Bodyweight, gender, and quality of life: a population-based longitudinal study

Purpose

The objective of the paper is to describe trajectories of health-related quality of life (HRQL) associated with categories of body mass index (BMI): underweight, normal weight, overweight, obese class I, and obese classes II and III.

Methods

Data come from the longitudinal Canadian National Population Health Survey. Analyses are based on data for 3,864 men and 4,745 women who were 40+ in 1998/1999 and followed through 2006/2007. HRQL was measured with the Health Utilities Index Mark 3. Multi-level growth modeling was used.

Results

HRQL declined with age. For men, there was a large HRQL decrement for being underweight; trajectories for all other BMI categories were very similar. For women being underweight was associated with higher HRQL at younger ages but lower at older ages. Otherwise, for women, HRQL was ordered from highest to lowest: normal, overweight, obese class I, and obese classes II and III.

Conclusions

Given that excess weight is a risk factor for mortality and the development of chronic conditions, the HRQL results for men are surprising. The HRQL results for women may reflect both the importance of body image on mental health and the health effects of excess weight.     

The impact of weight loss on health-related quality-of-life: implications for cost-effectiveness analyses

Purpose

To assess the impact of weight loss on health-related quality-of-life (HRQL), to describe the factors associated with improvements in HRQL after weight loss, and to assess the relationship between obesity as assessed by body mass index (BMI) and HRQL before and after weight loss.

Methods

We studied 188 obese patients with BMI ≥ 32 kg/m² with one or more comorbidities or ≥35 kg/m². All patients had baseline and follow-up assessments of BMI and HRQL using the EuroQol (EQ-5D) and its visual analog scale (VAS) before and after 6 months of medical weight loss that employed very low-calorie diets, physical activity, and intensive behavioral counseling.

Results

At baseline, age was 50 ± 8 years (mean ± SD), BMI was 40. 0 ± 5.0 kg/m², EQ-5D-derived health utility score was 0.85 ± 0.13, and VAS-reported quality-of-life was 0.67 ± 0.18. At 6-month follow-up, BMI decreased by 7.0 ± 3.2 kg/m², EQ-5D increased by 0.06 [interquartile range (IQR) 0.06–0.17], and VAS increased by 0.14 (IQR 0.04–0.23). In multivariate analyses, improvement in EQ-5D and VAS were associated with lower baseline BMI, greater reduction in BMI at follow-up, fewer baseline comorbidities, and lower baseline HRQL. For any given BMI category, EQ-5D and VAS tended to be higher at follow-up than at baseline.

Conclusion

Measured improvements in HRQL between baseline and follow-up were greater than predicted by the reduction in BMI at follow-up. If investigators use cross-sectional data to estimate changes in HRQL as a function of BMI, they will underestimate the improvement in HRQL associated with weight loss and underestimate the cost-utility of interventions for obesity treatment.     

The longitudinal association between weight change and health-related quality of life: the KORA S4/F4 cohort study

Objectives

Despite the increasing importance of patient-centered perspectives, the impact of weight change on the health-related quality of life (HRQL) has remained unclear. This work aims to investigate this longitudinal relationship.

Methods

Data was collected from a population-based cohort study of 3,080 Germans. Anthropometrics and HRQL were assessed at baseline and after a 7-year follow-up period. Using linear regression the average change in HRQL scores was calculated among 5 mutually exclusive weight change groups. Multilevel growth modeling was conducted to differentiate between interpersonal (cross-sectional) and intrapersonal (longitudinal) associations between body mass index (BMI)/BMI change and HRQL.

Results

Heavy weight gain (≥10 % body weight) was associated with impairments in physical health among women (?2.82 points, CI: ?4.29, ?1.34) and obese men (?4.33 points, CI: ?7.62, ?1.04) and with improvements in mental health among women (+3.20 points, CI: +1.37, +5.02). Results from the multilevel models were consistent, showing negative associations between BMI change and physical health, positive associations between BMI change and mental health and a high degree of similarity between interpersonal and intrapersonal associations.

Conclusions

Weight gain leads to clinically relevant impairments in physical health. More research is needed to clarify the antipodal effects of weight change on physical and mental health components.     

Validity of self-reported BMI in older adults and an adjustment model

Study objectives

To determine reporting bias of self-reported vs. measured anthropometrics (body weight, height, body mass index, BMI), and to adjust self-reported BMI regarding the bias.

Methods

We compared self-reported with measured anthropometrics utilizing 659 control persons (age mean 68; range 37 to 80 years) from a case-control stroke study. The Bland-Altman approach examined the agreement between self-reported and measured values. A linear model was applied to correct the bias dependent on sex, age and self-reported BMI.

Results

Under-reporting of weight and over-reporting of height was found. On average, this resulted in lower self-reported BMIs by 1.0 kg/m² in men, 1.2 kg/m² in women (p?<?0.001). Bias correction of self-reported BMIs was derived from self-reported BMI (p?<?0.001), age (p?<?0.001), age-BMI interaction (p?<?0.001) and sex (p?<?0.05). Under-estimation of correct BMI resulted in the under-estimation of an overweight prevalence, with relatively low sensitivity regarding self-reported values (88 %). Our estimates should be recalibrated, if applied to other studies.

Conclusion

Self-reported anthropometric measures are systematically biased despite high correlations with measured values. A correction removes the average bias and improves accuracy.     

Interviewer BMI effects on under- and over-reporting of restrained eating: evidence from a national Dutch face-to-face survey and a postal follow-up

Objectives

To determine the effect of interviewer BMI on self-reported restrained eating in a face-to-face survey and to examine under- and over-reporting using the face-to face study and a postal follow-up.

Methods

A sample of 1,212 Dutch adults was assigned to 98 interviewers with different BMI who administered an eating questionnaire. To further evaluate misreporting a mail follow-up was conducted among 504 participants. Data were analyzed using two-level hierarchical models.

Results

Interviewer BMI had a positive effect on restrained eating. Normal weight and pre-obese interviewers obtained valid responses, underweight interviewers stimulated under-reporting whereas obese interviewers triggered over-reporting.

Conclusion

In face-to-face interviews self-reported dietary restraint is distorted by interviewer BMI. This result has implications for public health surveys, the more so given the expanding obesity epidemic.     

Relationship between obesity and serum reactive oxygen metabolites in adolescents

Objectives

Various cross-sectional studies have revealed a significant positive relationship between systemic oxidative stress and obesity-related indices such as body mass index (BMI, kg/m²). However, little is known of the role of oxidative stress during adolescence. The aim of this study was to determine the association between obesity and serum reactive oxygen metabolites (ROM) in adolescents.

Method

A total of 595 healthy junior high school students from northern Japan were enrolled in the study. Oxidative stress was evaluated by measuring serum levels of ROM. Obesity indices included BMI and percentage body fat (PBF). The analyses were stratified by sex and controlled for age and menarche. Partial correlation coefficients and analysis of covariance were also analyzed.

Results

In female students, ROM levels increased with increasing BMI and PBF. Therefore, ROM levels were significantly higher in the underweight group than in the BMI-classified overweight–obese (P < 0.001) and normal weight groups (P < 0.05). ROM levels were significantly higher in the high PBF group than in the underweight (P < 0.05) and normal groups (P < 0.001).

Conclusion

The results of this study show that, regardless of menarche, obesity indicators such as BMI and PBF are correlated with the level of oxidative stress in female adolescents.     

Self-reported rate of eating is associated with higher circulating ALT activity in middle-aged apparently healthy Japanese men

Purpose

Elevated circulating activities of alanine aminotransferase (ALT), a marker for liver injury, and the lifestyle of a higher rate of eating in healthy and preclinical subjects are associated with increased risk of obesity and diabetes. In this study, we examined the associations between self-reported rate of eating and circulating ALT activity in middle-aged apparently healthy Japanese men.

Methods

We conducted a cross-sectional study of 3,929 apparently healthy men aged 40–59 years (mean ± SD age, 49.2 ± 5.8 years; BMI, 23.5 ± 2.8 kg/m²) who participated in health checkups in Japan. We analyzed their clinical serum parameters and lifestyle factors, including self-reported rate of eating. Associations between self-reported rate of eating and liver injury markers [ALT, γ-glutamyl transpeptidase (GTP), and aspartate aminotransferase (AST)], other clinical parameters or lifestyle factors were determined using analysis of variance followed by Tukey’s test. Multivariate logistic regression analyses (MLRA) were performed with ALT activity as the dependent variable and independent variables that included self-reported rate of eating.

Results

MLRA showed that ALT activity showed trends for higher self-reported rate of eating after adjustment for age, energy intake, and smoking status. The association between ALT activity and self-reported rate of eating disappeared after adjustment for BMI.

Conclusion

The results of this study show that ALT activity is positively associated with self-reported rate of eating in middle-aged apparently healthy Japanese men.     

Impaired parent-reported health-related quality of life of underweight and obese children at elementary school entry

Purpose

Examine the health-related quality of life of 5–6-year-old underweight, overweight and obese children.

Methods

Our cross-sectional study included 3,227 parent–child dyads from the “Be active, eat right” study. Parents completed questionnaires regarding child and parental characteristics. Health-related quality of life of the child was measured using the Child Health Questionnaire Parent Form 28. Children were classified normal weight, overweight, obese, severely obese, and underweight according to the international age and gender BMI cutoff points. Bootstrap analyses were performed for general linear models corrected for potential confounding variables.

Results

Severely obese children (β, ?2.60; 95 % CI, ?4.80 to ?0.57, p < 0.01) and underweight children (β, ?1.11; 95 % CI, ?1.85 to ?0.39, p < 0.01) had lower parent-reported scores on the physical summary scale. On the physical functioning profile scale parents of overweight and severely obese children also reported statistically significant lower scores (p < 0.05 and p < 0.01, respectively).There were no significant differences regarding the psychosocial summary scale scores between the different weight categories.

Conclusion

Underweight and overweight children experience impaired health-related quality of life on the physical functioning domain. Physicians, teachers and parents should be aware of the possible negative impact on health-related quality of life in underweight and overweight 5–6-year-old children.     

Overweight and obesity prevalence and determinants in Italy: an update to 2010

Purpose

To provide updated information on trends and determinants of underweight, overweight, and obesity in Italian adults.

Methods

We considered data from 5 surveys conducted annually between 2006 and 2010, on a total of 14,135 subjects aged 18 years or more (6,834 men and 7,301 women), representative of the Italian adult population, including self-reported information on height and weight.

Results

Overall, 3.1 % of the Italian adult population was underweight (body mass index, BMI, <18.5 kg/m²; 0.8 % men, 5.3 % women), 31.8 % overweight (25≤ BMI <30 kg/m²; 39.8 % men, 24.4 % women), and 8.9 % obese (BMI ≥30 kg/m²; 8.5 % men, 9.4 % women). We observed no specific pattern of overweight/obesity across calendar years in men (multivariate prevalence ratios, PR, for 2010 vs 2006: 0.95; p for trend: 0.980) and a non-significant decreased trend in women (PR: 0.92; p for trend: 0.051). Prevalence of overweight/obesity significantly increased with age (PRs for ≥65 vs 18–24 years: 2.01 in men, 2.65 in women), decreased with education (PRs for high vs low education: 0.79 in men, 0.54 in women), and was less frequent in single than in married adults (PRs: 0.85 in men, 0.78 in women). Overweight/obesity was significantly more frequent in adults from southern versus northern Italy (PRs: 1.13 in men, 1.32 in women) and in former versus never smokers (PRs: 1.23 in men, 1.19 in women).

Conclusions

In Italy, we did not find unfavorable trends in overweight and obesity prevalence across calendar years. However, there are specific subgroups of the population with elevated prevalence of overweight and obesity, mainly adults from southern Italy and less educated ones.     

Health-related quality of life and healthcare utilization in multimorbidity: results of a cross-sectional survey

Purpose

We assessed the associations between multimorbidity and health-related quality of life (HRQL), and healthcare utilization, based on 16 common self-reported chronic conditions.

Methods

A cross-sectional questionnaire survey including the EQ-5D was conducted in a sample of the general population of adults (≥18 years) living in Alberta, Canada. Multiple linear and logistic regressions were used to assess the association between multiple chronic conditions and HRQL, hospitalization and emergency department (ED) use.

Results

A total of 4,946 respondents reported their HRQL, noting problems mostly with pain or discomfort (48.0 %). All chronic conditions were associated with a clinically important reduction in HRQL, the highest burden with anxiety or depression (?0.19, 95 % CI ?0.21, ?0.16) and chronic pain (?0.19, 95 % CI ?0.21, ?0.17). Multimorbidity was associated with a clinically important reduction in the EQ-5D index score (?0.12, 95 % CI ?0.14, ?0.11) and twice the likelihood of being hospitalized (OR = 2.2, 95 % CI 1.7, 2.9) or having an ED visit (OR = 1.8, 95 % CI 1.4, 2.2).

Conclusions

Pain or discomfort is a common problem in people living with chronic conditions, and the existence of multimorbidity in these individuals is associated with a reduction in the HRQL as well as frequent hospitalization and emergency department visits.     

Health-related quality of life (HRQL) in immunodeficient adults with selective IgA deficiency compared with age- and gender-matched controls and identification of risk factors for poor HRQL

Purpose

Selective IgA deficiency (SIgAD) is the most common primary immunodeficiency with a prevalence of 1/600 in the general population. Any targeted health-related quality of life (HRQL) study of adults with SIgAD has never been presented. The objectives of the study were to compare HRQL between SIgAD adults and randomly selected age- and gender-matched population controls, and to identify risk factors for poor HRQL.

Methods

Thirty-two SIgAD individuals and 63 controls answered three questionnaires (clinical data, Short Form-36 Health Survey (SF-36), infection-related HRQL) at baseline before undergoing medical/dental examinations and laboratory assessments. HRQL in SIgAD was re-evaluated after 6 and 12 months.

Results

Baseline: Selective IgA deficiency individuals reported significantly increased fear of contracting infections (p < 0.01). Those scoring high on fear also perceived significantly poorer physical health (p < 0.01). SF-36 results indicated that SIgAD individuals perceived poorer HRQL, although this was not statistically significant. Follow-up: Compared with SF-36 responses at baseline, SIgAD individuals reported significantly more pain (p < 0.01) at 6 months, poorer general health (p < 0.05) and summarised physical HRQL (p < 0.01) at 6 and 12 months and decreased vitality at 12 months. The summarised mental scale remained stable over time. Risk factors for poor HRQL: The number of antibiotic treatments during the previous year (p < 0.001), number of daily medications (p < 0.01), allergic rhinoconjunctivitis (p < 0.05), chronic musculoskeletal symptoms at least every week (p < 0.05) and anxiety and/or insomnia (p < 0.05) were identified as independent risk factors for poor HRQL.

Conclusion

The study highlights the importance of identifying and thoroughly evaluating, educating and following up individuals with SIgAD, as their HRQL may be negatively affected due to health problems possible to prevent and treat.     

Correlates of objectively measured physical activity in adults and older people: a cross-sectional study of population-based sample of adults and older people living in Norway

Objectives

The aims of the study were to identify correlates of objectively measured physical activity and to determine whether the explanatory power of the correlates differed with sex, weight status or level of education.

Methods

Physical activity was assessed objectively in 3,867 participants, aged 20–85 years, for a consecutive 7 days using the ActiGraph GT1M activity monitor. Demographic and biological variables and levels of psychological, social environmental and physical environmental correlates were self-reported.

Results

The complete set of correlates explained 18.6 % (p < 0.001) of the variance in overall physical activity. Age and physical activity identity were the most important factors, explaining 4.8 and 3.2 % of the variance, respectively, whereas social environmental and physical environmental correlates did not significantly increase the amount of explained variance. Small interaction effects between demographic and biological variables and the correlates were observed.

Conclusions

Self-efficacy, perceived behavioural control and physical activity identity might be important targets for intervention. Intervention efforts aimed at influencing psychological correlates of physical activity may prove equally effective regardless of sex, weight status and level of education.     

Health-related quality of life in relation to walking habits and fitness: a population-based study of 75-year-olds

Purpose

To assess health-related quality of life (HRQL) in relation to walking habits and fitness status in older persons. A second aim was to examine fitness status as a mediator in the relation between walking habits and HRQL.

Methods

A cross-sectional population-based sample of 75-year-olds from Gothenburg, Sweden, was examined (n = 698, response rate 61 %). Walking habits were assessed as weekly frequency and duration. HRQL was assessed with the Short Form-36 (SF-36) and fitness with maximal and self-selected gait speed, chair-stand, stair-climbing capacity, grip strength and one-leg stance.

Results

The proportion of 75-year-olds who attained recommended levels of moderate physical activity (≥ 150 min/week), described as walking, was 60 %. This was positively associated with most subscales of SF-36 and with all fitness tests except grip strength. Maximal gait speed was the fitness test with the highest correlations to all SF-36 subscales. Fitness, described with maximal gait speed, was a partial mediator in most relations between walking habits and SF-36. After adjustment for confounders, associations between regular walking and SF-36 were no longer significant, except for Role Physical, General Health and Role Emotional in women.

Conclusions

Attaining recommended levels of walking, as well as a high fitness status, is positively associated with several aspects of HRQL in older persons. Fitness, described with maximal gait speed, seems to have a partial role in the relation between walking habits and HRQL, suggesting that other mechanisms are also involved.     

Socio-economic and demographic factors influencing nutritional status among early childbearing young mothers in Bangladesh

Background

Early childbearing influences women’s health. This study aims to examine the effects of socio-demographic factors on nutritional status of early childbearing mothers in Bangladesh based on Body Mass Index (BMI) as the indicator.

Methods

Data was extracted from Bangladesh Demographic and Health Survey (BDHS)-2011. The survey was performed on 17,842 married women aged 15–49. We focused on early childbearing mothers (age?≤?24, and who had delivered their first child?≤?20). Mothers who were underweight (BMI?≤?18.5 kg/m²) would be further classified into various grades of chronic energy deficiency (CED): mild (17.0?≤?BMI?<?18.5 kg/m²), moderate (16.0?≤?BMI <17.0 kg/m²), and severe (BMI?<?16.0 kg/m²). Multiple logistic regression model was used to examine the effect of socio-demographic factors on nutritional status.

Results

Mean age of the mothers was 20.49?±?2.37 years (ranged 15–24 years). The prevalence of underweight among early childbearing mothers was 32.1 % (urban 25 % and rural 35.1 %). Most of the underweight mothers had mild (62.2 %) CED, while the remaining had either moderate (25.9 %) or severe (11.9 %) CED. Multiple logistic regression analysis demonstrated that young mothers from rural areas, poor families, and those who were illiterate or with low level of education, working, and married to unemployed husband were at higher risk for being underweight. Young mothers who had non-caesarean delivered, delivered at home, or married at early age and had more than two children were also at higher risk for being underweight.

Conclusions

The prevalence of underweight among early childbearing mothers in Bangladesh is very high (32.1 %), associated with the still common practice of teenage marriage. Education level, wealth index, occupation, place of residence, age at first marriage and parity were important predictors for their nutritional status. The government and non-government organizations should take initiatives to reduce the prevalence of underweight mothers in Bangladesh.

     

Health-related quality of life in children with obstetrical brachial plexus palsy

Purpose

We aimed to determine the health-related quality of life (HRQL) of children with obstetrical brachial plexus palsy (OBPP) and examine its association with gender, age, injury level, injured side, and functional status.

Methods

We conducted a controlled, cross-sectional study including 70 children with OBPP. Fifty-two age-matched children without any health problems were included as controls. HRQL was assessed with the short parent form of the Child Health Questionnaire (CHQ-PF28), and functional status was measured using the active movement scale (AMS).

Results

Children with OBPP scored significantly lower on most of the CHQ-PF28 subscales than the healthy controls (p < 0.05). Gender or age did not significantly affect scores in any domain (p > 0.05). CHQ-PF28 scores showed that there were significant differences according to the side of injury between groups, especially in the “parental impact-time” and “family activities” domains (p < 0.05). There were no statistically significant differences in CHQ-PF28 scores between groups that had an upper trunk involvement and total injury groups (p > 0.05), except in the “bodily pain/discomfort” domain (p < 0.05). The AMS score was weakly to moderately correlated with the “mental health” and “parental impact-time” and “general health perceptions” domains.

Conclusion

The study demonstrated that children with OBPP have a poorer HRQL than their healthy peers. Side of injury, limitations in shoulder flexion, shoulder internal rotation, elbow flexion, elbow extension, and forearm supination were important factors affecting the HRQL of the children. The health concepts and factors discussed in the study can guide clinicians aiming to improve QoL of children with OBPP.     

Self-rated health: analysis of distances and transitions between response options

Purpose

We explored health differences between population groups who describe their health as excellent, very good, good, fair, or poor.

Methods

We used data from a population-based survey which included self-rated health (SRH) and three global measures of health: the SF36 general health score (computed from the 4 items other than SRH), the EQ-5D health utility, and a visual analogue health thermometer. We compared health characteristics of respondents across the five health ratings.

Results

Survey respondents (N = 1.844, 49.2 % response) rated their health as excellent (12.2 %), very good (39.1 %), good (41.9 %), fair (6.0 %), or poor (0.9 %). The means of global health assessments were not equidistant across these five groups, for example, means of the health thermometer were 95.8 (SRH excellent), 88.8 (SRH very good), 76.6 (SRH good), 49.7 (SRH fair), and 33.5 (SRH poor, p < 0.001). Recoding the SRH to reflect these mean values substantially improved the variance explained by the SRH, for example, the linear r ² increased from 0.50 to 0.56 for the health thermometer if the SRH was coded as poor = 1, fair = 2, good = 3.7, very good = 4.5, and excellent = 5. Furthermore, transitions between response options were not explained by the same health-related characteristics of the respondents.

Conclusions

The adjectival SRH is not an evenly spaced interval scale. However, it can be turned into an interval variable if the ratings are recoded in proportion to the underlying construct of health. Possible improvements include the addition of a rating option between good and fair or the use of a numerical scale instead of the classic adjectival scale.     

How good is “very good”? Translation effect in the racial/ethnic variation in self-rated health status

Purpose

To examine the influence of translation when measuring and comparing self-rated health (SRH) measured with five response categories (excellent, very good, good, fair, and poor), across racial/ethnic groups.

Methods

Using data from the California Health Interview Survey, which were administered in five languages, we analyzed variations in the five-category SRH across five racial/ethnic groups: non-Hispanic white, Latino, Chinese, Vietnamese, and Korean. Logistic regression was used to estimate independent effects of race/ethnicity, culture, and translation on SRH, after controlling for risk factors and other measures of health status.

Results

Latinos, Chinese, Vietnamese, and Koreans were less likely than non-Hispanic whites to rate their health as excellent or very good and more likely to rate it as good, fair, or poor. This racial/ethnic difference diminished when adjusting for acculturation. Independently of race/ethnicity, respondents using non-English surveys were less likely to answer excellent (OR = 0.24–0.55) and very good (OR = 0.30–0.34) and were more likely to answer fair (OR = 2.48–4.10) or poor (OR = 2.87–3.51), even after controlling for other measures of SRH.

Conclusions

Responses to the five-category SRH question depend on interview language. When responding in Spanish, Chinese, Korean, or Vietnamese, respondents are more likely to choose a lower level SRH category, “fair” in particular. If each SRH category measured in different languages is treated as equivalent, racial/ethnic disparities in SRH among Latinos and Asian subgroups, as compared to non-Hispanic whites, may be exaggerated.     

Are Parental Perceptions of Child Activity Levels and Overall Health More Important than Perceptions of Weight?

Objectives To examine relationships between parental perceptions of child weight and overall health, reported lifestyle behaviors and measured body mass index (BMI). Methods Using community-partnered methods, we surveyed families residing in a two census tract area identified for targeted interventions to decrease diabetes related disparities. The survey included demographics, child dietary and physical activity behaviors, and parental perception of child’s health and weight. We measured child BMI using a standardized protocol. Results We surveyed parents of 116 children with a mean age of 7 years (range 3–15) with 51 % boys, 74 % Hispanic, and 26 % Black. Over half of the children (55 %) were overweight or obese. Half (50 %) of the parents underestimated their children’s weight. Reported daily hours of walking and/or running trended higher (3.6 vs. 2.6 h, p = 0.08) for children perceived to be of normal weight. Parents who correctly estimated their child’s weight status reported more hours of daily walking/running than parents who underestimated child weight status, 4.5 versus 2.4 h, p = 0.0002. Parents of healthy weight children were more likely to report that children were in excellent or very good health compared to parents of overweight/obese children, 75 versus 56 % respectively (p = 0.04). We found significant racial/ethnic differences in reported diet and physical activity behaviors and perception of overall health. Conclusions for Practice Parental perceptions of child health and physical activity level may be related to perceptions of their child’s weight status. Study findings informed community-based initiatives for reducing diabetes risk among children.     

Health-related quality of life and utility scores in short-term survivors of pediatric acute lymphoblastic leukemia

Purpose

Increase of survival in pediatric acute lymphoblastic leukemia (ALL) has made outcomes such as health-related quality of life (HRQL) and economic burden more important. To make informed decisions on the use of healthcare resources, costs as well as utilities need to be taken into account. Among the preference-based HRQL instruments, the Health Utilities Index (HUI) is the most employed in pediatric cancer. Information on utility scores during ALL treatment and in long-term survivors is available, but utility scores in short-term survivors are lacking. This study assesses utility scores, health state, and HRQL in short-term (6 months to 4 years) ALL survivors.

Methods

Cross-sectional single-center cohort study of short-term ALL survivors using HUI3 proxy assessments.

Results

Thirty-three survivors (median 1.5 years off treatment) reported 14 unique health states. The majority of survivors (61 %) enjoyed a perfect health, but 21 % had three affected attributes. Overall, HRQL was nonsignificantly lower compared to the norm, although the difference was large and may be clinically relevant. Cognition was significantly impaired (p = 0.03).

Conclusion

Although 61 % of short-term survivors of ALL report no impairment, the health status of the other patients lead to a clinically important impaired HRQL compared to norms. Prospective studies assessing utility scores associated with pediatric ALL should be performed, enabling valid and reliable cost-utility analyses for policy makers to make informed decisions.     

The role of gender in the association of social capital, social support, and economic security with self-rated health among older adults in deprived communities in Beirut

Purpose

To examine gender variations in the association of self-rated health (SRH) with social capital, social support, and economic security among older adults from three deprived communities in the suburbs of metropolitan Beirut.

Methods

A population-based cross-sectional study using the Older Adult Component of the Urban Health Survey. Face-to-face interviews were conducted with 328 older men and 412 older women aged 60 years and above. SRH was assessed by a single question and treated as a dichotomous outcome, and several indicators of social capital, social support, and economic security were examined as independent variables.

Results

Women were significantly more likely to report poor SRH compared to men (37.2 vs. 25.9 %, respectively). Better social capital indicators decreased significantly the odds of poor SRH among both men (OR = 0.76, 95 % CI: 0.65–0.89) and women (OR = 0.71, 95 % CI: 0.62–0.82). Social support was strongly associated with SRH among women (OR = 0.56), but not among men (OR = 0.94). The reverse situation was observed for economic security (OR = 0.57 among men, OR = 0.80 among women).

Conclusions

In these deprived neighborhoods, social and economic factors may have gender-specific effects on the promotion of well-being among older adults, with social support being more salient to women’s SRH and economic security being more salient to men’s SRH. In health studies among older people, SRH captures not only social and physical health but also broader economic well-being.