Predictors of health-related quality of life changes after lifestyle intervention in persons at risk of type 2 diabetes mellitus

Purpose

To assess health-related quality of life (HRQOL) of subjects at risk of type 2 diabetes undergoing lifestyle intervention, and predictors for improved HRQOL.

Methods

The Finnish Diabetes Risk Score was used by general practitioners to identify individuals at risk. Low-intensity interventions with an 18-month follow-up were employed. HRQOL was assessed using the SF-36 at baseline and compared with results from a general Norwegian population survey and further at 6 and 18 months. Simple and multiple linear regression analyses were applied to identify predictors of changes in HRQOL of clinical importance.

Results

Two hundred and thirteen participants (50 % women; mean age: 46 years, mean body mass index: 37) were included: 182 returned for 18-month follow-up, of whom 172 completed the HRQOL questionnaire. HRQOL was reduced with clinical significance compared with general Norwegians. The mean changes in HRQOL from the baseline to the follow-up were not of clinical importance. However, one out of three individuals achieved a moderate or large clinical improvement in HRQOL. The best determinant for improved HRQOL was obtained for a composite, clinically significant lifestyle change, i.e. both a weight reduction of at least 5 % and an improvement in exercise capacity of at least 10 %, which was associated with an improvement in five out of the eight SF-36 domains.

Conclusion

Subjects at risk of type 2 diabetes report a clinically important reduction in HRQOL compared with general Norwegians. The best predictor of improved HRQOL was a small weight loss combined with a small improvement in aerobic capacity.     

Polycyclic Aromatic Hydrocarbons Degrading Microflora in a Tropical Oil-Production Well

The surrounding environment near Dagang oil-production well suffers polycyclic aromatic hydrocarbons (PAHs) pollution. In the present study, indigenous microorganisms capable of degrading PAHs were isolated and the efficiency of PAHs removal was investigated. Seven PAH-degrading strains were isolated with the ability to grow on naphthalene, phenanthrene, pyrene and fluorene. They belonged to the genus Pseudomonas, Bacillus and Rhodococcus. The strain having the highest degrading capacity for each PAH was selected by the screening test. The removal efficiency of PAHs was found to be in the order of naphthalene > fluorene > phenanthrene > pyrene. The kinetics of PAHs degradation was then followed by liquid chromatography determination and the results showed it conforms to a first-order reaction kinetic model. This study would be highly important for investigating the ability of microorganisms to utilize PAHs as growth substrates.     

Vitamin D and health-related quality of life in a community sample of older Canadians

Purpose

To assess how vitamin D status is associated with health-related quality of life (HRQOL) among older residents of Canada.

Design

We analysed baseline data of 1,493 Canadians aged 50 years and over in Alberta on HRQOL (EQ-5D-5L) and serum 25-hydroxyvitamin D (25(OH)D) as a measure of vitamin D status. We applied multivariable regression methods to examine the association between vitamin D status and each of the five dimensions and the summary index of the EQ-5D-5L.

Results

Participants with higher serum 25(OH)D levels were significantly less likely to report problems with mobility, usual activities, and depression and anxiety. Specifically, age- and gender-adjusted odds ratios for reporting problems with mobility, usual activities, and depression and anxiety were 0.58 (95 % confidence interval 0.44–0.78), 0.67 (0.50–0.89), and 0.67 (0.51–0.88) per 100 nmol/L increase in 25(OH)D, respectively. No significant associations were observed for problems with self-care and with pain and discomfort. HRQOL scores combining the responses of each of the five dimensions increased significantly with increasing serum 25(OH)D levels.

Conclusions

This is the first study to reveal the importance of vitamin D for the five dimensions of HRQOL in a community-based sample. The observed associations of vitamin D and HRQOL call for intervention studies to strengthen the evidence of the potential benefits of vitamin D supplementation for HRQOL among older adults.     

Urinary 1-hydroxypyrene as a comprehensive carcinogenic biomarker of exposure to polycyclic aromatic hydrocarbons: a cross-sectional study of coke oven workers in China

Purpose

Polycyclic aromatic hydrocarbons (PAHs) are multiple compounds that include many carcinogens. We conducted a cross-sectional study in steel plant workers in Anshan, China, to identify biomarkers that reflect the carcinogenicity of PAHs.

Methods

Subjects were 57 workers and 20 controls. Level of personal exposure to PAHs was measured using GC–MS. In accordance with the assessment methods defined by the United States Environmental Protection Agency (US EPA), 15 PAHs were selected for the analysis. For the measurement of urinary metabolites, urine samples were treated with β-glucuronidase and analyzed using HPLC with a fluorescence detector.

Results

The mean range of personal exposure to 15 PAHs (total PAHs) was 178.85, 47.08–1,329.45 (geometric mean, 5th and 95th percentile) μg/m³. Ten known urinary metabolites (1-hydroxynaphthalene, 2-hydroxynaphthalene, 2-hydroxyfluorene, 1-hydroxyphenanthrene, 3-hydroxyphenanthrene, 9-hydroxyphenanthrene, 1-hydroxypyrene, 3-hydroxybenz[a]anthracene, 6-hydroxychrysene, and 3-hydroxybenzo[a]pyrene) and four unknown peaks were detected. The highest correlation was between total PAHs and urinary 2-hydroxynaphthalene (Spearman r = 0.716, P < 0.01). Among the detected urinary metabolites, 2-hydroxyfluorene, 1-hydroxyphenanthrene, 3-hydroxyphenanthrene, and 1-hydroxypyrene were found to correlate significantly with the “Σ carcinogenic potency of PAHs” (sum of seven carcinogenic PAHs calculated from the levels of personal PAHs and relative potency factors), and with the greatest correlation found for 1-hydroxypyrene (Spearman r = 0.630, P < 0.01).

Conclusions

The analysis of personal exposure to 15 PAHs and 10 urinary metabolites, and calculation of Σ carcinogenic potency, indicated that urinary 1-hydroxypyrene was the most comprehensive carcinogenic biomarker of exposure to PAHs.     

Effects of Ce(III) and CeO2 Nanoparticles on Soil-Denitrification Kinetics

Cerium (Ce)-based compounds, such as CeO₂ nanoparticles (NPs), have received much attention in the last several years due to their popular applications in industrial and commercial uses. Understanding the impact of CeO₂ NPs on nutrient cycles, a subchronic toxicity study of CeO₂ NPs on soil-denitrification process was performed as a function of particle size (33 and 78 nm), total Ce concentration (50–500 mg L^?1), and speciation [Ce(IV) vs. Ce(III)]. The antimicrobial effect on the soil-denitrification process was evaluated in both steady-state and zero-order kinetic models to assess particle- and chemical-species specific toxicity. It was found that soluble Ce(III) was far more toxic than Ce(IV)O₂ NPs when an equal total concentration of Ce was evaluated. Particle size-dependent toxicity, species-dependent toxicity, and concentration-dependent toxicity were all observed in this study for both the steady-state and the kinetic evaluations. Changes in physicochemical properties of Ce(IV)O₂ NPs might be important in assessing the environmental fate and toxicity of NPs in aquatic and terrestrial environments.     

Psychometric properties of quality of life and health-related quality of life assessments in people with multiple sclerosis

Purpose

There is substantial interest in testing interventions for improving quality of life (QOL) and health-related quality of life (HRQOL) in people with multiple sclerosis (MS). Yet, there is limited research on the psychometric properties of QOL [e.g., Satisfaction with Life Scale (SWLS), Leeds MS Quality of Life Scale (LMSQOL)] and HRQOL [e.g., Short Form 12 Health Survey (SF-12) and Multiple Sclerosis Impact Scale-29 (MSIS-29)] measures in this population. Such research is important for designing and interpreting interventions. We examined the test–retest reliability, measurement error, and interpretability of QOL (i.e., SWLS and LMSQOL) and HRQOL (i.e., SF-12 and MSIS-29) measures over 6 months in people with MS.

Methods

Individuals with MS (n = 274) completed the SWLS, LMSQOL, SF-12 and MSIS-29 on two occasions, 6 months apart. We estimated test–retest reliability [intraclass correlation coefficient (ICC)], measurement error [standard error of measurement (SEM) and coefficient of variation] and interpretability [smallest detectable change (SDC)].

Results

Intraclass correlation coefficient values ranged between moderate and good (ICC range = 0.669–0.883); the MSIS-29 physical component had the best reliability, and the SF-12 mental component had the worst reliability. Measurement error, based on percent SEM, varied among measures; the physical and mental components of the SF-12 (%SEM = 4.6 and 5.3, respectively) had the best measurement error, and the MSIS-29 mental component (%SEM = 13.2) and the SWLS (%SEM = 12.7) had the worst measurement error. Interpretability, based on percent SDC, varied among measures; interpretability was best for the physical and mental components of the SF-12 (%SDC = 12.7 and 14.7, respectively) and worst for the MSIS-29 mental component (%SDC = 36.7) and the SWLS (%SDC = 35).

Conclusion

We provide novel data for helping researchers and clinicians select and interpret QOL and HRQOL measures and scores for interventions among people with MS. Such information will better inform our understanding of intervention effectiveness.     

Investigation of effect of reconstruction filters on cone-beam computed tomography image quality

Cone-beam CT (CBCT) using kV imagers integrated with linear accelerators is now widely used in verifying patient position during radiation therapy. Current CBCT acquisition protocols have lowered tube current to keep the imaging dose to a minimum. This affects the usability of CBCT data sets in treatment planning by reducing the soft tissue contrast and accuracy of CT numbers (Hounsfield values). The purpose of this study is to investigate the effect of reconstruction filters on full-fan and half-fan acquisition modes of CBCT and assess the image quality parameters of contrast- to -noise ratio, spatial resolution, pixel stability and uniformity. The results of this study show the relation between the noise and resolution of a CBCT image by using different reconstruction filters and provide possible estimations of the impact of filters on image quality and subsequent optimization for image-guided radiotherapy purposes.     

Using Rasch analysis to examine the distress thermometer’s cut-off scores among a mixed group of patients with cancer

Purpose

The distress thermometer (DT) is commonly used in cancer care to improve detection of distress. The DT’s recommended cut-off score of 4 or 5 has typically been established using the Hospital Anxiety and Depression Scale (HADS) by receiver operating characteristic curve analysis. The present analysis complements these studies by critically examining the use of the HADS to identify the DT’s cut-off score and corroborating the DT’s cut-off scores using item response theory (Rasch analysis).

Methods

The DT and HADS were completed by 340 patients with cancer. Rasch dimensionality analysis was performed on the HADS-Total, and test characteristic curves were examined to equate the DT and the HADS subscales. Identified DT cut-off scores were then examined for their sensitivity and specificity.

Results

Rasch analysis did not support the unidimensionality of HADS-Total. The test characteristic curves indicated that a cut-off score of ≥8 on the HADS-Anxiety and HADS-Depression subscales was equivalent to a score of 6 and 7 on the DT, respectively. However, a DT cut-off score of 5 resulted in the best balance between sensitivity and specificity across the HADS-Anxiety and HADS-Depression subscales.

Conclusions

Despite being a popular practice, the present findings did not support combining the HADS-Anxiety and HADS-Depression subscales to identify the DT’s cut-off score. Furthermore, these results inform the use of the DT as a preliminary screening tool and suggest that when a single screen is used, a DT cut-off score of 6 or 7 might be more appropriate than the typical cut-off score of 4.     

Patient’s response to a simple question on recovery after hemodialysis session strongly associated with scores of comprehensive tools for quality of life and depression symptoms

Purpose

Many maintenance hemodialysis patients do not feel well after the hemodialysis session and need a time to recover. The main objective of the study was to investigate whether a simple question about the need of some time to recover from hemodialysis was associated with scores of comprehensive tools of depression symptoms and health-related quality of life (HRQOL).

Methods

Cross-sectional evaluation of 800 Brazilian patients enrolled in the Prospective Study of the Prognosis of Chronic Hemodialysis Patients (PROHEMO). The KDQOL-SF was used for HRQOL and the 20-item CES-D and BDI for depression symptoms. Linear and logistic models were used for multivariable adjustments.

Results

Patients who reported some time to recover (30 %) had significantly (P < 0.001) higher depression symptoms scores (mean difference = 4.75 for CES-D and 4.48 for BDI). HRQOL scores were, in general, lower for patients who referred a time to recover, with mean differences larger than 4.0 (P < 0.05) both for physical and mental components. Strong associations of needing a time to recover and lower scores of several kidney disease-targeted HRQOL components were also observed. Differences in depression symptoms and HRQOL were largely reduced after adjustments for symptoms (muscle pain/cramps, faintness, fatigue, nausea/vomiting).

Conclusions

The results support the validity of a simple question on post-hemodialysis recovery as a proxy for scores of complex instruments for depression symptoms and HRQOL. The results suggest that the poorer HRQOL and higher depression probability in patients who need a time to recover from hemodialysis could be partially explained by the presence of hemodialysis-related symptoms.     

Distribution of polycyclic aromatic hydrocarbons concentrations simultaneously obtained in gas,rainwater and particles

This study reported the distribution of polycyclic aromatic hydrocarbons (PAHs) concentrations simultaneously obtained in gas/rain/particle in rain event from 2010 to 2012 in Osaka, Japan. A sampling method for rain and the materials of a rain collector were also surveyed. Benzene and a glass bottle were used to prevent the decrease of PAHs in rainwater. The average concentration of Σ9PAHs in rainwater ranged between 17.49 and 646.52 ng dm^?3. The mean ratio of these Σ9PAHs in gas versus particles was 77.9 and 68.3 % during rain and no rain, respectively. During rain, the PAHs in particles were scavenged by rain and were incorporated via washout by collision with each other. Therefore, the ratio of PAHs in rainwater was similar to that in particles. The low molecular weight LMW-PAHs from gas were recognized as being dissolved in rain but did not affect the ratio of PAHs in rain. Four rings PAH were dominant in gas/rain/particles. The seasonal variation of Σ9PAHs in rainwater was reported and discussed, and the PAHs levels during the winter and spring were higher compared with that of summer and autumn. Furthermore, the sampling method of PAHs in snow is also developed.     

Comparing Hospital-Based Resource Utilization and Costs for Prostate Cancer Patients With and Without Bone Metastases

Background

Since 2010, several new treatments for prostate cancer (PCa), which have entered the US market, are poised to have an impact on treatment approaches; however, there is a paucity of evidence with respect to treatment patterns and costs. As new treatment patterns emerge, it will be imperative to understand treatment patterns and costs of care prior to the advent of novel treatments.

Objective

As the PCa treatment landscape is evolving, this study sought to compare the hospital-based utilization and costs in two cohorts of patients with PCa: patients with bone metastases (w/BM) and patients without bone metastases (w/oBM). Comparisons were also made for patients with inpatient versus outpatient encounters.

Methods

Patients in the Premier Perspective Database, a US hospital database, between January 2006 and December 2010, treated in an inpatient or outpatient setting for PCa (International Classification of Diseases, 9th Revision [ICD-9] diagnosis codes 185, 233.4) were included. Patients were required to be ≥40 years of age with no additional cancers. Patients were put into cohorts on the basis of the presence of bone metastases (ICD-9 code 198.5 or use of zoledronic acid or pamidronate disodium). Utilization of PCa-related treatments was compared, controlling for age, race, hospital type, payer type, bed size, and admission source and type. Differences in treatments were assessed utilizing logistic regression, while differences in costs were analyzed using gamma-distributed generalized linear models with a log-link function. All costs are reported in US$ 2010.

Results

There were 23,747 hospitalizations for men w/BM (13,716 inpatient; 10,031 outpatient) and 187,708 hospitalizations (74,435 inpatient; 113,258 outpatient) for men w/oBM. The mean length of stay for men w/BM was 4 days compared with 2 days for men w/oBM (P < 0.0001). Overall, the mean cost per encounter was US$9,728 in men with w/BM and US$7,405 in men w/oBM (P = 0.0006). For inpatient stays, the mean cost per encounter was US$14,145 for men w/BM and US$11,944 for men w/oBM. For outpatient visits, the mean cost per encounter was US$3,688 for men w/BM and US$4,422 for men w/oBM. Men w/BM received hormone therapy (44.3 %) and secondary hormone therapy (46.4 %) most often, while men w/oBM received radiation (48.8 %) and surgery (31.9 %) most often.

Conclusion

Costs and utilization of PCa-related treatments vary on the basis of the presence of metastases and treatment setting (inpatient vs. outpatient).     

Assessing the validity of single-item life satisfaction measures: results from three large samples

Purpose

The present paper assessed the validity of single-item life satisfaction measures by comparing single-item measures to the Satisfaction with Life Scale (SWLS)—a more psychometrically established measure.

Methods

Two large samples from Washington (N = 13,064) and Oregon (N = 2,277) recruited by the Behavioral Risk Factor Surveillance System and a representative German sample (N = 1,312) recruited by the Germany Socio-Economic Panel were included in the present analyses. Single-item life satisfaction measures and the SWLS were correlated with theoretically relevant variables, such as demographics, subjective health, domain satisfaction, and affect. The correlations between the two life satisfaction measures and these variables were examined to assess the construct validity of single-item life satisfaction measures.

Results

Consistent across three samples, single-item life satisfaction measures demonstrated substantial degree of criterion validity with the SWLS (zero-order r = 0.62–0.64; disattenuated r = 0.78–0.80). Patterns of statistical significance for correlations with theoretically relevant variables were the same across single-item measures and the SWLS. Single-item measures did not produce systematically different correlations compared to the SWLS (average difference = 0.001–0.005). The average absolute difference in the magnitudes of the correlations produced by single-item measures and the SWLS was very small (average absolute difference = 0.015–0.042).

Conclusions

Single-item life satisfaction measures performed very similarly compared to the multiple-item SWLS. Social scientists would get virtually identical answer to substantive questions regardless of which measure they use.     

Change and predictors of quality of life in institutionalized older adults with dementia

Purpose

This study aims to assess the change in and predictive factors of the quality of life (QoL) of institutionalized older adults with dementia over a 20-month period.

Methods

Information was used from a follow-up study conducted over an average period of 19.61 ± 1.93 months on a sample of 274 institutionalized older adults aged 60 or over, diagnosed with dementia. Two linear regression models were built to predict change in the EQ-5D index and the quality of life in Alzheimer’s disease (QOL-AD) scale, taking as independent variables: sociodemographic characteristics and measures of functional ability (Barthel Index), depression in dementia (Cornell Scale), number of chronic health problems, cognitive level (MEC, the Spanish Mini-Mental State Examination) and severity of dementia (Clinical Dementia Rating) at baseline.

Results

The majority of the participants were women (81.75 %) with an average age of 84.70 ± 6.51 years, single (78.15 %), with severe dementia and moderate functional dependence. There was a significant decrease on the EQ-5D, EQ-VAS and QOL-AD between baseline and follow-up scores. The main predictors of QoL of the institutionalized older adults with dementia were the number of chronic problems and baseline scores of the QoL measures.

Conclusions

A significant decrease in the QoL of institutionalized older adults was observed over a 20-month period. Results suggest that interventions aimed at reducing the number of chronic medical conditions may have a beneficial effect on older adults’ QoL.     

Tribal Veterans Representative (TVR) Training Program: The Effect of Community Outreach Workers on American Indian and Alaska Native Veterans Access to and Utilization of the Veterans Health Administration

American Indians and Alaska Natives serve at the highest rate of any US race or ethnic group, yet are the most underserved population of Veterans and do not take advantage of the Department of Veterans Affairs (VA) benefits and services. Barriers to seeking care include stigma, especially for mental health issues; distance to care; and lack of awareness of benefits and services they are entitled to receive. In response to this underutilization of the VA, an innovative program—the Tribal Veterans Representative (TVR) program—was developed within the VA to work with American Indians and Alaska Natives in rural and remote areas. The TVR goes through extensive training every year; is a volunteer, a Veteran and tribal community member who seeks out unenrolled Native Veterans, provides them with information on VA health care services and benefits, and assists them with enrollment paperwork. Being from the community they serve, these outreach workers are able to develop relationships and build rapport and trust with fellow Veterans. In place for over a decade in Montana, this program has enrolled a countless number of Veterans, benefiting not only the individual, but their family and the community as well. Also resulting from this program, are the implementation of Telemental Health Clinics treating Veterans with PTSD, a transportation program helping Veterans get to and from distant VA facilities, a Veteran Resource Center, and a Veteran Tribal Clinic. This program has successfully trained over 800 TVRs, expanded to other parts of the country and into remote areas of Alaska.     

Similarities and Differences in the Epidemiology of Pyloric Stenosis and SIDS

Similar temporal declines in infantile hypertrophic pyloric stenosis (IHPS) and sudden infant death syndrome (SIDS) and other common features have led to hypotheses about a shared etiology. We carried out a population-based study to highlight similarities and differences between IHPS and SIDS. We used vital statistics and hospitalization data on all live births in Washington State, USA (1987–2009). Changes in IHPS and SIDS rates over time were quantified using rate ratios with 95 % confidence intervals (CI). The duration between birth and diagnosis of IHPS or SIDS was examined as a function of gestational age at birth. Logistic regression analysis was used to identify risk factors and quantify adjusted temporal trends (2000–2008). Although both IHPS and SIDS rates declined significantly between 1987 and 2008, the patterns and magnitude of the declines (40 and 74 %, respectively) were different. IHPS and SIDS shared risk factors such as maternal smoking and single parent status but other factors showed qualitatively or and quantitatively different associations. Primiparity was a risk factor for IHPS [odds ratio (OR) 1.24, 95 % CI 1.09–1.41], and a protective factor for SIDS (OR 0.44, 95 % CI 0.36–0.55), while male sex had a stronger association with IHPS (OR 4.51, 95 % CI 3.85–5.28 vs 1.36, 95 % CI 1.13–1.64). Both IHPS and SIDS showed significant inverse associations between gestational age at birth and chronologic age at diagnosis/death. IHPS and SIDS share some epidemiologic features and risk factors but other risk factors have qualitatively or quantitatively different effects and recent temporal trends in the two diseases are dissimilar.     

Effects of Physiochemical Properties of Test Media on Nanoparticle Toxicity to Daphnia magna Straus

The physicochemical property of standard test media significantly influenced the aggregation and dissolution of Ag, CuO and ZnO nanoparticles (NPs) and the toxicity of the NPs to Daphnia magna. For all the NPs, the highest amount of metal ions was released from the ISO medium, whereas acute toxicity to D. magna was highest in the moderately hard water medium (EC₅₀ = 4.94, 980, and 1,950 μg L^?1 for Ag, CuO, and ZnO, respectively). By comparing EC₅₀ values based on the total and dissolved concentrations of NPs with those of metal salt solutions, we found that both particulate and dissolved fractions were likely responsible for the toxicity of Ag NPs, whereas the dissolved fraction mostly contributed to the toxicity of CuO and ZnO NPs.     

Assessment of Arsenic-Induced DNA Damage in Goldfish by a Polymerase Chain Reaction-Based Technique Using Random Amplified Polymorphic DNA Markers

Arsenic is a groundwater contaminant of global concern. It is a potent human carcinogen, and its marked genotoxic effects have been reported in several human and animal studies. The present work investigates the applicability of the random amplified polymorphic DNA (RAPD) assay to study the DNA-damaging effects of arsenic at low-level exposure in goldfish Carassius auratus. Four experimental groups of fish, A, B, C and D, were exposed to 0, 10, 50, and 1,000 µg L^?1 of arsenic, respectively, in aquaria water for 15 consecutive days. Genomic DNA extraction was followed by RAPD–polymerase chain reaction amplification for each fish separately. One arbitrary decamer primer (PUZ-19) of 33 primers used appeared as the most informative and was capable of exhibiting marked alterations in RAPD profiles between arsenic-exposed and unexposed (control) samples. Different sets of 11 loci were amplified in various experimental groups with four clear polymorphic bands by the primer PUZ-19. The X and XIII amplification loci, which were prominent in the unexposed group, failed to appear in the arsenic-exposed groups. In contrast, the I and XI RAPD bands appeared as new amplification loci in all of the exposed groups. Such alterations in genomic DNA, however, did not exhibit a clear dose-dependent tendency. The RAPD assay, because of its efficacy to unmask alterations in genomic DNA induced by arsenic at low exposure level of 10 µg L^?1, appears to be a sensitive and potential tool for detecting arsenic genotoxicity.     

Longitudinal changes in health-related quality of life in normal glucose tolerance,prediabetes and type 2 diabetes: results from the KORA S4/F4 cohort study

Purpose

The aim of this study was to examine how transition between normal glucose tolerance, prediabetes and diabetes over a 7 year period is associated with change in health-related quality of life (HRQL) in an elder German population-based cohort.

Methods

We used data from 1,046 participants of the KORA S4/F4 cohort study aged 55–74 years at baseline. Based on an oral glucose tolerance test, prediabetes was defined as impaired fasting glucose and/or impaired glucose tolerance. HRQL was assessed with the SF-12 questionnaire. Using linear regression, we estimated mean change in HRQL over time, depending on glucose status at baseline and follow-up, adjusted by demographic and lifestyle variables.

Results

Individuals progressing to prediabetes or diabetes experienced a greater loss in the physical component score than patients with persistent normal glucose tolerance (?2.31 and ?7.44 vs. ?1.08), but the difference was only significant for subjects converting to diabetes. Subjects with prediabetes at baseline and diabetes at follow-up had a significant loss in mental health compared to subjects with persistent prediabetes.

Conclusions

There is first evidence that worsening of glucose metabolism over time is associated with deteriorating HRQL, however, further and larger longitudinal studies are needed to confirm these findings.     

Quality of life along the diabetes continuum: a cross-sectional view of health-related quality of life and general health status in middle-aged and older Finns

Purpose

To examine the general health status and health-related quality of life (HRQOL) along the diabetes continuum of middle-aged and older Finns, and to determine the glucose metabolism stage by which the HRQOL has decreased noticeably.

Methods

The cross-sectional sample consisted of 920 persons aged 51–75 from the general population in a single municipality in a rural area of Eastern Finland. Data were adjusted for age, sex, smoking history, current alcohol consumption, employment and marital status. The HRQOL and health status were evaluated using two preference-based HRQOL instruments, 15D and SF-6D, and one health profile instrument, 36-Item Short Form Health Survey (SF-36).

Results

Individuals with impaired glucose tolerance (IGT) and type 2 diabetes had noticeably low mean SF-6D, 15D and general health status. The decrease in overall HRQOL was mainly due to a decline in the physical dimensions of HRQOL. The adjusted odds ratios (95 % CI) for having noticeably low HRQOL on SF-6D, 15D and general health dimension of SF-36 associated with IGT were 1.95 (1.18–3.25), 1.35 (0.84–2.18) and 2.00 (1.21–3.29), respectively.

Conclusions

The progression along the diabetes continuum was significantly associated with a decrease in HRQOL and health status. Furthermore, the data indicate that when a person is detected to have IGT, the HRQOL and general health status have already diminished noticeably. The prevailing evidence suggests that detection and intervention before a patient develops IGT is essential in order to minimize the loss of quality of life and quality-adjusted life years.     

Ecotoxicological Evaluation of Sewage Sludge Contaminated with Zinc Oxide Nanoparticles

The objective of this work was to evaluate the ecotoxicological qualitative risk associated with the use of sewage sludge containing Zn oxide nanoparticles (ZnO-NPs) as soil amendment. A sludge-untreated soil and two sludge-treated soils were spiked with ZnO-NPs (0–1,000 mg/kg soil). Soil ecotoxicity was assessed with Eisenia fetida (acute and sublethal end points), and the unfilterable and filterable (0.02 μm) soil leachates were tested with a battery of biomarkers using Chlorella vulgaris, Daphnia magna, and the fish cell line RTG-2 (Oncorhynchus mykiss). The production of E. fetida cocoons in sludge-treated soils was lower than that in sludge-untreated soils. The highest effect in the algal growth inhibition test was detected in sludge-untreated soil, most likely caused by the loss of organic matter in these samples. The D. magna results were always negative. Toxic effects (lysosomal cell function and production of reactive oxygen species) in RTG-2 cells were only observed in sludge-treated soils. In general, the toxicity of ZnO-NPs in sludge-treated soils was similar to that of sludge-untreated soil, and the filterable leachate fraction [Zn salt (Zn²⁺)] did not produce greater effects than the unfilterable fraction (ZnO-NPs). Thus, after the addition of ZnO-NP—enriched sewage sludge to agricultural soil, the risk of toxic effects for soil and aquatic organisms was shown to be low. These findings are important because repeated use of organic amendments such as sewage sludge may cause more and more increased concentrations of ZnO-NPs in soils over the long-term.