Subjective memory and mood of Hong Kong Chinese adults with epilepsy

Clinicians are often confronted with the self-report of memory difficulties by patients. This study explored the possible correlates of subjective memory in 67 adult Chinese patients with epilepsy in Hong Kong. These correlates include epilepsy-related factors, mood state, and actual performance on neuropsychological tests. Results suggested that there exists no significant systematic relationship between subjective and illness-related factors such as seizure frequency, age at onset, and medication. Instead, stepwise regression analysis revealed that mood (anxiety) explained about 17% of the variance of subjective memory difficulties, whereas performance on a memory test accounted for only 8% of the variance. Findings are discussed in the light of the need to attend to the anxiety of patients with epilepsy in the process of rehabilitation.     

Cognitive-behavioral group treatment program for adults with epilepsy in Hong Kong

A subjective sense of uncertainty is a common theme in the experience of patients with epilepsy. Lack of control has also been implicated as an etiologic factor in the development of psychosocial problems in epilepsy. Cognitive-behavioral interventions emphasizing the mediating role of thoughts and self-control appear to be particularly relevant for patients with epilepsy because anxiety and depression are the most common problems. Despite its apparent importance, very little systematic research has been published on the effectiveness of psychological treatment of epilepsy. The purpose of the present study was to conduct a seminal outcome evaluation of psychological intervention for adult patients in Hong Kong. Using a waitlist control group, the treatment program focused particularly on cognitive restructuring and seizure control. Results indicated significant gains by the treatment group in overall quality of life and self-efficacy. In particular, marked improvements were noted for emotional well-being, seizure, and stress management. The clinical implications are discussed in the context of developing specific intervention programs and outcome measures specific to the various needs of adult patients with epilepsy.     

Eleven influential factors for quality of life in adults with epilepsy

BACKGROUND： Research focused on the quality of life of epileptic patients began only very recently in China; in particular, most research has focused on children, but less on epileptic adults. OBJECTIVE： To survey and analyze 11 influential factors for quality of life in adults with epilepsy by using quality of life epilepsy-31 scale. DESIGN： Cross-sectional study. SETTING： Department of Neurology, First Hospital Affiliated to Jinan University; Department of Neurology, First Affiliated Hospital of Wenzhou Medical College. PARTICIPANTS： A total of 107 adults with epilepsy for longer than one year were selected from Department of Neurology, First Hospital Affiliated to Jinan University between March 2004 and December 2006. The included patients met the Classification and Diagnostic Criteria of Epileptic Attack published by International Anti-Epilepsy League in 1981, and they provided informed consent. METHODS： General states, including course, attack frequency, marriage status, educational level, occupational types, economic status, attack types, drug types, and drug amount, were recorded. There were seven aspects in the Quality of Life Epilepsy-31 scale, including attack worry, life satisfaction, emotion, vigor/tiredness, drug influence, cognitive function, and social function. The scores positively correlated with the quality of life. Possible influential factors for quality of life were analyzed by one-way ANOVA and multivariate regression analysis. MAIN OUTCOME MEASURES： Course, attack frequency, marriage status, educational level, occupational types, economic status, attack types, drug types, drug amount, age, and sex. RESULTS： A total of 107 epileptic patients were included in the final analysis. Influential factors for quality of life in epileptic adults included attack frequency, educational level, economic status, attack types, drug amount, age, and course of disease （P 〈 0.05）. Among them, attack frequency negatively correlated with attack worry, life satisfaction, emotion, vigor/tir     

Gender differences in quality of life among Canadian adults with epilepsy

The clinical literature suggests epilepsy may impact quality of life in males and females differently. Previous research on gender issues has focused primarily on biological-biomedical factors over psychological and social factors. In this study we compare subjective and objective quality of life in adults persons with epilepsy to persons without epilepsy by gender using the biopsychosocial model in the Canadian Community Health Survey (CCHS), a large epidemiological survey that covers 98% of the Canadian population. Logistic regression analyses were conducted using self-rated health status and the Health Utility Index(?) 3 (HUI3) as the outcomes. Quality of life was significantly moderated after controlling for the biological-biomedical variables in all analyses except the HUI3. Males with epilepsy were more likely to have HUI3 scores of 0.70 or greater than males without epilepsy (OR = 1.61, 95%CI 1.32-1.96). For males with epilepsy the HUI3 was further moderated, but remained significantly better in the final model that controlled for biological, psychological and social factors (OR = 1.43, 95%CI 1.17-1.76). Our findings provide support for treatment approaches that focus on the whole person. Such approaches should take into account gender differences when examining objective quality of life.     

Psychosocial adjustment of people with epilepsy in Hong Kong

PURPOSE: In light of the issues associated with the psychosocial adjustment of people with epilepsy that have been widely reported, this study examined these issues within a Chinese cultural context. METHODS: Fifty patients with epilepsy completed The Washington Psychosocial Inventory, the Coping Inventory for Stressful Situations, and a questionnaire that assessed their psychosocial difficulties and coping styles. Multiple regression procedure was used to examine the strength of various medical and social factors in predicting the psychosocial adjustment problems of these participants. RESULTS: Social factors, such as self-perception and coping strategies, were more powerful predictors of psychosocial adjustment in people with epilepsy than the medical factors associated with epilepsy. CONCLUSIONS: These findings showed that psychosocial maladjustment is a significant issue for people with epilepsy in Hong Kong. The emerging importance of social factors as predictors of psychosocial adjustment in epilepsy, as compared with medical factors, highlights the need for developing tailored counseling therapy and social support groups for people with epilepsy.     

Self-management practices associated with quality of life for adults with epilepsy

Journal of Neurology - Epilepsy self-management practices enhance a patient’s competence and confidence in managing their chronic condition, which is assumed to lead to an improved quality of...     

Depression predicts cognitive decline in Hong Kong Chinese older adults

Depression is quite common among the elderly members of Hong Kong Chinese society. This study examined the impact of depression on change in cognitive functioning among the older people. The respondents were 260 people aged 70 years or older from a longitudinal study of a representative community sample of the elderly population in Hong Kong. Using multiple regression models, the authors found that depression at baseline measurement was negatively associated with cognitive functioning three years later, even after sociodemographic, physical health status, smoking status, exercise behavior and social support variables were applied in regression models.     

Chinese cultural dynamics of unemployability of male adults with psychiatric disabilities in Hong Kong

Work and employment has long been regarded as crucial for the mental health of human beings. Unemployment may lead to deterioration of physical and mental health. Nevertheless, for adults with psychiatric disabilities, discontinuity of employment is common. They may have various reasons to discontinue their employment. In Hong Kong, only 2.5% of people with psychiatric disabilities discharged from sheltered workshops are able to seek open employment. By means of illustration, the authors will show that traditional Chinese work culture tends to reinforce the discontinuity of employment of adult males with psychiatric disabilities. In Chinese culture, work is a means to occupy time, control misbehavior, show consistency of words and deeds, and to glorify parents and ancestors. All these factors contribute to the fulfillment of an adult male role and identity in traditional Chinese culture. In this case history, instead of finding realistic employment, a male adult with psychiatric disability tried to indulge himself in what he felt was his ideal job to fulfill all requirement as an adult male in Chinese culture. The imaginative ideal job gave him excuses to discontinue open employment. Its implications to vocational rehabilitation with male adults with psychiatric disability are also discussed.     

成年癫痫患者生活质量-31量表的信度和效度

目的 考核QOLIE-31评价成年成年癫痫患生活质量的信度和效度。方法 采用随机抽样调查方法，用QOLIE-31量表信函调查成年癫痫患52例。计算该量表的重测信度。内部一致性信度和构建效应。结果 QOLIE-31量表具有较好的信度和效度。结论 QOLIE-31量表是一份较好的用于测量我国癫痫病人生活质量的量表。     

Age- versus time-comparative self-rated health in Hong Kong Chinese older adults

OBJECTIVES: The main objectives were to examine the relation between age-comparative (self vs others of same age) self-rated health (SRH) and time-comparative (self this year vs last year) SRH, and to evaluate which was more strongly associated with specific physical health problems. METHODS: Cross-sectional data on two SRH measures and various physical health problems from 18749 male and 37413 female clients aged 65 or over from 18 Elderly Health Centres in Hong Kong were analysed using logistic regression with adjustment for potential confounders. RESULTS: Men were more likely to report 'better' and less likely to report 'worse' SRH than women. 'Normal' was the most common option but the proportions choosing this decreased with age on both SRH measures. There was a fairly weak but statistically significant correlation between these two measures, with Kappa coefficients of 0.125 and 0.167 for men and women, respectively. For both men and women, there were significantly positive linear trends between age-comparative SRH options from 'better' to 'worse' and physical health problems, such as respiratory diseases, musculoskeletal diseases, any active chronic diseases, functional disability, depressive symptoms, taking medication regularly, and admission to hospital last year. However, for time-comparative SRH, those who rated 'normal' had the smallest odds ratios in all of the physical health problems above than those who rated 'better' or 'worse'. CONCLUSIONS: The two SRH measures correlated with each other weakly but significantly. Age-comparative SRH was linearly, and time-comparative SRH was curvilinearly associated with physical health problems.     

Seizure frequency and the health-related quality of life of adults with epilepsy.

OBJECTIVE: To compare the health-related quality of life (HRQL) of a nonsurgical sample of adults with epilepsy with that of age- and gender-equivalent norms, and to analyze the relative importance of seizure frequency, time since last seizure, gender, and comorbidity on HRQL in the epilepsy sample. METHODS: Data were obtained from 139 adults with epilepsy from three US centers and published norms on the Medical Outcomes Study Short-Form 36 (SF-36). Patients were classified according to number of seizures over the prior 4 weeks (zero, one to five, six or more). Bivariate and multivariate modeling was used. RESULTS: HRQL scores for seizure-free patients were similar to the general population. Significant differences between seizure frequency groups were found for seven domains and the physical and mental component summary scales of the SF-36 (p<0.001). No differences were found in bodily pain. The largest differences were in physical role and social functioning, and general health (p<0.001). In the multivariate model, seizure frequency was a significant inverse predictor of HRQL across all domains (p<0.01 to 0.001). Men reported poorer physical function than women (p<0.05), and patients with a comorbid condition had poorer HRQL in the areas of pain (p<0.05) and general health perception (p<0.01). Time since last seizure was not related uniquely to HRQL. CONCLUSIONS: Seizure-free adults can have HRQL levels comparable with those of the general population. As seizure frequency increases, patients report more impaired HRQL, regardless of time since last seizure, gender, and comorbid status. Potential for difficulties in HRQL should be considered in clinical assessment and in evaluating treatment outcomes.     

成年癫痫患者生活质量的研究

目的运用QOLIE-31量表中文版调查评估广东地区成年癫痫患者的生活质量。方法对398例患者采用简单随机抽样,信函调查等调查方法进行调查,用SPSS 10.0软件进行统计学处理。结果198例不同性别间P>0.05.不同性别之间生活质量无显著性差异;婚姻在发作担忧、总的生活质量、感情幸福、精力和疲劳以及中国文化调适等方面有显著性差异P<0.05,不同经济状况之间在发作担忧和药物作用方面存在显著差异P<0.05;不同学历在社会功能一项P<0.05.表示不同学历在社会功能方面有显著性意义。结论在不同性别之间成年癫痫患者的生活质量无明显不同;婚姻、学历和经济状况对患者的生活质量有不同的影响。     

成年癫痫患者生活质量的研究

目的　评价成年癫痫患者的生活质量。方法　对符合入选标准的 33例成年癫痫患者和正常对照者 17名 ,进行癫痫患者生活质量量表 31(QOLIE 31)、Zung氏抑郁自评表 (SDS)的评估。结果　SDS评分水平与QOL的多个方面呈独立负相关 ,病程是总体健康水平、药物影响的独立危险因素。全身强直 阵挛发作 (GTC ,17例 )、复杂部分性发作 (CPS ,16例 )两组患者在药物影响 (分别为 6 1 0± 2 3 8和 5 6 6± 19 4,对照组为 10 0± 0 0 )、对发作的担忧两方面均与对照组有显著性差异 (P <0 .0 0 1)。GTC组从事脑力劳动的人数大大低于学历背景相似的对照组 (P =0 0 1) ,而CPS组从事脑力劳动的人数与对照组相比差异无显著性意义 (P =0 .479) ,GTC组与CPS组相比未见显著性差异 (P =0 .0 97)。男性癫痫患者在婚育方面受到的影响有大于女性患者的趋势。结论　成年癫痫患者生活质量低于健康对照组。     

成年难治性癫痫患者立体定向术后生活质量的调查分析

目的调查分析立体定向手术治疗对成年难治性癫痫患者生活质量的影响。方法对92例无明确致痫灶的成年难治性癫痫患者进行立体定向手术治疗,采用症状自评量表(SCL-90)、癫痫患者生活质量量表-31(QOLIE-31)在手术前及手术后半年、1年、2年、3年、4年、5年对患者进行连续评估。结果尽管部分患者术后癫痫症状不能完全控制,但患者总的生活质量在手术后各阶段均较术前明显提高。手术效果EngelⅠ级患者术后各时间段的生活质量优于Ⅱ~Ⅳ级患者的生活质量。术前具有明显精神症状患者术后各时间段的生活质量与术前无精神症状患者的术后生活质量比较无明显差异。结论对于经术前综合评估不能确定致痫灶,特别是伴有明显精神症状的难治性癫痫患者,立体定向手术治疗是一种有效的治疗手段,可显著改善这部分患者的生活质量。     

Cognitive-behavioural group therapy for Hong Kong Chinese adults with mental health problems.

Ninety-one Chinese in the community, aged between 18 and 45, with mental health problems ranging from mild to moderate degree, were treated by cognitive behavioural group therapy (CBGT) for a period of 3 months. All subjects were assessed on multiple measures at 4 time points: screening, pre-treatment (after 3 months), post-treatment and at 3-month follow-up. Attendance was good. A standard practice manual was developed to ensure consistent treatment by 2 group workers. After controlling for the placebo effect in the waiting period, treatment effect was demonstrated which was sustained after a three month period. The all-round improvement included a decrease in psychiatric symptoms, improvement in self-assessment, better and more social activities and being more able to cope with problems. In terms of psychiatric diagnosis, depressed subjects gained the most benefit and personality disorder subjects the least. Parents seemed to benefit more than non-parents.     

Factors associated with impaired quality of life in younger and older adults with epilepsy

The purpose of this study is to weigh psychological state, patients' demographics, seizure-related factors, and medical comorbidity in older adults with epilepsy against the same parameters in younger adults in an attempt to identify best quality of life (QoL) predictors. The Quality of Life in Epilepsy Inventory for Adults (QOLIE-31) and the Beck Depression Inventory-II (BDI-II) were completed by 146 patients with localization-related epilepsy. There was no statistical difference in the QOLIE-31 total score between younger and older adults. Best QoL predictors were BDI-II and seizure frequency, with BDI-II providing more than 3 times the impact of seizure frequency. BDI-II also substantively predicted most QOLIE-31 domains. Additionally, epilepsy duration positively correlated with overall QoL only among older adults. In summary, in younger as well as older adult epilepsy patients, depressive symptoms emerge as the strongest predictor of QoL. However, older adults appear to adapt better to their chronic health problem.     

Determinants of life satisfaction in Hong Kong Chinese elderly: A longitudinal study

The objective of the current study was to identify the predictive variables of life satisfaction in Chinese elderly people. Data came from a longitudinal study of a representative community sample of the elderly Chinese population in Hong Kong. Life satisfaction three years later is associated with a number of variables including gender, age, marital status, years of education, chronic illness, functional impairment, self-rated health, somatic complaints, vision, hearing, social network, social support from family members, quality of social support and financial strain. Using multiple regression models, the authors found that younger elderly persons with less financial strain, better social support, fewer somatic complaints and more education reported a higher level of life satisfaction three years later. These findings were consistent with previous Western studies.     

Myasthenia gravis in Hong Kong Chinese

A territory-wide study of myasthenia gravis (MG) was conducted in Hong Kong. Two hundred and sixty-two Chinese patients (159 adult and 103 paediatric onset) were identified, corresponding to a point prevalence and period prevalence of 53.5 and 62.2 per million respectively, and an average annual incidence of 4.0 per million population. Nine patients died, 7 from MG, giving a case fatality rate of 0.027. Female predominance was present in the whole group of patients (female to male ratio 1.6:1) and in those with adult disease (ratio 2.1:1), but not in those with onset in childhood (ration 1.1:1). Onset of disease was most common in the first 3 decades of life, and became less common in subsequent decades. Juvenile onset MG occurred in 39.3% of patients and restricted ocular MG in 47.9%. Familial occurrence was found in 5 patients. In the 159 adult onset patients, ocular disease was most common (32.7%), followed by mild generalised (29.6%), moderately severe generalised (24.5%), fulminating (11.9%) and late severe disease (1.3%). The mean age of onset of symptoms was 36.7 years. The symptomatology was similar to that of Caucasoid populations. Autoimmune thyroid disease was the commonest associated disease, and the incidence of thymoma among thymic abnormalities was high at 38%.