The impact of influenza-like illness in young children on their parents: a quality of life survey

Background

Influenza-like illness can cause excess paediatric morbidity and burden on parents.

Objectives

We determined the quality of life (QoL) impact of children’s influenza-like illness (ILI) on their parents.

Methods

We conducted a prospective cohort study in childcare centres and a general practice in Sydney, Australia. Using PAR-ENT-QoL, we measured QoL of parents of children aged 6 months–3 years before the 2010 influenza season, then again for parents of children with ILI (ILI group) using SF-12v2 Acute Form and PAR-ENT-QoL, and contemporaneously for parents of aged-matched children without ILI (non-ILI group).

Results

Of 381 children enrolled from 90 childcare centres, 105 developed ILI. PAR-ENT-QoL scores of the ILI group were significantly lower in the post-ILI follow-up interviews than at baseline (60.99 vs. 79.77, p < 0.001), and those of non-ILI group at follow-up interviews (60.99 vs. 84.05, p < 0.001). SF-12v2 scores of the ILI group were also significantly lower than those of non-ILI group: physical component summary (50.66 vs. 53.16, p = 0.011) and mental component summary (45.67 vs. 53.66, p < 0.001). Two factors were significantly associated with parental QoL: total time spent caring child during ILI and whether the child had severe ILI or not. Correlations between PAR-ENT-QoL and SF-12v2 scores were satisfactory.

Conclusions

Parents had significantly lower QoL while their child had ILI, compared with before ILI and with parents of children without ILI. The public health impact of ILI in children on the QoL in families is far from negligible. QoL measurement can complement economic evaluation of ILI disease burden and provide a more complete picture of impact.     

Role of global stress in the health-related quality of life of caregivers: evidence from the Survey of the Health of Wisconsin

Purpose

Informal caregivers play a critical role in the care of individuals who are aging or have disabilities and are at increased risk for poor health outcomes. This study sought to determine whether and to what extent: (1) global stress and health-related quality of life (HRQoL) differed between caregivers and non-caregivers; (2) global stress mediated the relationship between caregiving status and HRQoL; and (3) caregiver strain (i.e., stress attributable to caregiving) was associated with worse HRQoL after accounting for global stress.

Methods

Cross-sectional data were from the 2008–2010 Survey of the Health of Wisconsin, a representative sample of adults aged 21–74 years. Participants (n = 1,364) completed questionnaires about caregiving status, sociodemographics, global stress, and HRQoL. Staged generalized additive models assessed the impact of caregiving on HRQoL and the role of caregiver strain and global stress in this relationship.

Results

In the last 12 months, 17.2 % of the sample reported caregiving. Caregivers reported worse mental HRQoL than non-caregivers (β ?1.88, p = 0.02); global stress mediated this relationship (p < 0.01). Caregivers with the highest levels of strain reported worse mental and physical HRQoL (β ?7.12, p < 0.01), and caregivers with the lowest levels of strain reported better mental HRQoL (β 2.06, p = 0.01) than non-caregivers; these associations were attenuated by global stress (p < 0.01).

Conclusion

Global stress, rather than caregiving per se, contributes to poor HRQoL among caregivers, above and beyond the effect of caregiving strain. Screening, monitoring, and reducing stress in multiple life domains presents an opportunity to improve HRQoL outcomes for caregivers.     

Personality traits of the Five-Factor Model are associated with work-related stress in special force police officers

Purpose

The police work is particularly stressful. The aim of this work was to clarify whether the personality factors are associated with perceived stress levels or reactivity to environmental stressors in a special body of police.

Methods

The police officers in charge of guaranteeing public order at the L’Aquila G8 meeting were subjected to a control of their levels of work-related stress in anticipation of the event. Personality was assessed by the Italian version of the Five-Factor Model questionnaire, while stress was measured three times (during routine work in January 2009, preparation and imminence of the event, in April and July 2009, respectively) with the demand/control/support model of Karasek and the effort/reward imbalance model of Siegrist. A total of 289 of 294 officers took part in the survey.

Results

Some personality traits of the Five-Factor Model were associated with stress levels and stress reactivity. Neuroticism (low emotional stability) showed the strongest associations with job strain (demand/control ratio) (β = 0.115, p < 0.05) and effort/reward imbalance (β = 0.270, p < 0.001) and was associated with most of the stress variables. High agreeableness was associated with low effort/reward imbalance (β = ?0.157, p < 0.01).

Conclusions

Personality factors may mitigate or increase the strain induced by environmental stressors.     

Evaluation of the similarities and differences in response patterns to the Pediatric Quality of Life Inventory and the Child Oral Health Impact Scores among youth with cleft

Purpose

To examine (a) the pattern of responses to a generic health-related quality of life (HRQL) measure (Pediatric Quality of Life Inventory—PedsQL) and an oral health-related quality of life (OHRQoL) measure (Child Oral Health Impact Profile—COHIP), and (b) the associations of these scores with surgical recommendation status among youth with cleft.

Methods

Cross-sectional data (baseline) regarding clinicians’ surgical recommendations and quality of life (QoL) measures were examined from an ongoing observational study on treatment outcomes. Approximately one-third of the racially and geographically diverse sample (N = 1,200; $\bar{x}$  = 11.6 years) received surgical recommendations to correct either visible (aesthetic) or invisible (functional) defects. Effect sizes were used to quantify differences in QoL based on surgical recommendation and to compare the sensitivity of the PedsQL and COHIP subscales. Using Pearson coefficients, the scores of those recommended for surgery were compared with those without a surgical recommendation.

Results

A moderate correlation (0.52) was found between the total scores on the PedsQL and COHIP (p < 0.0001). Subscale correlations between the QoL measures ranged from 0.19 to 0.48 with the strongest correlation between the PedsQL Emotional (r = 0.47) and COHIP Socioemotional Well-being subscale. The effect size for the COHIP Socioemotional Well-being (0.39) was larger than the PedsQL Social/Emotional (0.07/0.11) subscale (Z = 5.30/Z = 4.64, p < 0.0001, respectively), and the total COHIP (0.31) was significantly greater than the total PedsQL scale (0.15, z = 2.65, p = 0.008).

Conclusions

A significant relationship was found between generic HRQL, OHRQoL, and surgical needs among youth with cleft with the COHIP having larger effect sizes than the PedsQL among surgical groups.     

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.     

Health behaviors contribute to quality of life in patients with advanced heart failure independent of psychological and medical patient characteristics

Background

Little is known about the contribution of health behaviors to quality of life (QoL) in heart transplant candidates. We examined physical activity, dietary habits, psychological, and medical patient characteristics as correlates of QoL among patients enrolled in the multisite Waiting for a New Heart Study.

Method

QoL (Minnesota Living with Heart Failure Questionnaire), demographic variables, psychological variables (e.g., depression, coping styles), and health behaviors (physical activity, dietary habits) were assessed in 318 patients (82 % male, 53 ± 11 years) at the time of wait-listing and analyzed in 312 patients (excluding six underweight patients). Eurotransplant provided BMI and medical variables to compute the Heart Failure Survival Score (HFSS). Hierarchical multiple regression models were used to assess the independent contribution of health behaviors to QoL.

Results

The HFSS was unrelated to QoL. As expected, psychological characteristics (depression, anxiety, vigilant coping style) contributed to impaired QoL, accounting for 22.9, 35.9, and 12.9 % of the variance in total, emotional, and physical QoL, respectively. Physical inactivity further impaired QoL (total: 4.1 %, p < 0.001; physical: 7.4 %, p < 0.001). Dietary habits typically considered as unhealthy (i.e., infrequent consumption of fruits/vegetables/legumes; frequent intake of foods high in saturated fats) were related to enhanced physical QoL, but only among the overweight and obese patients.

Conclusion

Lifestyle interventions to modify negative emotions and to increase physical activity could help to improve QoL in heart transplant candidates, regardless of their disease severity. The role of eating habits in QoL among obese and overweight patients needs further exploration.     

Determinants of quality of life in community-dwelling older adults: comparing three cut-offs on the excellent-to-poor spectrum

Purpose

The aim of this study was to identify modifications in health, economic and social determinants of quality of life (QoL) in community-dwelling older adults when using different cut-offs to defining favorable QoL.

Methods

Data of year 2011 annual assessment in 1003 older men and women from the Lc65+ cohort study were used. Overall QoL was self-rated as ‘excellent,’ ‘very good,’ ‘good,’ ‘fair,’ or ‘poor.’ To identify significant health (self-rated health, SF-12v2 physical and mental health), economic (financial situation), and social (living with others, being socially supported, emotional support, group activities participation) determinants of QoL, a cut-off was set at three different positions to define favorable QoL on the ‘excellent’ to ‘poor’ spectrum: at least ‘good’ (model 1); at least ‘very good’ (model 2); and ‘excellent’ only (model 3).

Results

In all three models, bivariable analyses indicated significant associations between QoL and at least one variable from each health, economic, and social dimension. In multivariable analyses, only health-related variables remained significantly associated with QoL in model 1. Model 3 additionally retained financial situation. In model 2, QoL was positively associated with physical health [odds ratio (OR) 1.10, p < 0.001], mental health (OR 1.12, p < 0.001), self-rated health (OR 2.43, p < 0.001), group activities participation (OR 1.43, p = 0.037), being socially supported (OR 1.58, p = 0.024), and not reporting financial difficulties (OR 1.76; p = 0.036).

Conclusions

Using different cut-offs to defining favorable QoL results in important changes in the number and type of significant health, economic and social determinants. A cut-off between ‘good’ and ‘very good’ appears to best reflect the multidimensional nature of QoL.

     

Ten-year change in self-rated quality of life in a type 1 diabetes population: Wisconsin Epidemiologic Study of Diabetic Retinopathy

Purpose

To investigate a 10-year change of quality of life and associated factors in a population with type 1 diabetes.

Methods

The Medical Outcome Study Short Form-36 (SF-36) was administered in participants (n = 520) at the 1995–1996 and 2005–2007 examination phases of the Wisconsin Epidemiologic Study of Diabetic Retinopathy (WESDR). Physical (PCS) and mental (MCS) component summary scores were calculated. The associations between changes of quality of life and demographic, socioeconomic, and clinical factors were analyzed.

Results

PCS score decreased (p < 0.001) and MCS score increased (p < 0.001) after 10 years. The development of cardiovascular disease and the presence of limb amputation were associated with decrease in the PCS score. Those who were working and retired had increased MCS; those who were working and stopped had a decrease in the MCS score. Change in visual acuity and diabetic retinopathy status did not have a significant impact in health-related quality of life scores.

Conclusions

Our findings reinforce the necessity to make every attempt to decrease complications of diabetes in individuals with long-term type 1 diabetes in order to attenuate the diminished quality of life associated with those complications such as cardiovascular disease. Change in employment status, likely due to development of these complications, was also strongly associated with poorer quality of life and suggests the benefits of preventing or decreasing complications to keep people with type 1 diabetes in the workforce.     

Reliability and validity of the Thai version of the Pediatric Quality of Life Inventory 4.0

Purpose

The study aimed to evaluate the reliability and validity of the Thai version of the Pediatric Quality of Life Inventory? 4.0 Core Scales (PedsQL) as a measure of health-related quality of life (HRQOL).

Methods

The PedsQL items were completed by 2,086 pupils aged 8–15 years and 1,914 parents from four schools, and 100 pediatric outpatients and 100 parents from a University Hospital. Test–retest reliability was conducted in a randomly selected of 150 pupils at a 1-month interval.

Results

Internal consistency reliability for the Total Scale score (α = 0.84 self-report, 0.88 proxy-report), Physical Health Summary score (α = 0.76 self-report, 0.79 proxy-report), and Psychosocial Health Summary score (α = 0.74 self-report, 0.85 proxy-report) exceeded the minimum reliability standard of 0.70. School children had significantly higher mean HRQOL scores compared to those with chronic health conditions for all subscales with the mean differences of 3.1–12.4 for self-report (p < 0.03) and 7.7–15.6 for proxy-report (p < 0.001). Test–retest reliability showed intraclass correlation coefficients above 0.60 in all subscales (p < 0.001).

Conclusions

The Thai version of PedsQL had adequate reliability and validity and could be used as an outcome measure of HRQOL in Thai children aged 8–15 years.     

Relationship between implantation of missing anterior teeth and oral health-related quality of life

Purpose

The aim of the present study was to investigate the relationship between anterior teeth implantation and oral health-related quality of life (OHRQoL).

Methods

Participants completed the Chinese version of the Oral Health Impact Profile-14 (OHIP-14) prior to implantation and at 6 months following crown restoration. Participant demographic information was recorded. Six months following implant crown restoration, participants were asked to self-assess their overall oral health and implant restoration. A Kruskal–Wallis test and Spearman correlation test were used for statistical analyses. A p value <0.05 was considered statistically significant.

Results

A total of 238 patients (133 women and 105 men) completed the study. OHP-14 scores were negatively correlated with self-assessment of both overall oral health (r = ?0.788, p < 0.001) and implant restoration (r = ?0.739, p < 0.001) after implant crown restoration. There were no significant differences between qualitative reasons for dissatisfaction or between quantity of reasons given for dissatisfaction (p = 0.845). Six months following crown restoration, the overall OHIP-14 scores and the four common factors (disability, psychological discomfort, functional limitation, pain, and discomfort) decreased significantly compared to preimplantation scores (p < 0.001). From the paired differences between genders before and after implantation, significant differences were observed in overall quality (p = 0.044) and disability (p = 0.029). Patients with a higher education level scored significantly higher on overall quality of life (p = 0.031) and psychological discomfort (p = 0.002) following crown restoration.

Conclusions

Our findings indicate that the implantation of anterior missing teeth could significantly improve patient OHRQoL. Gender and education level were shown to affect implantation results.     

Effect of aerobic exercise on quality of life in population with diabetic peripheral neuropathy in type 2 diabetes: a single blind,randomized controlled trial

Objective

To evaluate the effect of 8-week moderate intensity aerobic (heart-rate reserve 40–60 %) exercise on neuropathy quality of life in type 2 diabetes.

Methods

A single blind, parallel-group, randomized controlled trial was carried out in a tertiary setting. People with type 2 diabetes were eligible for the study if they had clinical neuropathy which was defined by a minimum score of seven on the Michigan diabetic neuropathy score. Following which, the patients were randomly assigned to an 8-week program by a computer-generated random number tables to intervention or control group. Repeated measure analysis of variance was used for data analysis (p < 0.05 was considered significant).

Results

There were 47 participants in the control group and 40 participants in the study group after randomization but 37 from the control group and 29 from the intervention group completed the final analysis. The two groups had a significant difference, pre–post intervention in scores of pain (F = 7, p = 0.01), sensory symptoms (F = 4.60, p = 0.04), restricted activities of daily living (F = 4.97, p = 0.03), disruptions in social relationships (F = 5.43, p = 0.02), specific impact on quality of life (F = 9.28, p < 0.001) overall quality of life (F = 28.72, p < 0.001), and total score (F = 31.10, p < 0.001). Degrees of freedom for all the components were 1, 62.

Conclusion

Moderate intensity aerobic exercise is cornerstone in improving the quality of life of individuals with peripheral neuropathy in type 2 diabetes.     

Effects of ergonomic intervention on work-related upper extremity musculoskeletal disorders among computer workers: a randomized controlled trial

Purpose

The aim of the study was to determine effects of ergonomic intervention on work-related upper extremity musculoskeletal disorders (WUEMSDs) among computer workers.

Methods

Four hundred computer workers answered a questionnaire on work-related upper extremity musculoskeletal symptoms (WUEMSS). Ninety-four subjects with WUEMSS using computers at least 3 h a day participated in a prospective, randomized controlled 6-month intervention. Body posture and workstation layouts were assessed by the Ergonomic Questionnaire. We used the Visual Analogue Scale to assess the intensity of WUEMSS. The Upper Extremity Function Scale was used to evaluate functional limitations at the neck and upper extremities. Health-related quality of life was assessed with the Short Form-36. After baseline assessment, those in the intervention group participated in a multicomponent ergonomic intervention program including a comprehensive ergonomic training consisting of two interactive sessions, an ergonomic training brochure, and workplace visits with workstation adjustments. Follow-up assessment was conducted after 6 months.

Results

In the intervention group, body posture (p < 0.001) and workstation layout (p = 0.002) improved over 6 months; furthermore, intensity (p < 0.001), duration (p < 0.001), and frequency (p = 0.009) of WUEMSS decreased significantly in the intervention group compared with the control group. Additionally, the functional status (p = 0.001), and physical (p < 0.001), and mental (p = 0.035) health-related quality of life improved significantly compared with the controls. There was no improvement of work day loss due to WUEMSS (p > 0.05).

Conclusions

Ergonomic intervention programs may be effective in reducing ergonomic risk factors among computer workers and consequently in the secondary prevention of WUEMSDs.     

Quality of life and self-esteem of persons with paraplegia living in São Paulo, Brazil

Purpose

To evaluate the quality of life (QoL) and self-esteem of paraplegic persons.

Methods

The sample consisted of 60 outpatients with traumatic paraplegia living in São Paulo, Brazil, from whom clinical and demographic data were obtained. QoL was assessed by the 36-item Short-Form (SF-36) health survey questionnaire, and self-esteem was measured by Rosenberg’s Self-Esteem (RSE) scale. Statistical analysis was performed using Student’s t-test, analysis of variance and Fisher’s least significant difference (LSD) test at a significance level of 5%.

Results

Participants were predominately men (86.7%) with a mean age of 32.9 (standard deviation [SD] = 9.47) years, low education level and low income. The SF-36 dimensions that received the lowest scores were physical functioning, role physical and role emotional. Cronbach’s alpha for the SF-36 questionnaire was 0.80. A significant statistical difference was found between the presence of pressure ulcers and low scores on mental health (P = 0.001), as determined by Student’s t-test. The mean self-esteem score was 8.35 and there was a significant statistical difference between low self-esteem scores and occupation (P = 0.008).

Conclusion

Participants reported low QoL and self-esteem. The results provide background information that may be useful in the development of strategies to reduce the impact of spinal cord injury (SCI) on the life and health of persons with SCI, improving their QoL.     

Validity of the FACT Hepatobiliary (FACT-Hep) questionnaire for assessing disease-related symptoms and health-related quality of life in patients with metastatic pancreatic cancer

Purpose

Evaluate reliability and validity of the Functional Assessment of Cancer Therapy-Hepatobiliary (FACT-Hep) questionnaire and its derivative FACT Hepatobiliary Symptom Indexes (FHSI-18 and FHSI-8) in people with metastatic pancreatic cancer.

Methods

Self-reported questionnaire data from a randomized controlled Phase II study evaluating the efficacy and safety of conatumumab (AMG 655), ganitumab (AMG 479) or placebo combined with gemcitabine were evaluated. The following were assessed: internal consistency, using Cronbach’s α; discriminant validity, comparing baseline patient-reported outcomes (PRO) scores across Eastern Cooperative Oncology Group (ECOG) performance status (PS) levels; and ability to detect change, comparing change from baseline PRO score at each cycle across PS and tumour response groups.

Results

The analysis included 96 patients. All scale scores demonstrated good internal consistency (Cronbach’s α > 0.7) and discriminant validity. Baseline scores were significantly poorer among patients with PS = 1 versus patients with PS = 0 (e.g. difference in FACT-Hep total score ?17.27; p < 0.001). Ability to detect change was established for Cycles 2/3 versus baseline; PRO scores reduced in the PS-worsened group versus the PS-stable group (e.g. difference in FACT-Hep total score ?24.29; p < 0.001). All PRO scale scores showed significant decline for progressive disease versus stable disease (e.g. difference in FACT-Hep total score ?12.58; p = 0.004). Changes on the FHSI-18 and FHSI-8 scales were similar in magnitude whether ECOG improved or worsened.

Conclusions

FACT-Hep detects change and is a reliable and valid instrument for measuring health-related quality of life in patients with metastatic pancreatic cancer.     

Association of patient demographics on quality of life in a sample of adult patients with cardiac arrhythmias

Purpose

Identify predictors of quality of life (QOL) in patients with any form of cardiac arrhythmia (CA).

Methods

Data from the Medical Panel Expenditure Survey were analyzed from 2004 to 2009. Patients aged ≥18 with any form of CA (identified via ICD-9-CM codes) were included. Primary outcomes included the physical and mental component scores (PCS and MCS) of the Short-Form 12 version 2 (SF-12) and EuroQoL-5D (EQ-5D) utility scores (US version). Patient demographics included insurance status, urban status, geographical region, federal poverty level, education, comorbidities, and disease-related risk factors of CA.

Results

Approximately 5,750,440 individuals had CA. Non-Hispanic Whites had the highest SF-12 MCS (mean 50.9; p < 0.001 across racial groups) and utility scores (mean 0.76; p < 0.001 across racial groups). Patients with both private and public insurance had significantly higher PCS (p = 0.001) and MCS (p < 0.001) in comparison with patients only covered by public insurance. Patients on antiarrhythmic agents had higher SF-12 MCS (51.4 vs. 48.4; p < 0.001) compared to individuals not on antiarrhythmic agents.

Conclusions

Significantly lower QOL existed in specific subpopulations (e.g., patients with only public health insurance, racial/ethnic minorities, and those not exposed to antiarrhythmic agents) within the CA population.     

The impact of taste and smell alterations on quality of life in head and neck cancer patients

Purpose

Taste and smell alterations (TSAs) are among the most frequent and troublesome symptoms reported by head and neck cancer (HNC) patients after treatment. Little is known about the relationship between TSAs and quality of life (QoL) among HNC patients. The aim of this study was to determine the effect of TSAs on overall QoL among tube-fed and orally fed HNC patients before treatment, at end of treatment and at 2.5-month follow-up.

Methods

Data were collected in a longitudinal study prior to treatment (n = 126), at end of treatment (n = 100) and at 2.5-month follow-up (n = 85). Chemosensory Complaint Score (CCS) and the University of Washington Quality of Life Questionnaire version 3 were used to assess TSAs and QoL, respectively. Generalized estimated equation modeling was used to estimate the effect of CCS on QoL.

Results

At end of treatment, QoL and CCS had declined for both tube-fed and orally fed patients and thereafter improved, but not to pre-treatment levels. Neither QoL nor CCS mean scores were different between the two groups at any time point. CCS was a significant predictor of overall QoL (β = ?1.82, p < 0.0001), social-emotional (β = ?1.76, p < 0.0001), physical (β = ?1.12, p < 0.0001) and overall functions (β = ?1.15, p < 0.0001) at a multivariate level. Taste was reported as an important symptom for both tube-fed and orally fed groups at end of treatment and follow-up.

Conclusions

TSAs are an important symptom and an independent predictor of QoL for both tube-fed and orally fed HNC patients. HNC patients need support to manage TSAs, regardless of the method of nutritional intake.

     

Validity of self-reported BMI in older adults and an adjustment model

Study objectives

To determine reporting bias of self-reported vs. measured anthropometrics (body weight, height, body mass index, BMI), and to adjust self-reported BMI regarding the bias.

Methods

We compared self-reported with measured anthropometrics utilizing 659 control persons (age mean 68; range 37 to 80 years) from a case-control stroke study. The Bland-Altman approach examined the agreement between self-reported and measured values. A linear model was applied to correct the bias dependent on sex, age and self-reported BMI.

Results

Under-reporting of weight and over-reporting of height was found. On average, this resulted in lower self-reported BMIs by 1.0 kg/m² in men, 1.2 kg/m² in women (p?<?0.001). Bias correction of self-reported BMIs was derived from self-reported BMI (p?<?0.001), age (p?<?0.001), age-BMI interaction (p?<?0.001) and sex (p?<?0.05). Under-estimation of correct BMI resulted in the under-estimation of an overweight prevalence, with relatively low sensitivity regarding self-reported values (88 %). Our estimates should be recalibrated, if applied to other studies.

Conclusion

Self-reported anthropometric measures are systematically biased despite high correlations with measured values. A correction removes the average bias and improves accuracy.     

The effects of anxiety sensitivity,pain hypervigilance,and pain catastrophizing on quality of life outcomes of patients with chronic pain: a preliminary,cross-sectional analysis

Purpose

In the fear-avoidance model (FAM) of chronic pain, pain-related fear is one of the most prominent predictors of negative adjustment outcomes. While existing data point to the effects of anxiety sensitivity, pain hypervigilance, and pain catastrophizing on pain-related fear, the nature of their multivariate relationships remains unclear. This study explored the possible mediating role of pain hypervigilance in the relationship of anxiety sensitivity and pain catastrophizing with pain-related fear, and their effects on quality of life (QoL) outcomes within the FAM framework.

Methods

A sample of 401 Chinese patients with chronic musculoskeletal pain completed the standardized measures assessing the FAM components and QoL. Structural equation modeling (SEM) was used to evaluate six hypothesized models.

Results

Results of SEM showed adequate data-model fit [comparative fit indexes (CFIs) ranging from 0.92 to 0.94] on models which specified pain hypervigilance as mediator of anxiety sensitivity and pain catastrophizing with pain-related fear on two QoL outcomes (QoL-Physical and QoL-Mental). Results consistent with net suppression effects of pain catastrophizing on anxiety sensitivity were found in SEM when both anxiety sensitivity and pain catastrophizing were included in the same full model to predict QoL-Physical (CFI = 0.95; Sobel z = 8.06, p < 0.001) and QoL-Mental (CFI = 0.93; Sobel z = 8.31, p < 0.001).

Conclusions

These cross-sectional analyses gave results consistent with pain hypervigilance, mediating the relationship of pain catastrophic cognition and anxiety sensitivity with pain-related fear. The net suppression effects of pain catastrophizing point to anxiety sensitivity, enhancing the effect of pain catastrophic cognition on pain hypervigilance. These findings elucidate how the interdependence of dispositional factors might influence pain adjustment and functioning.     

Antioxidant and inflammatory response following high-fat meal consumption in overweight subjects

Purpose

Postprandial metabolic stress as a consequence of ingestion of high-energy meals is recognized as an important risk factor for cardiovascular disease. The objective of this study was to evaluate the inflammatory and antioxidant response of the body to the acute ingestion of a high-fat meal (HFM).

Methods

Fifteen healthy overweight subjects were recruited for the study. After HFM consumption, plasma glucose, insulin, uric acid (UA), triglycerides (TG), total cholesterol (TC), thiols (SH), inflammatory cytokines (IL-6 and TNF-α) and dietary antioxidants were measured at 0, 0, 5, 1, 2, 4, 6 and 8 h points from ingestion.

Results

The ingestion of HFM induced significant increases in both TG and TC, with peaks at 4 h (p < 0.001) and 8 h (p < 0.01), respectively. IL-6 and TNF-α significantly increased postprandially, reaching maximum concentrations 8 h after meal consumption (p < 0.001). Whereas plasma concentrations of vitamins and carotenoids were not changed by HFM, SH and UA increased, peaking 2–4 h postingestion (p < 0.001 and 0.01, respectively). Increments of SH and UA were positively correlated with AUC for TG (Pearson coefficient 0.888, p < 0.001 and 0.923, p < 0.001, respectively).

Conclusions

Present results indicate that as a consequence of an excess of dietary fat, the body responds through an inflammatory reaction, which is accompanied by an increment of endogenous antioxidant defenses, mediated by UA and SH, but not by vitamins C and E and carotenoids. Although further studies are needed, results of the current investigation represent novel findings on endogenous strategies of redox defense from fat overloads.     

Direct Medical Cost and Glycemic Control in Type 2 Diabetic Saudi Patients

Background

The prevalence of diabetes mellitus continues to increase globally. Furthermore, it is projected that healthcare expenditure on this epidemic will mount to US$490 billion in 2030. Information on the economic burden of diabetes care in Saudi Arabia is largely lacking.

Objectives

This retrospective observational study evaluated the direct medical cost of type 2 diabetes mellitus (T2DM) in a Saudi population in relation to glycemic control at a governmental institution from a payer’s perspective.

Methods

Three hundred subjects attending a university hospital were classified into three groups (n = 100 each) based on HbA1c values to <7 %, 7–9 %, and >9 %. The total direct medical costs were calculated for drug therapy, diagnostic procedures, hospitalization, and outpatient visits. The year of valuation for the costings was 2010/2011.

Results

The total annual direct medical cost per group was found to be US$1,384.19 for HbA1c <7 %, US$2,036.11 for HbA1c 7–9 %, and US$3,104.86 for HbA1c >9 % (p < 0.001). There was also a statistically positive relationship in the total care cost of diabetic patients and the number of co-morbidities (p < 0.001). A direct association of the cost of medications that have been disbursed for diabetic patients and the medical specialty of the treating physician (r = 0.390; p < 0.0001), and the cost of laboratory analyses (r = 0.351; p < 0.0001), was observed as also between the cost of laboratory diagnosis and days of hospitalization (r = 0.478; p < 0.0001). Multivariate analysis showed that the relationship between HbA1c and total cost is independent of age and gender, while co-morbidities remain as a significant predictor for the total cost.

Conclusions

Collectively, the estimated direct annual medical cost of diabetes care in Saudi Arabia would be enormous. The current study offers more insight into the economic burden of diabetes on the country.