H.U.B city steps: methods and early findings from a community-based participatory research trial to reduce blood pressure among african americans

Background

Although lifestyle interventions targeting multiple lifestyle behaviors are more effective in preventing unhealthy weight gain and chronic diseases than intervening on a single behavior, few studies have compared individual and combined effects of diet and/or exercise interventions on health-related quality of life (HRQOL). In addition, the mechanisms of how these lifestyle interventions affect HRQOL are unknown. The primary aim of this study was to examine the individual and combined effects of dietary weight loss and/or exercise interventions on HRQOL and psychosocial factors (depression, anxiety, stress, social support). The secondary aim was to investigate predictors of changes in HRQOL.

Methods

This study was a randomized controlled trial. Overweight/obese postmenopausal women were randomly assigned to 12 months of dietary weight loss (n = 118), moderate-to-vigorous aerobic exercise (225 minutes/week, n = 117), combined diet and exercise (n = 117), or control (n = 87). Demographic, health and anthropometric information, aerobic fitness, HRQOL (SF-36), stress (Perceived Stress Scale), depression [Brief Symptom Inventory (BSI)-18], anxiety (BSI-18) and social support (Medical Outcome Study Social Support Survey) were assessed at baseline and 12 months. The 12-month changes in HRQOL and psychosocial factors were compared using analysis of covariance, adjusting for baseline scores. Multiple regression was used to assess predictors of changes in HRQOL.

Results

Twelve-month changes in HRQOL and psychosocial factors differed by intervention group. The combined diet + exercise group improved 4 aspects of HRQOL (physical functioning, role-physical, vitality, and mental health), and stress (p ≤ 0.01 vs. controls). The diet group increased vitality score (p < 0.01 vs. control), while HRQOL did not change differently in the exercise group compared with controls. However, regardless of intervention group, weight loss predicted increased physical functioning, role-physical, vitality, and mental health, while increased aerobic fitness predicted improved physical functioning. Positive changes in depression, stress, and social support were independently associated with increased HRQOL, after adjusting for changes in weight and aerobic fitness.

Conclusions

A combined diet and exercise intervention has positive effects on HRQOL and psychological health, which may be greater than that from exercise or diet alone. Improvements in weight, aerobic fitness and psychosocial factors may mediate intervention effects on HRQOL.     

中国9省市中老年人群体重指数与健康相关生命质量的关系

目的 研究中国中老年人BMI与健康相关生命质量(HRQOL)的关系.方法 汇集9省市(汀苏、安徽、甘肃、青海、福建、北京、吉林、江西、河南)横断面健康状况调查中老年人群数据共9539例.采用秩和检验比较BMI分类不同的中老年人生命质量的差异;用多元logistic回归模型检验排除性别、年龄、婚姻状况、学历、运动水平和慢性病史等混杂因素后,中老年人BMI分类与生命质最的相关性.结果 与体重正常的中老年人相比,体重过轻组SF-36的生理领域(P<0.001)、心理领域(P<0.01)及其8个维度(生理机能、精神健康,P<0.05;生理职能、躯体疼痛、健康状况、精力、社会功能、情感职能,P<0.01)生命质量均显著较差;超重组心理领域生命质量显著较好(P<0.05);肥胖组生理机能维度显著较差(P<0.01),心理领域(P<0.05)、精神健康维度(P<0.01)显著较好.排除已知的混杂因素后,体重过轻组在生理领域(OR=1.67,95%CI:1.35～2.06)、心理领域(OR=1.39,95%CI:1.13～1.70)以及所有8个维度生命质量减损的危险度显著增高;超重组心理领域(OR=0.86,95%CI:0.78～0.95)及其生理职能、精力、社会功能、情感职能、精神健康维度生命质最受损的危险度显著降低;肥胖组生理机能维度(OR=1.51,95%CI:1.27～1.80)受损的危险度显著增高,心理领域(OR=0.71,95%CI:0.60～0.85)及其精力、情感职能、精神健康维度生命质量受损的危险度显著降低.结论 BMI分类不同的中老年人其SF-36各领域生命质量不同,体重过轻组生理领域和心理领域生命质量均较差,超重和肥胖组心理领域生命质最较好,肥胖组生理领域生命质量较差.超重和肥胖的中老年人生命质量的减损与慢性疾病有关.     

Relationship between health status and utility measures in older claudicants

The purpose of this study was to examine the relationship between health status and health utility measures in 34 older claudicants and to determine which attributes of health status were significant predictors of health state valuation/preference. The MOS SF-36 was used to assess health status and the rating scale and multiattribute Health Utility Index (HUI) were used to assess utility scores. With regard to health status, the bodily pain and physical functioning subscales contributed the most to reductions in quality of life (QoL) with mean subscale scores substantially lower than reported population norms. Patients rated their health status approximately one-third below a state of perfect health on both utility measures. Moderate correlations were observed between the MOS SF-36 subscale scores and the HUI and rating scale scores. In multivariable regression models, physical functioning and mental health were the best predictors of HUI scores, whereas general health and vitality were the best predictors of rating scale scores. Approximately 50% of the variance in utility scores was explained by these attributes. This study provides further documentation that bodily pain and reductions in physical function contribute to reductions in QoL in older patients with intermittent claudication. Other attributes of health status, however, notably psychological distress, were predictive of patients' preference for health states. Recognized constructs of physical and mental health explained the substantial variation in the utility/preference assessment in this population. Furthermore, these data are consistent with those reported in the Dutch Iliac Stent Trial.     

Mental health status of the South Australian population

OBJECTIVE: To determine, by the use of a telephone survey, the mental health status of SA adults (18+ years) using the GHQ-28, SF-12 and self-report as indicators of mental health, and to examine risk factors for mental health morbidity. SAMPLE: A random representative sample of South Australian adults selected from the Electronic White Pages. Overall, 2,501 interviews were conducted (74.0% response rate). RESULTS: Overall, 19.5% of respondents had a mental health problem as determined by the GHQ-28, 11.8% as determined by the mental health component summary score of the SF-12 and 11.9% self-reported a mental health condition. The percentage of people with a mental health problem who had used a psychologist or a psychiatrist in the previous 12 months was 9.6% for people diagnosed by the GHQ-28, 16.2% by SF-12 and 23.7% for self-report. The logistic regression analyses undertaken to describe people with a mental health problem as determined by the GHQ-28 and to describe people who visited a psychologist or psychiatrist produced different age categories, demographic and co-morbidity indicators. Variables found in both analyses included living in the metropolitan area, being economically inactive and being a high user of health services. CONCLUSIONS: One in five South Australian adults has a mental problem. Although the prevalence is higher for younger age groups, older adults are more likely to visit a psychologist or a psychiatrist. IMPLICATIONS: Telephone interviewing produces robust indicators of the prevalence of mental health problems and is a cost-effective way of identifying prevalence estimates or tracking changes over time.     

Impact of Long-Term Complications on Quality of Life in Patients with Type 2 Diabetes not Using Insulin

Objectives: The complications of diabetes have the potential to greatly impact the health-related quality of life (HRQOL) of patients with type 2 diabetes. The effect of diabetic complications on HRQOL was assessed in 1233 patients with type 2 diabetes who were not using insulin.
Methods and data: Patients were aged 35 and older and had stable fasting serum glucose (FSG) after washout of antidiabetic therapy. Patients who required insulin or suffered from severe cardiovascular or hepatic disease, neuropathy, or retinopathy were excluded. Patients completed the SF-36 generic quality of life questionnaire. Demographic data, including body mass index (BMI), blood glucose hemoglobin A1c (HbA_1c), FSG, and the presence and severity of eight specified diabetic complications were also collected. A linear regression analysis was performed for each of the SF-36 domains and for the physical and mental health summary scales.
Results: The most prevalent diabetic complications were hypertension (46% of patients), peripheral sensory neuropathy (PSN; 12%), coronary artery disease (CAD; 8%), retinopathy (8%), and peripheral vascular disease (PVD; 7%). Most (73%) of the complications were assessed to be mild. PSN was associated with significantly lower scores (i.e., worse quality of life) in the mental health scale; CAD was associated with significant reductions of all but role-emotional and mental health scales of the SF-36; and PVD was associated with significantly lower physical and social functioning scales. Hypertension did not have an independent effect on HRQOL.
Conclusions: The presence of even mild diabetic complications has a significant impact on patients' quality of life. Early diagnosis and treatment is essential to help prevent deterioration of HRQOL in these patients.     

Tracking Healthy Days -- a window on the health of older adults

In collaboration with its partners in the public health and aging services communities, the Centers for Disease Control and Prevention (CDC) Health Care and Aging Studies Branch has developed and validated a brief set of health-related quality of life (CDC HRQOL) measures for tracking the perceived physical and mental health of adults over time. For the past 12 years, these measures -- also called the Healthy Days measures -- have been used in an expanding set of population health surveys, surveillance systems, performance report cards, and evaluation studies, and they have provided useful disease and disability burden data to inform decision making and provide new insights for prevention research. Although now used continuously to assess health-related quality of life for Americans aged 12 years and older, the measures and population data have been especially valuable in applications affecting older adults, for which health-related quality of life is an outcome of primary importance. The CDC HRQOL measures are recommended to public health and social service professionals as a feasible way to assess perceived physical and mental health needs of older adults and to document the effects of policies and interventions.     

Perceived and objective neighborhood environment attributes and health related quality of life among the elderly in Bogotá, Colombia

This study examines associations between neighborhood environment attributes and health related quality of life (HRQOL) and self-rated health (SRH) among older adults (60 years and over) in Bogotá, Colombia. Perceived and objective neighborhood environmental characteristics were assessed in a cross sectional multilevel design with 1966 older adults within 50 neighborhoods. Outcome variables included HRQOL (physical and mental dimensions) and SRH measured with the Spanish version of the Short Form 8 (SF-8). Independent variables included perceived and objective neighborhood characteristics as well as self-reported levels of walking. Hierarchical linear and logistic regression models were used for the analysis. Among perceived neighborhood characteristics, safety from traffic was positively associated with both HRQOL dimensions and SRH. Having safe parks was positively associated with the mental dimension of HRQOL and with SRH. Street noise was negatively associated with both HRQOL dimensions. Regarding objective neighborhood characteristics, residing in areas with more than eight percent of land covered by public parks was positively associated with SRH. Objective and perceived neighborhood characteristics could provide insight into potential interventions among older adults from rapidly urbanizing settings in Latin America.     

Health-related quality of life of HIV-infected women: evidence for the reliability,validity and responsiveness of the Medical Outcomes Study Short-Form 20

The purpose of this study was to assess the reliability, validity and responsiveness of a health-related quality of life (HRQOL) instrument, the Medical Outcomes Short-Form 20-ltem General Health Survey (MOS SF-20), in a sample of women with the human immunodeficiency virus (HIV). Longitudinal data were collected on 202 HIV-infected women without AIDS who were receiving care at Kings County Hospital or SUNY Health Sciences Center, Brooklyn, New York. Internal consistency results showed acceptable reliability for the four multi-item MOS scales (role function, physical function, general health perceptions and mental health). Symptomatic patients and patients with lower Karnofsky Performance Status (KPS) ratings reported lower HRQOL than those who were asymptomatic or who had higher KPS scores. Patients who were older, unemployed or who had a history of injection drug use (IDU) also reported lower HRQOL. than those who were younger, employed or who had no drug use history. Adjusted mean scores on the MOS role and physical functioning scales proved sensitive to differences in clinical status over time. The MOS SF-20 is a reliable and valid instrument of HRQOL for women with HIV infection. Its sensitivity to differences in clinical status over time suggest that it may be useful as an HRQOL indicator for HIV/AIDS clinical trials.     

Tracking Healthy Days — A Window on the Health of Older Adults

In collaboration with its partners in the public health and aging services communities, the Centers for Disease Control and Prevention (CDC) Health Care and Aging Studies Branch has developed and validated a brief set of health-related quality of life (CDC HRQOL) measures for tracking the perceived physical and mental health of adults over time. For the past 12 years, these measures — also called the Healthy Days measures — have been used in an expanding set of population health surveys, surveillance systems, performance report cards, and evaluation studies, and they have provided useful disease and disability burden data to inform decision making and provide new insights for prevention research.

Although now used continuously to assess health-related quality of life for Americans aged 12 years and older, the measures and population data have been especially valuable in applications affecting older adults, for which health-related quality of life is an outcome of primary importance. The CDC HRQOL measures are recommended to public health and social service professionals as a feasible way to assess perceived physical and mental health needs of older adults and to document the effects of policies and interventions.

     

Psychosocial predictors of physical activity and health-related quality of life among adults with physical disabilities: an integrative framework

BackgroundPeople with disabilities report lower physical activity (PA) and health-related quality of life (HRQOL) levels than people without disabilities. Therefore, it is important to identify factors that motivate individuals with disabilities to be physically active and thus increase their HRQOL.ObjectivesThe purpose of the study was to prospectively explore the effects of past theory of planned behavior (TPB) constructs on future (6-month) HRQOL (physical and mental health) through past stages of change (SOC) and future (6-month) PA among adults with physical disabilities. Two models were tested whereby the SOC and PA served as the mediators between the TPB constructs, physical health (PH-Model), and mental health (MH-Model). It was hypothesized that both models would fit the sample data.MethodsParticipants were 141 adults with physical disabilities (mean age = 46.04, females = 70.9%). The online survey was completed at two different time periods. First, the TPB constructs and SOC were assessed using self-report standardized questionnaires. Six months later, participants completed standardized self-report scales about their PA and HRQOL levels. Using LISREL 8, two path analyses were conducted to examine the two study models (PH-Model and MH-Model).ResultsBased on the two path analyses, attitude had the highest effect on SOC followed by perceived behavioral control within both well-fit models. The PH-Model explained more variance in PA (26%) and physical health (55%) than the MH-Model.ConclusionsHealth promoters should reinforce both positive intentions and behavioral experiences to increase PA and HRQOL among adults with physical disabilities.     

Health-related quality of life in family members of patients with an advanced cancer diagnosis: A one-year prospective study

ABSTRACT: BACKGROUND: Receiving a cancer diagnosis affects family members as well as the person diagnosed. Family members often provide support for the sick person in daily life out of duty and love, and may not always think of their own vulnerability to illness. To individualise support for them, family members who are most at risk for becoming ill must be identified. The aim of this study was to investigate health-related quality of life (HRQOL) in family members of patients with advanced lung or gastrointestinal cancer 3 to 15 months after diagnosis. METHODS: Data on mental and physical dimensions of HRQOL were collected from family members of these patients in this prospective quantitative study. Five assessments using the Short Form 36 Health Survey (SF-36) and EuroQol (EQ-5D) were conducted during a 1-year period starting 3 months after diagnosis. Thirty-six family members completed the study, i.e. participated in all five data collections. RESULTS: No statistically significant changes in physical or mental HRQOL within the study group appeared over the 1-year follow-up. Compared with norm-based scores, family members had significantly poorer mental HRQOL scores throughout the year as measured by the SF-36. Family members also scored statistically significantly worse on the EQ-5D VAS in all five assessments compared to the norm-based score. Findings showed that older family members and partners were at higher risk for decreased physical HRQOL throughout the 1-year period, and younger family members were at higher risk for poorer mental HRQOL. CONCLUSIONS: It is well known that ill health is associated with poor HRQOL. By identifying family members with poor HRQOL, those at risk of ill health can be identified and supported. Future large-scale research that verifies our findings is needed before making recommendations for individualised support and creating interventions best tailored to family members at risk for illness.     

Predictors of quality of life among women with coronary heart disease

Background Health-related quality of life (HRQOL) is an increasingly relevant outcome as the population ages and associated morbidities increase. The purpose of this study was to evaluate predictors of HRQOL among ethnically diverse women hospitalized for coronary heart disease (CHD) and determine the impact of a brief, educational intervention on HRQOL 6 months post-hospitalization. Methods Women (n = 160; mean age 63 years, 53% minority) admitted for CHD at three academic hospitals who completed a 6 month secondary prevention trial were studied. The SF-36 was administered at admission and 6 months. Multiple linear regressions were used to identify significant independent predictors of 6 month HRQOL. Results Significant improvements in HRQOL were noted from admission to 6 months post-hospitalization. Subjects reporting better HRQOL at 6 months included those who were employed, married, physically active, enrolled in cardiac rehabilitation, and not depressed. Women who received an educational intervention had significantly less bodily pain at 6 months compared with usual care in a model adjusted for baseline HRQOL and physical activity goal adherence (p = 0.04). Conclusions Baseline HRQOL (8 SF-36 subscales), physical activity (3 SF-36 subscales) and marital status (1 SF-36 subscale) were the major determinants of HRQOL at 6 months post-hospitalization. Future interventions and preventive efforts should be targeted to women with CHD who have impaired HRQOL and may be at increased risk of poor clinical outcomes.     

Health-related quality of life and comorbidity among older women veterans in the United States

Purpose

This paper examines the predictors of quality of life among older women (≥65 years of age) veterans in the United States focusing on the effect of comorbidity on health-related quality of life (HRQOL).

Methods

Data from the National Survey of Women Veterans, a cross-sectional nationally representative population-based, stratified random sample of women veterans, were used with an analytic sample size of 1,379 older women veterans. The SF12 physical and mental composite scores (PCS and MCS) were used as outcome measures, and a weighted comorbidity index was used as a covariate.

Results

Older women veterans who are married, employed, with higher income, and higher education have better physical health (PCS). For mental health, education is positively correlated, whereas depression and posttraumatic stress disorder are negatively correlated with MCS. After adjusting for socio-demographic, mental health, and chronic health indicators, the results showed that SF12 PCS varied by VA use status for each level of Seattle Index of Comorbidity. The same pattern was not found for MCS.

Conclusion

For each level of comorbidity, VA users have worse HRQOL which might suggest that case mix adjustments comparing VA users and non-VA users must take into account more than comorbidity alone.     

The association between infant feeding pattern and mother’s quality of life in Taiwan

Background This study compared the health-related quality of life (HRQOL) of mothers using different infant feeding methods. Methods We used the Medical Outcomes Study 36-item Short-Form (SF-36) to measure the HRQOL of 1,747 mothers and used the scores to look for associations with infant feeding methods (not breastfeeding, breastfeeding for <1 month, breastfeeding 1–5 months, and still breastfeeding at the 6th month). The mothers were chosen via a stratified sampling from the Taiwan national birth registration data between November and December 2003. Results HRQOL and breastfeeding duration were positively associated. Of the eight unadjusted domain scores of the SF-36, general health perception and mental health were significantly different among these four different infant feeding groups (P < 0.05). After controlling for potential confounding factors, mothers who breastfed for 6 months or longer had a higher HRQOL score than the other mothers. In addition, their physical functioning, general health perception and mental health scores were higher than those of mothers who did not breastfeed (P < 0.05). Mother’s family income and parity and child’s health status were also associated with mother’s quality of life. Conclusions Compared to the other mothers, mothers who breastfed for six moths or longer had better HRQOL. However, the limitation that this study was cross-sectional in design should be considered and further studies are needed.     

Health-related quality of life following blind rehabilitation

Purpose The purpose of this study was to investigate the effect of residential blind rehabilitation on patients’ vision-targeted health-related quality of life (HRQOL) and general physical and mental function. Method The National Eye Institute 25-item Visual Function Questionnaire (NEI VFQ) plus appendix questions, the 12-item Short-Form Health Survey (SF-12), Hope Scale and Coopersmith self-esteem inventory were administered to 206 legally blind veterans prior to their entering a residential (in-patient) blind rehabilitation program and again to 185 and 176 of the original cohort at 2 and 6 months after completion of the rehabilitation program, respectively. Data on visual acuity, visual field extent, contrast sensitivity and scanning ability were also collected. The duration of the in-patient rehabilitation programs ranged from 11 to 109 days. Questionnaire scores were compared pre-rehabilitation and post-rehabilitation. Results Following rehabilitation there was a significant improvement in nine of 11 NEI VFQ subscales and in a composite score at both the 2- and 6-month post-rehabilitation intervals. Mental health (SF-12) and self esteem also improved significantly although physical health ratings declined over the course of the study (approximately 10 months). Conclusions Residential blind rehabilitation appears to improve patients’ self-reported vision-targeted HRQOL, self-esteem and mental health aspects of generic HRQOL.     

For richer, for poorer, in sickness and in health: older widowed women's health, relationships and financial security.

AIM: This study contrasts the health and social needs of widowed older women with needs of married older women. METHOD: 12,624 women aged 70-75 years across Australia completed baseline questionnaires for the Australian Longitudinal Study on Women's Health: 34.5% of the women were widowed, and 13.5% of these widowed women had lost their spouse within the past 12 months (recently widowed). RESULTS: Recently widowed women had particular physical and mental health needs as well as financial and practical needs relating to managing on their income. They had the lowest self-rated health, were most likely to report they were stressed about their health, and scored significantly lower than married women on all 8 sub-scales of the SF-36. Women were more likely to say they make their own decisions about their life if they were widowed than if they were married. However, stress with relationships with children or other family members was more likely to be reported by widows than other women.     

Rural–Urban Analyses of Health-Related Quality of Life Among People With Multiple Sclerosis

ABSTRACT:  Context: Health-related quality of life (HRQOL) is a multi-dimensional construct including aspects of life quality or function that are affected by physical health and symptoms, psychosocial factors, and psychiatric conditions. HRQOL gives a broader measure of the burden of disease than physical impairment or disability levels. Purpose: To identify factors associated with HRQOL among people with multiple sclerosis (MS) utilizing the SF-8 Health Survey. Methods: Data presented in this study were collected in a survey of 1,518 people with MS living in all 50 states. The survey sample was randomly selected from the database of the National Multiple Sclerosis Society, using ZIP codes to recruit the survey sample. A multiple linear regression model was employed to analyze the survey data, with the Physical Component Summary and the Mental Component Summary of the SF-8 the dependent variables. Independent variables were demographic characteristics, MS-disease characteristics, and health services utilized. Findings: People with MS in rural areas tended to report lower physically related HRQOL. Worsening MS symptoms were associated with reduced physical and mental dimensions of HRQOL. In addition, people with MS who received a diagnosis of depression tended to have reduced physical and mental dimensions of HRQOL. Receiving MS care at an MS clinic was associated with better physically related HRQOL, while having a neurologist as principal care physician was associated with better mental-related HRQOL. Conclusion: The challenge is to increase the access that people living with MS in rural areas have to MS-focused specialty care.     

Social support and health-related quality of life among older adults--Missouri, 2000

Overall health can be influenced by multiple factors, including a person's psychological, behavioral, and social well-being. Studies have demonstrated an association between increased levels of social support and reduced risk for physical disease, mental illness, and mortality. Social support includes real or perceived resources provided by others that enable a person to feel cared for, valued, and part of a network of communication and mutual obligation. Social support can be critical for those older adults who rely on family, friends, or organizations to assist them with daily activities, provide companionship, and care for their well-being. The 1965 Older Americans Act recognized the need for social support by requiring that agencies on aging provide in-home services and group meals to foster social interactions. To examine how social support is related to health-related quality of life (HRQOL), CDC analyzed data from the 2000 Missouri Older Adults Needs Assessment Survey (MOANAS) of adults aged > or =60 years. This report describes the results of that analysis, which indicated that visits with friends or relatives, having close friends for emotional support, and the perception of help being available if sick or disabled were associated with better HRQOL and particularly with better mental health among older adults. Implementing effective prevention programs for older adults and encouraging interventions by agencies on aging can help improve HRQOL among older adults who have little social support.     

Health-related quality of life among adults 65 years and older in the United States, 2011–2012: a multilevel small area estimation approach

PurposeThe purpose of this study was to develop county-level estimates of poor health-related quality of life (HRQOL) among aged 65 years and older U.S. adults and to identify spatial clusters of poor HRQOL using a multilevel, poststratification approach.MethodsMultilevel, random-intercept models were fit to HRQOL data (two domains: physical health and mental health) from the 2011–2012 Behavioral Risk Factor Surveillance System. Using a poststratification, small area estimation approach, we generated county-level probabilities of having poor HRQOL for each domain in U.S. adults aged 65 and older, and validated our model-based estimates against state and county direct estimates.ResultsCounty-level estimates of poor HRQOL in the United States ranged from 18.07% to 44.81% for physical health and 14.77% to 37.86% for mental health. Correlations between model-based and direct estimates were higher for physical than mental HRQOL. Counties located in the Arkansas, Kentucky, and Mississippi exhibited the worst physical HRQOL scores, but this pattern did not hold for mental HRQOL, which had the highest probability of mentally unhealthy days in Illinois, Indiana, and Vermont.ConclusionsSubstantial geographic variation in physical and mental HRQOL scores exists among older U.S. adults. State and local policy makers should consider these local conditions in targeting interventions and policies to counties with high levels of poor HRQOL scores.