Physical activity in relation to quality of life in newly diagnosed colon cancer patients: a 24-month follow-up

Purpose

Self-reported health status in cancer patients is an independent predictor of medical outcomes. This study investigated the association between changes in recreational physical activity in colon cancer survivors and quality of life (QoL) across a 24-month follow-up beginning at diagnosis.

Methods

Patients (n = 453) diagnosed with stage II colon cancer were recruited from the North Carolina Central Cancer Registry from 2009 to 2011. Patients were interviewed annually about health behaviors (e.g., dietary intake, physical activity, alcohol and tobacco use), socioeconomic variables, and treatment. To index QoL, the Functional Assessment of Cancer Therapy-Colorectal (FACT-C) and Short Form-12 (SF-12) were utilized.

Results

Baseline vigorous exercise showed a positive correlation with the Functional Assessment of Cancer Therapy-General (FACT-G) Colorectal Cancer Scale (CCS) (β = 0.15, 95 % CI 0.07–0.23), FACT-C (β = 0.39, 95 % CI 0.06–0.72), and Trial Outcome Index (TOI) (β = 0.28, 95 % CI 0.01–0.55). Race modified the association between vigorous activity and the FACT-G (P _interaction = 0.010), FACT-C (P _interaction = 0.020), TOI (P _interaction < 0.010), and the PCS (P _interaction < 0.010). As compared to no change, increasing physical activity over a 24-month period following diagnosis significantly improved scores from the FACT-G (β = 3.13, 95 % CI 0.48–5.77, P _trend = 0.054), FACT-C (β = 3.51, 95 % CI 0.35–6.68, P _trend = 0.08) TOI (β = 2.46, 95 % CI 0.16–4.75, P _trend = 0.04), and PCS of the SF-12 (β = 3.28, 95 % CI 0.93–5.63, P _trend < 0.01).

Conclusion

Vigorous exercise is a significant predictor of higher QoL in stage II colon cancer patients. Patients with increased recreational physical activity have significantly improved QoL over 24 months following diagnosis.     

Stigma related to sex work among men who engage in transactional sex with men in Ho Chi Minh City,Vietnam

Objectives

Male sex workers (MSW) in Vietnam face high levels of stigma related to sex work, which may be associated with depression and increased vulnerability to HIV.

Methods

In 2010, 300 MSW completed a behavioral and psychosocial survey. Multivariable models assessed factors associated with sex work-related stigma and the association between stigma and depression.

Results

Factors associated with increased stigma included having disclosed sexual orientation to healthcare workers (b 1.75, 95 % CI 0.69–2.80), meeting clients in the street/park (b 1.42, 95 % CI 0.32–2.52), and having been forced to have sex without a condom (b 2.36, 95 % CI 1.27–3.45). Factors associated with decreased stigma included meeting clients via the telephone or internet (b ?1.26, 95 % CI ?2.39 to ?0.12) and receiving financial support from family or friends (b ?1.31, 95 % CI ?2.46 to ?0.17). Stigma was significantly associated with increased odds of depression (AOR 1.07, 95 % CI 1.01–1.15).

Conclusions

Addressing stigma and depression in HIV prevention interventions is crucial for tailoring these programs to MSWs’ needs, and may result in decreased HIV spread.     

Is Dietetic Treatment for Undernutrition in Older Individuals in Primary Care Cost-Effective?

ObjectivesUndernutrition in older age is associated with adverse clinical outcomes and high health care costs. This study aimed to evaluate the cost-effectiveness of a dietetic treatment in primary care compared with usual care in older, undernourished, community-dwelling individuals.DesignA parallel randomized controlled trial.SettingPrimary care.ParticipantsA total of 146 undernourished, independently living older (≥65 years) individuals.InterventionDietetic treatment.MeasurementsMain outcomes were change in kilogram body weight compared with baseline and quality-adjusted life years (QALYs) after 6 months. Costs were measured from a societal perspective. The main analysis was performed according to the intention-to-treat principle. Multiple imputation was used to impute missing data and bootstrapping was used to estimate uncertainty surrounding cost differences and incremental cost-effectiveness ratios. Cost-effectiveness planes and cost-effectiveness acceptability curves were estimated.ResultsThe participants were randomized to receive either dietetic treatment (n = 72) or usual care (n = 74). After 6 months, no statistically significant differences were found between the dietetic treatment and usual care group in body weight change (mean difference 0.78 kg, 95% CI −0.26–1.82), QALYs (mean difference 0.001, 95% CI −0.04–0.04) and total costs (mean difference €1645, 95% CI −525–3547). The incremental cost-utility ratio (ICUR) for QALYs was not interpretable. The incremental cost-effectiveness ratio (ICER) for body weight gain was 2111. The probability that dietetic treatment is cost-effective compared with usual care was 0.78 for a ceiling ratio of €5000 for body weight and 0.06 for a ceiling ratio of €20.000 for QALY.ConclusionIn this study, dietetic treatment in older, undernourished, community-dwelling individuals was not cost-effective compared with usual care.     

The role of lifestyle, health, and work in educational inequalities in sick leave and productivity loss at work

Purpose

To investigate the influence of lifestyle, health, and work conditions in the association between education and productivity loss at work and sick leave.

Methods

Employees of six companies filled out a questionnaire on demographics, lifestyle-related, health, and work-related factors, and productivity loss at work and sick leave at baseline (n = 915) and after 1-year (n = 647).

Results

Employees with a low education were more likely to report productivity loss at work (OR = 1.49, 95 % CI 0.98–2.26) and sick leave (OR = 1.81, 95 % CI 1.15–2.85). After adjustment for lifestyle, health, and work conditions, the association between education and productivity loss at work did not attenuate. Work conditions attenuated the association between low education and sick leave (OR = 1.62, 95 % CI 1.01–2.61), and additional adjustment for health and lifestyle-related factors further reduced the strength of the association (OR = 1.42, 95 % CI 0.86–2.34).

Conclusion

Work conditions and lifestyle-related factors partly explained the association between education and sick leave, but did not influence the association between education and productivity loss at work. The educational differences in sick leave prompt for interventions that address behavioral aspects as well as work-related and lifestyle-related factors.     

Pediatric adiposity stabilized in Switzerland between 1999 and 2012

Purpose

Several countries have recently reported stabilization and/or a decrease in the prevalence of pediatric obesity. However, systematic, repeated national monitoring studies are scarce, and it is unclear whether this trend would be sustained. The objective was to present the latest overweight and obesity prevalence in Swiss children and to investigate trends in prevalence from 1999 to 2012.

Methods

Using probability-proportionate-to-size cluster sampling, nationally representative samples of children aged 6–12 years were recruited in 1999 (n = 594), 2002 (n = 2,493), 2004 (n = 328), 2007 (n = 2,218), 2009 (n = 907), and 2012 (n = 2,963). Height and weight were measured to calculate BMI (kg/m²). BMI cutoffs proposed by the Centers for Disease Control and Prevention (CDC) and by the International Obesity Task Force were used to determine the prevalence of overweight (excluding obesity) and obesity. Waist circumference was measured in 2007 and 2012, and multiple skinfold thicknesses assessed in 2002 and 2012.

Results

Using the CDC criteria, prevalences of overweight and obesity in 2012 were 11.9 % (95 % CI 10.7–13.1) and 7.1 % (95 % CI 6.2–8.0), respectively, and did not change between 1999 and 2012 (β = ?0.144, p = 0.293 and β = ?0.063, p = 0.552, respectively). Boys had significantly higher obesity prevalence than girls in 2007 (5.6 vs. 3.4 %) and 2012 (8.1 vs. 5.9 %). Percentage of children with excess waist circumference and body fat percentage did not differ between 2007 and 2012, and 2002 and 2012, respectively.

Conclusion

Our data indicate the prevalence of childhood adiposity in Switzerland stabilized between 1999 and 2012, but ≈1 in 5 children remain overweight or obese and further efforts are needed to control the epidemic.     

Anthropometric measures change and quality of life in elderly people: a longitudinal population-based study in Southern Brazil

Purpose

To analyze the effects of anthropometric measures change on quality of life (QoL) in elderly, using measured anthropometric data on body mass index (BMI) and waist circumference (WC).

Method

Population-based cohort study investigating a sample of elderly (≥60) assessed in 2009 (n = 1705) and followed up in 2013 (n = 1197). QoL was evaluated in 2013 using the CASP-19. Variables evaluated as exposure including BMI and WC in 2009 (both standardized), categories of anthropometric measures change from 2009 to 2013 (excess weight = BMI ≥ 25.0 kg/m²; large WC = top quartile), and the absolute BMI and WC change in same period. Multivariate linear regressions adjusted for possible confounding factors and mediators were used.

Results

Both BMI and WC at baseline were associated with lower QoL scores, even after adjustment for confounding variables (β _BMI = ?0.9; 95 % CI ?1.5; ?0.3 and β _WC = ?1.0; 95 % CI ?1.7; ?0.4). Additionally, QoL scores were lower among elderly with excess weight (β = ?1.4; 95 % CI ?2.9; 0.0) or large WC (β = ?3.3; 95 % CI ?5.2; ?1.4) in both waves than among those whose BMI and WC were always normal, but changes in anthropometric measures did not affect QoL. The presence of chronic diseases was a partial mediator of these associations, especially for effects of BMI change. Anthropometric measures change treated as a continuous variable was not associated with QoL.

Conclusions

Having excess weight and large WC in both waves was associated with lower QoL scores in elderly, but changing the anthropometric measures did not affect this outcome. Maintaining weight and WC within normal limits during aging can help to preserve QoL.

     

Organizational factors associated with work-related sleep problems in a nationally representative sample of Korean workers

Purpose

The purpose of this study was to assess the association of organizational factors with work-related sleep problems (WRSP) among Korean workers.

Methods

The data were derived from the First Korean Working Conditions Survey conducted in 2006 with a representative sample of the Korean working population (n = 10,039).

Results

The overall prevalence of WRSP was 5.1  % (95  % confidence interval (CI) 4.7–5.5). Those who experienced sexual harassment at work (adjusted odds ratio (aOR) 3.47: 95 % CI 1.77–6.81), discrimination due to sex (aOR 2.44: 95 % CI 1.36–4.36) or age (aOR 2.22: 95 % CI 1.52–3.23), violence at work (aOR 1.98: 95 % CI 1.06–3.68), threat of violence (aOR 1.96: 95 % CI 1.05–3.66), poor work-life balance (aOR 1.78: 95 % CI 1.44–2.20), low job satisfaction (aOR 1.69: 95 % CI 1.37–2.09), high cognitive (OR 1.64: 95 % CI 1.32–2.03) and emotional (aOR 1.53: 95 % CI 1.22–1.91) demands, job insecurity (aOR 1.32: 95 % CI 1.07–1.63), and high work intensity (aOR 1.55: 95 % CI: 95 % CI 1.25–1.92) had an increased risk of WRSP compared to their respective counterparts (p < 0.01). Low social support was not significantly associated with WRSP (aOR 0.88: 95 % CI 0.67–1.15).

Conclusion

The results revealed that poor psychosocial working conditions may be related to a high prevalence of WRSP among representative Korean workers.     

Work-related psychosocial and mechanical risk factors for neck/shoulder pain: a 3-year follow-up study of the general working population in Norway

Purpose

This study examines the impact of work-related psychosocial and mechanical exposure on the development of neck/shoulder pain in the general working population.

Methods

A randomly drawn cohort from the general population in Norway aged 18–66 was followed up for 3 years (n = 12,550, response rate = 67 %). Eligible respondents were in paid work during the reference week in 2006 and 2009, or temporarily absent from such work (n = 6,745). Four work-related psychosocial factors and six mechanical exposures were measured. Outcomes of interest were moderate or severe neck/shoulder pain at follow-up adjusted for baseline neck/shoulder pain.

Results

In total, 16.9 % (1,138 individuals) reported neck/shoulder pain during the last month at follow-up. Work related psychosocial predictors of neck/shoulder pain were high job demands (highest OR 1.41, 95 % CI 1.11–1.78) and low levels of supportive leadership (highest OR 1.66, 95 % CI 1.08–2.54). Mechanical factors were neck flexion (highest OR 1.77, 95 % CI 1.31–2.39) and lifting in awkward postures (highest OR 1.81, 95 % CI 1.21–2.71). The estimated population risk attributable to these factors was about 23 %. The relative risk for neck/shoulder pain associated with psychosocial exposure was slightly influenced by adjustment for physical risk factors, and vice versa. There was no substantial confounding related to age, gender, education, occupation or psychological distress.

Conclusions

Highly demanding jobs, neck flexion and awkward lifting appear as the most important predictors of neck/shoulder pain.     

Depressive symptoms,health-related quality of life,and cardiac event-free survival in patients with heart failure: a mediation analysis

Purpose

Health-related quality of life (HRQOL) and depressive symptoms both are associated with an adverse prognosis in heart failure (HF), although their associations with outcomes have been examined only in isolation. Therefore, it is unknown how HRQOL and depressive symptoms might interact in their associations with outcomes. The present study was conducted to determine whether the association between HRQOL and cardiac event-free survival is mediated by depressive symptoms in HF patients given that depressive symptoms are associated strongly with HRQOL.

Methods

A total of 209 HF patients (61 ± 11 years, 24 % female, 49 % NYHA III/IV) participated. The Minnesota Living with HF Questionnaire and the Patient Health Questionnaire-9 were used to measure HRQOL and depressive symptoms, respectively. Patients were followed for a median of 357 days to determine cardiac event-free survival.

Results

In Cox regression analysis, HRQOL [hazard ratio (HR) 1.013; 95 % confidence interval (CI) 1.001–1.026] and depressive symptoms (HR 1.075; 95 % CI 1.025–1.127) predicted cardiac event-free survival separately, controlling for demographic and clinical variables. HRQOL independently explained 38.7 % of the variance in depressive symptoms (p < 0.05; standardized β = 0.695) in a multiple regression. When HRQOL and depressive symptoms were entered in the model simultaneously, only depressive symptoms independently predicted cardiac event-free survival (HR 1.068; 95 % CI 1.001–1.139), demonstrating a mediation effect of depressive symptoms.

Conclusions

Depressive symptoms mediated the relationship between HRQOL and cardiac event-free survival. Interventions targeting HRQOL to enhance patient outcomes must also address patient depressive symptoms to be fully efficacious.     

Metabolic syndrome and quality of life in the elderly: age and gender differences

Purpose

The metabolic syndrome (MetS) is highly prevalent in Western older populations. MetS is an intriguing entity, because it includes potentially reversible risk factors. Some studies have suggested an inverse correlation between MetS and health-related quality of life (HRQoL), but data regarding older subjects are scanty and conflicting. The aim of this study was to assess the association between HRQoL and MetS in older, unselected community-dwelling subjects.

Methods

We analyzed data of 356 subjects aged 75+ living in Tuscania (Italy). HRQoL was assessed using the Health Utilities Index, Mark 3. Diagnosis of MetS was defined according to the National Cholesterol Education Program’s ATP-III criteria.

Results

MetS was reported by 137 (38%) participants. According to linear regression analysis, MetS was associated with significantly better HRQoL in men (B = 0.19 95% CI = 0.06–0.32; p = 0.006), but not in women. Also, when the regression model was analyzed in men, MetS was associated with better HRQoL (B = 0.17, 95% CI = 0.01–0.32; p = 0.035) only among participants aged 80+. No significant associations were found in men between HRQoL and any of the single components of MetS.

Conclusions

MetS is not associated with worse HRQoL among community-dwelling elderly; it is associated with significantly better HRQoL among the oldest men.     

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.     

Egg consumption and risk of GI neoplasms: dose–response meta-analysis and systematic review

Purpose

Previous epidemiological studies on egg consumption and the risk of gastrointestinal (GI) neoplasms suggest a positive association; however, data are limited and the evidence remains controversial. This study aims to investigate and quantify the potential dose–response relationship with an evaluation of cancer site-specific differences.

Methods

Relevant studies were identified after the literature search via electronic databases until January 2014. Subgroup analysis for serving portions was performed using two standardized classification methods: (1) less than 3, or 3 or more eggs per week; (2) less than 3, 3–5, or more than 5 eggs per week. Method two excludes studies that only reported consumption frequency. Pooled adjusted odds ratios (ORs) comparing highest and lowest categories of dietary pattern scores were calculated using a random-effects model.

Results

Thirty-seven case–control and seven cohort studies were included for meta-analysis, which contained a total of 424,867 participants and 18,852 GI neoplasm cases. The combined odds ratio (OR) was calculated to 1.15 (95 % CI 1.09–1.22; p value heterogeneity <0.001), showing only a slight increase in risk. The correlation was stronger for colon cancers 1.29 (95 % CI 1.14–1.46; p value heterogeneity <0.22). Dose–response analysis revealed similar results with stratification methods, and the ORs for an intake of <3 and ≥3 eggs per week were 1.14 (95 % CI 1.07–1.22; p value heterogeneity = 0.38) and 1.25 (95 % CI 1.14–1.38; p value heterogeneity = 0.25), respectively. With method 2, the ORs for an intake of <3, 3–5, and >5 eggs per week were 1.13 (95 % CI 1.06–1.21; p value heterogeneity = 0.25), 1.14 (95 % CI 1.01–1.29; p value heterogeneity = 0.06), and 1.19 (95 % CI 1.01–1.39; p value heterogeneity <0.001), respectively.

Conclusion

This study provides evidence that egg consumption is associated with a positive dose–response association with the development of GI neoplasms.     

Changes in body anthropometry and composition in obese adolescents in a lifestyle intervention program

Purpose

Impact of lifestyle modification on obesity control during adolescence, a period of significant physical growth and development, is less quantitatively evaluated. Therefore, we investigated the impact of changes in reported energy intake and physical activity on anthropometrics and body composition in adolescents.

Methods

Participants were obese adolescents aged 11–18 years. All of them have a body mass index (BMI) ≥ 95th percentile specific for age and gender according to the 2000 CDC Growth Charts. The intervention consists of supervised physical activity, structured nutrition education and dietary modification, and behavioral support in 6 months. Hundred and forty-five obese adolescents completed the study.

Results

Compared to baseline, significant reductions in body weight (?1.4 kg, p < 0.001) and BMI (?0.1 kg/m², p < 0.001) were observed at 6 months. When compared to expected growth trajectories on the 2000 CDC Growth Charts, body weight and BMI were reduced by 3.6 kg and 1.5 kg/m², respectively, in boys and 5.6 kg and 1.9 kg/m² in girls. Age was inversely associated with changes in weight (β = ?1.48 kg, p < 0.01) and BMI (β = ?0.32 kg/m², p = 0.03). There was a dose–response relationship between reduction in energy intake and weight loss. A decrease of 100 kcal/day was significantly associated with reductions in body weight 0.30 kg, BMI 0.09 kg/m², and BMI Z score 0.01 (all p < 0.01). Physical activity was not significantly associated with changes in anthropometrics or body composition.

Conclusions

Reduction in energy intake was a significant predictor of obesity reduction in these adolescents. A quantitative evaluation of adolescent weight loss programs should account for natural growth and development.     

Factors influencing self- and parent-reporting health-related quality of life in children with brain tumors

Purpose

Health-related quality of life (HRQOL) is not only a degree of health but also reflects patient perceptions and expectations of health. For children with brain tumors, better understanding of HRQOL requires the use of complementary reports from parents and interviewer-administered reports for children. Here, we aimed to test whether or not the trait anxiety of children and the psychological distress of their parents influence children’s and parents’ responses to HRQOL questionnaires, and whether or not the report-administration method for children influences children’s responses to HRQOL questionnaires.

Methods

One hundred and thirty-four children aged 5–18 with brain tumors and one of their parents completed the Pediatric Quality of Life Inventory^? (PedsQL^?) Brain Tumor Module questionnaires. In addition, the children also completed the State-Trait Anxiety Inventory for Children (STAIC), and the parents also completed the Kessler-10 (K10) and health and sociodemographic characteristics questionnaires. The child questionnaires were administered either by the child (self-administered) or an interviewer. Rater-dependent perceptions about HRQOL were derived from the subscales scores of the PedsQL^? Brain Tumor Module using structural equation modeling based on a multitrait-multimethod model. The STAIC trait-anxiety score, K10 score, report-administration method, and other health and sociodemographic factors related to each child’s or parent’s perceptions were identified through multiple linear regression analyses of the questionnaire responses. We used a path analysis to estimate the change in a PedsQL^? child-reported score that occurs when interviewer-administration changes the child’s perception about HRQOL.

Results

Surveys for 89 children were self-administered while those for 45 were interviewer-administered. The perceptions of the children and parents were calculated by fitting data to the model (chi-squared P = 0.087, normed fit index = 0.932, comparative fit index = 0.978, standardized root mean squared residual = 0.053, and root mean square error of approximation = 0.054). The children’s perception of HRQOL was affected by their STAIC trait-anxiety score (b = ?0.43, 95% CI [?0.60, ?0.25]). The parent’s perception was affected by their child’s treatment status (b = 0.26, 95% CI [0.09, 0.43]), the parent’s K10 score (b = ?0.21, 95% CI [?0.37, ?0.04]), and by education level (b = 0.17, 95% CI [0.00, 0.34]). The change in the child-reported PedsQL^? score in relation to the method of administration ranged from ?1.1 (95% CI: ?3.5, 1.3) on the procedural anxiety subscale to ?2.5 (95% CI: ?7.6, 2.6) on the movement and balance subscale.

Conclusion

Child-reporting of HRQOL is little influenced by the method of administration. Children’s perception about HRQOL tended to be influenced by their trait anxiety, while parents’ perception was influenced by their psychological distress, academic background, and their child’s treatment status.     

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.     

Prognostic value of quality of life measured after treatment on subsequent survival in patients with nasopharyngeal carcinoma

Purpose

Pretreatment quality of life (QoL) has been used to predict survival in cancer patients. In this study, we examined the prognostic value of QoL measured after treatment on subsequent survival in patients with nasopharyngeal carcinoma (NPC).

Methods

We enrolled 273 patients with NPC who had been curatively treated for more than 1 year. The EORTC QLQ-C30 and H&N35 questionnaires were completed 1 year after radiotherapy. The predictability of QoL variables on disease-specific survival (DSS) and overall survival (OS) was analyzed using Cox’s proportional hazards models.

Results

Twenty-nine (10.6 %) patients developed locoregional relapse and 27 (9.9 %) had distant metastasis after the QoL survey with subsequent 5-year DSS and OS rates of 87.9 % and 84.0 %, respectively. Based on the QLQ-C30, scales of physical functioning, fatigue, and appetite loss significantly predicted DSS and OS (p < 0.05). In the H&N35, only sexuality was significantly correlated with DSS and OS (p < 0.05). An increment of 10 points in physical functioning (HR: 0.69; 95 % CI: 0.48–0.90; p = 0.004) or a decline of 10 points in fatigue problems (HR: 1.40; 95 % CI: 1.19–1.61; p = 0.0002), appetite loss (HR: 1.21; 95 % CI: 1.03–1.40; p = 0.02), and sexuality (HR: 1.14; 95 % CI: 1.02–1.25; p = 0.019) was associated with better OS.

Conclusion

Some QoL variables measured after the treatment provide prognostic value on subsequent survival in patients with NPC.     

Sexual and physical abuse in childhood is associated with depression and anxiety over the life course: systematic review and meta-analysis

Objectives

To determine whether depression and anxiety in adulthood are associated with abuse exposure in childhood.

Methods

A search of PUBMED, EMBASE and PSYCHINFO databases (2002–2012) was supplemented by hand searches of bibliographies of articles and reviews. We included studies contrasting abuse exposure vs. no-abuse exposure before age 16 years to depression and anxiety after age 16 years. Data on sample and exposure and outcome instruments, covariates and odds ratios (ORs) with the respective 95 % confidence intervals (CI) were extracted. Combined ORs and 95 % CI were calculated using random effects models. Heterogeneity was quantified using the I ² test.

Results

Inclusion criteria were met by 19 studies with 115,579 study participants, for assessing depression (n = 14) and anxiety (n = 13). The combined ORs for depression were 2.04 (95 % CI: 1.65–2.53) for sexual abuse and 1.49 (95 % CI: 1.29–1.72) for physical abuse. The combined ORs for anxiety were 2.52 (95 % CI: 2.12–2.98) for sexual abuse and 1.70 (95 % CI: 1.33–2.18) for physical abuse.

Conclusions

High levels of depression, anxiety and distress are reported in adults exposed to childhood sexual and physical abuse. These findings require increased awareness for the potential needs of adults exposed to child abuse and public health interventions to prevent child abuse.     

The health-related quality of life burden of co-morbid cardiovascular disease and major depressive disorder in Australia: findings from a population-based, cross-sectional study

Purpose

Health-related quality of life (HRQOL) can be significantly impaired by the presence of chronic conditions such as cardiovascular disease (CVD) and major depressive disorder (MDD). The aim of this paper was to (1) identify differences in HRQOL between individuals with CVD, MDD, or both, compared to a healthy reference group, (2) establish whether the influence of co-morbid MDD and CVD on HRQOL is additive or synergistic and (3) determine the way in which depression severity interacts with CVD to influence overall HRQOL.

Methods

Population-based data from the 2007 Australian National Survey of Mental Health and Well-being (NSMHWB) (n = 8841) were used to compare HRQOL of individuals with MDD and CVD, MDD but not CVD, CVD but not MDD, with a healthy reference group. HRQOL was measured using the Assessment of Quality of Life (AQOL). MDD was identified using the Composite International Diagnostic Interview (CIDI 3.0).

Results

Of all four groups, individuals with co-morbid CVD and depression reported the greatest deficits in AQOL utility scores (Coef: ?0.32, 95% CI: ?0.40, ?0.23), after adjusting for covariates. Those with MDD only (Coef: ?0.27, 95% CI: ?0.30, ?0.24) and CVD only (Coef: ?0.08, 95% CI: ?0.11, ?0.05) also reported reduced AQOL utility scores. Second, the influence of MDD and CVD on HRQOL was shown to be additive, rather than synergistic. Third, a significant dose–response relationship was observed between depression severity and HRQOL. However, CVD and depression severity appeared to act independently of each other in impacting HRQOL.

Conclusions

HRQOL is greatly impaired in individuals with co-morbid MDD and CVD; these conditions appear to influence HRQOL in an additive fashion. HRQOL alters with depression severity, therefore treating depression and improving HRQOL is of clinical importance.     

Association between body mass index and mortality among institutionalized elderly adults in Japan

Background

The purpose of this study is to assess the association between body mass index (BMI) and mortality among nursing home residents in Japan.

Methods

A one-year prospective cohort study was conducted with 8,510 elderly individuals across 140 nursing homes. Baseline measurements included age, sex, height, weight, BMI, activities of daily living (ADL) (Barthel Index), and degree of dementia. Information regarding dates of discharge and mortality were also obtained to calculate person-years. Cox’s proportional hazards model was used to estimate hazard ratios.

Results

Mean age and BMI were 84.3 [standard deviation (SD) 8.1] years and 20.6 (SD 3.8) kg/m², respectively. Hazard ratios of mortality adjusted for sex, age, ADL, degree of dementia, and type of home were 2.4 [95 % confidence interval (CI): 1.9–3.1] for the 1st quintile of BMI (<17.3 kg/m²), 1.7 (95 % CI: 1.3–2.3) for the 2nd quintile (17.3–19.2 kg/m²), 1.5 (95 % CI: 1.2–2.0) for the 3rd quintile (19.3–21.1 kg/m²), and 1.2 (95 % CI: 0.9–1.6) for the 4th quintile (21.2–23.5 kg/m²) (P for trend <0.001), compared with the reference 5th quintile (23.6≤ kg/m²).

Conclusions

There was a clear inverse dose-dependent relationship between BMI and mortality. Future studies should be conducted to determine the effects of nutritional intervention on mortality in institutionalized elderly adults.     

Intake of vegetables and fruit and risk of esophageal adenocarcinoma: a meta-analysis of observational studies

Objectives

To study the association between the intake of fruit and vegetables and risk of esophageal adenocarcinoma (EAC), we summarized the evidence from observational studies in categorical and linear dose–response meta-analyses.

Methods

Eligible studies published up to June 2013 were retrieved via computerized searches of MEDLINE and EMBASE. Random-effects models were used to calculate summary relative risks (SRRs) and the corresponding 95 % confidence intervals (CIs). Between-study heterogeneity was assessed using the Cochran’s Q and I ² statistics.

Results

A total of 12 studies involving 1,572 cases of EAC were included in this meta-analysis. Based on the highest versus lowest analysis, inverse associations were observed between intakes of vegetable (SRRs = 0.76, 95 % CIs 0.59–0.96; P _{heterogeneity} = 0.098, I ² 40.4 %; n = 9 studies), intakes of fruit (SRRs = 0.73, 95 % CIs, 0.55–0.98; P _{heterogeneity} = 0.03, I ² = 52.9 %; n = 9 studies), and intakes of total vegetables and fruit combined (SRRs = 0.68, 95 % CI 0.49–0.93; P _{heterogeneity} = 0.162, I ² = 38.9 %; n = 5 studies). Similar results were also observed in a linear dose–response analysis.

Conclusion

These data support the hypothesis that intakes of vegetables and fruit may significantly reduce the risk of EAC. Further investigation with prospective designs, validated questionnaires, and good control of important confounders is warranted.