapy alone. We assessed angina-specific health status (with the use of the Seattle Angina Questionnaire) and overall physical and mental function (with the use of the RAND 36-item health survey [RAND-36]). At baseline, 22% of the patients were free of angina. At 3 months, 53% of the patients in the PCI group and 42% in the medical-therapy group were angina-free (P<0.001). Baseline mean (+/-SD) Seattle Angina Questionnaire scores (which range from 0 to 100, with higher scores indicating better health status) were 66+/-25 for physical limitations, 54+/-32 for angina stability, 69+/-26 for angina frequency, 87+/-16 for treatment satisfaction, and 51+/-25 for quality of life. By 3 months, these scores had increased in the PCI group, as compared with the medical-therapy group, to 76+/-24 versus 72+/-23 for physical limitation (P=0.004), 77+/-28 versus 73+/-27 for angina stability (P=0.002), 85+/-22 versus 80+/-23 for angina frequency (P<0.001), 92+/-12 versus 90+/-14 for treatment satisfaction (P<0.001), and 73+/-22 versus 68+/-23 for quality of life (P<0.001). In general, patients had an incremental benefit from PCI for 6 to 24 months; patients with more severe angina had a greater benefit from PCI. Similar incremental benefits from PCI were seen in some but not all RAND-36 domains. By 36 months, there was no significant difference in health status between the treatment groups. Among patients with stable angina, both those treated with PCI and those treated with optimal medical therapy alone had marked improvements in health status during follow-up. The PCI group had small, but significant, incremental benefits that disappeared by 36 months. (ClinicalTrials.gov number, NCT00007657.)

Selection of patients for inpatient rehabilitation or direct home discharge following total joint replacement surgery: a comparison of health status and out-of-pocket expenditure of patients undergoing hip and knee arthroplasty for osteoarthritis

To analyse the differences in patient health outcomes and out-of-pocket costs following hip and knee joint replacement for osteoarthritis between patients who went home immediately after the acute care hospital stay and those who were admitted to inpatient rehabilitation care before going home. One hundred and eighteen patients undergoing total hip or knee replacement in Sydney, Australia completed cost diaries, SF-36 and WOMAC Index, pre-operatively and for one year post-operatively. The health status of all groups improved significantly from before surgery to 12 months post-surgery. No significant difference in health status at 12 months post-surgery was seen between home and rehabilitation patients for either hip or knee replacement. Both hip replacement home and rehabilitation patients and knee replacement home patients reported lower out-of-pocket expenditure from before surgery to 1 year post-surgery. The majority of total joint replacement patients can be discharged directly home and achieve excellent outcomes at 12 months post-surgery. We would recommend more focused randomized studies to explore the most suitable patient selection for rehabilitation.

Empowerment of Senior Citizens for Retired Life

In the present study 120 senior citizens residing in the rehabilitative institutes of U. T. Chandigarh and State Uttar Pradesh participated. It was found that majority of male and female senior citizens suffer from depression, lose their social status and become economically poor after retirement. Health wise males were poor or good in their health status, while greater percentage of female senior citizens was good in their health status. There was significant difference in health status of male and female senior citizens.