Health Related Quality of Life in Patients with Cirrhosis

HRQOL is a multidimensional concept that usually includes self-report of the way in which physical, emotional, social, or other domains of well-being are affected by a disease or its treatment. The concept of HRQOL is a direct descendent of the World Health Organization definition of health in that HRQOL is thought to encompass multiple domains: (1) biological functioning, (2) psychological functioning, and (3) social functioning. Cirrhosis of the liver has a considerable negative impact on HRQOL. This paper describes the instruments that can be used to measure HRQOL in patients with cirrhosis, factors associated with poor HRQOL, and interventions that may result in improvement in HRQOL for patients with cirrhosis.     

Health Related Quality of Life in Diabetic Patients Measured by the Nottingham Health Profile

The aim of the present study was to assess the health related quality of life of adult diabetic patients using the Nottingham Health Profile (NHP) as a measure. A further aim was to describe different Quality of Life (QOL) outcomes in different treatment groups of diabetes. The target population consisted of all registered adult (18 years or older) diabetic patients (n = 2519) in the district of Oulu, a city of 100000 inhabitants in Northern Finland. All these persons were invited to participate in a screening examination for diabetic retinopathy, and the NHP questionnaire was mailed along with this invitation. A total of 1804 patients (72 %) returned the NHP questionnaire when they came to the fundus photography session. The data were analysed by using mean values of NHP dimensions with the 95 % confidence intervals (CI) and the logistic regression analysis to predict the risk (OR) for having at least one health problem in a particular dimension. The results indicated that patients with tablet treatment had significantly lower QOL levels than the ‘general population’ in all NHP dimensions. The diet treatment group patients had lower QOL levels than the ‘general population’ only in the ‘Sleep’ and ‘Social isolation’ dimensions. The diet group had a significantly better QOL level in all six dimensions of QOL of NHP than the tablet treatment or combined treatment (patients treated with tablets and insulin) groups. The tablet treatment and combined treatment groups did not differ significantly in any of the NHP dimensions. The logistic models testing the presence of at least one problem in the NHP dimensions showed that the number of other diseases increased the risk of having QOL problems in all dimensions and duration of the diabetes and the age of the patient had risk increasing effects in four NHP dimensions while the gender had only a small effect on the QOL in diabetic patients. The study shows that the NHP questionnaire as a general measure of the QOL reveals differences in the QOL between the different treatment groups and between diabetic patients and general population.     

Food Security Status is Related to Mental Health Quality of Life Among Persons Living with HIV

This study evaluated the association between health related quality of life and food security among persons living with HIV (PLHIV). We studied 167 PLHIV who completed questionnaires assessing food security, disease symptomatology, and several domains of the SF-36 health related quality of life survey. HIV disease state was assessed from medical records. Associations between independent and outcome variables were determined through linear regression models. Compared to food security, very low food security was significantly associated with lower mental component summary scores, [average difference ?4.98 (95 % CI ?9.85, ?0.10)]; mental health, [average difference ?5.44 (95 % CI ?10.08, ?0.81)]; and general health, [average difference ?5.13 (95 % CI ?9.65, ?0.65)] after adjusting for covariates. About a fourth of participants experienced severe food insecurity, which negatively influenced their mental health and general wellbeing. The inclusion of resources for food assistance in HIV treatment programs may help ameliorate mental health challenges faced by PLHIV.     

Usage of Supplemental Alternative Medicine by Community-Based Patients with Gastroesophageal Reflux Disease (GERD)

There is an increasing trend towards alternative medicine usage by the general US population. However, the extent and type of supplemental alternative medicine used specifically by community-based patients with GERD is unknown. A previously validated questionnaire that included questions about patient demographics, 18 types of alternative medicine, and attitudes towards alternative and conventional medicine was utilized. Consecutive patients seen by community-based physicians in Arizona (Tucson, Phoenix, and Flagstaff) and Wisconsin (Milwaukee) for GERD received the questionnaire during the years 1999 and 2000. Patients completed the questionnaire and returned it to the Tucson VA Medical Center by mail. A total of 185 patients were surveyed (82 men, mean age 55.8 years). Of those, 61.6% used alternative medicine for any reason. However, only 3.8% of patients used supplemental alternative medicine for GERD. Females were twice as likely (95% CI, 1.10–3.67) to use alternative medicines for any reason (including GERD). Patients with daily acid regurgitation were 5.75 times (95% CI, 1.03–32.17) more likely than patients with less frequent acid regurgitation to use alternative medicines specifically for GERD. None of the other demographics, health characteristics, or attitudes were predictive of supplemental alternative medicine use for any reason (or specifically for GERD). In conclusion, only a small percentage of GERD patients seen by community-based practitioners use supplemental alternative medicine specifically for GERD symptoms, despite a higher usage of supplemental alternative medicine for non-GERD-related illness. Being female and having acid regurgitation daily were positively associated with alternative medicine usage for GERD.     

Factors Associated with Quality of Life Among Rural Women with HIV Disease

This cross-sectional study examined physical, psychological, and social factors associated with quality of life (QOL) among a sample of 399 rural women with HIV disease living in the Southeastern United States. Of the socio-demographic variables, age (p = .003), race (p < .0001), and time of HIV diagnosis (p = .03) were significantly associated with QOL. In bi-variate analysis, HIV symptoms (frequency and extent symptoms were bothersome), perceived stigma, internalized stigma, and depression were significantly and negatively associated with QOL whereas social support, problem-focused coping, perceived situational control, and healthy lifestyles were significantly and positively associated with QOL (all p < .0001). In adjusted analysis, HIV symptom frequency, depression, problem-focused coping, perceived situational control, perceived stigma, healthy lifestyles, and race remained significant predictors of QOL and explained 55% of the variance in QOL among the study participants (model F _{7, 390} = 66.7; p < .0001). The study findings identify potential points of interventions to improve QOL among rural women with HIV disease.     

Successful Cognitive Aging and Health-Related Quality of Life in Younger and Older Adults Infected with HIV

Neurocognitive impairments commonly occur and adversely impact everyday functioning in older adults infected with HIV, but little is known about successful cognitive aging (SCA) and its health-related quality of life (HRQoL) correlates. Seventy younger (≤40 years) and 107 older (≥50 years) HIV+ adults, as well as age-matched seronegative comparison groups of younger (N = 48) and older (N = 77) subjects completed a comprehensive battery of neuropsychological, psychiatric, medical, and HRQoL assessments. SCA was operationalized as the absence of both performance-based neurocognitive deficits and self-reported symptoms (SCA-ANDS) as determined by published normative standards. A stair-step decline in SCA-ANDS was observed in accordance with increasing age and HIV serostatus, with the lowest rates of SCA-ANDS found in the older HIV+ group (19 %). In both younger and older HIV+ adults, SCA-ANDS was strongly related to better mental HRQoL. HIV infection has additive adverse effects on SCA, which may play a unique role in mental well-being among HIV-infected persons across the lifespan.     

Health-Related Quality of Life in Patients with Crohn's Disease (Influence of Surgical Operation-A Prospective Trial)

Improvement of health-related quality of life(HRQOL) is a major determinant in decisionmaking forsurgery in patients with Crohn's disease (CD). Thisstudy was designed to investigate the short- andlong-term effect of surgical resection for CD on HRQOL.Sixteen patients were investigated within one weekbefore surgery and 3, 6, and 24 months postoperatively.Besides the Crohn's disease activity index (CDAI), four instruments: the time trade-off technique(TTO), the direct questioning of objectives (DQO), therating form of inflammatory bowel disease patientsconcerns (RFIPC), and the Beck depression inventory-were used for assessment of HRQOL. CDAI decreasedsignificantly after operation and 10 patients remainedin remission for 24 months. Two patients hadpostoperative relapses and went into remission afterprednisolone treatment. Four patients developed chronicactive disease. HRQOL was significantly improved in allpatients three and six months postoperatively. Exceptfor the four patients with chronic active disease, all other patients (N = 12) had alsosignificantly improved HRQOL after 24 months. Inconclusion, surgical resections in CD lead to along-term improvement of HRQOL with the exception ofpatients with chronic active disease. This finding might be taken inconsideration for the indication of surgery inCD.     

Health Related Quality of Life in Iranian Hemodialysis Patients With Viral Hepatitis: Changing Epidemiology

Background

There are surprisingly a few studies that evaluate the impact of chronic viral hepatitis, which is common in HD (hemodialysis) patients, on HRQOL (health related quality of life).

Objectives

We conducted a study to evaluate the impact of chronic viral hepatitis on HRQOL and to compare their HRQOL with non-infected HD patients via a HRQOL questionnaire.

Patients and Methods

The Iranian adapted version of the Kidney Disease Quality of Life Short Form (KDQOL-SF) version 1.3 questionnaires were filled out by the HD patients. In all HD patients, serum HBsAg, HBS Abs, and HCV Abs [enzyme-linked immunosorbant assay (ELISA)] were routinely checked every six months. Patients were considered to have chronic HBV infection if HBsAg was positive for more than six months. In all HD patients, third generation assay was used to detect HCV infection. Furthermore, serum HCV-RNA (PCR) was examined in anti-HCV-positive patients for confirmation of HCV infection.

Results

in this cross sectional study 4101 patients from 103 dialysis units in Iran between October 2010 and August 2011 were included. Prevalence of hepatitis B and hepatitis C infection was 2.1% and 1.3% respectively. Almost all KDQOL items for viral hepatitis patients had equivalent or better scores than those without viral hepatitis. In the logistic regression after adjustment for age, sex, educational level, marital status, dialysis vintage, HBs Ag positivity and HCV Ab positivity, only age (P < 0.001) and educational level (P = 0.015) had negative impact on quality of life.

Conclusions

Our data show that not only general health and physical activity were preserved but also health perception may be better among HD patients with viral hepatitis.     

Illness Perceptions and Quality of Life in Patients with Chronic Obstructive Pulmonary Disease

This study aimed at identifying cognitive and emotional representations relevant for improving health care communication and quality of life (QoL) in patients with chronic obstructive pulmonary disease (COPD). One-hundred-seventy-one COPD outpatients completed questionnaires on illness perceptions and QoL. After controlling for the effects of age, pulmonary function, and dyspnea, patients with decreased attention to symptoms, with more positive beliefs about the effects and outcomes of their illness, and with less strong emotional reactions to the illness, had higher QoL scores. The results of this study are discussed in relation to the associations found in other illnesses.     

Suicidal Ideation Among Psychiatric Patients with HIV: Psychiatric Morbidity and Quality of Life

This study explored suicidality among 190 (68% male) participants in an HIV mental health clinic. Twenty-six percent had suicidal thoughts within 30 days of admission, 49% had a plan, and 48% expressed intent stating there was moderate or high likelihood they would take action. The most prevalent diagnoses among those with suicidal ideation were major depression (64%), drug dependence (52%), and depressive personality disorder (50%). In regression analyses, individuals with major depression, dysthymia, substance abuse, thought disorder, posttraumatic stress disorder, and borderline and avoidant personality disorders were at increased risk for suicidality whereas those with narcissistic personality disorder were at decreased risk. In addition, six of seven quality-of-life variables were associated with suicidal ideation, with the strongest correlations found for leisure/social (r = .36) and family/friends (r = .33). At-risk individuals, especially those with dual disorders, unstable interpersonal relations, and a restricted social environment, should be carefully screened for suicidality.     

Association of Integrated Mental Health Services with Physical Health Quality Among VA Primary Care Patients

BackgroundIntegrated care for comorbid depression and chronic medical disease improved physical and mental health outcomes in randomized controlled trials. The Veterans Health Administration (VA) implemented Primary Care–Mental Health Integration (PC-MHI) across all primary care clinics nationally to increase access to mental/behavioral health treatment, alongside physical health management.ObjectiveTo examine whether widespread, pragmatic PC-MHI implementation was associated with improved care quality for chronic medical diseases.Design, Setting, and ParticipantsThis retrospective cohort study included 828,050 primary care patients with at least one quality metric among 396 VA clinics providing PC-MHI services between October 2013 and September 2016.Main Measure(s)For outcome measures, chart abstractors rated whether diabetes and cardiovascular quality metrics were met for patients at each clinic as part of VA’s established quality reporting program. The explanatory variable was the proportion of primary care patients seen by integrated mental health specialists in each clinic annually. Multilevel logistic regression models examined associations between clinic PC-MHI proportion and patient-level quality metrics, adjusting for regional, patient, and time-level effects and clinic and patient characteristics.Key ResultsMedian proportion of patients seen in PC-MHI per clinic was 6.4% (IQR=4.7–8.7%). Nineteen percent of patients with diabetes had poor glycemic control (hemoglobin A1c >9%). Five percent had severely elevated blood pressure (>160/100 mmHg). Each two-fold increase in clinic PC-MHI proportion was associated with 2% lower adjusted odds of poor glycemic control (95% CI=0.96–0.99; p=0.046) in diabetes. While there was no association with quality for patients diagnosed with hypertension, patients without diagnosed hypertension had 5% (CI=0.92–0.99; p=0.046) lower adjusted odds of having elevated blood pressures.Conclusions and RelevancePrimary care clinics where integrated mental health care reached a greater proportion of patients achieved modest albeit statistically significant gains in key chronic care quality metrics, providing optimism about the expected effects of large-scale PC-MHI implementation on physical health.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-021-07287-2.KEY WORDS: Health services, Mental health, Diabetes, Hypertension, Veterans     

Opioid Use is Associated with Decreased Quality of Life in Patients with Crohn's Disease

Background/Aims:

Quality of life is an important consideration in the management of patients with Crohn''s disease. Previous studies suggest that Crohn''s disease patients using opioids may have decreased quality of life and increased risk of mortality. Our aim was to determine the association between health-related quality of life (HRQoL) and opioid use in patients with Crohn''s disease while controlling for disease severity.

Patients and Methods:

We conducted a cross-sectional study recruiting Crohn''s disease patients at our center. Disease activity was measured using the Harvey-Bradshaw Index (HBI), and HRQoL was measured using the Inflammatory Bowel Disease Questionnaire (IBDQ).

Results:

We enrolled 38 Crohn''s disease patients using opioids and 62 patients not using opioids. Patients using opioids had an increased duration of disease (median 18.5 vs. 9 years, P = 0.005), increased surgeries related to Crohn''s disease (median 3 vs. 0, P < 0.001), and increased prednisone use (29% vs. 11.3%, P = 0.03). Patients using opioids had increased disease activity (median HBI score 9.0 vs. 3.0, P < 0.001). Quality of life was lower in patients using opioids (mean IBDQ score 109.3 vs. 162.9, P < 0.001). This finding was significant when controlling for HBI scores, number of previous surgeries, and prednisone use (P = 0.003).

Conclusions:

Opioid use in Crohn''s disease patients appears to be associated with disease activity and severity. HRQoL is markedly decreased in patients using opioids and this association is significant even when controlling for variables reflecting disease severity. Our findings suggest that Crohn''s disease patients using opioids are likely to be significantly impacted by their disease.     

Association of Medication Adherence with Workplace Productivity and Health-Related Quality of Life in Patients with Asthma

Objective. Examine the association of medication adherence with workplace productivity and health-related quality of life (HRQL) in asthma patients. Methods. Adult patients with asthma in a state health insurance program identified from medical claims (July 2001-June 2003) were mailed a three-part survey to measure HRQL (St. George's Respiratory Questionnaire), workplace productivity (Workplace Productivity Short Inventory), and self-reported medication adherence (Morisky Scale). Results. The symptoms domain had the worst HRQL scores, followed by the activity and impacts domains; 39% of the participants reported themselves as “high” adherent, whereas 19% were “medium,” and 42% were “low” adherent. Asthma resulted in productivity losses of $597 ± $1,024 (absenteeism) and $658 ± $1,808 (presenteeism) per enrollee per year. Conclusions. Asthma was associated with HRQL detriments and workplace productivity losses.     

健康干预对社区2型糖尿病患者生活质量的影响

目的探讨健康干预对社区2型糖尿病患者生活质量的影响。方法采用调查问卷方式对社区健康服务中心182例糖尿病患者糖尿病知识、自我护理能力、糖尿病代谢各种自控指标、生活满意度进行健康管理前后的评估,同时根据评估情况进行个性化健康管理。结果健康干预前后患者的自我护理能力,糖尿病知识知晓率及总评分,糖尿病代谢自控指标、生活满意度均有明显提高(P0.01)。结论健康干预的实施能有效改善被管理人员的整体健康状况和生活质量。     

健康管理干预对社区2型糖尿病患者生活质量的效果评价

目的探讨健康管理干预对社区2型糖尿病患者生活质量的影响。方法采用调查问卷方式对21家社区健康服务中心182例糖尿病患者的糖尿病知识、自我护理能力、糖尿病代谢各种自控指标、生活满意度进行健康管理前后的评估,同时根据评估情况进行个性化健康管理。结果干预前后182例糖尿病患者糖尿病基本知识、并发症预防知识及检查治疗知识、空腹血糖、餐后2h血糖、末梢血血糖间差异均有统计学意义（P〈0．01）。干预前、后患者定期监测血糖、足部自我检查率间差异均有统计学意义（P〈0．01）。干预前后患者体力健康、精神健康、总体功能及总分、生活满意度差异均有统计学意义（P〈0．01）。结论健康管理的实施能有效改善2型糖尿病患者的整体健康状况和生活质量。     

Association of Medication Adherence with Workplace Productivity and Health-Related Quality of Life in Patients with Asthma

Objective. Examine the association of medication adherence with workplace productivity and health-related quality of life (HRQL) in asthma patients. Methods. Adult patients with asthma in a state health insurance program identified from medical claims (July 2001–June 2003) were mailed a three-part survey to measure HRQL (St. George's Respiratory Questionnaire), workplace productivity (Workplace Productivity Short Inventory), and self-reported medication adherence (Morisky Scale). Results. The symptoms domain had the worst HRQL scores, followed by the activity and impacts domains; 39% of the participants reported themselves as “high” adherent, whereas 19% were “medium,” and 42% were “low” adherent. Asthma resulted in productivity losses of $597 ± $1,024 (absenteeism) and $658 ± $1,808 (presenteeism) per enrollee per year. Conclusions. Asthma was associated with HRQL detriments and workplace productivity losses.