Quality of life and eating disorders

Objective: Eating disorders (EDs) can have a serious impact on various life domains and may lead to physical, mental and social impairment and consequently to poor quality of life (QOL). This study compared the QOL of ED patients and former ED patients in a large community based sample to the QOL of a normal reference group and to the QOL of patients with mood disorders. Differences between ED diagnostic groups were examined. The study investigated what factors contribute to QOL.Methods: A generic health-related quality of life questionnaire, the Short Form-36 (SF-36), and the Eating Disorder Examination-Questionnaire were administered to 156 ED patients – 44 anorexia nervosa patients, 43 bulimia nervosa patients, 69 eating disorder not otherwise specified patients – and 148 former ED patients.Results: ED patients reported significantly poorer QOL than a normal reference group. No differences were found between the diagnostic groups. Former ED patients still had poorer QOL than a normal reference group. ED patients reported significantly poorer QOL than patients with mood disorders. Self esteem contributed most to QOL.Conclusion: EDs have a severe impact on many domains of QOL. Therefore QOL needs to be addressed in effectiveness research and clinical practice.     

The Importance of Quality Perioperative Patient Education

Surgical patients, both inpatient and outpatient, need perioperative education in order to know how to prepare for surgery and what they can expect in the days following their surgical procedure. Quality perioperative patient education not only improves postoperative patient outcomes, but contributes as well to high patient satisfaction scores, which are currently tied to Centers for Medicare and Medicaid Services (CMS) reimbursements. This paper will demonstrate the importance of patient education and describe some perioperative Internet-based resources.     

Patient expectations and health-related quality of life

Objective

The measurement of health-related quality of life (HRQL) has become increasingly common in health services research. Whilst useful, its focus on behaviour, capacities and activities means that it remains relatively specific. This paper explores the possibility of extending the evaluation of health by considering the concept of patients’ expectations.

Design

In-depth and semi-structured interviews were used to explore the concept of expectations from the patients’ perspective. Patients’ expectations were then used in the construction of a two-part questionnaire.

Settings and participants

Expectations were explored with a group of 33 cardiac patients. The resulting questionnaire was given to 400 cardiac patients in a large teaching hospital in London.

Results

Patients identified a range of expectations which related to their health and seemed to represent the desired results of their hospital stay. Comparison of the content of patient expectations with a commonly used generic measure of HRQL, the Short-Form 36 (SF-36), found some overlap but indicated that patients seemed to adopt a broader approach to their health. Expectations that patients identified were used to construct two scales to measure expectations and their evaluation. The internal consistency of these scales was 0.82 and 0.88, respectively.

Conclusion

The study indicates the potential complexity of the concept of expectations and the need for further exploration. It also demonstrates the feasibility of constructing standardized scales to measure patient expectations. Whilst conceptually different from HRQL such standardized expectations scales could provide a useful adjunct to HRQL measurement and provide a meaningful context for the interpretation of HRQL data.

     

Positive cancer care in Peru: Patient and provider perspectives

Abstract

Peruvian women experience high mortality from reproductive cancers, partially due to suboptimal cancer care utilization and experiences. In this qualitative study, we examined factors contributing to positive cancer care experiences. Our sample included 11 cancer patients and 27 cancer providers who attended the First International Cancer Symposium survivorship conference in Lima, Peru in 2015. We conducted thematic analysis. Emergent themes revealed that, for patients, individualized empathic care by providers was an important facilitator to positive cancer care experiences. For providers, the ability to provide such care depended on provider norms and facility infrastructure to support such patient-centered practices.     

Patient experiences with information in a hospital setting: Associations with coping and self-rated health in chronic illness

The structural relations between patient experiences with information provided by hospital staff, coping behaviour and changes in self-rated health were studied in a cohort of people with chronic illness (n = 556) over a period of 2 years. A structural equation approach was applied to model cross-sectional and longitudinal effects. Positive experiences with information were cross-sectionally but not longitudinally associated with improved self-rated health. Patient experiences with information are not related to avoidance coping, but positive experiences contribute to more frequent use of supportant coping. The findings in the present study indicate that measures of patient experiences with information are not merely a reflection of patients’ health or coping behaviour. More theoretical work is required to describe the relationships between different patient reported outcomes. The insight into mechanisms underlying changes in physical and mental health in chronic illness could be further improved by evaluating the effects of specific educational and psychosocial interventions in a longitudinal design.     

Improving mental health and wellbeing in elderly people isolated at home due to architectural barriers: A community health intervention

ObjectivesTo explore the health effects of a community health intervention on older people who are isolated at home due to mobility problems or architectural barriers, to identify associated characteristics and to assess participants’ satisfaction.DesignQuasi-experimental before–after study.SettingFive low-income neighbourhoods of Barcelona during 2010–15.Participants147 participants, aged ≥59, living in isolation due to mobility problems or architectural barriers were interviewed before the intervention and after 6 months.InterventionPrimary Health Care teams, public health and social workers, and other community agents carried out a community health intervention, consisting of weekly outings, facilitated by volunteers.MeasurementsWe assessed self-rated health, mental health using the General Health Questionnaire (GHQ-12), and quality of life through the EuroQol scale. Satisfaction with the programme was evaluated using a set of questions. We analysed pre and post data with McNemar tests and fitted lineal and Poisson regression models.ResultsAt 6 months, participants showed improvements in self-rated health and mental health and a reduction of anxiety. Improvements were greater among women, those who had not left home for ≥4 months, those with lower educational level, and those who had made ≥9 outings. Self-rated health [aRR: 1.29(1.04–1.62)] and mental health improvements [β: 2.92(1.64–4.2)] remained significant in the multivariate models. Mean satisfaction was 9.3 out of 10.ConclusionThis community health intervention appears to improve several health outcomes in isolated elderly people, especially among the most vulnerable groups. Replications of this type of intervention could work in similar contexts.     

Patient Satisfaction, Treatment Experience, and Disability Outcomes in a Population-Based Cohort of Injured Workers in Washington State: Implications for Quality Improvement

Objective. To determine what aspects of patient satisfaction are most important in explaining the variance in patients' overall treatment experience and to evaluate the relationship between treatment experience and subsequent outcomes.
Data Sources and Setting. Data from a population-based survey of 804 randomly selected injured workers in Washington State filing a workers' compensation claim between November 1999 and February 2000 were combined with insurance claims data indicating whether survey respondents were receiving disability compensation payments for being out of work at 6 or 12 months after claim filing.
Study Design. We conducted a two-step analysis. In the first step, we tested a multiple linear regression model to assess the relationship of satisfaction measures to patients' overall treatment experience. In the second step, we used logistic regression to assess the relationship of treatment experience to subsequent outcomes.
Principal Findings. Among injured workers who had ongoing follow-up care after their initial treatment ( n =681), satisfaction with interpersonal and technical aspects of care and with care coordination was strongly and positively associated with overall treatment experience ( p <0.001). As a group, the satisfaction measures explained 38 percent of the variance in treatment experience after controlling for demographics, satisfaction with medical care prior to injury, job satisfaction, type of injury, and provider type. Injured workers who reported less-favorable treatment experience were 3.54 times as likely (95 percent confidence interval, 1.20–10.95, p= .021) to be receiving time-loss compensation for inability to work due to injury 6 or 12 months after filing a claim, compared to patients whose treatment experience was more positive.     

Quality of life aspects of bladder cancer: A review of the literature

Not much is generally known regarding the burden imposed by bladder cancer upon patient health-related quality of life (HRQL). The role of HRQL in affecting patient preferences and utility assessment and, ultimately, the selection of therapeutic regimen, or patient satisfaction with that selection, is considered increasingly important by the medical community. Therefore, the main focus of this evaluation was to review the international medical literature to better understand the impact of bladder cancer on patient HRQL. A search was performed using electronic and manual databases for published articles on HRQL and bladder cancer for the years 1966 onward. Thirty-five references dealing with HRQL were analyzed as part of this review. Of these, 29 were published after 1989. Most studies have identified urinary and sexual HRQL domains as being of greatest concern to patients. However, little is known about the short- and long-term impacts of specific therapeutic options for either superficial bladder cancer (SBC) or invasive bladder cancer (IBC). Increased awareness and use of the HRQL instruments such as the FACT-BL as well as the EORTC-QLQ-BLS24 and the EORTC-QLQ-BLM30 (when they are validated for SBC and IBC, respectively), should increase our understanding of the impact of this disease and its management options on patient HRQL.     

Patient Safety Outcomes in Small Urban and Small Rural Hospitals

Purpose: To assess patient safety outcomes in small urban and small rural hospitals and to examine the relationship of hospital and patient factors to patient safety outcomes.
Methods: The Nationwide Inpatient Sample and American Hospital Association annual survey data were used for analyses. To increase comparability, the study sample was restricted to hospitals with fewer than 100 beds. Out of 292 hospitals in the sample, 185 were rural hospitals and 107 were urban hospitals. AHRQ Patient Safety Indicators (PSI) were used to examine 9 common patient safety outcomes at these hospitals. The unit of analysis was the patient. Associations between hospital location and patient and hospital characteristics were determined using 1-way analysis of variance (ANOVA) and Pearson chi-square test. Multivariable analysis using generalized estimating equation regression models assessed the relationship between hospital location and PSIs.
Results: Most of the observed rates for the 9 PSIs were higher (indicating worse outcomes) for small urban hospitals than for small rural hospitals. In the multivariable analyses, after adjusting for important patient and hospital characteristics, many of these differences disappeared, except for decubitus ulcer. Small urban hospitals had significantly higher odds for decubitus ulcer than small rural hospitals.
Conclusion: These results deviate from findings in the literature that urban-rural differences in patient safety rates exist. This study highlights the importance of understanding the factors that differ between small urban and small rural hospitals while developing hospital-relevant patient safety interventions at these hospitals.     

基于病人视角的卫生服务质量评估研究趋势与需求分析

卫生服务质量评估是卫生服务质量信息公开与医疗保险论质计酬两个重要问题的共同关键点。国际卫生服务质量评估发展的一个重要方向是强调基于病人视角的评估,国内卫生服务质量评估虽然强调以病人为中心,但其实是基于供方视角的以病人为中心,在需方看来,这些指标可能只是远在以病人为中心的圆周上。另外,从理论上讲,卫生服务质量的好坏是病人满意度高低的前提,因此,卫生服务质量评估研究的价值更大。     

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.     

The impact of measuring patient-reported outcomes in clinical practice: a systematic review of the literature

Objective The purpose of this paper is to summarize the best evidence regarding the impact of providing patient-reported outcomes (PRO) information to health care professionals in daily clinical practice. Methods Systematic review of randomized clinical trials (Medline, Cochrane Library; reference lists of previous systematic reviews; and requests to authors and experts in the field). Results Out of 1,861 identified references published between 1978 and 2007, 34 articles corresponding to 28 original studies proved eligible. Most trials (19) were conducted in primary care settings performed in the USA (21) and assessed adult patients (25). Information provided to professionals included generic health status (10), mental health (14), and other (6). Most studies suffered from methodologic limitations, including analysis that did not correspond with the unit of allocation. In most trials, the impact of PRO was limited. Fifteen of 23 studies (65%) measuring process of care observed at least one significant result favoring the intervention, as did eight of 17 (47%) that measured outcomes of care. Conclusions Methodological concerns limit the strength of inference regarding the impact of providing PRO information to clinicians. Results suggest great heterogeneity of impact; contexts and interventions that will yield important benefits remain to be clearly defined.     

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.     

Quality of life of children and adolescents with clinical obesity,perspectives of children and parents

Background/objectivesChildhood obesity can have important psychological impacts. The objective of this study was to evaluate the Health Related Quality of Life (HRQoL) of children and adolescents with overweight and obesity. The participants were referred to an outpatient hospital-based obesity treatment. Additionally, we investigated the differences between parent- and self-reported HRQoL.Subjects/methodsChildren and adolescents aged 3−18 years with overweight or obesity, referred by their general practitioner or youth health care physician to the pediatric outpatient clinic of Hospital Gelderse Vallei (Ede, the Netherlands) for multidisciplinary obesity treatment, were enrolled in this cross-sectional study (n = 119).Interventions/methodsParent-proxy reported HRQoL was assessed using the Child Health Questionnaire Parental Form 50 (CHQ-PF50, n = 119) and the Infant Toddler Quality of Life Questionnaire 97 (ITQOL-97). Adolescents completed CHQ Child Form 87 (CHQ-CF87, n = 45) and Impact of Weight on Quality of Life-Kids (IWQOL-Kids, n = 38) to assess self-reported HRQoL.ResultsThe mean age of the children was 9.6 years (SD 4.3). Both parent-proxy reports and child self-reports showed lower HRQoL in children with a higher degree of obesity, especially in the physical domains of HRQoL (p < 0.05). Child self-reported scores were significantly lower than parent-proxy scores on the subscales ‘bodily pain/discomfort’ and ‘general health perceptions’, and significantly higher on ‘behavior’ and ‘family cohesion’ (p < 0.05).ConclusionsChildhood obesity has a negative effect on HRQoL, especially on the physical aspects. The discordance between parent and child reports underscores the importance of using a combination of parent-proxy and child self-reports to assess HRQoL.     

Health related quality of life and disease severity in patients with alpha-1 antitrypsin deficiency

Study question: To describe health-related quality of life (HRQL) in individuals with alpha-1 antitrypsin (AAT) deficiency, examine the cross-sectional relationship between disease severity and HRQL, and explore changes in lung function and HRQL over time in a subset of these individuals. Material/Methods: Forty-five adults with AAT deficiency and moderate to severe emphysema completed the Chronic Respiratory Disease Questionnaire (CRQ), six-minute walk distance (6-MWD) and pulmonary function tests (PFTs). Twenty of the 45 were followed for two additional years with repeated measurements of CRQ and PFTs. Results: The mean ± SD age was 49 ± 8 years. Initial CRQ subscale scores were: dyspnea 17.5 ± 4.3; fatigue 17.0 ± 5.46; emotional function 33.1 ± 8.67; and mastery 21.7 ± 4.65. No relationship was found between percent predicted forced expiratory volume in one second (FEV₁%) and CRQ score; 6 MWD and fatigue correlated significantly (r = 0.32, p < 0.05). Repeated PFT and CRQ measurements in 20 subjects showed statistically significant declines in FEV₁ and slow vital capacity (SVC), but no change in CRQ scores. Conclusions: Results suggest persons with AAT deficiency face challenges to HRQL that are similar to older adults with chronic pulmonary disease. Further research is needed on the nature of the relationship between disease severity and HRQL in this population.     

The relative contributions of race/ethnicity, socioeconomic status, health, and social relationships to life satisfaction in the United States

Purpose  To evaluate racial/ethnic disparities in life satisfaction and the relative contributions of socioeconomic status (SES; education, income, employment status, wealth), health, and social relationships (social ties, emotional support) to well-being within and across racial/ethnic groups. Methods  In two cross-sectional, representative samples of U.S. adults (the 2001 National Health Interview Survey and the 2007 Behavioral Risk Factor Surveillance System; combined n > 350,000), we compared life satisfaction across Whites, Hispanics, and Blacks. We also evaluated the extent to which SES, health, and social relationships ‘explained’ racial/ethnic group differences and compared the magnitude of variation explained by life satisfaction determinants across and within these groups. Results  Relative to Whites, both Blacks and Hispanics were less likely to be very satisfied. Blacks were somewhat more likely to report being dissatisfied. These differences were reduced or eliminated with adjustment for SES, health, and social relationships. Together, SES and health explained 12–15% of the variation in life satisfaction, whereas social relationships explained an additional 10–12% of the variance. Conclusions  Racial/ethnic life satisfaction disparities exist for Blacks and Hispanics, and these differences are largest when comparing those reporting being ‘satisfied’ to ‘very satisfied’ versus ‘dissatisfied’ to ‘satisfied.’ SES, health, and social relationships were consistently associated with life satisfaction, with emotional support having the strongest association with life satisfaction.     

鄂西北山区结核病患者健康教育效果评价

目的 了解结核病患者结核病防治知识健康教育效果.方法 以问卷调查的方式了解结核病患者健康教育前后结核病相关知识的知晓程度.结果 健康教育前结核病患者基本知晓结核病一般知识,但对结核病症状、检查、转诊、治疗、政策等知识缺乏,并且卫生习惯欠佳.对结核病常见症状、日常接触是否可以感染结核病、有了结核病到哪里就诊、结核病诊断方法、治愈结核病的关键措施、我国政府对结核病患者的治疗政策这6个问题回答准确率较低,分别是39.2%、27.7%、41.2%、30.4%、25.0%、33.1%;健康教育后这6个问题回答正确率分别是90.5%、87.8%、88.5%、89.2%、87.2%、87.8%.恐惧结核病,面对别人大声说笑、咳嗽、打喷嚏、随地吐痰,不接受痰菌及X线检查,不同意转诊到结核病防治所或疾病预防控制中心的人员健康教育前分别为84.5%、66.2%、23.6%、20.3%;健康教育后分别为8.1%、6.8%、2.0%、0.7%,两者相比均存在显著性差异.结论 健康教育能提高结核病患者的相关防治知识水平,能使结核病患者心理、态度及行为明显改善,有利于控制结核病的传播,降低结核病的发病率.     

Patient reported outcome measures: a model-based classification system for research and clinical practice

PURPOSE: The umbrella term Patient Reported Outcomes (PRO) has been successfully proposed for instruments measuring perceived health outcomes, but its relationship to current conceptual models remains to be established. Our aim was to develop a classification system for PRO measures based on a valid conceptual model. METHODS: We reviewed models and classification schemes of health outcomes and integrated them in a common conceptual framework, based on the models by Wilson and Cleary and the International Classification of Functioning (ICF). We developed a cross-classification system based on the minimum common set of consistent concepts identified in previous classifications, and specified categories based on the WHO International Classifications (ICD-10, and ICF). We exemplified the use of the classification system with selected PRO instruments. RESULTS: We identified three guiding concepts: (1) construct (the measurement object); (2) population (based on age, gender, condition, and culture); and (3) measurement model (dimensionality, metric, and adaptability). The application of the system to selected PRO measures demonstrated the feasibility of its use, and showed that most of them actually assess more than one construct. CONCLUSION: This classification system of PRO measures, based on a valid integrated conceptual model, should allow the classification of most currently used instruments and may facilitate a more adequate selection and application of these instruments.