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PubMed1997

A hospital-based case-control study of quality of life in older asthmatics.

Asthma is a common but neglected problem in older people, the impact of which is relatively unstudied. The aim of this study was to objectively assess quality of life and depression in older asthmatics. The subjects studied were 50 hospitalized known asthmatics, over 55 yrs of age (mean age 72 yrs). Of these, 40 had objective evidence of asthma, and were compared to 40 age- and sex-matched controls. Using a structured questionnaire, the Geriatric Depression Score, subjective health status (short form (SF)-36), and other comparative disability data were recorded. Spirometric results were also recorded. Depressive symptoms were common in both groups but were not significantly different. Mean SF-36 scores were significantly worse in the asthmatics, especially for components of physical function (p = 0.04), physical role limitation (p = 0.01), energy (p = 0.01), health change (p = 0.01), and general health perception (p = 0.01). However mental, mental role and social scores were similar in both groups. We conclude that quality of life is impaired in hospitalized asthmatics compared to controls. Physical components appear to be most adversely affected. Depressive symptoms are common but no overall difference was found for psychological disability. Older asthmatics appear to adapt well to adverse situations.

Activities of Daily Living↗
PubMed2005

Cancer history and other personal factors affect quality of life in patients with hepatitis C.

BACKGROUND: Although patients with chronic hepatitis C (CHC) have been found to have reduced quality of life, little is known about how other characteristics affect their quality of life. The purpose of this study was to investigate the effect of other characteristics, including history of cancer, on quality of life in patients with CHC. METHODS: One hundred forty patients from clinics at three hospitals in New York City completed a detailed epidemiologic interview about demographic and lifestyle characteristics and the SF-36 measuring health-related quality of life. We compared results from our patients to normative data using t-tests of differences between means. We used multivariate analyses to determine other personal and health-related factors associated with quality of life outcomes. RESULTS: Compared to normative data, these patients had reduced quality of life, particularly on physical functioning. The summary Physical Component Score (PCS) was 45.4 +/- 10.6 and the Mental Component Score (MCS) was 48.2 +/- 11.1, vs norms of 50 +/- 10.0; p-values were < 0.0001 and < 0.05, respectively. In multivariate analyses, the PCS was significantly lower among those with cancer history, > or = 2 other chronic conditions, less education, low physical activity, and higher alanine aminotransferase (ALT) levels. Cancer was more important for men, while other chronic conditions were more important for women. On the MCS, history of depression, low physical activity, alcohol use, and female gender were independently associated with poorer scores. CONCLUSION: Several health and lifestyle factors independently influence quality of life in CHC patients. Different factors are important for men and women.

Adult↗
PubMed2004

Improvement in physiological outcomes and health-related quality of life following cardiac rehabilitation in patients with acute myocardial infarction.

BACKGROUND: The present study examined the impact of an 8-week cardiac rehabilitation (CR) program on physiological outcomes and health-related quality of life (HRQOL) of patients with acute myocardial infarction (AMI). METHODS AND RESULTS: A total of 124 consecutive AMI patients were divided into a supervised outpatient CR group (n=82) and a non-CR group as a control (n=42). Peak oxygen uptake, handgrip strength, and knee extension muscular strength were used as physiological outcome measures. HRQOL outcomes were assessed by the Medical Outcome Study Short Form 36 (SF-36). CR group patients performed both aerobic exercise and moderate resistance training from 1 month (T1) to 3 months (T2) after AMI onset. Age, sex, body mass index, medications, and ejection fraction were similar in both groups. Significantly greater increases in overall physiological outcomes from T1 to T2 were measured in the CR group compared with those of the non-CR group. There were also significantly greater improvements in 4 of the 8 SF-36 health status subscales (physical functioning, role-physical, general health, and vitality) in the CR group compared with the non-CR group. CONCLUSIONS: Eight weeks of exercise training have specific effects on improvement in HRQOL and physiological outcomes in Japanese patients.

Aged↗
PubMed1996

A review of the quality-of-life aspects of urinary urge incontinence.

Urinary incontinence (UI) is prevalent and costly, occurring in 15 to 30% of the US population over the age of 60 years. Among people aged 15 to 64 years, UI occurs in 1.5 to 5% of men and 10 to 25% of women. Severe incontinence occurs in 6% of the general US population, and it is estimated that $US10 billion per year is spent in direct costs alone on care for these patients. This review presents a description of the various types of UI and describes the prevalence and costs of the condition. In addition, 3 approaches to assessing the impact of UI on quality of life are discussed, namely generic measures, disease-specific measures and qualitative approaches. We also review papers on UI and sexual functioning, UI in men, and some aspects of treatment. The review was conducted in the process of developing a new disease-specific measure for urinary urge incontinence (UUI). In general, the literature suggests that UUI has a greater impact than stress incontinence on quality of life, and that UI affects social and psychological functioning more than physical functioning. Only in a minority of individuals is the impact of UI disabling; however, most individuals with UI show significant reduction in their social functioning. Several studies suggest that the impact of UI is not solely a function of its severity, but also depends on individual coping abilities. Some studies also indicate that the social problems associated with UI grow with time, but it is not clear if that is a function of increasing severity of the condition, or the particular adaptations required for coping with this problem. An important distinction appears to be the ability of individuals to avoid public notice of their condition because of uncontrolled accidents. In summary, there is a need for a new measure of the quality-of-life impact of UUI that is based on the literature and on in-depth interviews with patients.

Aged↗
PubMed2003

Gabapentin: in postherpetic neuralgia.

Gabapentin is a structural analogue of the neurotransmitter gamma-aminobutyric acid (GABA) approved for use in adults with postherpetic neuralgia. Gabapentin does not bind to GABA(A) or GABA(B) receptors. Its mechanism of action in humans is unclear, but may involve binding to alpha2delta calcium channel subunits in animal models. Reductions in the mean daily pain score from baseline to week 7 or 8 of treatment (primary endpoint) were significantly greater with gabapentin 1800-3600 mg/day than placebo therapy in two well designed trials in patients with postherpetic neuralgia. The proportion of responders (patients showing a > or =50% reduction in mean daily pain score at endpoint versus baseline) was significantly greater with gabapentin than placebo. Daily sleep rating scores, the Short Form McGill Pain Questionnaire (total pain scores), Patient and Clinician Global Impression of Change and measures on the Short Form-36 Health Survey (including physical functioning, role-physical, bodily pain, vitality or mental health) improved to a significantly greater extent with gabapentin than placebo. Adverse events associated with gabapentin in patients with postherpetic neuralgia were usually mild to moderate in intensity, with dizziness, somnolence and peripheral oedema being commonly reported.

Acetates↗
PubMed2005

Patients with extreme obesity: change in mental symptoms three years after gastric banding.

OBJECTIVE: Extreme obesity causes grave psychosocial and psychopathological problems in addition to somatic morbidity. One possible treatment is gastric banding, a surgical reduction of stomach volume. The aim of this study was to investigate whether gastric banding leads to lasting change in: 1) the Body Mass Index (BMI); 2) social factors such as work and partnerships, eating behavior, anxiety and depression symptoms; and 3) health related quality of life. METHOD: We surveyed a sample of 50 adipose women (BMI > 40 kg/m2). Primary outcome measures were self-reported changes on the scales of the Three-Factor Eating Questionnaire (TFEQ), the Hospital Anxiety and Depression Scale (HADS-D), and the Health Survey (SF-36). RESULTS: In comparison with the control group, we observed significant changes in BMI (p < 0.01) and the existence of a partnership (p < 0.01), on all three scales of the TFEQ (p < 0.01), on both scales of the HADS-D (anxiety: p < 0.05; depression:p < 0.01), and on all scales of the SF-36 Health Survey (p between < 0.05 and < 0.01 in every case). The most marked changes in all the qualities investigated occurred within the first 12 months of surgery. CONCLUSIONS: Three years after gastric banding, positive changes in BMI reduction, partnership, eating behavior, anxiety, depressive symptomatology, and health related quality of life could be observed. There was also a significant correlation between BMI reduction and reduction firstly on the depression scale (HADS-D) and secondly on the SF-36 scales for physical functioning (PHFU), role physical (ROPH), mental health (PSYC), and vitality (VITA).

Adult↗
PubMed2003

Using telerehabilitation to promote TBI recovery and transfer of knowledge.

Advances in the design and delivery of trauma care and acute medical management have increased the number of survivors of traumatic brain injury (TBI), producing societal consequences and medical challenges. Although access to health care for rural patients remains a critical challenge, teletherapy may represent a viable means for the delivery of therapeutic services to such patients. A case study is presented in which teletherapy was successfully utilized to improve the functional outcomes, both physical and cognitive, of a patient with a severe TBI. A physical therapist from a metropolitan rehabilitation center employed teletherapy to provide Neuro Developmental Treatment for a patient and to mentor staff in a nursing home located over 100 miles from the metro area. The patient, who participated in 48 physical teletherapy sessions over a 24-week period, demonstrated improvements in physical functioning and neuropsychological status. During the course of therapy, goals were adjusted upward to match the patient's improvements. This case study provides confirmatory evidence that teletherapy represents an effective and efficient means for providing rehabilitation services for patients in rural communities, as well as for facilitating mentoring relationships between seasoned professionals and trainees located in rural settings.

Adult↗
PubMed1991

Quality of life and cataracts: a review of patient-centered studies of cataract surgery outcomes.

In the next 10 years growing numbers of adults will be reaching the age at which senile cataracts typically develop. At the same time, pressure is strong to contain medical expenses. In order to formulate wise public policy in this area it is important to describe the effects of this treatment on the patient's quality of life. After a general discussion of research on patient-centered medical outcomes, 18 studies of patient-centered cataract surgery outcomes are reviewed. Then the findings, both direct outcomes (visual acuity, percentage visual impairment, complications, visual functioning, physical and mental functioning, general well-being, and satisfaction with care) as well as modifying factors (type of prosthesis, presurgical functional status, condition of fellow eye, other ocular pathology, comorbidity, age, gender, socioeconomic status, attitudes, and values) are summarized. The closing discussion summarizes findings, describes two studies underway, and suggests directions for future studies of cataract surgery effects.

Cataract Extraction↗
PubMed1986

The reliability and validity of a ten-item measure of functional status.

The accurate assessment of functional status is an important clinical activity in family practice. Many of the measures of function developed for research purposes, however, have questionable applicability to primary care practices. The Duke-UNC Health Profile (DUHP) is a 63-item instrument that assesses four dimensions of function: symptom experiences, physical function, social function, and emotional function. The reliability and validity of a ten-item subset (the mini-DUHP) of the DUHP was examined for 71 white adults with a profile of high stressful life changes and weak social supports. These subjects completed the DUHP on two occasions and provided personal morbidity data by monthly mailed questionnaire for an intervening six-month period. On both administrations of the instrument, mini-DUHP scores were strongly correlated with composite DUHP scores (r = .81 and .84) and moderately correlated with each of the four functional dimension scores. The mini-DUHP demonstrated good temporal stability (r = .58). Mini-DUHP scores, determined both before and after the six-month period, were correlated with cumulative self-reported hospital days, bed disability days, restricted activity days, and physician utilization. Responses to the mini-DUHP strongly predicted bed disability, restricted activity, and physician visits after controlling for the effects of sociodemographic characteristics by multivariate analysis. This ten-item scale may be useful and practical in the assessment and monitoring of function in a primary care setting.

Adult↗
PubMedDate not supplied

[Changes in the physical condition, vestibular function and bone system in rats exposed to long-term rotation].

The unrestrained rats were rotated for 21 and 30 days at 1.1 and 2.0 G. The exposure did not deteriorate their equilibrium function or physical condition, i. e. static and dynamic endurance. However, the exposure decreased the reactivity and sensitivity of the semicircular canals. Bone parameters-longitudinal and transverse bone growth, metaepiphysis morphometry-indicated that the rats developed an acute stress-reaction accompanied by an inhibited growth of limb bones during the first 7 days of rotation. By experimental day 30 the animals became adapted to the new environment.

Animals↗
PubMed1995

Patients' perception of health on renal replacement therapy: evaluation using a new instrument.

Patients' perception of their health is an important outcome measure in the management of chronic disease. Comparing that perception from patients receiving different forms of renal replacement therapy (RRT) with data from the general population could be used to monitor the effectiveness of treatment. The short form 36 (SF-36) questionnaire is a general measure of health status which has been validated in the UK and uses eight health scales comprising physical function, social function, role limitation (physical and emotional), mental health, energy, pain and overall health. Using the SF-36 questionnaire, the perception of health of patients receiving RRT was compared with data from healthy control subjects. One hundred and seventy-two of 185 (93%) patients receiving RRT--transplant (n = 102), haemodialysis (n = 43), and peritoneal dialysis (n = 27) completed the questionnaire; scores were compared with those from 542 healthy control subjects. The perception of health of haemodialysis and peritoneal dialysis patients was significantly worse than transplanted patients and controls in six of the eight scales (P < 0.05 dialysis versus transplant and controls). That of transplanted patients was worse in only two and better in one of the eight scales compared with the general population (P < 0.05). Patients were also stratified into low, medium, and high-risk groups based on age and comorbidity and were analysed irrespective of treatment modality. Scores were significantly different across the risk groups in five of the eight scales. We conclude that the SF-36 questionnaire is acceptable to patients on RRT and enables the perception of health of patients receiving RRT to be compared with that of the general population.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1996

Education, age, and the cumulative advantage in health.

The positive association between educational attainment and health is well established, but the way in which the education-based gap in health varies with age is not. Do the health advantages of high educational attainment and disadvantages of low educational attainment diverge or converge with age? The cumulative advantage perspective predicts a diverging SES gap in health with age, but past evidence does not allow us to accept or reject the hypothesis. We address this issue in two samples, cross-sectionally and over time, with three health measures. The first data set consists of a 1990 telephone interview of a national probability sample of U.S. households. There are 2,031 respondents, aged 18 to 90. The second is a national probability sample of U.S. households in which 2,436 respondents aged 20 to 64 were interviewed by telephone in 1979 and reinterviewed in 1980. We find that the gap in self-reported health, in physical functioning, and in physical well-being among people with high and low educational attainment increases with age. The health advantage of the well educated is larger in older age groups than in younger. Health advantages of high income and disadvantages of low income also diverge with age, but household income does not explain education's positive effect.

Activities of Daily Living↗
PubMed1997

Psychosocial predictors of mental health in a population of elderly women. Test of an explanatory model.

The understanding of adjustment to aging calls for models that illustrate the interaction of psychosocial and health factors. The authors surveyed a group of retired Catholic sisters, examining the contributions of psychosocial factors and religiousness to life satisfaction, psychological distress, and depression. Life satisfaction was best explained by a four-factor model that included mastery, social support, physical functioning, and religious commitment. General level of distress was best predicted by physical functioning, social support, and mastery, but not religiousness. Depression, on the other hand, was predicted by mastery, social support, and religious commitment. These data are consistent with a proposed model in which internal, external, and coping resources mediate the psychological impact of impaired functional status.

Activities of Daily Living↗
PubMed2003

Functional status is well maintained in older women during adjuvant chemotherapy for breast cancer.

BACKGROUND: While adjuvant chemotherapy is known to improve survival in older women with breast cancer, there is little information about its effects on physical function and health-related quality of life. PATIENTS AND METHODS: 'Young' (<65 years of age) and 'older' (> or = 65 years of age) postmenopausal women completed the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core Module (QLQ-C30) and BR23 questionnaires and other measures prior to, during and at the completion of anthracycline-based adjuvant chemotherapy, and then 6 and 12 months later. RESULTS: Physical, role and social function decreased during chemotherapy and emotional function improved (all P <0.01). The decline in physical function was more marked in young (age range 31-64 years; n = 45) than in older women (65-80 years; n = 20) (P <0.05), despite similar baseline values and drug dose intensities. Physical and role function had recovered at 6 months post-chemotherapy. Older patients had consistently better emotional function (P <0.01). CONCLUSIONS: Physical function and other functional domains are impaired in postmenopausal women during adjuvant chemotherapy for breast cancer, but recover subsequently. Physical function appeared to be better maintained in the older women, who tolerated adjuvant chemotherapy well overall. A knowledge of these effects is important for clinical decision-making and when defining social support needs during adjuvant chemotherapy.

Activities of Daily Living↗
PubMed2005

Does it matter what patients think? The relationship between changes in patients' beliefs about angina and their psychological and functional status.

OBJECTIVE: The aim of this study is to examine the association between changes in misconceived or maladaptive beliefs about angina and patients' functional and psychological status. METHOD: The method used was a prospective follow-up study over 1 year of 133 people with angina. RESULTS: Beliefs about angina were significantly associated with functional and psychological status. People with more misconceived or maladaptive beliefs were more anxious and physically limited than were people with fewer such beliefs, with differences in physical functioning that were clinically significant. Change in angina beliefs over 1 year was the most significant predictor for physical functioning at follow-up, after controlling for the effects of demographic variables and the outcome variable at baseline, whereas change in the frequency of angina did not contribute significantly to this model. CONCLUSION: Misconceived and maladaptive beliefs about angina are associated with reductions in both functional and psychological status. These beliefs are easily and quickly identified using a simple questionnaire and should be corrected.

Adult↗
PubMed1999

A prospective study on quality of life of laryngeal cancer patients treated with radiotherapy.

BACKGROUND: The aim of this study was to describe prospectively quality of life and mood before and after radiotherapy for laryngeal cancer. METHODS: Sixty-five patients with Tis-T3 laryngeal cancer treated with radiotherapy completed the European Organization for Research and Treatment of Cancer (EORTC) Core Questionnaire, the EORTC Head and Neck Cancer module, and the Center for Epidemiologic Studies Depression Scale before treatment and 6 and 12 months later. RESULTS: There was a significant but temporary deterioration of physical functioning, fatigue and most head and neck symptoms. Speech was the only symptom which improved. Patients with T2 tumors had significantly worse physical symptoms compared with patients with T1 tumors. There was a high level of depressive symptomatology at baseline, followed by an improvement after treatment. CONCLUSIONS: After radiotherapy for laryngeal cancer, a temporary deterioration of physical functioning and symptoms occurs, mostly caused by side effects of treatment. Despite physical deterioration, there is an improvement of emotional functioning and mood after treatment, probably as a result of psychological adaptation and coping processes.

Adult↗
PubMed2000

Impact of smoking on health-related quality of life after percutaneous coronary revascularization.

BACKGROUND: PTCA is performed primarily to improve health-related quality of life (HRQOL) in patients with symptomatic coronary artery disease. In patients undergoing PTCA, smoking has been shown to increase risks of late myocardial infarction and death. Whether smoking also affects HRQOL after PTCA is currently unknown. METHODS AND RESULTS: We examined the relation between smoking status and HRQOL among 1432 patients who underwent PTCA as part of 2 multicenter clinical trials. HRQOL was assessed with the use of the Medical Outcomes Study SF-36 questionnaire. Patients were classified as smokers (n=301), quitters (n=141), or nonsmokers (n=990) on the basis of their smoking status at the time of their index procedure and during the first year of follow-up. For the overall population, HRQOL improved significantly after PTCA for all scales except general health perception, with improvements ranging from 5.5 points for mental health to 23.2 points for role-physical functioning. After adjustment for baseline characteristics and initial HRQOL, nonsmokers had gains at 6 months that were larger than those of smokers for all health domains: physical function (15.4 versus 10.4 points), role-physical (24.5 versus 13.9), pain (18.4 versus 13.3), general health perception (1.7 versus -4.5), vitality (11.0 versus 4. 7), social function (12.8 versus 3.5), role-emotional (13.5 versus 6. 7), and mental health (6.8 versus 0.8; P:<0.02 for all comparisons). Quitters had 6-month HRQOL improvements that were greater than those in smokers for all domains as well. Findings were similar at 1 year. CONCLUSIONS: Quality-of-life benefits of PTCA are diminished by continued smoking. Efforts to promote smoking cessation at the time of PTCA may substantially improve the health outcomes of these procedures.

Age Factors↗