Various Aspects Of Quality Of Life Research Articles

Does age or gender influence quality of life in children with atopic dermatitis?

Quality of life (QoL) is impaired in children with atopic dermatitis (AD) but the various aspects of QoL may not be equally affected. Aim. To evaluate if age and gender affect some aspects of QoL in children with AD. The Children's Dermatology Life Quality Index (CDLQI) was used for all children with AD seen at a paediatric dermatology clinic over a 3-year period. Disease severity was assessed using the SCORing Atopic Dermatitis (SCORAD) and Nottingham Eczema Severity Score (NESS) tools. We reviewed CDLQI in 133 children (70 male and 63 female; age range 5-16 years) with AD. Itch, sleep disturbance, treatment and swimming/sports were the four aspects of QoL issues that were most commonly affected, in 50%, 47%, 38% and 29% of patients, respectively. Problems with interpersonal issues (friendship, school/holidays, and teasing/bullying) occurred in only a minority of children (<or= 10%). Girls had more problems with issues of clothes and shoes than did boys (OR = 2.86, 95% CI 1.05-8.00; P = 0.038). Significant itch and sleep disturbance affected both genders similarly but were generally more common in children <or= 10 years (itch: OR = 2.31, 95% CI 1.04-5.14; P = 0.039; and sleep: OR = 2.31, 95% CI 1.05-5.13; P = 0.037). Not all aspects of QoL are affected equally in children with AD. The disease seems to affect personal domains of itch and sleep more than the interpersonal issues. Age and gender are relevant factors in QoL, with the issue of clothes/shoes being more troublesome for girls. itch and sleep disturbance seem to be a problem mainly in younger children.

Chemotherapy‐induced alopecia and effects on quality of life among women with breast cancer: a literature review

Alopecia is a common side effect of chemotherapies used in the treatment of breast cancer. The aim of this review is to describe the effects of alopecia on quality of life (QOL) in this population. We conducted a literature review using Medline, Embase, Cumulative Index to Nursing and Allied Health Literature and PsycInfo databases. We searched for studies on the effects of alopecia on various aspects of QOL in breast cancer patients including anxiety and distress, body image, sexuality, self-esteem, social functioning, global QOL and return to work outcomes. A total of 38 articles were included in the review. Hair loss consistently ranked amongst the most troublesome side effects, was described as distressing, and may affect the body image. We found very little quantitative data on other aspects of QOL. More research is needed to determine the presence and extent of negative effects on chemotherapy-induced alopecia on various aspects of QOL.

Quality of life in focal, segmental, and generalized dystonia

The objective of this study was to assess quality of life (QoL) in a community-based sample of people with various forms of dystonia and to identify the factors that predict QoL in dystonia. QoL was assessed using two generic questionnaires: the Medical Outcomes Study Short-Form 36 (SF36) and the EuroQol questionnaire. A host of demographic, clinical, and psychosocial variables were measured to identify the best predictors of QoL in dystonia. A comparison of EuroQol and SF36 scores with the norms for the general UK population of similar age showed that people with dystonia had scores indicative of worse QoL on all domains, particularly those related to physical and social functioning. The impairment of QoL was seen in all age groups and was similar for men and women. Compared to the focal dystonia group, participants with generalized dystonia scored significantly worse on all QoL measures. Participants who were unemployed also scored significantly worse. There was also a trend for younger and separated/divorced participants to score worse on QoL measures. A stepwise regression analysis revealed that functional disability, body concept, and depression were important predictors of QoL in dystonia. Dystonia influences various aspects of QoL, particularly those related to physical and social functioning. The impairment of QoL was greater for participants with generalized dystonia, those who were unemployed, younger, and separated/divorced. Functional disability, body concept, and depression were the best predictors of QoL in dystonia. Efforts to improve health care for people with dystonia should not only focus on management of the movement disorder but also consider modifying functional disability and negative body concept and depression that contribute to poor QoL in this disorder.

Modern Economic Growth and Quality of Life: Cross Sectional and Time Series Evidence

To what extent are improvements in quality of life (material living levels, health, education, political and civil rights, happiness, and the like) associated with economic growth? International comparisons of quality of life (QoL) conditions almost always point to a strong positive association with real GDP per capita. Historical experience, however, frequently belies the results of these comparisons. More often than not the timing of various improvements in QoL, material living levels excepted, is different from that in real GDP per capita – some indicators preceding, others following. Moreover, the sequence of improvements in various aspects of QoL is not always the same from one part of the world to another. And sometimes, as in the case of happiness and life satisfaction, QoL indicators remain unchanged despite a doubling or more of real GDP per capita. In contrast to the results of simple international point-of-time comparisons, history suggests that improvements in many realms of life are not an automatic result of economic growth.

Quality of life of children following bone marrow transplantation: critical review of the research literature

Children's quality of life (QOL) following bone marrow transplant (BMT) is an important but poorly understood concept. The aim of this paper is to critically review all research study designs to determine the QOL of childhood BMT recipients and to identify implications for research, practice and theory. The studies' methodological quality was evaluated separately by two investigators according to a set of formal criteria modified from Hoodin and Weber (Psychosomatics 44 (2003) 181). The review yielded one retrospective, one cross-sectional, six descriptive surveys and two prospective longitudinal study designs. The studies included 568 childhood BMT recipients ranging from 0.8 to 33 years. Only one study used a generic and disease-specific, psychometrically sound, QOL measure. Timing of assessments ranged from pre-BMT to 21 years following BMT. Due to the poor methodological quality, rendering conclusions across the studies was challenging. While the available evidence seems to suggest children experience good QOL following BMT, several studies found BMT to have a negative impact on various aspects of QOL. These results appear to be influenced by timing and type of measurements undertaken. Ultimately, there is a need for larger, more methodologically rigorous trials using prospective longitudinal study designs with pre- and post-measures to examine all QOL domains in children.

Topophilia and Quality of Life: Defining the Ultimate Restorative Environment

Mental stress is increasingly recognized as an environmental contributor to disease burden in many parts of the world. One way people try to reduce mental stress is through features of the built environment. Architects often give us “nature” in the form of water or trees to create restorative settings, while others favor complex and challenging sculpture or structures. In this month’s issue, Oladele A. Ogunseitan of the University of California, Irvine, asks us to consider the study of topophilia as a source for criteria to help us judge which elements of an environment truly have a restorative effect [EHP 113:143–148]. The term topophilia was coined by the geographer Yi-Fu Tuan of the University of Wisconsin and is defined as the affective bond with one’s environment—a person’s mental, emotional, and cognitive ties to a place. Topophilia is studied here as a latent construct, an abstract psychological concept similar to “attitude” or “intelligence” whose variability can only be observed indirectly through its effect on measurable responses. Ogunseitan surveyed 379 people on the Irvine campus, asking them to rate the importance of features such as color, flowers, and complexity to an environment they consider restorative. He then compared these values with data from a World Health Organization quality of life (QOL) survey administered along with the topophilia questions. The environmental features surveyed mapped closely onto four domains of topophilia: ecodiversity (the presence of flowers, water, and other elements of nature), synesthetic tendency (a commingling of colors, smells, and other sensory stimuli), environmental familiarity (which includes spaciousness and privacy), and cognitive challenge (which includes structural complexity and texture). Structural equation modeling showed a positive correlation between topophilia and various aspects of QOL. That is, people who had the highest topophilia ratings (who, for example, most highly valued flowers or color as important for achieving a restorative effect) tended to have the highest QOL scores. Ecodiversity had the highest correlation with overall QOL. Within this category, the presence of flowers and proximity to lakes or the ocean were most significantly correlated with QOL. Ogunseitan notes that “complexity” and other features associated with the cognitive domain—and much loved by some architects—were not linked with higher QOL. He also was surprised that none of the synesthetic tendency qualities such as smells or sounds were associated with improved QOL, given the postulated health benefits—and obvious commercial appeal—of aromatherapy and recorded “nature” sounds. The results would appear to buttress previous research indicating that people prefer “natural” environments to those that emphasize complex designs or artificial sensory stimulation, but Ogunseitan stresses that this study represents only an initial foray into understanding the complex relationship between quality of life and restorative environments. The current study design assumes that when people rate aspects of their environment highly, there really is a chance that those features are restorative to mental health beyond their aesthetic appeal. Although the results of such correlational research do not imply causation, Ogunseitan notes, they can offer insights to guide future research.

A Randomized Study Comparing High–Energy TUMT to TURP: Quality–of–Life Results

Purpose: To evaluate the impact of high–energy transurethral microwave thermotherapy (TUMT) and transurethral prostatic resection (TURP) on quality of life (QoL) in patients with benign prostatic hyperplasia (BPH).Materials and Methods: A total of 147 patients with BPH were randomized to receive either high–energy TUMT treatment (Prostasoft 2.5) or a TURP and were followed for 1 year. All patients completed a QoL questionnaire to assess perception of urinary difficulties, sexual function, daily activities, psychological well–being, social activities and improvement in QoL.Results: For almost all scales the standardized Cronbach’s α was adequate. Between the various QoL scales there is a statistically significant correlation except for social well–being and sexual functions. There is also a significant correlation between the QoL scales and age, IPSS and Madsen. For the sexual functions there is only a correlation with age. A significant difference in improvement in favor of the TURP group was observed in general perception of urinary difficulties and activities of daily living. However, no difference between the groups was observed for the QoL scale measuring experienced improvement. The sexual function is not influenced by both treatment modalities. Both groups have a significant improvement in clinical outcome at all points of measurement. TURP has a better clinical outcome.Conclusion: Both TUMT and TURP have a significant positive effect on various aspects of QoL. In particular, perception of urinary difficulties and activities of daily living are positively influenced by both treatments. TURP, however, has a greater impact than high–energy TUMT.

Improvement in quality of life differs between women and men after coronary artery bypass surgery.

To study improvement in quality of life (QoL) after coronary artery bypass grafting (CABG) in relation to gender. Women generally report worse QoL after CABG than men. However, women are older and more symptomatic prior to surgery, which should be considered in comparative analyses. We studied consecutive patients who underwent CABG between 1988 and 1991 [n = 2121] with a QoL questionnaire containing the Physical Activity Score, the Nottingham Health Profile and the Psychological General Well-being Index prior to, 3 months, 1 year and 2 years after surgery. Females were older than men with more concomitant diseases preoperatively. QoL was improved on all postoperative occasions for both sexes. Improvement in the Physical Activity Score was somewhat, although not significantly, greater in males. Improvement in the Nottingham Health Profile was greater in females. General well-being showed no consistent pattern for improvement. QoL is significantly improved after CABG in both sexes throughout follow-up. There is a complex association between improvement in various aspects of QoL and gender.

Types of spiritual well-being among persons with chronic illness: Their relation to various forms of quality of life

Objectives: Derive a spiritual well-being classification and thereby enhance understanding of the relation between spiritual well-being, quality of life (QOL), and health among persons with chronic illness or disability. Design: Cluster analyses were performed to develop a spiritual well-being classification. Analysis of variance was used to compare cluster groups on various dimensions of QOL. Setting: Part of a larger QOL study conducted at a midwestern medical center. Patients: A convenience sample of 216 inpatients: amputation ( n = 74), postpolio ( n = 37), spinal cord injury ( n = 34), breast cancer ( n = 36), and prostate cancer ( n = 35). Minors were excluded from the study. Main Outcome Measures: Spiritual Well-Being Scale (SWBS), Functional Assessment of Cancer Therapy (FACT), Functional Living Index-Cancer (FLIC), Sickness Impact Profile (SIP), Medical Outcome Survey-Short Form (SF-36), and the Satisfaction With Life Scale (SWLS). Results: Three types of spiritual well-being were identified: religious ( n = 146), existential ( n = 37), and nonspiritual ( n = 30). Significant cluster differences ( p < .03 to p < .001) were observed across all QOL domains and life satisfaction. Compared with the other cluster groups, the nonspiritual group reported significantly lower levels of QOL and life satisfaction and the highest proportion of health status change with respect to both improvement and decline in health. Conclusions: Three types of spiritual well-being were empirically identified in this sample. Subtypes differed significantly with respect to various aspects of QOL. Further research is needed to validate this classification and to determine if type of spiritual well-being has a causal effect on treatment outcome or on the recovery process.

EXERCISE TRAINING IMPROVES QUALITY OF LIFE IN PATIENTS WITH CHRONIC HEART FAILURE 958

The purpose of this study was to determine the impact of exercise training on measures of quality of life (QOL) in patients with chronic heart failure(CHF). Twenty eight patients with CHF (Etiology: Ischemic heart disease; NYHA: II or III) were randomly assigned to exercise training [ExT:n=14, age:58±5yrs; LVEF:28±10%] or no training [NTr: n=14; age:60±5yrs; LVEF:28±10%]. ExT consisted of walking 30 min, 3 days/wk for 16 wks. Measurements of QOL were based on the Nottingham Health Profile questionnaire. Following ExT, exercise capacity (VO2peak) and exercise time increased 24% (13.0±3.5 to 16.2±4.0 ml/kg/min) and 32% (12.3±3.5 to 16.25±4.3 min), respectively (p≤0.05). QOL scores for Energy, Pain, Emotional Reaction (ER), and Physical Mobility (PM) were significantly reduced following exercise training (seetable). Sleep and Social did not change in either ExT or NTr. The NTr group also did not change in Energy, Pain, ER, or PM over time. Perception of energy, pain, ER, and PM improved markedly after a supervised exercise training program for patients with CHF. This suggests that the benefits of ExT extend beyond physiological adaptations and include improvements of various aspects of QOL.

On the receiving end. VI. Which dimensions of quality-of-life scores carry prognostic information?

Quality of life (QL) of patients with advanced malignancy is an important consideration when assessing the impact of the disease and its treatment (I, 2). QL scores are also powerful independent predictors of survival duration, at least in breast cancer (3-51, melanoma (6) and lung cancer (7). Current methods permit simple, reliable and valid measurement of important aspects of QL (1, 3, 8, 9). The reason for the association between QL scores and prognosis is uncertain. A simple explanation might be that the QL score provides a better measure of the extent of the underlying disease, and thus its prognosis, than other clinically recorded parameters. Even this explanation would, of course, be sufficient to justify the measurement of QL. Alternatively, there is a possibility that better perceived QL actively prolongs survival. If true, this could justify interventions aimed at prolonging survival by improving QL. Preliminary studies have demonstrated that psychosocial intervention can improve aspects of QL (IO), and may improve survival (II). The Spitzer QL Index (QLI) (121 was designed as a concise measure of QL. It measures five separate dimensions of QL: physical performance, activities of daily living, health, support by others and outlook, using a three-point scale for each. The authors have recently analysed the prognostic associations of the components of the QLI obtained at the time of entry to two independent multicentre randomized clinical trials of treatment for metastatic breast cancer and malignant melanoma. Patients in each trial also completed linear analogue self assessment (LASA) scales measuring physical well-being (PWB), mood, pain, nausea and appetite. This paper now presents a comparison of the prognostic significance of various aspects of QL as assessed by patients and physicians.

The functional assessment of cancer therapy (FACT) scale. Development of a brain subscale and revalidation of the general version (FACT-G) in patients with primary brain tumors

This report describes the development and validation of a brain subscale for the Functional Assessment of Cancer Therapy (FACT) scale, and the revalidation of the subscales of the general version (FACT-G), which measure physical, social, family, emotional, and functional well-being and the quality of the relationship with the physician. 101 patients with primary brain tumors, after giving informed consent, participated in the last two phases of a four-phase validation process: item generation, item reduction, validation, and reliability testing. In the validation phase, FACT-G subscale and total scores as well as the brain subscale scores were correlated with other tests of mood, response, bias, and quality of life (QOL). Test-retest reliability testing was performed with 46 patients who had primary brain tumors. Validity and reliability coefficients were high for the FACT-G and brain subscale, except for the comparison with a second QOL measure (FP-QLI) and the Karnofsky Performance Status (KPS). The lower scores were the result of inherent differences in the two QOL instruments and the relatively high performance status of the brain tumor patients, which restricted the KPS score range. The FACT-G has good psychometric properties supporting its broad generalizability and the brain subscale tests substantially different QOL issues than the core instrument. Use of this scale with the addition of the brain subscale provides a well rounded view of the various aspects of QOL from the patient's perspective. With modifications and further psychometric testing, the brain subscale may have broader applicability to subpopulations of patients with other brain disorders.

The Functional Assessment of Cancer Therapy scale: development and validation of the general measure.

We developed and validated a brief, yet sensitive, 33-item general cancer quality-of-life (QL) measure for evaluating patients receiving cancer treatment, called the Functional Assessment of Cancer Therapy (FACT) scale. The five-phase validation process involved 854 patients with cancer and 15 oncology specialists. The initial pool of 370 overlapping items for breast, lung, and colorectal cancer was generated by open-ended interview with patients experienced with the symptoms of cancer and oncology professionals. Using preselected criteria, items were reduced to a 38-item general version. Factor and scaling analyses of these 38 items on 545 patients with mixed cancer diagnoses resulted in the 28-item FACT-general (FACT-G, version 2). In addition to a total score, this version produces subscale scores for physical, functional, social, and emotional well-being, as well as satisfaction with the treatment relationship. Coefficients of reliability and validity were uniformly high. The scale's ability to discriminate patients on the basis of stage of disease, performance status rating (PSR), and hospitalization status supports its sensitivity. It has also demonstrated sensitivity to change over time. Finally, the validity of measuring separate areas, or dimensions, of QL was supported by the differential responsiveness of subscales when applied to groups known to differ along the dimensions of physical, functional, social, and emotional well-being. The FACT-G meets or exceeds all requirements for use in oncology clinical trials, including ease of administration, brevity, reliability, validity, and responsiveness to clinical change. Selecting it for a clinical trial adds the capability to assess the relative weight of various aspects of QL from the patient's perspective.