WHO BREF Research Articles

Impact of Support Group Intervention on Quality of Life of Patients With Advanced Breast Cancer

Background: Health-related quality of life is an important end point in breast cancer care. Assessing quality of life in breast cancer patients could contribute to improved treatment outcome and could even serve as monitor along with medical parameters. The need for psychosocial support is well established among breast cancer patients with levels of psychological distress and depression, particularly after diagnosis and treatment. Cancer support helps patients to cope with cancer by adjusting their attitudes, knowledge, and expectation about the disease. Aim: To determine the impact of support group intervention on quality of life of patients with advanced breast cancer To create awareness, educate, counsel and support as well as to mediate in the weaknesses of the medical care system in dealing with breast cancer patients. Methods: A prospective cohort study involving breast cancer patients using a system of breast cancer support group that organizes a two month period meeting for all breast patients in University of Nigeria Teaching Hospital Enugu. Educational information on breast cancer, nutritional needs, exercise and the need for regular follow-up in breast cancer care were given to them as well as the means of overcoming the psychosocial burden in cancer. QOL assessment evaluating the four domains (physical, social, psychological and environmental) on selected patients with advanced breast cancer using WHO BREF was administered. Results: A total of 113 breast cancer patients were involved in this study. At the end of the intervention, 14 women (12.4%) were censored due to death, while postassessment was carried out for only 99 women. Postintervention analysis showed that there was a significant positive correlation between availability of social support to respondents (FS score) and the four quality of life domains ( P < 0.05). Further analysis also showed that respondents' quality of life significantly increased across all domains at postintervention ( P < 0.05). Conclusion: Patients receiving support group intervention all had improved quality of life.

A cross sectional comparative study of quality of life of treatments seekers at de-addiction centre in central India using WHO BREF scale

Background: Substance use disorders (SUDs) are a major global health problem affecting quality of life of human being. It has major impact on physical, psychological, social and environmental aspect of life. The aim is to assess Quality of Life (QoL) of persons seeking treatment at de-addiction centre by comparing it with those not seeking treatment, using WHOQOL BREF scale. Methods: A cross sectional comparative study is done on 250 persons admitted and seeking treatment at de-addiction centre during August 2014 to December 2015. A five-point scale rated WHOQOL-BREF questionnaire was used to assess quality of life. Results: Majority of study participants (85.60%) rated their quality of life as poor when compared to comparison group who rated their quality of life as good (52.80%). Majority of study participants (82.80%) were dissatisfied with their health. It was observed that the mean score of the physical, psychological, social and environmental domain in the study group was significantly lower in study group when compared to comparison group (p<0.001). Conclusions: Substance abuse had detrimental effect on the physical, social, psychological and environmental domain affecting their overall health and quality of life.

Does glycaemic status influence quality of life of type II diabetes patients: an exploratory study in Mysuru, Karnataka, India

Background: Type II diabetes is a major public health problem in India. The epidemiological shift of the disease towards younger and middle aged individuals has resulted in longer duration of life with diabetes among the patients. Diabetes being a lifestyle disease, requiring robust behavioural and social adjustments influences the quality of life of an individual to a largest extent.Methods: A cross-sectional study conducted among 200 type II diabetic patients attending JSS Hospital, Mysuru for a period of one year. Information regarding socio-demographic characteristics like gender, education, occupation was collected in a pretested proforma by interview technique. Assessment of Quality of life was done using the WHO BREF questionnaire. Glycemic status of subjects was assessed using glycosylated haemoglobin (HbA1C) levels. The Data entry and Statistical analysis were done using Microsoft Excel and SPSS 22version. Descriptive statistics like mean and standard deviation of QOL calculated and analysed with Sociodemographic variables, inferential statistics like Chi-square and Man-Whitney U test was done.Results: Among 200 study participants majority, 53.5% belonged to age group of 41-60 years, 57.5% were males, 67.5% belonged to lower socio economic class according to BG Prasad classification, 85% were married, 51% were Obese, 44.5% were having family history of diabetes, 48% were having Hypertension, 68.5% were on oral hypoglycemic, 10.5% were on Insulin, 20.5% were on both oral hypoglycaemic and Insulin. Overall Quality of Life was poor in 114 (57%), 114 (57%) had Poor Physical QoL score, 109 (54.5%) had poor psychological QoL score, 108 (54%) had poor social QoL score and 113 (56.5%) had poor environmental QoL score and 87 (43.5%). Median score of overall score of QoL was less in uncontrolled diabetes when compared to controlled diabetes status, this difference was statistically significance (P value- 0.04).Conclusions: Patients with type 2 diabetes have a substantially lower quality of life. QOL was poorer in subjects with uncontrolled glycemic status compared those with good diabetic control.

Quality Of Life in Stroke Patients - A Qualitative Study

Abstract Introduction: In India stoke is a leading cause of death and acquired human disability. A review of stroke outcome measures in 174 acute stroke trials showed that death was recorded in 76%, impairment in 76%, disability in 42% and handicap in only 2%. One dimension that is rarely measured is health-related quality of life (HRQOL) which aims to assess the impact of disease from the perspective of the patient. Although there is an association between neurological deficits and QL, they are not synonymous. Objectives: study the health related quality of life with patients of stoke within 3 months of stroke. Methodology: Study Settings: Hospital based study- A continuation of Stroke RegistrySample Size: We took 20 patients from the registryThe patients with fresh stoke attack and also who were attending the follow up within the first 3 months of the attack was enrolled into the study. Basic demographic data and the data of stroke outcomes were taken. HRQOL was evaluated using the WHO BREF. Results: It was seen that majority (55%) of patients expressed a fair physical domain post stroke. About 40% were of opinion that their physical domain was poor. Assessing the psychological domain, majority of the patients said it was poor, 40% said that it was fair. About half (50%) of the patients showed that they had poor environmental domain, whereas only 35% it was fair. Conclusion: The quality of life is hampered by stroke in majority of the patients.

EP 39. Clinical experience with deep brain stimulation in Huntington’s disease

Introduction Deep brain stimulation (DBS) of the subthalamic nucleus (STN) or globus pallidus internus (GPi) are well-established standard procedures for various movement disorders, e.g. Parkinson’s disease or dystonia. Until now, application of DBS in Huntington’s disease (HD) has been performed only as an individual and experimental treatment option reported in a few cases. Objective We present a prospective controlled case series of six patients with HD and bilateral DBS of the GPi. Material and Methods Indication for DBS was stated in six patients with severe, treatment-refractory chorea. The procedure was performed in general, intravenous anaesthesia. Bilateral lead placement in the GPi was achieved with stereotactic MRI-coordinates and intraoperative microrecordings. Stereotactic coordinates were as follows: (x) 19–20 mm lateral the midline of the intercommissural line, (y) 3 mm anterior and (z) 2–3 mm inferior the midpoint of the intercommissural line. Also intraoperative stimulation via the implanted leads was performed to evaluate stimulation induced-side effects like dystonic movements, eye movements etc. After insertion of the leads a second stereotactic MRI was performed to rule out any intracerebral complications and to document the definite position of the lead. Clinical evaluation included the motor score of the Unified Huntington‘s disease rating scale (UHDRS), Total Functional Capacity score (TFC), the Functional Assessment score (FA) and the 26-item version of the World Health Organisation questionnaire (WHO Bref) preoperatively and six months postoperatively. Results In all 6 patients leads were successfully implanted bilaterally in general anaesthesia. In one case one lead needed to be revised due to dislocation detected in the control, second MRI. Also in one case, second MRI revealed a small local haemorrhage in the course of one lead, but no clinical neurological deficits were observed in the patient postoperatively. Standard stimulation parameters were programmed and adjusted individually (mono- or bipolar mode, 30–130 hertz, 50–100 microseconds, amplitude 2–5.0 milliampere). The chorea subscore of the UHDRS motor score improved by 47% (range 21–86%; p Conclusion DBS of the GPi is an additional invasive treatment option for well-selected patients with HD. Risks and complications of the procedure and related to the implanted materials are low and acceptable. Continuous clinical experience and long-term follow-up of these patients are needed to evaluate the significance and evidence of DBS in HD.

Escitalopram reduces severity of depression and improves quality of life in patients with chronic obstructive pulmonary disease in an open label parallel group study

Background: Chronic obstructive pulmonary disease (COPD) is characterised by progressive and persistent airflow limitation with frequent exacerbations and hospitalizations contributing to overall morbidity and mortality. We evaluated the efficacy of antidepressant escitalopram therapy in depressed individuals suffering from chronic obstructive pulmonary disease. Methods: The sample comprised of sixty patients. Thirty patients received antidepressant escitalopram, while the remaining half served as controls. Hamilton depression rating and WHO–BREF questionnaire were the tools to assess severity of depression and quality of life. The severity of COPD was recorded using spirometry (FEV1%). Clinical assessments were at baseline and at week-2 and week-8 of follow up in both intervention and control groups. Results: It was found that both the groups were similar on the severity of the illness (COPD) at entry. FEV 1% of both the groups showed similar improvement after 8 weeks. Treatment with escitalopram showed a significant decrease in the severity of depression score and improvement on all the domains of quality of life when compared with the baseline. After the intervention, it was found that the HAM-D scores in the experimental group decreased from 24.44 to 17.50 while in the control group, it was from 20.11 to 19.67. The magnitude of improvement was significantly higher with intervention compared to controls. Conclusions: Escitalopram reduces severity of depression and improves quality of life which was independent of improvement in FEV1. It could be asserted that this antidepressant improved the patient’s mood, fatigue and helplessness, which could have improved the quality of life of these patients.

Quality of Life among Persons with Physical Disability in Udupi Taluk: A Cross Sectional Study.

Background:Disability is not just a health problem or attribute of individuals, but it reflects the problems individuals experience in their interaction with society and physical movements. Disabled persons remain neglected part of society and they also experience various barriers due to restriction of participation.Objectives:The aim was to assess the quality of life (QOL) of physically disabled persons, the impact of physical disability on activities of daily living (ADL) and to study the awareness about laws and facilities available for disabled persons.Materials and Methods:A cross-sectional community based study was conducted among 130 physical disabled persons who were selected using convenience sampling technique. The WHO BREF scale was used to assess QOL, while assessment of ADL was done using Barthel Index. Socio-demographic assessment was done using Udai Pareek scale. SPSS version 15.0 was used to analyze data. Categorical variables were expressed as frequencies and percentages. As per guidelines physical, psychological, social, and environmental domain scores for WHO BREF scale were calculated.Results:Among the study participants, 36.2% had a disability from birth that is, congenital. The second common cause of disability was found to be postpolio residual paralysis as it was found among 26.2% respondents. Other causes found were stroke/paralysis and accidents, in 19.2% and 18.5% respondents, respectively. Activities such as transfer, mobility, and stair climbing showed greater impact of physical disability. It was found that 11.5% respondents required help in one of the ADL. QOL score was found to be low under the psychological domain reflecting on negative feelings, bodily image, appearance, spirituality, and self-esteem of respondents.Conclusion:Physical disability had affected social participation as well as marriage of the respondents. However, it was found that very few of them are aware about facilities provided under persons with disability act.

English

All the aspects of status, style, satisfaction, mental state or well- being together reflect the multi-dimensional nature of 'Quality of Life' in an individual. Geriatric health problems relating to the quality of life often remains neglected. They demonstrate higher rates of morbidity, mortality, hospitalizations and experience a poorer quality of life. Hence, this study was conducted to explore the different domains of Quality of Life affected by socio demographic factors and to assess the status of morbidity in the elderly. A cross-sectional qualitative study was conducted on all the elderly who visited the PHC (Mundakur), field practice area of K.S. Hegde Medical Academy. All the elderly above the age of 60 years irrespective of sex were included and WHO BREF on Quality of life was administered to them by the first author in person. The basic demographic data along with their morbid and co-morbid conditions were asked for and the details were collected after obtaining informed consent. The data was tabulated and analysed using the statistical package of SPSS 17.0 version. Independent t-test was applied to compare the mean scores of different variables and the domains. The distribution of participants in this study were as follows: 55% were males while 45% were females.75% of the participants belonged to the age group of 60-69 years, 25% of the participants were 70 years and above. 66.66% of the individuals were married and 33.34% were either unmarried or widowed. Illiterates were 21.6%, literates were 78.4%.Males & literates had a slightly better quality of life than females and illiterates. With increasing age, the quality of life decreases. Married people had a slightly better quality life than those who were widowed / single. The most common morbidities were found to be vision impairment, hypertension &arthritis.

Quality of life, level of physical activity and depression in dialysis patients

PURPOSE: The main objectives of our study are to assess the QOL depression and the level of physical activity in hemodialysis patients. METHOD: The self reported measures WHO BREF Questionnaire, Beck depression inventory scale and Global physical activity questionnaire were given to the participants who were receiving hemodialysis and age matched normal individuals at the time of study and consented. And the data was collected with the necessary personal and demographical data. In data Analysis descriptive statistics and non parametric man Whitney and spearman’s correlation were done using SPSS v. 15. RESULT: The non parametric man Whitney u test was done to compare the means of total QOL score, physical health, psychological health, social relationship, environment and depression score. The groups compared show a significant difference and are not equal. The physical activity hypothesis testing showed significance with chisquare value 15.306, p<.05 which indicate there is difference between the patient group and normal in terms of physical activity. The non parametric correlation analysis was done between the QOL and depression scores. There was positive relationship between total raw QOL score and physical health, psychological health. The physical health was positively related to psychological health, environment score and negatively related to depression score. The psychological health was positively related to environment and negatively related to depression score. CONCLUSION: The present study showed compromised health related quality of life, low level physical activity and moderate level of depression among hemodialysis patients. The relationship between physical and psychological dimensions and low level of physical activity pronounces the importance of regular exercises or supervised physiotherapy training to improve the compromised health related quality of life.

Association between stigma, depression and quality of life of people living with HIV/AIDS (PLHA) in South India – a community based cross sectional study

BackgroundIndia has around 2.27 million adults living with HIV/AIDS who face several challenges in the medical management of their disease. Stigma, discrimination and psychosocial issues are prevalent. The objective of the study was to determine the prevalence of severe stigma and to study the association between this, depression and the quality of life (QOL) of people living with HIV/AIDS (PLHA) in Tamil Nadu.MethodsThis was a community based cross sectional study carried out in seven districts of Tamil Nadu, India, among 400 PLHA in the year 2009. The following scales were used for stigma, depression and quality of life, Berger scale, Major Depression Inventory (MDI) scale and the WHO BREF scale. Both Stigma and QOL were classified as none, moderate or severe/poor based on the tertile cut off values of the scale scores. Depression was classified as none, mild, moderate and severe. Logistic regression analyses were performed to study the risk factors.ResultsTwenty seven per cent of PLHA had experienced severe forms of stigma. These were severe forms of personalized stigma (28.8%), negative self-image (30.3%), perceived public attitude (18.2%) and disclosure concerns (26%). PLHA experiencing severe depression were 12% and those experiencing poor quality of life were 34%. Poor QOL reported in the physical, psychological, social and environmental domains was 42.5%, 40%, 51.2% and 34% respectively. PLHA who had severe personalized stigma and negative self-image had 3.4 (1.6-7.0) and 2.1 (1.0-4.1) times higher risk of severe depression respectively (p < .001). PLHA who had severe depression had experienced 2.7(1.1-7.7) times significantly poorer QOL.ConclusionsSevere forms of stigma were equivalently prevalent among all the categories of PLHA. However, PLHA who had experienced severe depression had only developed poor QOL. A high level of social support was associated with a high level of QOL.