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PubMed2005

Prepregnancy health status and the risk of preterm delivery.

BACKGROUND: Despite extensive evaluation, our understanding of risk factors for premature delivery is incomplete. OBJECTIVE: To examine whether a woman's health status and risk factors before pregnancy are associated with a woman's risk of preterm delivery, independent of risk factors that occur during pregnancy. DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort of pregnant women in the San Francisco Bay area who delivered a singleton infant (n = 1619). MAIN OUTCOME MEASURE: Preterm delivery (<37 weeks' gestational age). RESULTS: Sociodemographic characteristics alone explained 13.0% of the risk of preterm delivery, whereas risk factors that occurred before pregnancy explained 39.8% and risk factors that occurred during pregnancy explained 47.1%. After we adjusted for sociodemographic characteristics, prepregnancy risk factors, and pregnancy risk factors, women who reported poor physical function during the month before conception were nearly twice as likely to experience a preterm delivery (odds ratio, 1.97; 95% confidence interval, 1.18-3.30) as women with better physical function. CONCLUSION: A broader focus on the health of women prior to pregnancy may improve rates of preterm delivery.

Adolescent↗
PubMed1995

Sensitivity to change of health status measures in a randomized controlled trial: comparison of the COOP charts and the SF-36.

This study compared the sensitivity to change of comparable dimensions of a multi-item multi-dimensional health status measure (the SF-36) with the equivalent single item domains on the Dartmouth COOP charts. One hundred and twenty nine patients were randomized to either day case laparoscopic surgery (n = 60) or open inguinal hernia repair (n = 69). Respondents completed the SF-36 and COOP charts at baseline (prior to surgery) and at follow up at 10 days and 6 weeks. Equivalent dimensions of physical functioning, mental health/emotional condition, social activities, pain and overall condition/general health on the two questionnaires were compared. Despite slightly different pictures of change provided by the physical functioning and 'overall condition/general health' dimensions the general picture of change provided by the two instruments was similar. At 10 days, patients who underwent open surgery reported far greater levels of dysfunction than those who underwent laparoscopic surgery on both questionnaires. At 6 weeks the pain dimension of both questionnaires indicated a large improvement from baseline, whilst no other domain on either questionnaire for either group indicated such improvement. The general picture of change provided by the two measures was similar. The results suggest that both the SF-36 and the COOP charts may prove suitable for the assessment of health perception outcomes in surgical clinical trials. Differences on certain domains were caused in large measure by the nature of the questions posed. The study once again highlights the importance of checking item content to determine the suitability of any particular measure for a given study.

Adult↗
PubMed1999

Staff responsibility to exercise.

Recent attention has been focused on the importance of exercise for improving the physical functioning of renal patients. The involvement of the dialysis staff in encouragement and implementation of programs is critical to the success of patient efforts in improving physical functioning. Staff responsibility initially consists of various developmental steps that are focused on gaining staff support and developing a plan that matches the needs and the resources available to the unit. Each staff member plays a critical role in the development, implementation, and evaluation of the exercise program. A concerted effort from all staff to incorporate exercise as a routine part of the patient care will enhance the potential of success and patient participation.

Exercise Therapy↗
PubMed2003

Effects of estrogen plus progestin on health-related quality of life.

BACKGROUND: The Women's Health Initiative (WHI) and other clinical trials indicate that significant health risks are associated with combination hormone use. Less is known about the effect of hormone therapy on health-related quality of life. METHODS: The WHI randomly assigned 16,608 postmenopausal women 50 to 79 years of age (mean, 63) with an intact uterus at base line to estrogen plus progestin (0.625 mg of conjugated equine estrogen plus 2.5 mg of medroxyprogesterone acetate, in 8506 women) or placebo (in 8102 women). Quality-of-life measures were collected at base line and at one year in all women and at three years in a subgroup of 1511 women. RESULTS: Randomization to estrogen plus progestin resulted in no significant effects on general health, vitality, mental health, depressive symptoms, or sexual satisfaction. The use of estrogen plus progestin was associated with a statistically significant but small and not clinically meaningful benefit in terms of sleep disturbance, physical functioning, and bodily pain after one year (the mean benefit in terms of sleep disturbance was 0.4 point on a 20-point scale, in terms of physical functioning 0.8 point on a 100-point scale, and in terms of pain 1.9 points on a 100-point scale). At three years, there were no significant benefits in terms of any quality-of-life outcomes. Among women 50 to 54 years of age with moderate-to-severe vasomotor symptoms at base line, estrogen and progestin improved vasomotor symptoms and resulted in a small benefit in terms of sleep disturbance but no benefit in terms of the other quality-of-life outcomes. CONCLUSIONS: In this trial in postmenopausal women, estrogen plus progestin did not have a clinically meaningful effect on health-related quality of life.

Aged↗
PubMed2003

Quality of life of children after repair of transposition of the great arteries.

BACKGROUND: We sought to assess quality of life of children with transposition of the great arteries (TGA) enrolled during transition in management strategy from atrial to arterial switch operation. METHODS AND RESULTS: Neonates enrolled by the Congenital Heart Surgeons Society in a prospective study of TGA between 1985 and 1989 were eligible. A Child Health Questionnaire was sent for completion by the child between February and June 2000. Data were compared with published normative values. Child Health Questionnaires were completed by 306 of 708 survivors at a mean age of 13+/-1 years. Diagnosis included TGA (n=202, 66%), TGA/ventricular septal defect (VSD) (n=84, 27%), and TGA/VSD/pulmonary stenosis (n=20, 7%). Repair type was arterial switch (n=189, 62%), atrial switch (n=105, 34%; Senning=58, Mustard=47), or Rastelli (n=12, 4%). Children with TGA scored significantly higher than published norms in all categories except self-esteem. TGA/VSD/pulmonary stenosis was associated with lower scores than TGA and TGA/VSD in physical functioning (P=0.002), general health perceptions (P=0.012), and mental health (P=0.048). Arterial repair was associated with higher scores than atrial or Rastelli repair in physical functioning (P<0.001), pain (P=0.004), mental health (P=0.019), self-esteem (P=0.004), and general health perceptions (P<0.001). By multivariable analyses, the most common independent factors impacting scores were repair type, perfusion parameters, and gender. CONCLUSIONS: Quality of life and health status as perceived by children 11 to 15 years after TGA repair is excellent when compared with published normative data and is better after arterial switch operation than after atrial repair.

Adolescent↗
PubMed2005

Falls and injury prevention should be part of every stroke rehabilitation plan.

OBJECTIVE: To evaluate falls incidence, circumstances and consequences in people who return home after stroke rehabilitation, so that appropriate falls and injury prevention strategies can be developed. DESIGN: Prospective cohort study. SETTING: Community. SUBJECTS: Fifty-six subjects with stroke who were participating in a rehabilitation programme and returning to live in a community setting completed the study. MAIN MEASURES: Subjects completed a prospective falls diary for six months after discharge from rehabilitation, and were interviewed after falls. Physical function was measured by the Berg Balance Scale (BBS) and the Functional Independence Measure (FIM). RESULTS: Forty-six per cent of people (26/56) fell, with most falls (63/103 falls) occurring in the two months after discharge from rehabilitation. One subject had 37 similar falls and these falls were excluded from further analysis. Falls occurred more often indoors (50/66), during the day (46/66) and towards the paretic side (25/66). People required assistance to get up after 25 falls (38%) and 36 falls (55%) resulted in an injury. People sought professional health care after only 16 falls, and activity was restricted after 29 falls (44%). The Berg Balance Scale and Functional Independence Measure scores were lower in people who had longer lies after a fall, and who restricted their activity after a fall (p < 0.05). Lower physical function scores were also associated with falling in the morning, wearing multifocal glasses at the time of a fall, and injurious falls (p < 0.05). CONCLUSION: Falls are common when people return home after stroke. Of concern are the small number seeking health professionals' assistance after a fall, the high proportion restricting their activity as a result of a fall and the number of falls occurring towards the paretic side.

Accidental Falls↗
PubMedDate not supplied

The oral hygiene performance test: development and validation of dental dexterity scale for the elderly.

This paper describes a test which was developed for use in assessing the functional oral hygiene status of an elderly population. The instrument was tested among 80 community-dwelling elderly subjects 65 or more years old. The instrument, the Oral Hygiene Performance Test [OHPT], is a direct-observation measure which objectively quantifies the individual's ability to perform oral hygiene and thus reduces subjective evaluation. The test utilized several items from other already-validated instruments currently in use in geriatric medicine to assess functional abilities in a geriatric population. Additional items were developed by the research team and were included in this 17-item test. The OHPT was validated with common measures of physical function and direct-observation measures. Construct validity was assessed by comparison of the OHPT scores with other commonly used measures of other dimensions. The instrument proved to be reliable and demonstrated construct as well as concurrent validity. It appears that the OHPT can prove useful to clinicians in assessing the oral physical function of elderly patients with regard to their maintenance of oral hygiene. Because the OHPT is a direct-observation instrument, it can even elicit higher functions in elderly patients. While effective among the studied population, the instrument may still need to be validated among more diverse populations, such as various ethnic groups and demented or severely impaired populations.

Black or African American↗
PubMed2003

Self-assessed quality of life after acoustic neuroma surgery.

OBJECT: The aim of this study was to determine if factors such as postoperative hearing, facial function, headaches, or other factors have an impact on self-assessed quality of life (QOL) after acoustic neuroma surgery. METHODS: The SF-36 and seven additional questions on the impact of surgery on the QOL were sent to 135 consecutive patients who had undergone acoustic neuroma surgery. The Spearman rho correlations were calculated for each of the eight categories of the SF-36 (general health, physical functioning, physical role limitations, emotional role limitations, mental health, energy/vitality, pain, social functioning). The results were correlated with patients' sex, age, persistent headache, years since surgery, postoperative hearing level, and facial function. The response rate was 74.8%. The transformed scores of the eight categories of the SF-36 were lower than age-matched healthy controls in approximately half of the categories. The strongest trend toward lower scores with statistical significance in two categories was persistent headaches. Some categories demonstrated trends toward lower scores with females or age older than 55 years. Postoperative hearing and facial functioning, and time since surgery showed no statistically significant impact on QOL measured by the SF-36. Responses to the additional questions indicate that hearing, facial function, and headache influenced people's feelings about surgery and had an impact on their return to work. CONCLUSIONS: The QOL scores are not consistently lower than population normative values compared with different normative studies. The strongest correlation was between the presence of persistent headache and QOL. Other correlations were not consistent in all categories, and few were statistically significant. These trends in some categories do not explain the difference seen between patients after acoustic neuroma surgery in this study and normal populations in other studies.

Adult↗
PubMedDate not supplied

Psychologic functioning and physical health: a paradigm of flexibility.

Recent evidence suggests that positive psychologic factors may be protective against coronary artery disease (CAD). We consider this possibility through a paradigm that explores three interrelated factors that may promote healthy psychologic functioning: vitality, emotional flexibility, and coping flexibility. Vitality is a positive and restorative emotional state that is associated with a sense of enthusiasm and energy. Flexibility is related both to the ability to regulate emotions effectively and cope effectively with challenging daily experiences. A variety of factors may diminish vitality, including chronic stress and negative emotions. Pathophysiologically, chronic stress and negative emotional states can both invoke a "chronic stress response" characterized by increased stimulation of the sympathetic nervous system and hypothalamic-pituitary-adrenal axis, with resultant peripheral effects, including augmented heart rate and blood pressure responsiveness and delayed recovery to stressful stimuli. Research indicates a wide array of stressful conditions--associated with either elements of relative inflexibility in psychologic functioning and/or relatively unabated stressful stimulation--that are associated with this type of exhausting hyperarousal. Conversely, new data suggest that positive psychologic factors, including positive emotions, optimism, and social support, may diminish physiological hyperresponsiveness and/or reduce adverse clinical event rates. Still other positive factors such as gratitude and altruistic behavior have been linked to a heightened sense of well-being but have not yet been tested for beneficial physiological effects. Pending further study, these observations could serve as the basis for expanding the potential behavioral interventions that may be used to assist patients with psychosocial risk factors for CAD.

Adaptation, Psychological↗
PubMed1999

A randomized trial of a combined physical activity and environmental intervention in nursing home residents: do sleep and agitation improve?

OBJECTIVES: The purpose of this study was to test whether an intervention combining increased daytime physical activity with improvement in the nighttime environment improves sleep and decreases agitation in nursing home residents. DESIGN: A randomized trial. SETTING: One community nursing home in the Los Angeles, California area. PARTICIPANTS: Twenty-nine incontinent residents (mean age 88.3 years, 90% female). INTERVENTION: Subjects were randomized to receive either (1) an intervention combining increased daytime physical activity (14 weeks in duration) plus a nighttime program (5 nights in duration) to decrease noise and sleep-disruptive nursing care practices (intervention group), or (2) the nighttime program alone (control group). MEASUREMENTS: Daytime physical activity monitors and structured physical function assessments; nighttime wrist activity monitors to estimate nighttime sleep; and timed daytime behavioral observations of sleep versus wakefulness, either in or out of bed, and agitation. RESULTS: Physical function measures did not change significantly (MANOVA for repeated measures, group by time effect). Wrist actigraphy estimation of nighttime percent sleep (time asleep over time monitored in bed at night) increased in intervention subjects from 51.7% at baseline to 62.5% at follow-up compared with 67.0% at baseline to 66.3% at follow-up in controls (MANOVA, group by time, F = 4.42, P = .045, df = 27). At follow-up, intervention subjects averaged a 32% decrease in the percent of daytime observations in bed compared with baseline, with essentially no change in controls (MANOVA, group by time, F = 5.31, P = .029, df = 27). Seven of 15 intervention subjects had a decrease in observed agitation at follow-up, compared with baseline, versus only 1 of 14 controls with a decrease in observed agitation. CONCLUSIONS: This study provides preliminary evidence that an intervention combining increased physical activity with improvement in the nighttime nursing home environment improves sleep and decreases agitation in nursing home residents.

Aged↗
PubMed2006

Impaired generic health status but perception of good quality of life in survivors of burn injury.

BACKGROUND: Although it is recognized that burn survivors face a variety of challenges related to physical, psychologic and social late-effects of their injury, the impact of thermal injury on the lives of patients is not fully understood. To learn more about burn patient needs and to obtain information relevant to the design of clinical programs for treatment and aftercare, self-reports on how burn patients perceive their health and quality of life may be of significant value. METHODS: The generic health status (evaluated by SF-36) and overall quality of life (evaluated by the Quality of Life Scale [QOLS]) of 95 adult burn patients (total body surface area burned = 18.5 +/- 14.2% [mean +/- SD]; 82.1% men) were assessed 47.0 +/- 23.8 months postburn and compared with population norms. RESULTS: The burn patient generic health status was significantly poorer than expected from general population scores, with reduced scores in the Physical Function (p < 0.001), Role Physical (p < 0.01), General Health (p < 0.001), Social Function (p < 0.001), and Role Emotional (p < 0.001) domains of the SF-36. Despite their reduced health status, overall quality of life was perceived as good, with QOLS scores similar to those of the general population. Patients living alone, unemployed, having nonburn physical illness, psychologic disorders, chronic pain, or having sustained full thickness injuries were found to be at particular risk. CONCLUSIONS: Forty-seven months postinjury, burn patients still experienced a significant reduction of generic health, reporting limitations related to both physical and psychosocial SF-36 domains. On the other hand, the patients as a group reported overall quality of life similar to that of the norm population, suggesting that they were able to feel satisfaction with their new situation of life. Identification of several risk factors for reduced generic health status and overall quality of life support the need for specialized multidisciplinary aftercare for burn patients.

Adult↗
PubMed1999

Eukaryotic translation initiation factors 4G and 4A from Saccharomyces cerevisiae interact physically and functionally.

The initiation of translation in eukaryotes requires several multisubunit complexes, including eukaryotic translation initiation factor 4F (eIF4F). In higher eukaryotes eIF4F is composed of the cap binding protein eIF4E, the adapter protein eIF4G, and the RNA-stimulated ATPase eIF4A. The association of eIF4A with Saccharomyces cerevisiae eIF4F has not yet been demonstrated, and therefore the degree to which eIF4A's conserved function relies upon this association has remained unclear. Here we report an interaction between yeast eIF4G and eIF4A. Specifically, we found that the growth arrest phenotype associated with three temperature-sensitive alleles of yeast eIF4G2 was suppressed by excess eIF4A and that this suppression was allele specific. In addition, in vitro translation extracts derived from an eIF4G2 mutant strain could be heat inactivated, and this inactivation could be reversed upon the addition of recombinant eIF4A. Finally, in vitro binding between yeast eIF4G and eIF4A was demonstrated, as was diminished binding between mutant eIF4G2 proteins and eIF4A. In total, these data indicate that yeast eIF4G and eIF4A physically associate and that this association performs an essential function.

Eukaryotic Initiation Factor-4A↗
PubMed2006

Is serum albumin a good marker for malnutrition in the physically impaired elderly?

BACKGROUND AND AIMS: Although serum albumin is well known as a marker of nutritional status, it has remained unclear whether impaired physical function affects serum albumin concentrations in older people. We examined whether hypoalbuminemia can be used as a marker of malnutrition in elderly subjects with various levels of physical impairment. METHODS: A total of 262 elderly subjects without acute illness were enrolled from various geriatric settings. For the nutritional assessment, serum albumin, total cholesterol, anthropometric measurements, and subjective global assessment (SGA) were determined. Physical function was evaluated by rating score of activity of daily living (ADL). RESULTS: As a whole, participants' serum albumin levels correlated with various nutritional parameters including anthropometric measurements and levels of serum total cholesterol as well as the SGA evaluation. However, after adjusting for age and gender, serum albumin levels in participants with a low ADL function did not correlate with nutritional parameters. Approximately 80% participants with low ADL function who were evaluated as being well nourished according to SGA evaluation had serum albumin levels lower than 35 g/l. CONCLUSIONS: The utility of serum albumin and the traditional cutoff (35 g/l) in older people with low ADL function is questionable even among those without inflammation.

Activities of Daily Living↗
PubMed1994

Impact of social support, social cognitive variables, and perceived threat on depression among adults with diabetes.

Tested was a model of social support and cognitive appraisal of self-efficacy, outcome expectancies, and illness threat on depression. Study participants were community-dwelling adults with diabetes who completed a mailed questionnaire (N = 362). Results of structural equation modeling indicated that 52% of the variance in depression was explained by the model--largely by the direct effects of physical functioning, the perceived availability of social support, and the perceived threat of diabetes as well as the indirect paths from perceived support to perceived threat and from physical functioning to perceived support and perceived threat of diabetes. Diabetes-specific social support, self-efficacy, and outcome expectancies were not significant predictors of depression.

Adaptation, Psychological↗
PubMed2003

Effect of end-stage renal disease on the quality of life of older patients.

OBJECTIVES: To assess the effect of chronic renal failure (CRF) on quality of life (QOL). DESIGN: Controlled cross-sectional study. SETTING: All 13 dialysis units in the French Lorraine region and six departments of a Nancy hospital. PARTICIPANTS: One hundred sixty-nine older patients with end-stage renal disease (ESRD) who were starting first dialysis (mean age +/- standard deviation = 76.2 +/- 5.1) and 169 age- and sex-matched non-CRF controls. MEASUREMENTS: QOL was assessed using the short-form health survey 36-item (SF-36) self-administered questionnaire. Information on comorbid conditions, clinical symptoms and laboratory findings was obtained from medical records. RESULTS: Mean QOL scores ranged from 11.2 (role limitation due to physical function (RP) dimension) to 55.5 (social function) in the ESRD group, and from 22.0 (RP) to 54.3 (mental health) in the non-CRF group. Among ESRD patients, factors related to QOL scores (physical function (PF) and vitality dimensions) were the conditions under which dialysis was initiated and comorbidity. Patients whose first dialysis was unplanned had 10.4 fewer points in the PF dimension than those in whom it was planned (P =.014). CONCLUSIONS: If dialysis initiation is planned, ESRD in older patients has no more effect on QOL than others diseases. However, patients whose dialysis is unplanned have severely impaired QOL. These results represent an argument for improving the predialysis care of older renal failure patients to optimize conditions at first dialysis.

Aged↗
PubMed2003

Osteopathic manipulative treatment for chronic low back pain: a randomized controlled trial.

STUDY DESIGN: A randomized controlled trial was conducted. OBJECTIVE: To determine the efficacy of osteopathic manipulative treatment as a complementary treatment for chronic nonspecific low back pain. SUMMARY OF BACKGROUND DATA: Osteopathic manipulative treatment may be useful for acute or subacute low back pain. However, its role in chronic low back pain is unclear. METHODS: This trial was conducted in a university-based clinic from 2000 through 2001. Of the 199 subjects who responded to recruitment procedures, 91 met the eligibility criteria. They were randomized, with 82 patients completing the 1-month follow-up evaluation, 71 completing the 3-month evaluation, and 66 completing the 6-month evaluation. The subjects were randomized to osteopathic manipulative treatment, sham manipulation, or a no-intervention control group, and they were allowed to continue their usual care for low back pain. The main outcomes included the SF-36 Health Survey, a 10-cm visual analog scale for overall back pain, the Roland-Morris Disability Questionnaire, lost work or school days because of back pain, and satisfaction with back care. RESULTS: As compared with the no-intervention control subjects, the patients who received osteopathic manipulative treatment reported greater improvements in back pain, greater satisfaction with back care throughout the trial, better physical functioning and mental health at 1 month, and fewer cotreatments at 6 months. The subjects who received sham manipulation also reported greater improvements in back pain and physical functioning and greater satisfaction than the no-intervention control subjects. There were no significant benefits with osteopathic manipulative treatment, as compared with sham manipulation. CONCLUSIONS: Osteopathic manipulative treatment and sham manipulation both appear to provide some benefits when used in addition to usual care for the treatment of chronic nonspecific low back pain. It remains unclear whether the benefits of osteopathic manipulative treatment can be attributed to the manipulative techniques themselves or whether they are related to other aspects of osteopathic manipulative treatment, such as range of motion activities or time spent interacting with patients, which may represent placebo effects.

Chronic Disease↗
PubMed2006

Health-related quality of life following a clinical weight loss intervention among overweight and obese adults: intervention and 24 month follow-up effects.

BACKGROUND: Despite a growing literature on the efficacy of behavioral weight loss interventions, we still know relatively little about the long terms effects they have on HRQL. Therefore, we conducted a study to investigate the immediate post-intervention (6 months) and long-term (12 and 24 months) effects of clinically based weight management programs on HRQL. METHODS: We conducted a randomized clinical trial in which all participants completed a 6 month clinical weight loss program and were randomized into two 6-month extended care groups. Participants then returned at 12 and 24 months for follow-up assessments. A total of 144 individuals (78% women, M age = 50.2 (9.2) yrs, M BMI = 32.5 (3.8) kg/m2) completed the 6 month intervention and 104 returned at 24 months. Primary outcomes of weight and HRQL using the SF-36 were analyzed using multivariate repeated measures analyses. RESULTS: There was complete data on 91 participants through the 24 months of the study. At baseline the participants scored lower than U.S. age-specific population norms for bodily pain, vitality, and mental health. At the completion of the 6 month clinical intervention there were increases in the physical and mental composite measures as well as physical functioning, general health, vitality, and mental health subscales of the SF-36. Despite some weight regain, the improvements in the mental composite scale as well as the physical functioning, vitality, and mental health subscales were maintained at 24 months. There were no significant main effects or interactions by extended care treatment group or weight loss group (whether or not they maintained 5% loss at 24 months). CONCLUSION: A clinical weight management program focused on behavior change was successful in improving several factors of HRQL at the completion of the program and many of those improvements were maintained at 24 months. Maintaining a significant weight loss (> 5%) was not necessary to have and maintain improvements in HRQL.

Adult↗