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PubMed2001

An inner city GP unit versus conventional care for elderly patients: prospective comparison of health functioning, use of services and patient satisfaction.

BACKGROUND: GP units are generally nurse-led wards, where GPs have direct admitting rights and retain clinical responsibility for their patients. While GP-led wards are not new, they are relatively uncommon in urban areas. In addition, there has been little comparative evaluation of this type of service. OBJECTIVES: The aim of the present study was to compare patients admitted to an inner city GP unit with comparable patients in conventional care (e.g. district nursing, nursing/residential homes, acute care of the elderly wards) in terms of mental and physical functioning, use of health and social services and patient satisfaction. METHODS: Study group patients were those admitted to the GP unit; comparison group patients were identified by GP practices or conventional services who had agreed to participate in the study. Suitable patients were aged 65 years or over and fitted the eligibility criteria for the GP unit. Patients were interviewed at three time points: admission to either the GP unit or conventional care, and at 1 and 3 months after admission. Baseline comparability was assessed by demographic and medical data, cognitive function, mental state, social support, use of health and social services, and mental and physical functioning (SF-12). Mental and physical functioning and use of health and social services were compared between the groups over time. Patient satisfaction with their care was also compared between groups. RESULTS: Change in the mental and physical functioning between patients on the GP unit (n = 67) and those in conventional care (n = 60) did not differ when the groups were compared at any of the three time points. However, the mental function of patients in the GP unit significantly improved between admission and 1 month after admission (P: < 0.05). This effect was not sustained at 3 months after admission. GP unit patients were consistently more positive about the care they received than patients receiving conventional care; this included communication and information, staff, care and the facilities. Both groups of patients were high users of health and social services, with similar patterns of use in both groups, which did not alter over time. CONCLUSIONS: Patients who received care on the GP unit experienced a similar physical outcome to patients in conventional settings; however, they appeared to enjoy a short-term improvement in mental functioning and were consistently more positive about the quality of their care. This study has important policy implications with regard to planning future intermediate care services and will be of particular interest to health service planners and those responsible for clinical governance.

Activities of Daily Living↗

PubMed2005

Surgery for thumb (trapeziometacarpal joint) osteoarthritis.

BACKGROUND: Surgery has been used to treat persistent pain and dysfunction at the base of the thumb. However, there is no evidence to suggest that any one surgical procedure is superior to another. OBJECTIVES: To investigate the effect of surgery in reducing pain and improving physical function, patient global assessment, range of motion, and strength in people with trapeziometacarpal osteoarthritis at 12 months. Additionally, it was the reviewers intention to investigate whether there was any improvement or deterioration in outcomes between the 12 months review and a 5 year follow-up. SEARCH STRATEGY: We searched the the following databases in the Cochrane Library 2004, Issue 4: Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database of Systematic Reviews, and the Database of Abstracts of Reviews of Effects (DARE) as well as MEDLINE (1966-Dec 2004), CINAHL (1982-Dec 2004), AMED (1985-Dec 2004), and EMBASE (1974-Dec 2004). Database searches were supplemented by hand searching conference proceedings and reference lists from reviews and papers. SELECTION CRITERIA: Studies were included if they were: randomised, quasi-randomised or controlled trials; intervention was surgery; and pain, physical function, patient global assessment, range of motion, or strength was measured as an outcome. DATA COLLECTION AND ANALYSIS: Two independent reviewers examined the identified studies according to the inclusion criteria. Included studies were assessed for methodological quality and then data, including adverse effects, was extracted and cross-checked. Authors were contacted to provide missing information. MAIN RESULTS: Seven studies involving 384 participants were included. Studies of five surgical procedures were identified (trapeziectomy, trapeziectomy with interpositional arthroplasty, trapeziectomy with ligament reconstruction, trapeziectomy with ligament reconstruction and tendon interposition (LRTI), and joint replacement). All studies reported results of a mixed group of participants with Stage II-IV osteoarthritis, with a range of improvement across all stages of 27 to 57 mm on a 0-100 VAS scale for pain and 18-24 mm on a 0-100 VAS scale for physical function. No procedure demonstrated any superiority over another in terms of pain, physical function, patient global assessment, range of motion or strength. However, participants who underwent trapeziectomy had 16% fewer adverse effects (p=0<.001) than the other commonly-used procedures studied in this review; conversely, those who underwent trapeziectomy with ligament reconstruction and tendon interposition had 11% more (p=0.03) (including scar tenderness, tendon adhesion or rupture, sensory change, or Complex Regional Pain Syndrome (Type 1). AUTHORS' CONCLUSIONS: No one procedure produced greater strength than any other. Although this also appears to be the case for pain and physical function, there was insufficient evidence to be conclusive. Trapeziectomy is safer and has fewer complications than the other procedures studied in this review, and conversely trapeziectomy with LRTI has more.

Hand Joints↗

PubMed2005

An improved density matrix functional by physically motivated repulsive corrections.

An improved density matrix functional [correction to Buijse and Baerends functional (BBC)] is proposed, in which a hierarchy of physically motivated repulsive corrections is employed to the strongly overbinding functional of Buijse and Baerends (BB). The first correction C1 restores the repulsive exchange-correlation (xc) interaction between electrons in weakly occupied natural orbitals (NOs) as it appears in the exact electron pair density rho(2) for the limiting two-electron case. The second correction C2 reduces the xc interaction of the BB functional between electrons in strongly occupied NOs to an exchange-type interaction. The third correction C3 employs a similar reduction for the interaction of the antibonding orbital of a dissociating molecular bond. In addition, C3 applies a selective cancellation of diagonal terms in the Coulomb and xc energies (not for the frontier orbitals). With these corrections, BBC still retains a correct description of strong nondynamical correlation for the dissociating electron pair bond. BBC greatly improves the quality of the BB potential energy curves for the prototype few-electron molecules and in several cases BBC reproduces very well the benchmark ab initio potential curves. The average error of the self-consistent correlation energies obtained with BBC3 for prototype atomic systems and molecular systems at the equilibrium geometry is only ca. 6%.

Journal Article↗

PubMed2003

Physical and functional modularity of the protein network in yeast.

While protein-protein interactions have been studied largely as a network graph without physicality, here we analyze two protein complex data sets of Saccharomyces cerevisiae to relate physical and functional modularity to the network topology. We study for the first time the number of different protein complexes as a function of the protein complex size and find that it follows an exponential decay with a characteristic number of about 7. This reflects the dynamics of complex formation and dissociation in the cell. The analysis of the protein usage by complexes shows an extensive sharing of subunits that is due to the particular organization of the proteome into physical complexes and functional modules. This promiscuity accounts for the high clustering in the protein net-work graph. Our results underscore the need to include the information contained in observed protein complexes into protein network analyses.

Models, Theoretical↗

PubMedDate not supplied

The relationship between function, self-perception, and spinal deformity: Implications for treatment of scoliosis in children with spina bifida.

The purpose of this study was to determine the relationship of spinal deformity with physical function and self-perception in children with spina bifida. Ninety-eight eligible children with scoliosis and spina bifida were identified; 80 of them (82%) consented to participate. Spinal deformity was measured in many ways, including scoliosis, coronal balance, and pelvic obliquity. Measures of physical function included the Sitting Balance Scale, Jebsen Hand Scale, Hoffer Ambulation Scale, the Spine Bifida Spine Questionnaire, and the Activities Scale for Kids (ASK). Self-perception was determined with Harter's Self-Perception Profile. No relationship was found between spinal deformity and overall physical function (ASK). Of all aspects of spinal deformity, only coronal imbalance was significantly related to only one aspect of physical function (ie, sitting imbalance). No aspect of spinal deformity was related to self-perception. In conclusion, surgeons should be clear in their indications for surgery and recognize that in the short term the potential benefit of surgery may be, at best, to improve only sitting balance.

Activities of Daily Living↗

PubMed1994

Physical and functional association of the high affinity immunoglobulin G receptor (Fc gamma RI) with the kinases Hck and Lyn.

The high affinity immunoglobulin G (IgG) receptor Fc gamma RI (CD64) is expressed constitutively on monocytes and macrophages, and is inducible on neutrophils. Fc gamma RI has recently been shown to be associated with the signal transducing gamma subunit of the high-affinity IgE receptor (Fc epsilon RI gamma). Induction of cytoplasmic protein tyrosine phosphorylation by Fc gamma RI cross-linking is known to be important in mediating Fc gamma RI-coupled effector functions. Recently, syk has been implicated in this role. We now report that the src-type kinases hck and lyn are physically and functionally associated with Fc gamma RI. Hck and lyn coimmunoprecipitated with Fc gamma RI from detergent lysates of normal human monocytes and of the monocytic line THP-1. Hck and lyn showed rapidly increased phosphorylation and increased exogenous substrate kinase activity after cross-linking of Fc gamma RI. These results demonstrate both physical and functional association of the Fc gamma RI/Fc epsilon RI gamma receptor complex with hck and lyn, and suggest a potential signal transducing role for these kinases in monocyte/macrophage activation.

Amino Acid Sequence↗

PubMed1996

Vertebral fracture and other predictors of physical impairment and health care utilization.

BACKGROUND: A better understanding of the impact of vertebral fractures on physical functioning would help clinicians gauge the potential benefits of identifying patients at high risk and prevent vertebral fractures due to osteoporosis. METHODS: We explored the associations of vertebral fractures and other potential predictors with physical impairment and health care utilization based on the data collected from 569 postmenopausal Japanese American participants of the Hawaii Osteoporosis Study, aged from 55 to 93 years. A major advantage of this study is the availability of serial spine radiographs for all participants. All vertebral fractures could be identified and the fracture dates estimated. RESULTS: Poor physical functioning was related to increases in number of recent vertebral fractures, age, body mass index, and number of other painful joints. Recent vertebral fractures had a strong impact on bending- and walking-related activities. For each recent vertebral fracture, the odds of impairment increased about 2 times and the odds of a physician visit for back pain increased 3.6 times. The number of recent vertebral fractures was also a significant predictor of poor performance in functional reach and walking speed tests. The effects of vertebral fractures on physical functioning may persist for several years. CONCLUSIONS: Recent vertebral fractures may lead to long-term poor physical functioning. Clinicians should take appropriate measures to identify those at risk, to prevent progression of osteoporosis, and to limit associated disability.

Activities of Daily Living↗

PubMed1994

Predicting work status for patients in an occupational medicine setting who report back pain.

OBJECTIVE: To determine the ability of patient-reported health status information to predict physician-determined fit-for-work status for patients reporting complaints of low back pain. DESIGN: Cross-sectional study using survey methods. SETTING: Occupational medicine section of a large multispecialty private clinic. PATIENTS: Four hundred sixty-two questionnaire packets were distributed to patients who were seen for work-related conditions or disorders over a 13-week period; 235 questionnaires were returned (51% response rate). One hundred seven responders reported low back pain and completed the Low Back Pain TyPE (Technology of Patient Experience) Tool. The mean (+/- SD) age of respondents was 39 (+/- 12) years; 67% of respondents were male, 70% were white, 87% were receiving worker's compensation, 58% were married, and 55% had a high school education or less. INTERVENTIONS: Questionnaire packets for self-administration containing health/functional status questions (short form [SF]-36, COOP Charts) and the Low Back Pain TyPE Tool were distributed to the patients. Other variables were abstracted from the medical records and administrative databases. MAIN OUTCOME MEASURES: The primary study outcome measured was fitness for work; patients were examined and categorized as fit or not fit for work by physicians who were unaware of the questionnaire results. RESULTS: Logistic regression analysis consisted of variables from 107 patients who reported low back pain. The final model contained the physical functioning scale (SF-36), employment status, smoking status, and physical functioning (SF-36) by gender interaction. Seventy-seven percent of the fit-for-work cases and 90% of the not-fit-for-work cases were correctly classified. CONCLUSION: Patient-reported physical function (as modified by gender), smoking status, and employment status predicted physician-determined work status for patients reporting low back pain in this study. Larger studies will be required to confirm this finding.

Adult↗

PubMed2006

Physical and functional interactions between pathogen-induced Arabidopsis WRKY18, WRKY40, and WRKY60 transcription factors.

Limited information is available about the roles of specific WRKY transcription factors in plant defense. We report physical and functional interactions between structurally related and pathogen-induced WRKY18, WRKY40, and WRKY60 transcription factors in Arabidopsis thaliana. The three WRKY proteins formed both homocomplexes and heterocomplexes and DNA binding activities were significantly shifted depending on which WRKY proteins were present in these complexes. Single WRKY mutants exhibited no or small alterations in response to the hemibiotrophic bacterial pathogen Pseudomonas syringae and the necrotrophic fungal pathogen Botrytis cinerea. However, wrky18 wrky40 and wrky18 wrky60 double mutants and the wrky18 wrky40 wrky60 triple mutant were substantially more resistant to P. syringae but more susceptible to B. cinerea than wild-type plants. Thus, the three WRKY proteins have partially redundant roles in plant responses to the two distinct types of pathogens, with WRKY18 playing a more important role than the other two. The contrasting responses of these WRKY mutants to the two pathogens correlated with opposite effects on pathogen-induced expression of salicylic acid-regulated PATHOGENESIS-RELATED1 and jasmonic acid-regulated PDF1.2. While constitutive expression of WRKY18 enhanced resistance to P. syringae, its coexpression with WRKY40 or WRKY60 made plants more susceptible to both P. syringae and B. cinerea. These results indicate that the three WRKY proteins interact both physically and functionally in a complex pattern of overlapping, antagonistic, and distinct roles in plant responses to different types of microbial pathogens.

Amino Acid Motifs↗

PubMed2001

The 2-minute walk test as a measure of functional improvement in persons with lower limb amputation.

OBJECTIVE: To determine the construct validity and responsiveness of the 2-minute walk test as a measure of function in individuals with lower extremity amputation. DESIGN: The distances walked in 2 minutes were compared with the results on the physical functioning subscale of the Medical Outcomes Study Short-Form 36-Item Health Survey (SF-36) and the Houghton Scale. SETTING: Regional amputee rehabilitation program. PATIENTS: Retrospective data from 290 patients (mean age, 66yr) with unilateral transtibial, unilateral transfemoral, or bilateral amputations. INTERVENTION: Repeated testing. MAIN OUTCOME MEASURES: Distance walked in 2 minutes, SF-36 (aggregated into physical and mental composite scores), and the Houghton score. We also examined the change in the distance before and after a rehabilitation program. RESULTS: The distance walked in 2 minutes showed a weak correlation with the physical functioning subscale of the SF-36 (r = .22, p = .008) and a moderate correlation with the total Houghton score at discharge from rehabilitation (r = .493, p <or= .001). The correlation between distance walked in 2 minutes and SF-36 physical functioning subscale at follow-up was moderate (r = .479, p < .001). There was a significant improvement in distance walked in 2 minutes at discharge and follow-up compared with baseline (mean change +/- standard deviation at discharge, 13.6 +/- 19.9m; at follow-up, 41.2 +/- 34m, p < .001). CONCLUSION: The 2-minute walk test was responsive to change with rehabilitation in persons with lower extremity amputation. In addition, the 2-minute walk test showed adequate correlation with measures of physical functioning and prosthetic use in this population.

Aged↗

PubMed2002

Correlative analysis of lateral vertebral radiographic variables and medical outcomes study short-form health survey: a comparative study in asymptomatic volunteers versus patients with low back pain.

This prospective comparative study was designed to investigate the possible link between SF-36 functional status and lateral roentgenographic variables of the standing lumbar spine in patients with low back pain (LBP) versus asymptomatic volunteers. To the authors' knowledge, no previous studies have correlated SF-36 scores and sagittal roentgenographic variables in patients with LBP versus asymptomatic individuals. A total of 100 male volunteers, used as controls, and an equal number of age-, height-, and weight-comparable patients of the same ethnicity with chronic LBP were compared on the basis of roentgenographic and SF-36 data. The roentgenographic variables that were measured included the following: lumbar lordosis, sacral inclination, L1-S1 vertebral inclination, L4-S1 distal lordosis, disc index, and L1-L5 vertebral index. These variables were correlated with the eight SF-36 scales both in patients and controls. As the patients with LBP get older, they show lower functional scores in Role-Emotional (p < 0.01) and Physical Functioning (p < 0.01). Body height was not found to be a predisposition favoring LBP, but tall patients with LBP showed less Bodily Pain than patients of short stature (p < 0.001). This study showed that patients with LBP had significantly lower scores than their asymptomatic counterparts in the following SF-36 scales: Role-Physical (p < 0.01), Bodily Pain (p < 0.01), Role-Emotional (p = 0.058), and Mental Health (p < 0.001). In the controls General Health, Physical Functioning, Social Functioning, and Role-Emotional, Bodily Pain, Mental Health, and Vitality correlated statistically significantly with individuals' age, height, weight, lumbar lordosis, sacral inclination, inclination of L1, L3, and L5 vertebra, L1-L5 vertebral index, and L1-L2, L2-L3, L3-L4, L4-L5, and L5-S1 disc index. For the patients with LBP this study showed that General health, Physical Functioning, Role-Emotional, Social Functioning, and Bodily Pain were significantly correlated with age, height, L1-L2 inclination, distal lordosis, L2-L5 index, and L4-L5 and L5-S1 disc index. This comparative study showed that the functional status of hard-working patients with chronic LBP is associated with degenerative changes on the lateral radiographs of the lumbosacral spine. Spine surgeons should take into consideration the results of this study in reconstruction of painful degenerative lumbosacral spine.

Adult↗

PubMed1995

Late physical and functional effects of osteoporotic fracture in women: the Rancho Bernardo Study.

OBJECTIVE: To examine the associations between osteoporotic fractures and difficulty performing selected physical and functional activities. DESIGN: Cross sectional analysis of a cohort study. SETTING: Geographically defined cohort located in Rancho Bernardo, California. PARTICIPANTS: Community-dwelling women aged 55 and older who participated in a study of osteoporosis between 1988-1991. Eighty percent of eligible women participated in the study. MAIN OUTCOME MEASURES: Self-reported difficulty performing seven physical activities and four functional tasks. RESULTS: The mean age of the 1010 women was 72.6 years. A total of 160 first minimal trauma fractures occurred between 1972 and 1991, including 62 wrist, 29 rib, 25 hip, and 23 spine fractures. The mean time since fracture was 6.7 years (range, 1 to 17 years). In multiply adjusted analyses, having experienced any osteoporotic fracture was significantly associated with a 1.7 to 3.0-fold increase in difficulty bending, lifting, reaching, walking, climbing stairs, and descending stairs. Any fracture was significantly associated with 1.9 to 6.7 times more difficulty in dressing, cooking, shopping, and performing heavy housework. Compared with the relative odds of physical limitation associated with any osteoporotic fracture, hip fractures were more strongly associated with difficulty walking (OR 3.6) and descending stairs (OR 4.1), whereas spine fractures demonstrated a stronger association with difficulty bending (OR 3.1), lifting (OR 3.4), and descending stairs (OR 4.2). CONCLUSIONS: Among older women, remote osteoporotic fracture at any site is associated with an approximate doubling of the risk of physical limitations and an even higher risk of functional limitations. Although this cross-sectional analysis cannot secure the direction of the association, the specificity of the effect of particular fractures on discrete activities supports causality.

Activities of Daily Living↗

PubMed2005

The initial course of daily functioning in multiple sclerosis: a three-year follow-up study.

We studied the initial course of daily functioning in multiple sclerosis (MS). A cohort of 156 recently diagnosed patients was prospectively followed for three years (five measurements). Domains of interest were neurological deficits, physical functioning, mental health, social functioning and general health. An a priori distinction was made between a relapse onset group (n = 128) and a non-relapse onset group (n =28). At baseline, neurological deficits are relatively minor for most patients, 26.3% have aberrant physical functioning scores, 38.5% have aberrant social functioning scores, 9% have aberrant mental health scores and 25% have aberrant general health scores. The neurological deficits and physical functioning deteriorated significantly over time. This deterioration was more pronounced and clinically relevant in the non-relapse onset group only. Mental health showed a significant, but not clinically relevant deterioration over time. Social functioning and general health showed non-significant effects for time. It is concluded that in the initial stage of MS, when neurological deficits are relatively minor and mental health is relatively unaffected, patients in both groups experience limitations in daily functioning. Patients in the non-relapse onset group have progressive neurological symptoms that are accompanied by progressive limitations in physical functioning, but not by progressive limitations in the other domains.

Activities of Daily Living↗

PubMed1997

The impact of kyphosis on daily functioning.

OBJECTIVES: To determine whether moderate or severe kyphosis is associated with decrements in physical function, especially mobility. DESIGN: Cross-sectional analysis of a cohort study. SETTING: The Johns Hopkins Functional Status Laboratory, a multidisciplinary, standardized, quantitative assessment center. PARTICIPANTS: A total of 231 community-dwelling volunteers aged 59 and older who participated in a 1-day evaluation. MEASUREMENTS: Age, gender, self report of physical function, standardized measurement of: kyphosis (both qualitatively clinical criteria and quantitative assessment), time to walk 5 meters (0.1 seconds), and time to climb a flight of stairs (0.1 seconds) at usual pace. RESULTS: Using multivariate step-wise regression analysis, the presence and severity of kyphosis, measured qualitatively, was independently associated with time to walk 5 meters and to climb a flight of stairs (P = .015, P < .001, respectively), adjusting for moderate-severe scoliosis, heart rate response to exercise, arthritis, vertigo, age, and gender. Similarly, quantitative kyphosis was associated independently with stair climb time (P = .005). Qualitative kyphosis was also associated with difficulty reaching (OR = 2.21 (95% CI: 1.14 to 4.29)) and difficulty performing heavy housework (OR = 1.64 (95% CI: 1.03 to 2.61)), adjusting for prior diagnosis of moderate-severe scoliosis, prior diagnosis of arthritis, age, and gender. CONCLUSION: Kyphosis, by both clinical and quantitative assessment, is associated with diminished function, especially performance of mobility tasks. This association should be verified prospectively. If predictive, the impact of kyphosis on physical function should be considered in osteoporosis prevention and treatment counseling.

Activities of Daily Living↗

PubMed2005

Untangling the web of functional and physical interactions in yeast.

An analysis of an integrated network of over 150,000 functional and physical interactions in yeast suggests that the network can be hierarchically decomposed into themes and thematic maps. This decomposition can be used to explore the organizational principles of integrated biological networks within cells.

Gene Expression Regulation, Fungal↗

PubMed2006

Functional significance of bone density measurements in children with osteogenesis imperfecta.

BACKGROUND: The treatment of osteogenesis imperfecta has been directed at improvement of bone mineral density, yet the importance of bone mineral density in predicting functional and clinical outcome in this patient population has not been demonstrated. We used a validated functional outcome measure to identify the relationship between bone mineral density and physical function in children with osteogenesis imperfecta, and we also evaluated the relationship of bone mineral density to the rate of surgery and fracture in patients with osteogenesis imperfecta. METHODS: Twenty patients (age range, four to seventeen years) with osteogenesis imperfecta who had undergone bone mineral densitometry as measured by dual x-ray absorptiometry of the lumbar spine, wrist, and proximal aspect of the femur between November 1999 and April 2001 were retrospectively analyzed. Functional outcome was measured with use of the Pediatric Outcomes Data Collection Instrument. These questionnaires were completed by the parents of all twenty patients and, in addition, by fifteen patients in the study who were between the ages of eleven and eighteen years. Fracture and surgery rates were calculated on the basis of the number of documented fractures and surgical procedures that the patient had had from the time of the initial presentation until the time of the latest follow-up visit. RESULTS: There were significant relationships between the bone mineral density of the lumbar spine and the scores obtained on the parent-completed questionnaires with regard to upper-extremity functioning (r = 0.57, p < 0.01), transfers and basic mobility (r = 0.55, p = 0.01), sports and physical functioning (r = 0.55, p = 0.01), and global functioning (r = 0.60, p < 0.004). There were also significant relationships between the bone mineral density of the wrist and the scores obtained on the child-completed questionnaires with regard to upper-extremity functioning (r = 0.82, p < 0.01), sports and physical functioning (r = 0.76, p < 0.01), and global functioning (r = 0.83, p = 0.001). There were significant negative relationships between the bone mineral density of the lumbar spine and the rate of fractures (r = -0.69, p < 0.001) and the bone mineral density of the lumbar spine and the rate of surgery (r = -0.60, p < 0.01). CONCLUSIONS: There is a relationship between bone mineral density and the functional outcome, rate of fracture, and rate of surgery in patients with osteogenesis imperfecta. Bone mineral density appears to be an indicator of disease severity and may be predictive of long-term functional outcome. To establish specific guidelines for treatment, more data on normative bone-mineral density in children with osteogenesis imperfecta will be needed.

Adolescent↗

PubMedDate not supplied

Determinants of perceived health in patients with left ventricular dysfunction: a structural modeling analysis.

OBJECTIVE: Few studies have evaluated the determinants of perceived health in patients with chronic illness. The present study was designed to evaluate the role of biomedical, demographic, and psychosocial influences on global subjective health by means of a structural equation modeling approach. METHOD: A conceptual model of perceived health was tested in a subsample of patients (N = 146) from the multicenter Studies of Left Ventricular Dysfunction (SOLVD) trial. Domain-specific quality of life constructs (emotional status, social support, and physical functioning), were assessed by means of multiple indicators. These latent (mediating) variables, along with six single-indicator biomedical and background variables, were modeled as predictors of a composite index of perceived health. RESULTS: A satisfactory fit was obtained for the proposed model, with practical fit indices ranging from .89 to .95. High levels of perceived health were associated with low levels of emotional distress and high levels of physical functioning. Social support was positively correlated with physical functioning and negatively associated with emotional distress. Among the background variables, no direct associations were observed between any of the single-indicator variables and perceived health. Several background variables (eg, age, income, walk-test scores) had indirect effects via associations with the latent variables of physical functioning and emotional distress. CONCLUSIONS: These findings support the use of a structural modeling approach in assessing determinants of perceived health in patients with congestive heart failure. Further research is needed to evaluate the utility of the model in other patient populations.

Activities of Daily Living↗

PubMed2000

Sleep apnea and quality of life.

OBJECTIVE: To investigate the effects of sleep apnea (SA) on the quality of life (QOL). DESIGN: A prospective study of QOL in patients with and without SA as defined by an apnea-hypopnea index (AHI) >5. SETTING: University-based outpatient clinics. PATIENTS: Primary care patients followed in a general internal medicine clinic as well as those referred to a sleep disorders clinic at the University of Wisconsin Hospital and Clinics were consecutively recruited and classified into 3 groups of subjects: (1) patients without SA (AHI<5) (n=46), (2) patients with mild SA (AHI 5-15) (n=16), and (3) patients with moderate to severe SA (AHI>15) (n=21). INTERVENTIONS: NA. MEASUREMENTS: QOL was assessed with the Medical Outcomes Study SF-36 Health Survey. Health history and demographic data were obtained via structured interview and medical record review. All subjects underwent overnight polysomnography for diagnosis of SA. RESULTS: After controlling for age, gender, body mass index, and number of comorbid conditions, the association between sleep apnea and QOL was significant in the domains of physical functioning and role limitation due to physical health problems (p<0.05) and was borderline in vitality (p<0.1). Patients with both mild and moderately severe SA scored significantly lower (worse) than did patients without SA in physical functioning and in role limitations due to physical-health (82 and 83 vs. 92, respectively). Moderate to severe SA subjects scored significantly lower in vitality than did subjects without SA (51 vs. 64, p<0.05). Subscales analysis revealed that subjects with moderate to severe SA had significantly lower scores that did those without SA in positive affect (69 vs. 79), current health perceptions (71 vs. 80) and vitality (50 vs. 70), p<0.05 for all comparisons. A large percentage of patients without SA had perfect scores of 100 (ceiling effect) on the physical, social, and role functioning scales. CONCLUSIONS: SA has an independent impact on several QOL domains after adjusting for differences in age, gender, body mass index, and comorbidity. QOL outcomes were likely attenuated by ceiling effects. Disentangling the scales that measure multidimensional QOL (positive and negative aspects) enhanced the ability of the SF-36 to detect important consequences of sleep apnea on QOL.

Depression↗