The health-related quality of life in eating disorders

Objective: This study investigated the perception of health-related quality of life (HRQoL) in ambulatory patients with eating disorders in relation to the severity of eating symptomatology and psychological comorbidity. Methods: One hundred ninety-seven study patients were consecutively recruited at the Eating Disorders Outpatient Clinic. Short Form-36 items (SF-36), a generic HRQoL questionnaire, the Eating Attitudes Test (EAT-40), and the Hospital Anxiety and Depression Scale (HAD) were used to measure different aspects of HRQoL. The results of the SF-36 were compared with the norms of the Spanish general population for women 18–34 years of age. Results: Patients with eating disorders were more dysfunctional in all areas of the SF-36 compared with women in the general population. There were no differences among the eating disorder diagnostic groups. Higher scores on the EAT-40 and the HAD were associated with a perception of greater impairment on all SF-36 subscales. Conclusion: The evaluation of HRQoL in these patients confirms the impact of these disorders on daily life in areas not directly related to eating disorders. The SF-36 is useful for discriminating among different levels of severity of eating disorders and other psychological comorbidities of these patients. This revised version was published online in June 2006 with corrections to the Cover Date.     

Health-related quality of life in patients with thyroid disorders

Limited reports are available on quality of life (HRQL) in thyroid diseases, and no data are available in euthyroid disorders, such as goiter and Hashimoto thyroiditis. Also, asymptomatic patients may suffer a reduction in perceived health status due to distress related to physical appearance and awareness of disease. We measured HRQL by means of Medical Outcome Study Short Form-36 (SF-36) and Nottingham Health Profile (NHP) questionnaires in 368 patients (hypothyroid, 81; hyperthyroid, 45 (for both states including overt and subclinical states); Hashimoto thyroiditis, 51; euthyroid goiter, 191). The final scores of the domains were compared with age- and sex-adjusted Italian normative values, by computing the effect size. All domains of SF-36, except bodily pain, were reduced in thyroid disease; this was mainly the case of role limitation (both physical and emotional), general health and social functioning. The domains of NHP were less severely affected. HRQL was impaired also in the absence of altered hormone levels. Mood/behavior disturbances were present in a large proportion of patients and were significantly associated with poor HRQL. HRQL was significantly reduced in patients with thyroid diseases referred to a secondary level endocrinology unit. Perceived health status may be considered as an additional outcome of management and therapy of thyroid disorders.     

Physical activity level and health-related quality of life in the general adult population: a systematic review

OBJECTIVE: Little is known regarding health-related quality of life and its relation with physical activity level in the general population. Our primary objective was to systematically review data examining this relationship. METHODS: We systematically searched MEDLINE, EMBASE, CINAHL, and PsycINFO for health-related quality of life and physical activity related keywords in titles, abstracts, or indexing fields. RESULTS: From 1426 retrieved references, 55 citations were judged to require further evaluation. Fourteen studies were retained for data extraction and analysis; seven were cross-sectional studies, two were cohort studies, four were randomized controlled trials and one used a combined cross sectional and longitudinal design. Thirteen different methods of physical activity assessment were used. Most health-related quality of life instruments related to the Medical Outcome Study SF-36 questionnaire. Cross-sectional studies showed a consistently positive association between self-reported physical activity and health-related quality of life. The largest cross-sectional study reported an adjusted odds ratio of "having 14 or more unhealthy days" during the previous month to be 0.40 (95% Confidence Interval 0.36-0.45) for those meeting recommended levels of physical activity compared to inactive subjects. Cohort studies and randomized controlled trials tended to show a positive effect of physical activity on health-related quality of life, but similar to the cross-sectional studies, had methodological limitations. CONCLUSION: Cross-sectional data showed a consistently positive association between physical activity level and health-related quality of life. Limited evidence from randomized controlled trials and cohort studies precludes a definitive statement about the nature of this association.     

Factors influencing health-related quality of life of Asians with anxiety disorders in Singapore

As little is known about health-related quality of life (HRQoL) in Asians with anxiety disorders, we assessed HRQoL in Singaporeans with anxiety disorders and identified factors influencing their HRQoL. Outpatients with anxiety disorders (n = 119) attending a hospital psychiatric clinic completed the Short Form 36 Health Survey (SF-36), Beck Anxiety Inventory (BAI) and General Health Questionnaire (GHQ-12). SF-36 score reduction from population norms (quantified as the number of standard deviations below the mean) in these subjects was compared with existing data on Singaporeans with various medical conditions and Americans with panic disorder (PD). Factors influencing HRQoL were examined using stepwise multiple linear regression models. SF-36 score reduction in these subjects (0.3-1.4 SD) was greater than that in Singaporeans with systemic lupus erythematosus or thyroid cancer survivors for seven scales but similar to that in Americans with PD (0.5-1.7 SD). BAI and GHQ-12 scores, presence of PD/generalized anxiety disorder, presence of chronic medical conditions, being married or increasing age accounted for 19-61% of the variance in six selected SF-36 scales. In conclusion, it can be said that Singaporeans with anxiety disorders experience clinically important reductions in HRQoL; both clinical and socio-demographic factors influence HRQoL in such subjects.     

Eating disorders and emotional and physical well-being: Associations between student self-reports of eating disorders and quality of life as measured by the SF-36

Objective: To assess health-related quality of life (HRQoL) in subjects with eating disorders in terms of eating disorder type and in relation to self-reports of longstanding illness, depression and self-harming behaviours. Method: Data on eating disorder history, SF-36 health status, longstanding illness, and self-reported frequencies of depression, self-harming behaviour, and suicidal thoughts or acts were collected during 1996 as part of a UK postal survey of students health. Completed questionnaires were returned by 1439 of 3750 students (response rate 42%). Results: Eighty-three respondents (5.8%; 8.9% of females) reported a probable eating disorder history: 54 (3.8%) bulimia nervosa, 22 (1.6%) binge eating disorder, and 7 (0.5%) anorexia nervosa. Eating disorder subjects reported more impairment in SF-36 emotional than physical well-being, with significantly lower mental (p<0.001) but not physical (p=0.21) component summary scores. This was most evident in bulimia nervosa and binge eating disorder subjects. Anorexia nervosa subjects reported fewer SF-36 emotional limitations although they were significantly more likely to report depression, self-harming behaviour, and suicidal ideation. Discussion: An eating disorder history is accompanied by HRQoL impairment primarily in emotional well-being. Anorexia nervosa subjects perceive fewer limitations than subjects with other eating disorders. While this is consistent with previous reports of better SF-36 emotional well-being in those with restrictive eating behaviours, it may also suggest that the SF-36 is insensitive to emotional distress in anorexia nervosa.     

Measuring subjective quality of life in people with serious mental illness using the SEIQoL-DW

In response to suggestions that available measures may not adequately reflect the idiosyncratic nature of subjective quality of life, the schedule for the evaluation of individual quality of life (SEIQoL) was developed to allow individuals first to select and define their own dimensions of quality of life, and then to assign a relative weight to each of the dimensions they have chosen. A simplified version of the instrument, the SEIQoL-direct weighting (SEIQoL-DW), can be used to elicit similar information from subjects with impaired cognitive functioning. The present study explored the feasibility of using this technique with a sample of 35 clients with serious mental illness served by assertive community treatment (ACT) teams. The SEIQoL-DW was well accepted by the study cohort. The SEIQoL-DW's global index was correlated with the satisfaction with life scale (SWLS), and with the quality of life inventory (QOLI). The SEIQoL-DW may have potential as a clinical planning tool that allows respondents to define personally relevant quality of life dimensions upon which attainable goals can be based. This revised version was published online in June 2006 with corrections to the Cover Date.     

健康教育对肿瘤化疗患者心理健康和生活质量的影响

目的探讨健康教育对肿瘤化疗患者心理健康和生活质量的影响。方法选择2009年1月—2011年11月在徐州市第三人民医院肿瘤科进行化疗的患者50例,随机分为观察组和对照组各25例。观察两组护理健康教育前后焦虑自评量表(SAS)、抑郁自评量表(SDS)的评分变化和癌症患者生活质量测定量表(E-ORTC QLQ-C30)评分变化。结果健康教育前,两组SAS、SDS和E-ORTC QLQ-C30量表各因子评分差异均无统计学意义(P0.05);健康教育后,观察组SAS、SDS评分明显低于对照组,而E-ORTC QLQ-C30量表各因子评分明显高于对照组(P0.05)。结论健康教育有效改善肿瘤化疗患者的心理健康,提高生活质量。     

重庆青少年青春期身心健康知信行与生活质量的关系

目的探讨青春期知信行在青春期阶段影响青少年生活质量过程中的调节作用,为制定改善青少年生活质量的措施提供依据。方法采用分层整群抽样,抽取重庆市2个区县6 746名中小学生,采用青春期发育量表(PDS)和基本情况调查表、青少年生活质量量表进行调查。结果青春期早期、中期和后期的青少年生理、心理维度及总生活质量得分低于青春期前青少年(P值均<0.05);青春期中期(B=-1.10)和后期(B=-2.88)的青少年社会维度得分低于青春期前青少年;但青春期阶段对青少年青春期维度生活质量的影响无统计学意义(P>0.05)。青春期知信行与青少年心理、社会、青春期维度和总生活质量呈正相关(B值分别为0.02,0.04,0.04,0.09,P值均<0.01),但对生理维度的影响无统计学意义(P=0.06)。交互作用分析显示,青春期知信行在青春期阶段对社会维度(B=0.03)和总生活质量(B=0.06)影响过程中起调节作用(P值均<0.05),但对心理维度无调节作用(P>0.05)。结论加强青少年青春期健康教育是提高和改善青少年生活质量的关键。     

Distinguishing between quality of life and health status in quality of life research: A meta-analysis

Despite the increasing acceptance of quality of life (QOL) as a critical endpoint in medical research, there is little consensus regarding the definition of this construct or how it differs from perceived health status. The objective of this analysis was to understand how patients make determinations of QOL and whether QOL can be differentiated from health status. We conducted a meta-analysis of the relationships among two constructs (QOL and perceived health status) and three functioning domains (mental, physical, and social functioning) in 12 chronic disease studies. Instruments used in these studies included the RAND-36, MOS SF-20, EORTC QLQ-30, MILQ and MQOL-HIV. A single, synthesized correlation matrix combining the data from all 12 studies was estimated by generalized least squares. The synthesized matrix was then used to estimate structural equation models. The meta-analysis results indicate that, from the perspective of patients, QOL and health status are distinct constructs. When rating QOL, patients give greater emphasis to mental health than to physical functioning. This pattern is reversed for appraisals of health status, for which physical functioning is more important than mental health. Social functioning did not have a major impact on either construct. We conclude that quality of life and health status are distinct constructs, and that the two terms should not be used interchangeably. Many prominent health status instruments, including utility-based questionnaires and health perception indexes, may be inappropriate for measuring QOL. Evaluations of the effectiveness of medical treatment may differ depending on whether QOL or health status is the study outcome.     

某医学院学生体育锻炼行为特征与心理健康的关系

目的探究医学院校大学生不同体育锻炼行为对心理健康的影响。方法运用症状自评量表（SCL-90）及大学生体育锻炼行为调查问卷对935名大学生进行团体测试。结果体育锻炼参与程度较高的大学生心理健康水平优于参与程度较低者,以混合类运动项目为主要锻炼手段者心理健康水平优于以周期性与非周期性项目为主要锻炼手段者。结论周锻炼次数3次以上且每次锻炼时间〉30min者,并且经常参与混合类项目对改善大学生的心理健康状况有积极的作用。     

Effects of two weight-loss diets on health-related quality of life

Purpose  To compare the effects of two diets on health-related quality of life (HRQOL). Methods  Overweight volunteers (n = 119) were randomized to follow a low-carbohydrate, ketogenic diet (LCKD) or a low-fat diet (LFD) for 24 weeks. HRQOL was measured every 4 weeks using the Short Form-36 and analyzed using linear mixed-effects models. Results  The mean age was 45 years and mean baseline body mass index was 34 kg/m²; 76% were women. At 24 weeks, five subscales (Physical Functioning, Role-Physical, General Health, Vitality, Social Functioning) and the Physical Component Summary score improved similarly in both diet groups. Bodily Pain improved in the LFD group only, whereas the Role-Emotional and Mental Health subscales and the Mental Component Summary (MCS) score improved in the LCKD group only. In comparison with the LFD group, the LCKD group had a statistically significant greater improvement in MCS score (3.1; 95%CI 0.2–6.0; effect size = 0.44) and a borderline significant greater improvement in the Mental Health subscale (5.0; 95%CI −0.3–10.4; effect size = 0.37). Conclusions  Mental aspects of HRQOL improved more in participants following an LCKD than an LFD, possibly resulting from the LCKD’s composition, lack of explicit energy restriction, higher levels of satiety or metabolic effects.     

Associations between illness duration and health-related quality of life in specified mental and physical chronic health conditions: results from a population-based survey

Purpose

We compared health-related quality of life (HRQOL) in incident (≤1 year since diagnosis), mid-term (>1–5 years since diagnosis), and long-term (>5 years since diagnosis) cases of mental and physical chronic illness with the general population and assessed the modifying effects of age and gender on the association between HRQOL and illness duration.

Methods

Data from the 2007 Australian National Health and Mental Wellbeing Survey were used. HRQOL was captured by the Assessment of Quality of Life Scale 4D. Multivariable linear regression analyses compared HRQOL of individuals with different duration of illnesses with those who did not have the condition of interest.

Results

The 8841 survey respondents were aged 16–85 years (median 43 years, 50.3% female). For the overall sample, worse HRQOL was associated with incident (P = 0.049) and mid-term (P = 0.036) stroke and long-term depression (P < 0.001) and anxiety (P = 0.001). Age had moderating effect on the associations between HRQOL and duration of asthma (P < 0.001), arthritis (P = 0.001), diabetes (P = 0.004), stroke (P = 0.009), depression (P < 0.001), bipolar disorder (P < 0.001), and anxiety (P < 0.001), but not heart disease (P = 0.102). In older ages, the greatest loss in HRQOL was associated with incident asthma, depression, and bipolar disorder. In younger ages, the greatest loss in HRQOL was associated with arthritis (any duration) and incident diabetes and anxiety. Additionally, gender moderated the association between HRQOL and arthritis, with worse HRQOL among men with incident arthritis (P = 0.047).

Conclusions

Loss of HRQOL associated with longer duration of chronic illness is most apparent in stroke and mental illness and differs between age groups.

     

The health-related quality of life of children and adolescents in home-based foster care

Objective To compare the health-related quality of life (HRQL) of 326 children and adolescents aged 6–17 years living in home-based foster care in metropolitan Adelaide, South Australia with the HRQL of a random sample of 3,582 children aged 6–17 years living in the community in Australia. Method In both groups, HRQL was assessed using the 50-item version of the Child Health Questionnaire (CHQ-PF50) completed by caregivers/parents, and the 87-item self-report version of the Child Health Questionnaire (CHQ-CF87) completed by 13–17 year olds. Results Young people in home-based foster care had significantly poorer HRQL in a wide range of different domains than those in the general community. Furthermore, among children in home-based foster care, those with mental health problems had significantly poorer HRQL in many domains than those without mental health problems. Demographic and placement characteristics of the children in home-based foster care were not significantly associated with differences in HRQL. Conclusion The findings highlight the importance of providing services and resources to improve the quality of life of children living in home-based foster care. All results of the analyses discussed in this paper are available upon request.     

A qualitative exploration of facilitators and barriers to physical activity participation in people with severe mental illness in Taiwan

BackgroundIdentifying factors associated with physical activity participation is critical for developing effective programs for individuals with severe mental illness (SMI). Previous studies have focused on western, developed countries; the purpose of this study was to qualitatively identify physical activity facilitators and barriers in people with SMI in Taiwan.MethodThirty-nine community-dwelling participants participated in one of five focus groups. Semi-structured open-ended questions were asked to identify physical activity barriers and facilitators. Qualitative data was organized and analyzed with thematic analysis using ATLAS.ti. software.ResultsParticipants had a mean age of 42 (SD = 11), were primarily female (51.3%), and had a diagnosis of schizophrenia (84.6%). Five facilitators and five barriers related to physical activity participation in the SMI group were identified. Facilitators included motivation by the health benefits of physical activity, engagement in preferred types of activity, support from family and friends, encouragement from health professionals, and convenient access to exercise equipment and facilities. Barriers included poor health, low self-efficacy, low support from family and friends, fear of negative societal attitudes toward mental illness, and an unsupportive physical environment.ConclusionsFactors related to physical activity participation in Taiwanese with SMI are multidimensional and include personal, social and physical environment factors. Future physical activity promotion programs for similar Taiwanese populations with SMI may want to consider targeting multiple levels of influence to help increase physical activity.     

Comparison of self-reported physical activity levels and quality of life between individuals with dysvascular and non-dysvascular below-knee amputation: A cross-sectional study

Background

Decreased physical ability of individuals with a dysvascular amputation when compared with non-dysvascular counterpart may impact on their ability to participate in regular physical activity and concomitant quality of life.

Comparison of perceived oral health in patients with temporomandibular disorders and dental anxiety using oral health-related quality of life profiles

BACKGROUND: Oral health-related quality of life (OHRQoL) instruments provide information beyond what is represented in their summary scores. Individual item information also provides useful insight into patient-related oral health problems. Our study aim was to compare patients' perceived impact from temporomandibular disorders (TMD) and from dental anxiety on oral health using item profiles contained within the Oral Health Impact Profile (OHIP). METHODS: We measured OHRQoL using the German version of the 14-item OHIP in 416 TMD patients, 173 dental anxiety patients, and 2,026 general population subjects. RESULTS: Dental anxiety patients demonstrated the highest mean OHIP summary scores, i.e., the worst OHRQoL (22.4 in anxiety patients, 14.0 in TMD patients, 4.1 in general population; P<0.001). The prevalence of frequently occurring responses of the individual items was 6-62% in dental anxiety patients, 3-40% in TMD patients, and 0.2-0.4% in the general population. The item prevalence of both patient groups was very similar for functional and pain-related OHRQoL domains. Dental anxiety patients indicated problems more frequently than TMD patients in the OHIP domains of psychological discomfort and psychological disability. CONCLUSIONS: This insight into patients' perceived oral health provided by OHIP item profiles may be important for patient diagnosis and outcome assessment in the clinical setting.     

云南少数民族居民心理和谐与生活质量关系研究

目的探讨云南少数民族居民心理和谐与生活质量关系。方法在云南省8个少数民族自治州抽取1758名成人被试,应用民族成年人心理和谐量表（MHS-EA）和世界卫生组织生活质量测定简表（WHO-QOL-BREF）进行测试。结果云南少数民族居民心理和谐总体水平[（3.67±0.54）分]处在不确定到基本和谐区间内;31.40％的居民心理和谐程度较高;57.20％的居民心理和谐水平处于“不确定”到“基本和谐”之间;另有11.40％的居民心理不和谐。生活质量总均分[（3.30±0.49）分]处在“一般”到“较好”区间内,9.50％的居民生活质量评定为“好”和“极好”,86.18％评为“一般”,4.32％评为“差”和“极差”。云南少数民族地区汉族的心理和谐水平和生活质量评分高于少数民族;民族居民的生活质量与心理和谐水平呈显著正相关（P〈0.001）,心理和谐总均分与生活质量总均分相关最高（r=0.61,P〈0.001）;心理和谐总均分是生活质量最有力的预测指标。结论云南少数民族居民心理和谐水平接近基本和谐,生活质量评分处于一般水平,两者都有较大的提升空间;生活质量与心理和谐显著相关;促进民族居民心理和谐可以有效提高其生活质量。     

The relationship between lipodystrophy-associated body changes and measures of quality of life and mental health for HIV-positive adults

Objectives:To investigate the relationship between lipodystrophy-specific symptom severity and wellbeing. Methods:HIV-positive adult patients with body fat redistribution (lipodystrophy syndrome) associated with antiretroviral therapy reported their total non-lipodystrophy symptoms and side effects and completed measures assessing body fat changes (yielding Atrophy, Hypertrophy and Total Lipodystrophy scores), mental health and quality of life. Effects of total symptom complex and lipodystrophy severity on quality of life and mental health were analyzed using Spearmans rho correlations. Logistic regression analyses were utilized to determine the relative-odds of depression produced by overall symptom count and lipodystrophy score increments. Results:Mean ratings for Hypertrophy and Atrophy corresponded to very mild and mild degrees of severity, respectively. The total symptom complex was associated with ratings for most of the mental health and quality of life measures. Patient-perceived body image scores were the sole study variable responsive to lipodystrophy severity ratings. In comparison to reference norms, a pronounced degree of body image impairment was evident. Conclusion: Although responsive to the total symptom profile, psychosocial measures typically utilized for evaluating quality of life and mental health status in HIV disease lacked sensitivity and specificity for measuring the consequences of lipodystrophy-associated fat distribution changes alone. Lipodystrophy severity did impact negatively on body image.     

The relationship between productivity and health-related quality of life: An empirical exploration in persons with low back pain

Objective: In economic evaluation of health care programmes normally health-related quality of life is part of measurement of a programmes effectiveness and productivity part of its costs. In this paper the relationship between quality of life and productivity is highlighted and empirically assessed in persons suffering from low back pain. Methods: A secondary analysis was performed on data from a sample of 483 patients treated for low back pain. Periodically, both quality of life (EQ-5D) and productivity indicators for both paid and unpaid work were measured. Mean EQ-5D scores were compared for groups of patients classified by level of productivity. The relationship between quality of life and productivity was also assessed using Spearman rank correlation coefficients. Results: Mean EQ-5D scores for patients without productivity losses were a half to a full standard deviation higher than for patients with the lowest levels of productivity. The correlation between quality of life and productivity was moderate. Conclusion: Lower levels of quality of life were associated with efficiency loss and absenteeism. However, due to the moderate strength of the relation the use of information on quality of life to model productivity costs in case of absence of productivity data was not recommended.     

Changes in symptoms and health-related quality of life in a nationally representative sample of adults in treatment for HIV

Patient-centered measures of functioning and well-being are needed to monitor and improve health for HIV-infected persons. We estimated the associations between HRQOL and symptoms over time in HIV-infected persons, adjusting for demographic and clinical characteristics using a longitudinal study of a nationally representative cohort of 2267 patients in care for HIV infection surveyed in 1996 and again in 1998. We used two global measures of HRQOL (overall health and overall quality of life) scored to have a mean of 50 and standard deviation of 10 in the sample. The total number of symptoms decreased (−1.29, p<0.001 for the difference), and overall health (1.09, p<0.001 for the difference) and overall quality of life (1.31, p<0.001 for the difference) improved over the period. Controlling for baseline symptoms and HRQOL, each additional symptom at follow-up (B=−1.14, p<0.001) was associated with worsened overall health and worsened overall quality of life (B=−0.95, p<0.001). The association of two additional symptoms with lower global HRQOL was similar in magnitude to the effect of having significant depressive symptoms or the diagnosis of AIDS. In conclusion, among HIV-infected patients, symptoms are significantly related to HRQOL over time. The functioning and well-being of patients with HIV is inextricably linked to the symptoms they experience.