A Community-Based Strategy for Improving Asthma Management and Outcomes for Preschoolers

Although almost one in ten (8.6%) preschool children has been diagnosed with asthma, few asthma management programs are designed for parents of preschool children. The Asthma Basics for Children program addressed this need in 2003–2008 by implementing a multi-layered approach that offered educational activities to center staff, parents, and children and PACE training to physicians in 31 Northern Manhattan daycare centers. Following program participation, 85% of parents reported reducing their child's triggers, 89% said it was easier to talk to their child's physician, and 80% were confident in their ability to manage their child's asthma. Children's any daytime symptoms dropped from 78% to 42%, any nighttime symptoms from 81% to 49%, any daycare absences from 56% to 38%, any asthma-related emergency department (ED) visits from 74% to 47%, and any asthma-related hospitalizations from 24% to 11% (p?<?.001 for all differences). Outcomes varied by level of exposure. In the Center-Only group (no parent participation), the only reduction was from 19% to 10% (McNemar?=?3.77, p?=?.052) in hospitalizations. Children whose parents participated in the program had significant reductions in daycare absences (62% to 38%, McNemar?=?11.1, p?<?.001), ED visits (72% to 43%, McNemar?=?19.2, p?<?.001), and hospitalizations (24% to 11%, McNemar?=?5.54, p?=?.018). Children whose parents and healthcare provider participated had the greatest improvements with asthma-related daycare absences dropping from 62% to 32% (McNemar?=?9.8, p?=?.001), ED visits from 72% to 37% (McNemar?=?14.4, p?<?.001), and hospitalizations from 35% to 15% (McNemar?=?8.33, p?=?.003). This study demonstrates that a multi-layered approach can improve asthma outcomes among preschoolers with a combination of parent and provider education having the greatest impact.     

“Top Performing” US Hospitals and the Health Status of Counties they Serve

This study (a) examined the relationships between “top performing” US hospitals and the health status of counties they serve and (b) compared the health status of “top performing” US hospital counties versus that of remaining US counties. Statistical analyses considered US News and World Report Honor Roll ranking data, as a measure of hospital performance, and County Health Rankings (CHR) data, as a measure of county health status. “Top performing” hospital Honor Roll scores were correlated with measures of Clinical Care (p?<?0.001). Counties with “top performing” US hospitals presented greater health status with regard to All Health Outcomes (p?<?0.001), Length of Life (p?<?0.001), Quality of Life (p?<?0.001), All Health Factors (p?<?0.001), Health Behaviors (p?<?0.001), and Clinical Care (p?<?0.001), than compared to remaining US counties. Hospital impact on county health status remains primarily recognized in clinical care and not in overall health. Also, counties that contain a “top performing” US hospital tend to present lower health risks to their citizens than compared to other US counties.     

A Preliminary Evaluation of a School-Based Media Education and Reduction Intervention

While media education and reduction programs have been proposed to prevent adverse health and academic outcomes related to heavy electronic media use among school-aged children, few have been formally piloted and evaluated. We used a quasi-experimental design to evaluate the effectiveness of Take the Challenge (TtC), a school-based media education/reduction program for the primary prevention of sleep deprivation, dysfunctional social-emotional behaviors, and poor academic performance. Sixth- to eighth-grade students at a rural Midwestern U.S. middle school received the TtC program, while a similar school in the same district served as the comparison group. Health-related and academic measures were collected from students and teachers at both schools before and after the intervention. The primary outcome measure was student-reported electronic media use (television, video games, Internet). Secondary measures included student health behaviors (student-reported sleep, exercise, and outdoor play) and academic activities (teacher-reported homework and classroom performance). Compared to the comparison group, students receiving TtC slept more and reduced television viewing, background television time, after-school video gaming, and weekend Internet use. Teachers reported increases in the extent to which TtC students completed homework assignments and stayed on task in the classroom. Well-designed school-based programs such as TtC can reduce electronic media use among middle-school children and improve related health and academic outcomes.     

A Meta-analysis of the Effectiveness of Interactive Middle School Cannabis Prevention Programs

This meta-analysis examines the effectiveness of interactive middle school-based drug prevention programs on adolescent cannabis use in North America, as well as program characteristics that could moderate these effects. Interactive programs, compared to more didactic, lecture style programs, involve participants in skill-building activities and focus on interaction among participants. A systematic literature search was conducted for English-language studies from January 1998 to March 2014. Studies included evaluations using random assignment or a quasi-experimental design of interactive school-based substance use prevention programs delivered to adolescents (aged 12–14) in North American middle schools (grades 6–8). Data were extracted using a coding protocol. The outcomes of interest were post-treatment cannabis use, intent to use, and refusal skills compared across intervention and control groups. Effect sizes (Cohen’s d) were calculated from continuous measures, and dichotomous measures were converted to the d index. A total of 30 studies yielding 23 independent samples were included. The random effects pooled effect size for cannabis use (k?=?21) was small (\( \overline{d} \)= -0.07, p?<?0.01) and favorable for the prevention programs. The pooled effect sizes for intention to use (k?=?3) and refusal skills (k?=?3) were not significant. Moderator analyses indicated significant differences in program effectiveness between instructor types, with teachers found to be most effective (\( \overline{d} \)= –0.08, p?=?0.02). The findings provide further support for the use of interactive school-based programs to prevent cannabis use among middle school students in North America.     

Healthcare costs and resource utilization of asthma in Germany: a claims data analysis

Introduction

Asthma is associated with a substantial economic burden on the German Statutory Health Insurance.

Aims and objectives

To determine costs and resource utilization associated with asthma and to analyze the impact of disease severity on subgroups based on age and gender.

Methods

A claims database analysis from the statutory health insurance perspective was conducted. Patients with an ICD-10-GM code of asthma were extracted from a 10 % sample of a large German sickness fund. Five controls for each asthma patient matched by age and gender were randomly selected from the same database. Costs and resource utilization were calculated for each individual in the asthma and control group. Incremental asthma-related costs were calculated as the mean cost difference. Based on prescribed asthma medication, patients were classified as intermittent or persistent. In addition, age groups of ≤5, 6–18, and >18 years were analyzed separately and gender differences were investigated.

Results

Overall, 49,668 individuals were included in the asthma group. On average, total annual costs per patient were €753 higher (p = 0.000) compared to the control group (€2,168 vs. €1,415). Asthma patients had significantly higher (p = 0.000) outpatient (€217), inpatient (€176), and pharmacy costs (€259). Incremental asthma-related total costs were higher for patients with persistent asthma compared to patients with intermittent asthma (€1,091 vs. €408). Women aged >18 years with persistent asthma had the highest difference in costs compared to their controls (€1,207; p < 0.0001). Corresponding healthcare resource utilization was significantly higher in the asthma group (p = 0.000).

Conclusions

The treatment of asthma is associated with an increased level of healthcare resource utilization and significantly higher healthcare costs. Asthma imposes a substantial economic burden on sickness funds.

     

Health and well-being benefits of spending time in forests: systematic review

Background

Numerous studies have reported that spending time in nature is associated with the improvement of various health outcomes and well-being. This review evaluated the physical and psychological benefits of a specific type of exposure to nature, forest therapy.

Method

A literature search was carried out using MEDLINE, PubMed, ScienceDirect, EMBASE, and ProQuest databases and manual searches from inception up to December 2016. Key words: “Forest” or “Shinrin -Yoku” or “Forest bath” AND “Health” or “Wellbeing”. The methodological quality of each randomized controlled trials (RCTs) was assessed according to the Cochrane risk of bias (ROB) tool.

Results

Six RCTs met the inclusion criteria. Participants’ ages ranged from 20 to 79 years. Sample size ranged from 18 to 99. Populations studied varied from young healthy university students to elderly people with chronic disease. Studies reported the positive impact of forest therapy on hypertension (n?=?2), cardiac and pulmonary function (n?=?1), immune function (n?=?2), inflammation (n?=?3), oxidative stress (n?=?1), stress (n?=?1), stress hormone (n?=?1), anxiety (n?=?1), depression (n?=?2), and emotional response (n?=?3). The quality of all studies included in this review had a high ROB.

Conclusion

Forest therapy may play an important role in health promotion and disease prevention. However, the lack of high-quality studies limits the strength of results, rendering the evidence insufficient to establish clinical practice guidelines for its use. More robust RCTs are warranted.

     

Language bias and self-rated health status among the Latino population: evidence of the influence of translation in a wording experiment

Purpose

This research uses a translation experiment to assess the Spanish translation of the “fair” response in the self-rated health measure among a representative study of the Latino population in the USA.

Methods

Using a unique Latino-specific survey (n = 1200), researchers built in a split sample approach in the self-rated health status measure where half of the Spanish-speaking respondents (n = 600) were randomly given “regular” and the other half were given “Mas o Menos” in translating the English “fair” response. We first estimate a logistic regression model to estimate differences across language categories on the probability of reporting poor and fair health and then estimate a multinomial logistic regression to test whether respondents who took the survey in Spanish and given “regular” are more likely to rate their health as fair compared to English speakers and Spanish-speaking respondents who are given the “Mas o Menos” version.

Results

From our logistic regression model, we find that Spanish-speaking respondents given the “regular” response are more likely to report poor health relative to English-speaking respondents and Spanish-speaking respondents who were randomly given “Mas o Menos.” The results from our multinomial logistic models suggest that Spanish respondents provided with “Mas o Menos” are more likely to rate their health as good relative to the base category of fair and relative to both English and Spanish speakers given “regular.”

Conclusion

This research informs the study of racial and ethnic disparities by providing a detailed explanation for mixed findings in the Latino health disparities literature. Researchers interested in self-rated health should translate the general self-rated health option “fair” to “Mas o Menos” as our wording experiment suggests that the current wording “regular” overinflates the reporting of poor health.

     

Evaluation of a Comprehensive Oral Health Services Program in School-Based Health Centers

Objectives In 2011, the Maternal and Child Health Bureau, within the Health Resources and Services Administration, awarded a 4-year grant to increase access to and assure the delivery of quality oral health preventive and restorative services to children. The grant was awarded to organizations serving high-need communities through school-based health centers (SBHCs). This article describes an independent evaluation investigating program efficacy, integration, and sustainability. Methods Program process and outcomes data were gathered from interim and final reports. Interviews with key informants were conducted by phone, and analyzed in NVivo qualitative software. Results Students had great need for comprehensive services: on average, 45% had dental caries at enrollment. Enrollment increased from 5000 to more than 9700, and the percent receiving preventive services increased from 58 to 88%. Results of the analytically weighted linear regression show statistically significant increases in the proportion of enrollees who had their teeth cleaned in the past year (t(4)?=?5.19, β?=?8.85, p?<?0.05) and those receiving overall preventive services (t(4)?=?13.52, β?=?10.93, p?<?0.01). Grantees integrated into existing programs using clear, consistent, and open communication. Grantees sustained the full suite of services beyond the grant period by increasing billing and insurance claims while still offering free and reduced-cost services to those uninsured or otherwise unable to pay. Conclusions for Practice This project demonstrates that access to comprehensive oral health care for children can be expanded through SBHCs. State Title V Block Grant and other similar federal initiatives can learn from the strategic approaches used to overcome challenges in the school-based environment.     

Kinetic-Based Reactivity for Michael Acceptors: Structural Activity Relationships and Its Relationship to Excess Acute Fish Toxicity

Acute aquatic toxicity is divided into the “physical” mode governed by weak, non-covalent interactions and the “chemical” mode governed by covalent reactions. The potency of chemical interactions is typically expected to be greater than that for physical ones. This enhanced potency is called “excess” toxicity. As databases have become complex, substances thought to elicit a chemical mode reveal a lack of excess toxicity. One mechanism where the latter is prevalent is Michael-type addition. A series of α-β-unsaturated substances were evaluated for reactivity. Second order rate constants (k′) were calculated (M^?1 s^?1) and found to vary from >4000 to <0.0003. The electron-withdrawing capacity of the polar group impacts k′ values; the sequence is nitro > carbonyl or sulfone ? sulfoxide, nitrile or amide. When the α-carbon and/or the β-carbon of the π-system are substituted, the k′ value is sharply reduced. Excess toxicity is associated with k′ values >0.01 (M^?1 s^?1).     

Prevalence and Losses in Quality-Adjusted Life Years of Child Health Conditions: A Burden of Disease Analysis

Objectives To estimate the prevalence and losses in quality-adjusted life years (QALYs) associated with 20 child health conditions. Methods Using data from the 2009–2010 National Survey of Children with Special Health Care Needs, preference weights were applied to 14 functional difficulties to summarize the quality of life burden of 20 health conditions. Results Among the 14 functional difficulties, “a little trouble with breathing” had the highest prevalence (37.1 %), but amounted to a loss of just 0.16 QALYs from the perspective of US adults. Though less prevalent, “a lot of behavioral problems” and “chronic pain” were associated with the greatest losses (1.86 and 3.43 QALYs). Among the 20 conditions, allergies and asthma were the most prevalent but were associated with the least burden. Muscular dystrophy and cerebral palsy were among the least prevalent and most burdensome. Furthermore, a scatterplot shows the association between condition prevalence and burden. Conclusions In child health, condition prevalence is negatively associated with quality of life burden from the perspective of US adults. Both should be considered carefully when evaluating the appropriate role for public health prevention and interventions.     

Attitudes and beliefs about musculoskeletal pain and its association with pain neuroscience knowledge among physiotherapy students in Israel

Background

Physiotherapy has a vital role in helping patients manage and overcome musculoskeletal pain. Healthcare providers’ beliefs about pain are associated with the beliefs of their patients. This study evaluated the attitudes, beliefs and level of pain neuroscience knowledge among Israeli Bachelor-level physiotherapy students.

Methods

First-year (n?=?29, before pain course), second-year (n?=?28, immediately after pain course and before clinical placements), and fourth-year (n?=?28, post-clinical placements) physiotherapy students completed the Health Care Providers’ Pain and Impairment Relationship Scale (HC-PAIRS, range 15–105, lower scores indicate a more positive attitude) to assess pain attitudes and beliefs. The Neurophysiology of Pain Questionnaire (NPQ, range 0–19, higher scores indicate more pain-related knowledge) was also completed to measure pain neuroscience knowledge. Two separate one-way ANOVAs with post hoc analyses were used to compare HC-PAIRS and NPQ results between the three groups of students. Pearson correlations were determined between HC-PAIRS and NPQ.

Results

HC-PAIRS scores of the first-year students were significantly higher than those of second- and fourth-year students (p?=?0.011, p?<?0.001, respectively), with no difference between second- and fourth-year students; indicating that first-year students had less-positive attitudes toward the ability of individuals with musculoskeletal pain to function. Similarly, NPQ scores showed that first-year students differed from second- and fourth-year students (p?<?0.001, p?<?0.001, respectively). The HC-PAIRS and NPQ correlation among the fourth-year students yielded a moderately negative association (r?=???0.462, p?=?0.01), indicating that pain neuroscience knowledge was associated with less belief that chronic pain justifies disability.

Conclusions

A specific curriculum about pain during physiotherapy undergraduate education contributes to a more positive evidenced-based attitude to musculoskeletal pain and patient function. The association between pain neuroscience knowledge and positive attitudes and beliefs regarding pain were enhanced after clinical placements, demonstrating that learning improves when integrated into practice. Due to the impact of pain training and the expected benefits to patient care, health policy decision makers and educators should verify that the pain curriculum is current with the best research evidence. Future studies with larger samples that include students from other healthcare disciplines, including medicine are warranted.

     

Effects of long-term multicomponent exercise on health-related quality of life in older adults with type 2 diabetes: evidence from a cohort study

Purpose

To establish the effect of a long-term multicomponent exercise (LTMEX) intervention (24 months) on health-related quality of life (HRQoL), in older adults with type 2 diabetes (T2D).

Methods

This longitudinal retrospective cohort study analyzes the effects of a supervised LTMEX program on HRQoL in older adults with T2D (n?=?279). Participants underwent one of two conditions: LTMEX (n?=?241) trained three times per week; and unchanged lifestyle—the control group (CO; n?=?38). Participants completed baseline, and 2-year follow-up evaluations including the Short Form Health Survey 36 (SF-36), anthropometric, hemodynamic components, and cardiorespiratory fitness (VO₂ peak).

Results

LTMEX improves HRQoL, specifically physical functioning (P?<?0.001), general health (P?<?0.05), vitality (P?<?0.001), mental health (MH; P?<?0.05), physical component score (P?<?0.001), mental component score (P?<?0.001), and total SF-36 (P?<?0.001). LTMEX group also decreased body weight (BW; P?<?0.005), waist circumference (WC; P?<?0.001), waist-to-hip ratio (WHR; P?<?0.001), and systolic blood pressure (SBP; P?<?0.001), and increased VO₂ peak (P?<?0.001). CO group increased WC (P?=?0.012), BMI (P?=?0.024), waist-to-hip ratio (WHR; P?=?0.003) and SBP (P?<?0.001), and decreased vitality (P?<?0.001) and MH (P?<?0.05).

Conclusions

A LTMEX intervention improves physical and mental HRQoL in older adults with T2D, and also anthropometric, hemodynamic profile, and cardiorespiratory fitness.

     

Investigating the Potential Impact of Social Talk on Prevention Through Social Networks: the Relationships Between Social Talk and Refusal Self-Efficacy and Norms

Interpersonal communication among participants plays an important role in the impact and effectiveness of prevention programs (Southwell & Yzer, Communication Theory 19:1–8, 2009). This study focused on adolescents’ informal conversations about a prevention program, referred to as social talk, from a social network perspective. We provide both a conceptualization of social talk in relation to prevention programs and an operationalization of it by examining adolescents’ social networks. Participants (N?=?185) were eighth-grade students attending a middle school substance-abuse prevention program called keepin’ it REAL (kiR). Participants engaged in both positive and negative social talk about kiR. Students with higher friendship indegree centrality were more likely to have greater positive social talk indegree centrality (r?=?.23 p?<?.01). These results indicated that youth considered as friends by most of their classmates were also reported as being positive in their comments with respect to kiR. Youth who talked positively about kiR tended to report personal anti-substance injunctive norms (b?=?0.71, p?<?.05). On the other hand, youth who were nominated as negative social talkers by their peers appeared to have less personal anti-substance injunctive norms (b?=??0.92, p?<?.05). Furthermore, youth who were more likely to talk negatively about kiR were less likely to perceive that their best friends (b?=??1.66, p?<?.05) or most youth in their age (b?=??1.49, p?<?.05) disapprove of substance use.     

Awareness of human papillomavirus and factors associated with intention to obtain HPV vaccination among Korean youth: quasi experimental study

Background

This study aimed to determine the awareness among fifth-grade girls and boys of sexually transmitted diseases (STDs), cancer, and human papillomavirus (HPV), and to determine the factors associated with intention to obtain the HPV vaccination.

Methods

A quasi experimental design was employed with Korean fifth-grade students as the subjects for this study (n=117). Prior to providing HPV education, the awareness and health beliefs regarding STDs and cancer prevention were assessed according to gender. After 2 hours of HPV education, gender comparisons were made with respect to the awareness and health beliefs, HPV knowledge, and intention to obtain the HPV vaccination, and the factors associated with that intention.

Results

Prior to the 2hours education session, only two boys knew that HPV is a virus. There were significant gender differences with respect to responses to the statements “STD is preventable” (χ²=8.76, p=0.013) and “cancer is preventable” (χ²=6.37, p=0.041), and concerns about the pain associated with vaccine injection (z=?2.44, p=0.015). After HPV education, there were no significant gender differences in HPV knowledge and intention to obtain the HPV vaccination. Awareness that “HPV vaccine can prevent cervical cancer” was significantly related to intention to obtain the HPV vaccine among both boys and girls.

Conclusions

Increased HPV knowledge could positively influence the intention to obtain the HPV vaccination among youth. Thus, HPV education at elementary school would be helpful to make students aware of HPV and the importance of HPV prevention.

     

Presenting comparative study PRO results to clinicians and researchers: beyond the eye of the beholder

Purpose

Patient-reported outcome (PRO) results from clinical trials can inform clinical care, but PRO interpretation is challenging. We evaluated the interpretation accuracy and perceived clarity of various strategies for displaying clinical trial PRO findings.

Methods

We conducted an e-survey of oncology clinicians and PRO researchers (supplemented by one-on-one clinician interviews) that randomized respondents to view one of the three line-graph formats (average scores over time for two treatments on four domains): (1) higher scores consistently indicating “better” patient status; (2) higher scores indicating “more” of what was being measured (better for function, worse for symptoms); or (3) normed scores. Two formats displayed proportions changed (pie/bar charts). Multivariate modeling was used to analyze interpretation accuracy and clarity ratings.

Results

Two hundred and thirty-three clinicians and 248 researchers responded; ten clinicians were interviewed. Line graphs with “better” directionality were more likely to be interpreted accurately than “normed” line graphs (OR 1.55; 95% CI 1.01–2.38; p?=?0.04). No significant differences were found between “better” and “more” formats. “Better” formatted graphs were also more likely to be rated “very clear” versus “normed” formatted graphs (OR 1.91; 95% CI 1.44–2.54; p?<?0.001). For proportions changed, respondents were less likely to make an interpretation error with pie versus bar charts (OR 0.35; 95% CI 0.2–0.6; p?<?0.001); clarity ratings did not differ between formats. Qualitative findings informed the interpretation of the survey findings.

Conclusions

Graphic formats for presenting PRO data differ in how accurately they are interpreted and how clear they are perceived to be. These findings will inform the development of best practices for optimally reporting PRO findings.

     

Contactable Non-responders Show Different Characteristics Compared to Lost to Follow-Up Participants: Insights from an Australian Longitudinal Birth Cohort Study

Objective This research aims to identify predictors of attrition in a longitudinal birth cohort study in Australia and assess differences in baseline characteristics and responses in subsequent follow-up phases between contactable non-responders and uncontactable non-responders deemed “lost to follow-up (LTF)”. Methods 3368 women recruited from three public hospitals in Southeast Queensland and Northern New South Wales during antenatal visits in 2006–2011 completed a baseline questionnaire to elicit information on multiple domains of exposures. A follow-up questionnaire was posted to each participant at 1 year after birth to obtain mother’s and child’s health and development information. Multivariate logistic regression was used to model the association between exposures and respondents’ status at 1 year. The effect of an inverse-probability-weighting method to adjust for non-response was studied. Results Overall attrition at 1-year was 35.4 %; major types of attrition were “contactable non-response” (27.6 %) and “LTF” (6.7 %). These two attrition types showed different responses at the 3-year follow-up and involved different predictors. Besides shared predictors (first language not English, higher risk of psychological distress, had smoked during pregnancy, higher levels of family conflict), distinguishable predictors of contactable non-responders were younger age, having moved home in the past year and having children under 16 in the household. Attrition rates increased substantially from 20 % in 2006 to 54 % in 2011. Conclusions This observed trend of increased attrition rates raises concern about the use of traditional techniques, such as “paper-based” questionnaires, in longitudinal cohort studies. The supplementary use of electronic communications, such as online survey tools and smart-device applications, could provide a better alternative.     

Development and Evaluation of an Integrated Asthma Awareness Curriculum for the Elementary School Classroom

Asthma is one of the most common causes of school absenteeism, and many children are affected by, or encounter, it in the school setting. An integrated curriculum that presents asthma as a real world example can raise all children’s awareness and understanding of asthma, not just those with the condition. A 15-lesson, asthma-based curriculum was developed to integrate with and enhance the core subjects of math, science, and communication arts. A pilot test was performed in fourth- and fifth-grade classes to assess student asthma knowledge gain, teacher acceptance, and grade appropriateness of the curriculum. During the 2006–2007 school year, 15 teachers were recruited from the St. Louis, MO, USA area to assess the curriculum through teaching and administering pre- and post-unit tests and completing a teacher evaluation for each lesson taught. Four additional classrooms served as comparisons. Paired t tests were used for each lesson taught, to evaluate pre-/post-test and classroom differences, and focus groups were used for qualitative evaluation. There was an increase in asthma knowledge between pre- and post-tests in both grades, individually and combined (p?<?0.001). Intervention post-test scores were higher than comparison classroom scores (p?<?0.001). Teacher feedback indicated that the lessons enhanced previously learned skills and increased students’ overall understanding of asthma. Offering asthma education in the classroom can provide an opportunity for all students to gain asthma knowledge and build health literacy about a leading chronic disease in school-aged children.     

Health-related quality of life in multiple sclerosis: role of cognitive appraisals of self,illness and treatment

Purpose

Health-related quality of life (HRQoL) is considered an important measure of treatment and rehabilitation outcomes in multiple sclerosis (MS) patients. In this study, we used multivariate regression analysis to examine the role of cognitive appraisals, adjusted for clinical, socioeconomic and demographic variables, as correlates of HRQoL in MS.

Methods

The cross-sectional study included 257 MS patients, who completed Multiple Sclerosis Impact Scale, Generalized Self-Efficacy Scale, Rosenberg Self-Esteem Scale, Brief Illness Perception Questionnaire, Treatment Beliefs Scale, Actually Received Support Scale (a part of Berlin Social Support Scale) and Socioeconomic Resources Scale. Demographic and clinical characteristics of the participants were collected with a self-report survey. Correlation and regression analyses were conducted to determine associations between the variables.

Results

Five variables, illness identity (β = 0.29, p ≤ 0.001), self-esteem (β = ?0.22, p ≤ 0.001), general self-efficacy (β = ?0.21, p ≤ 0.001), disability subgroup “EDSS” (β = 0.14, p = 0.006) and age (β = 0.12, p = 0.012), were significant correlates of HRQoL in MS. These variables explained 46 % of variance in the dependent variable. Moreover, we identified correlates of physical and psychological dimensions of HRQoL.

Conclusions

Cognitive appraisals, such as general self-efficacy, self-esteem and illness perception, are more salient correlates of HRQoL than social support, socioeconomic resources and clinical characteristics, such as type and duration of MS. Therefore, interventions aimed at cognitive appraisals may also improve HRQoL of MS patients.