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PubMed1998

[Fluctuations of physical function affected by sleep-awake rhythm--endocrine system].

Pituitary hormone secretion is changed by sleep-awake rhythm, which also regulates by the hypothalamo-pituitary axis. The endocrine rhythm is also affected by such factors as aging and environment conditions. Nocturnal secretion of growth hormone is known to be induced by slow-wave sleep. Plasma prolactin levels seem to increase during REM sleep. Serum thyroid stimulating hormone levels increase during the night. Plasma adrenocorticotropin and cortisol levels increase in the early morning and decreased in the night, which are not related to the sleep stage. The sleep-related hormone secretion is not shown in the patients with disordered hypothalamo-pituitary axis. The evaluation of sleep-related changes in pituitary hormone is important to assess the hypothalamo-pituitary function.

Adrenocorticotropic Hormone↗
PubMed2004

Enhancement of quality of life with adjustment of dry weight by echocardiographic measurement of inferior vena cava diameter in patients undergoing chronic hemodialysis.

BACKGROUND/AIMS: Ideal dry weight (DW) can serve as a marker of good quality of life (QOL) in patients receiving chronic hemodialysis. The size of the inferior vena cava (IVC) reflects the intravascular fluid status, and the diameter of IVC correlates indirectly with DW in these patients. Adjusting DW using echocardiographic measurement of the diameter of the IVC thus may be useful in maintenance of a better QOL in patients receiving chronic hemodialysis. METHODS: This study included 119 patients with ages ranging between 27 and 90 years (mean +/- standard deviation of 58.3 +/- 12.8). All of the patients received the IVC diameter (IVCD) measurement by echocardiography every 2 months for 1 year. The study group included 68 patients in whom the DW were adjusted by echocardiographic measurement of the IVCD, while the control group included 51 patients in whom the DW was adjusted by the conventional method. QOL was evaluated using the short form 36 questionnaire (SF-36) at the beginning and at the end of the study. Besides, the Kt/V(urea) value, a parameter of total urea clearance, was measured at the beginning and at the end of the study in patients of both groups. RESULTS: The scores of physical functioning, physical role functioning, general health and physical component summary showed a prominent improvement in the study group but not in the control group. The impact of periodic echocardiographic evaluation also demonstrated a significant change in the scores of physical functioning, physical role functioning and physical component summary in the study group. Furthermore, the Kt/V(urea) value, a parameter of total urea clearance, also increased significantly in the study group. CONCLUSION: Ideal DW is better adjusted by periodic echocardiographic measurement of the IVCD in patients undergoing chronic hemodialysis. Maintenance of a better DW leads to improve hemodialysis quality and QOL in these patients.

Activities of Daily Living↗
PubMed2004

Understanding quality of life in patients with colorectal cancer: comparison of data from a randomised controlled trial, a population based cohort study and the norm reference population.

BACKGROUND AND AIMS: Quality of life (QoL) is an important outcome measure in clinical studies. However, there is little experience with the interpretation of QoL results. METHODS: To guide interpretation of QoL results from a randomised controlled trial (RCT) targeting the effectiveness of the immune modulator G-CSF on postoperative recovery in high risk (ASA III/IV) colorectal cancer patients, we compared RCT data with data from a population based cohort study and norm reference data. QoL was assessed using the European Organisation for the Research and Treatment of Cancer (EORTC) QLQ-C30 and CR38 questionnaires. QoL results were analysed on discharge from hospital and six months postoperatively. RESULTS: Colorectal cancer patients (both from the RCT and the cohort study) showed the greatest differences in QoL scores compared to norm reference data at discharge from hospital. Six months postoperatively, global quality of life and pain approximated norm reference values indicating optimal recovery. However, deficits still appeared in scores for role functioning, physical functioning, social functioning and fatigue. The best improvements (discharge from hospital to six months postoperatively) were seen with respect to physical functioning, fatigue and pain. CONCLUSIONS: For further analysis of RCT data, physical functioning and fatigue scores may be more sensitive than global quality of life to detect differences in treatment effects.

Adult↗
PubMed1999

Measuring the effects of medication use on health-related quality of life in patients with rheumatoid arthritis. A review.

As the treatment of rheumatoid arthritis (RA) moves towards earlier and more consistently maintained therapy, often with highly toxic medications, the importance of assessing patients' health-related quality of life (HR-QOL) is of increasing concern to healthcare providers, insurers and policy-makers. As the course of RA can extend 20 years or more, and as patient involvement in their care and evaluation increases, the goal of therapy should be to work towards the HR-QOL desired by the patient. The challenge in HR-QOL measurement is its multidimensional nature, which takes into account not only how a person functions physically, mentally and socially, but also incorporates the individual's perceived well-being in their physical, mental and social aspects of daily life. This review focuses on measuring the HR-QOL outcomes of drug therapy in RA in clinical settings as well as in clinical drug trials. The most commonly used instruments in RAHR-QOL measurement are presented, with particular attention to those that have been used to assess the impacts of drug therapy. Traditionally, RA treatment outcomes assessment has focused on physical functioning and activities of daily living. As a result, there is an abundance of instruments that have been used in RA that measure physical functioning. Social and mental functioning are being assessed more frequently as clinicians and researchers recognise the added value of assessing these dimensions in addition to physical functioning. Patient perceived well-being (especially as it relates to physical, mental and social aspects of their lives), however, is still rarely measured. We conclude that there are few validated instruments which truly assess the impact of drug therapy on HR-QOL in RA; most are intended as measures of functional or health status. In addition, few studies have been conducted in natural clinical practice settings (as opposed to controlled clinical trial settings). Further, our review reveals that the psychological and social dimensions of HR-QOL are often lacking from some of the most popular RA instruments currently in use.

Adrenal Cortex Hormones↗
PubMed2006

Aquatic physical therapy for hip and knee osteoarthritis: results of a single-blind randomized controlled trial.

BACKGROUND AND PURPOSE: Aquatic physical therapy is frequently used in the management of patients with hip and knee osteoarthritis (OA), yet there is little research establishing its efficacy for this population. The purpose of this study was to evaluate the effects of aquatic physical therapy on hip or knee OA. SUBJECTS: A total of 71 volunteers with symptomatic hip OA or knee OA participated in this study. METHODS: The study was designed as a randomized controlled trial in which participants randomly received 6 weeks of aquatic physical therapy or no aquatic physical therapy. Outcome measures included pain, physical function, physical activity levels, quality of life, and muscle strength. RESULTS: The intervention resulted in less pain and joint stiffness and greater physical function, quality of life, and hip muscle strength. Totals of 72% and 75% of participants reported improvements in pain and function, respectively, compared with only 17% (each) of control participants. Benefits were maintained 6 weeks after the completion of physical therapy, with 84% of participants continuing independently. DISCUSSION AND CONCLUSION: Compared with no intervention, a 6-week program of aquatic physical therapy resulted in significantly less pain and improved physical function, strength, and quality of life. It is unclear whether the benefits were attributable to intervention effects or a placebo response.

Exercise Therapy↗
PubMed2004

Effect of intracranial bleeds on the health and quality of life of boys with hemophilia.

OBJECTIVES: To compare the health, physical function, and quality of life (QoL) of boys with hemophilia with and without a history of intracranial hemorrhage (ICH). STUDY DESIGN: Of 172 patients with hemophilia A or B, 18 (10%) had at least one episode of ICH. For outcome assessments, 16 of 18 (89%) boys with ICH and 32 controls, matched (1:2) for age and severity of hemophilia, were available. The outcome measures were neurologic function, physical function, and QoL. RESULTS: The median age of the boys at the first ICH was 5.9 months (range, 1 day to 2.7 years). Boys with ICH had a higher incidence of inhibitors and lower mean household income. Neurologic examination was abnormal in seven of 16 (44%) boys with ICH and nine of 32 (28%) controls (P=.3). The mean physical function in boys with ICH was lower (82%+/-25%) compared with controls (93.5%+/-12%, P=.045). The QoL was decreased in boys with ICH compared with controls (6.8+/-3.2 vs 8.5+/-1.4, P=.02), whereas health-related QoL was not significantly different between groups. CONCLUSION: The poorer long-term outcomes of boys with hemophilia appropriately treated for ICH, especially in the domain of QoL, suggest that new strategies to prevent ICH and to manage ICH effectively in this population are needed.

Adolescent↗
PubMed2003

Oral health and health-related quality of life in type 2 diabetic patients and non-diabetic controls.

The aim of the present study was to identify factors in oral health and also diabetes-related and socio-economic components that could be associated with the subject's health-related quality of life (HRQL). One-hundred-and-two randomly sampled type 2 diabetic and 102 age-matched and gender-matched non-diabetic subjects from the same residential area were studied cross-sectionally using the SF-36 questionnaire. Although the HRQL profiles were similar in nature, the control subjects indicated a more favorable health status in their HRQL scores than did type 2 diabetic subjects. Certain oral health factors contributed to deterioration of the patient's HRQL. Multiple regression analyses including both groups were used to determine variables explaining variance in the different HRQL domains. Dissatisfaction with teeth and mouth, feeling of dry mouth and poor financial status contributed to about one-fourth of the explanation of the variance in all health domains. Having diabetes played an important role in the domains Physical Functioning, Role functioning--Physical, General Health, and Social Functioning. Age was important for Physical Functioning and Role functioning--Physical. Our study indicates that different factors may be associated with impaired HRQL, especially among type 2 diabetic subjects, although only a partial understanding of its relation to oral health could be demonstrated.

Activities of Daily Living↗
PubMed2004

Health-related quality of life in a rare disease: hereditary hemorrhagic telangiectasia (HHT) or Rendu-Osler-Weber disease.

The levels of the health-related quality of life (HR-QoL) were analyzed in hereditary hemorrhagic telangiectasia (HHT) patients. The Short Form-36 Health Survey (SF-36) was administered to 50 HHT patients and scores were compared to a cohort of 2301 normal subjects. Clinical variables were patient age, illness duration, number of epistaxis episodes in the previous year and hemoglobin levels. Physical functioning, physical role limitations, bodily pain, social functioning, emotional role limitations and the physical component scores were lower among females. In multivariable analyses increasing age was related to lower physical functioning (p < 0.04), physical role limitations (p < 0.008), bodily pain (p < 0.05) and emotional role limitations (p < 0.01), while higher hemoglobin levels improved physical functioning (p < 0.03). The number of epistaxis episodes was negatively associated with physical role limitations (p < 0.009), vitality (p < 0.002), social functioning (p < 0.001), physical component summary (p < 0.001) and bodily pain (p < 0.01). Illness duration was negatively related to the mental component summary (p < 0.004). HHT patients had a lower HR-QoL with respect to normal controls in all domains except for bodily pain. Females had lower scores for several domains. Epistaxis was the most important clinical variable.

Adult↗
PubMed2006

The evaluation of quality of life in fibromyalgia syndrome: a comparison with rheumatoid arthritis by using SF-36 Health Survey.

Musculoskeletal disorders are the most common causes of deterioration in quality of life (QOL). We in this study aimed to assess (1) the impact of fibromyalgia syndrome (FS) on QOL comparing with that of rheumatoid arthritis (RA) patients and control subjects and (2) the impact of these two musculoskeletal disorders on various components of QOL using SF-36 Health Survey. Thirty-five patients with RA, 30 patients with FS, and 30 voluntary control subjects were included in the study. The groups were comparable in terms of demographic characteristics. QOL was evaluated by using Short-Form (SF)-36 Health Survey in all study participants, and Fibromyalgia Impact Questionnaire (FIQ), which is a specific health-status instrument for FS, was used in FS patients. Physical functioning, physical role, social functioning, bodily pain, general health, vitality, emotional role, and mental health scores were significantly lower in RA and FS patients than in control subjects (p<0.05). The between-groups comparisons revealed that FS patients had significantly lower mental health scores than RA patients (49.87 vs 62.51, respectively), (p<0.001). Total FIQ score correlated significantly with physical functioning, physical role, and bodily pain in FS patients. All parameters of SF-36 Health Survey except for social functioning correlated significantly with some of the variables of FIQ. FS has a negative impact on QOL, like RA. Furthermore, mental health was more severely affected in FS patients when compared with RA patients.

Adult↗