Health-related quality of life, functional impairment, and healthcare utilization by veterans: veterans' quality of life study

OBJECTIVES: To describe the health status of veterans receiving care in a veterans integrated service network (VISN). DESIGN: Cross-sectional survey with prospective follow-up. SETTING: Former Upper Midwest VISN 13 (now a part of VISN 23), a regional Veterans Affairs (VA) network comprising five inpatient facilities and associated outpatient clinics. PARTICIPANTS: All veterans in VISN 13 who had at least one inpatient or outpatient encounter between October 1, 1997, and March 31, 1998. MEASUREMENTS: Health-related quality of life (HRQOL) assessed using subscales and component summaries from the 36-item short form for veterans (SF36-V), functional status assessed according to limitations in activities of daily living (ADLs), healthcare utilization assessed according to outpatient visits and hospitalizations, and death. RESULTS: Of 70,334 eligible veterans, 40,508 responded and reported baseline HRQOL significantly lower than that of the general U.S. population for the physical (35.6, P<.001) and mental (46.4, P<.001) component summary scores (PCS and MCS, respectively) of the SF36-V. Many reported complete inability or some difficulty in completing ADLs such as getting in and out of a chair (35.1%) and walking (45.3%). More than 58% indicated some degree of difficulty with at least one of the ADLs. In multivariate analysis, PCS and MCS were significantly associated with subsequent use of inpatient and outpatient care and with mortality. CONCLUSION: The low quality of life and associated high rates of health services utilization in VA patients imply a need for innovative strategies to improve the HRQOL and functional status of this population.     

老年急性髓系白血病化疗患者心理弹性与生活质量和情绪状态相关性研究

目的 探讨老年急性髓系白血病化疗患者心理弹性与生活质量和情绪状态相关性,为治疗该病症提供参考.方法 选取2017年6月-2020年6月在华西医院接受化疗的210例住院老年白血病患者作为研究对象,选用心理弹性量表(CD-RISC)、癌症患者生活质量量表(FACT-G)、正负性情绪量表(PANAS)、一般资料调查表对其进行...     

Impact of functional dyspepsia on quality of life

Little information on functional status and well-being is available in patients with functional gastrointestinal disease. We aimed to evaluate whether quality of life is poorer in patients with functional dyspepsia. A consecutive sample of 73 patients with functional dyspepsia completed a validated questionnaire prior to endoscopy. Organic disease controls comprised 658 outpatients attending endoscopy. Quality of life was measured using the validated Medical Outcomes Survey (which assessed physical, role, and social functioning; mental health; health perception; and any bodily pain) and the Brief Symptom Inventory (for current anxiety and depression); additional specific gastrointestinal items were also included. A stepwise logistic regression analysis was used to assess the association between diagnostic group and the quality of life measures, adjusting for potential confounders. Patients who reported more interruptions in their daily activities due to abdominal pain and who had fewer limitations of physical functioning were more likely to have functional dyspepsia (vs other disease,P<0.01). Mental health, social functioning, and health perception also tended to be poorer in functional dyspepsia. We conclude that quality of life may be more impaired in patients with functional dyspepsia than in patients with other conditions, who present for upper endoscopy.This work was supported in part by grant AG09440 from the National Institutes of Health.     

Health status and health-related quality of life associated with hemophilia

The hemophilias are a group of disorders associated with a chronic burden of morbidity and early mortality. Improvements in these adverse features have been achieved by the use of clotting factor concentrates within comprehensive centers of specialized care providing home infusion programs. Offsetting effects from transfusion-transmitted hepatitis and HIV infection are in recent decline. The net impact of these changes merits assessment. To test the a priori hypotheses that increasing severity of factor VIII deficiency would be associated with an increasing burden or morbidity and that hepatitis and HIV positivity would impair health status further, a cross-sectional study of a population-based cohort was undertaken in a regional hemophilia program in Ontario, Canada. A survey was made of mild, moderate, and severe hemophiliacs over 13 years of age who self-reported their health status using a standard 15-item questionnaire. The responses were converted to levels in the Health Utilities Index Mark 2 (HUI2) and Mark 3 (HUI3) health status classification systems to form multi-element vectors from which single-attribute morbidity and overall health-related quality of life utility scores were determined. The burden of morbidity was greater in hemophiliacs than in the general population and correlated with the category of disease (mild < moderate < severe). Hepatitis and HIV positivity conferred additional burdens of morbidity, which were mainly in the attributes of mobility (HUI2), ambulation (HUI3), and pain (HUI2/3), all of these differences reaching levels of statistical significance. Despite demonstrable improvements in the safety, effectiveness, and utilization of clotting factor concentrates, hemophiliacs continue to experience an important burden of morbidity. Measurement of this burden, as reported here, provides a basis for future economic evaluation of the costs and consequences of health care interventions provided to this population.     

Home-based exercise: promising rehabilitation for symptom relief,improved functional status and quality of life for post-surgical lung cancer patients

Background

Post-thoracotomy non-small cell lung cancer (NSCLC) patients report cancer-related fatigue (CRF) as a severe symptom that may increase the occurrence and severity of other symptoms while decreasing functional status and quality of life (QOL). The aim of this pilot study was to describe the effects of a home-based rehabilitative exercise intervention on CRF, other symptoms, functional status, and QOL for post-surgical NSCLC patients starting within days after hospital discharge.

Methods

Seven post-thoracotomy NSCLC patients completed the Brief Fatigue Inventory (BFI) measuring CRF severity, and the M.D. Anderson Symptom Inventory measuring symptom severity at pre- and post-surgery, and at the end of each week of the six-week intervention. Additionally, the Medical Outcomes Short-Form-36 measuring physical and mental functional status; and the Quality of Life Index (QLI) measuring QOL were completed pre- and post-surgery, after week 3, and at the end of the intervention (week 6).

Results

Participants had a mean age of 65 years, a mean of 6 co-morbid conditions, and initiated the intervention within 4 days after hospital discharge. Participants’ CRF severity scores were reduced to mild levels while the mean number of symptoms decreased from 10.4 post-surgery to 7.0 at week 6 with lower levels of severity and interference. Likewise, participants’ post-intervention functional status and QOL improved to near or above pre-surgical levels.

Conclusions

The exercise intervention for post-surgical NSCLC patients showed promising preliminary efficacy in improving CRF, other symptom severity, functional status, and QOL. Further testing via a two-arm randomized controlled trial is being conducted.     

The impact of severe haemophilia on the social status and quality of life among Austrian haemophiliacs

Summary.  Although many studies of the impact of haemophilia on the quality of life were conducted, there is hardly any data on the social status of haemophiliacs. It was the aim of our study to obtain data on the social status of Austrian haemophiliacs and to compare these with an age- and sex-matched reference population. Furthermore, we collected data on the quality of life of haemophilia patients. We conducted a case–control study in two Austrian haemophilia centres with 53 patients (mean age 36.7 ± 10.6 years) and 104 male controls (mean age 36.7 ± 11.1 years). Socio-demographic data were collected using a standardized questionnaire and quality-of-life data using the SF-36. More patients (56.6%) than controls (37.5%) were married ( P  = 0.023), whereas more controls (17.3%) than patients (3.8%) had a partner with whom they were not married ( P  = 0.016). The percentage having children was equivalent in both groups (47% and 41% respectively), but controls had more children (mean number 1.5 in patients and 2.1 in controls, P  < 0.007). A greater number of patients was unemployed (34% of patients, 9% of controls, P  < 0.001) as well as retired (23% and 4% respectively; P  < 0.001). Patients had worse scores regarding physical functioning, role-physical, bodily pain and general health ( P  < 0.001), whereas vitality, social functioning, role-emotional and mental health were similar in both groups. Despite their disability, most of the Austrian haemophiliacs share a sound family environment. This suggests that they are highly capable of coping with their chronic disease and is indicated by good scores for role-emotional and mental health.     

110例老年功能性胃肠病患者的生存质量评价

[目的]采用脾胃病PRO量表探讨老年功能性胃肠病患者的生存质量.[方法]采用横断面调查,前瞻性研究,对应用脾胃病PRO量表收集的110例合格老年功能性胃肠病患者、148例中青年功能性胃肠病患者和236例健康志愿者用ANOVA分析、t检验对脾胃病PRO量表各领域和总分进行了统计分析.[结果]老年患者组、中青年患者组、老年健康者组、中青年健康者组各组的ANOVA分析结果表明,生理、心理、社会环境、总体生存质量各领域间的差异均具有统计学意义（F=250.071、118.249、132.028、102.118,P=0.000、0.000、0.000、0.000）.在生理、心理、社会环境3个领域中,老年患者组的生存质量平均得分比老年健康者组的低（t=-15.064、-5.548、-5.657;P=0.000、0.000、0.000）,老年患者组的生存质量平均得分比中青年患者组的高（t=4.477、7.956、10.950;P=0.000、0.000、0.000）.总体生存质量,老年患者组的生存质量平均得分比老年健康者组的低（t=-8.945、P=0.000）,老年患者组的生存质量平均得分比中青年患者组的高（t=2.242、P=0.026）.在各领域中,老年患者各年龄段的生存质量平均得分差异无统计学意义.[结论]在生理、心理、社会环境3个领域以及总体生存质量评分,老年功能性胃肠病患者的生存质量明显下降,但比中青年患者的高.     

Health status and health-related quality of life of children with haemophilia from six West European countries

Summary.  A multicentre, international, cross-sectional study was carried out in the frame of field testing of the first haemophilia-specific quality-of-life (QoL) questionnaire (Haemo-QoL). The aim of this paper is to describe health status and health care and their impact on QoL in haemophilic children in Western Europe. Children aged 4–16 years with severe haemophilia without inhibitors were enrolled by 20 centres in France, Germany, Italy, the Netherlands, Spain and the United Kingdom. Clinical information was collected by the physicians with a medical documentation form. Health-related QoL (HRQoL) of children was assessed with Haemo-QoL, available for three age groups. Clinical data were available in 318 patients, 85.5% with haemophilia A. The mean age at first bleeding was 11 months, at first joint bleed 25 months. Functional joint impairments were found in 11.3%. Prophylaxis treatment was given to 66.7% of children in whom breakthrough bleeds occurred 0.4 times a month compared to 1.1 bleeds in children receiving on-demand treatment. A significantly higher factor consumption was found only in the two younger age groups of prophylaxis patients compared to on-demand patients. HRQoL was satisfactory in this cohort: young children were impaired mainly in the dimension 'family' and 'treatment', whereas older children had higher impairments in the so-called 'social' dimensions, such as 'perceived support' and 'friends'. Health care of children in Western Europe is progressively improving with a large diffusion of home treatment and prophylaxis. This provides a high level of health status and HRQoL, being better in haemophilic adolescents on prophylaxis.     

Effect of gastrointestinal reconstruction on quality of life and nutritional status after pylorus-preserving pancreatoduodenectomy

A total of 31 Japanese patients who underwent pylorus-preserving pancreatoduodenectomy from January 1998 through September 2000 were studied regarding quality of life and nutritional status before and within two months (short term) and six months to one year (long term) after surgery. Quality of life was estimated using a questionnaire consisting of 23 items (13 physical and 10 psychosocial domains). Nutritional status was assessed by body weight, hemoglobin concentration, serum concentration of albumin and cholesterol, and pancreatic function. These data were compared between 18 patients with end-to-end (Imanaga) and 13 with end-to-side (Traverso) gastrointestinal reconstruction. In both groups, physical quality of life scores dropped at short term, and then returned to the normal level at long term after operation, showing mostly parallel changes with the parameters of nutritional status. However, the scores of psychosocial conditions, which reflected the patients mental health, remained low even at long term in both groups. The values of these parameters showed no statistical difference between the two groups at each time point. Postoperative quality of life and nutritional status were not different between Imanaga and Traverso reconstructions after pylorus-preserving pancreatoduodenectomy and mental health care would be necessary for at least one year after operation in both groups.     

Effects of sustained audit/feedback on self-reported health status of primary care patients

PURPOSE: Because limited audit/feedback of health status information has yielded mixed results, we evaluated the effects of a sustained program of audit/feedback on patient health and satisfaction. METHODS: We conducted a group-randomized effectiveness trial in which firms within Veterans Administration general internal medicine clinics served as units of randomization, intervention, and analysis. Respondents to a baseline health inventory were regularly mailed the 36-Item Short Form (SF-36) and, as relevant, questionnaires about six chronic conditions (ischemic heart disease, diabetes, chronic obstructive pulmonary disease, depression, alcohol use, and hypertension) and satisfaction with care. Data were reported to primary providers at individual patient visits and in aggregate during a 2-year period. RESULTS: Baseline forms were mailed to 34,050 patients; of the 22,413 respondents, 15,346 completed and returned follow-up surveys. Over the 2-year study, the difference between intervention and control groups (as measured by difference in average slope) was -0.26 (95% confidence interval [CI]: -0.79 to 0.27; P=0.28) for the SF-36 Physical Component Summary score and -0.53 (95% CI: -1.09 to 0.03; P=0.06) for the SF-36 Mental Component Summary score. No significant differences emerged after adjusting for deaths. There were no significant differences in condition-specific measures or satisfaction between groups after adjustment for provider type, panel size, and number of intervention visits, or after analysis of patients who completed all forms. CONCLUSION: An elaborate, sustained audit/feedback program of general and condition-specific measures of health/satisfaction did not improve outcomes. To be effective, such data probably should be incorporated into a comprehensive chronic disease management program.     

营养状况与老年女性慢性心力衰竭生存质量相关性研究

目的探讨老年女性慢性心力衰竭(CHF)患者生存质量与营养状况的相关性。方法选取老年女性CHF患者120例,按照心功能分级(NYHA)分为Ⅱ级组34例、Ⅲ级组54例、Ⅳ级组32例,另选取老年女性健康体检者30例为对照组。收集各组血清血红蛋白、淋巴细胞绝对值,进行微型营养评定量表(MNA)和明尼苏达心力衰竭生存质量量表(MLHFQ)评分。结果Ⅱ级组、Ⅲ级组、Ⅳ级组患者存在营养不良风险和营养不良的总发生率明显高于对照组(67.7%,81.5%,100.0%vs 33.3%,P<0.01)。Ⅱ级组、Ⅲ级组、Ⅳ级组白蛋白和MNA评分及Ⅲ级组、Ⅳ级组血红蛋白水平明显低于对照组,外周水肿深度明显高于对照组(P<0.05)。Ⅳ级组外周水肿深度明显高于Ⅱ级组及Ⅲ级组,血红蛋白和MNA评分明显低于Ⅱ级组及Ⅲ级组(P<0.05)。MNA评分和外周水肿深度与MLHFQ评分相关(P<0.01)。MLHFQ评分与住院天数呈正相关(r=0.327,P<0.01)。结论老年女性CHF患者营养不良问题普遍存在。MNA评分和外周水肿深度对预测老年女性CHF患者生存质量有重要意义。     

Well-being (quality of life) in connection with hypertensive treatment

Quality of life is often considered to equate how the medical treatment is subjectively perceived by the patient, but ought to include the total impact of the disease/treatment on the patient's emotional, physical, and social well-being. Recently, a proposal for a generally applicable definition of quality of life in health care was put forward. This definition includes general well-being, health, and welfare (external factors), as three fundamental components, and the definition is based on both objective and subjective judgments. General well-being is exclusively and expression of the individual's subjective experience and is based on his or her own qualitative evaluation of well-being in relation to condition, treatments, and experiences. Health is according to the proposed definition, judged both objectively (signs) and subjectively (symptoms). Apart from health and well-being, there is also reason to include objectively registrable factors at the welfare level (external factors) such as the consumption of medicines, number of days in hospital, length of sick leave, need of in-home care, etc. This review is an attempt to elucidate the effects of antihypertensive pharmacotherapy on the patient's general well-being. The topic will be discussed from several points of views (e.g., aims of antihypertensive treatment, occurrence of symptoms in the population, compliance with prescribed treatment, symptom inventories, the concept of quality of life.     

Physical activity and quality of life in people living with HIV

As life expectancy in people living with HIV (PWH) has increased, the focus of management has shifted to preventing and treating chronic illnesses. Regular physical activity (PA) has been shown to reduce the impact of HIV on both physical and mental health. Our objectives were to assess the PA levels of PWH compared to HIV negative controls; investigate factors associated with PA; and determine the effect of PA levels on quality of life and mental well-being. We recruited 110 PWH and 110 HIV negative controls in this cross-sectional, single-centre study. Physical activity, quality of life and mental well-being were assessed using the rapid assessment of physical activity tool, EQ-5D-5L Questionnaire, and the Warwick-Edinburgh Mental Well-being Score. Binary logistic regression and multiple linear regression were used to identify factors associated with PA levels and mental well-being scores respectively. PWH were less likely to meet the WHO-recommended PA requirements compared to controls (50.0% vs. 64.5%; p?=?0.041) and had significantly lower mental wellbeing and quality of life scores. Additionally, in PWH higher PA levels were associated with improved self-rated quality of life scores (p?=?0.027). Our results suggest that targeted exercise programmes could have a beneficial effect on health status in PWH.     

Health status and health-related quality of life associated with von Willebrand disease

Von Willebrand disease (VWD) is the commonest inherited disorder of hemostasis and the majority of women with this disorder experience excessive uterine bleeding. Yet very little information is available on the health-related quality of life (HRQL) in individuals with VWD. To test the a priori hypotheses that these individuals will have poorer HRQL than members of the general population, and that this burden of morbidity will correlate with the severity of VWD, a cross-sectional study was undertaken of a population-based cohort in a regional hemophilia program in Ontario, Canada. A survey was made of individuals over 13 years of age with VWD who self-reported their health status using a standard 15 item questionnaire. The responses were converted to levels in the Health Utilities Index Mark 2 (HUI2) and Mark 3 (HUI3) health status classification systems to form multi-element vectors from which single attribute morbidity and overall HRQL utility scores were determined. As a group, individuals with VWD were shown to have poorer HRQL than members of the general population and those with Type 2 disease carried a greater burden of overall morbidity than those with Type 1 disorder. Morbidity was evident mainly in the attributes of emotion, cognition with pain. A striking difference was observed between males and females, with the latter having overall HRQL utility scores similar to those reported previously for HIV positive, severe hemophiliacs. It is possible that this remarkable burden of morbidity reflects chronic iron deficiency associated with menorrhagia. A national study has been proposed to address this likelihood as it offers an opportunity for effective therapeutic intervention (iron supplementation) with a concomitant gain in health status and HRQL.     

Impact of chronic obstructive pulmonary disease on respiratory status and quality of life in newly diagnosed patients with lung cancer

OBJECTIVE AND BACKGROUND: A significant proportion of patients with lung cancer have associated COPD, which is considered an independent risk factor and cause of morbidity and mortality. However, the effect of COPD on respiratory status and quality of life in lung cancer has not been evaluated. METHODS: Newly diagnosed patients with lung cancer were assessed at diagnosis before starting treatment, for detailed respiratory status, spirometry and World Health Organization-Bref Quality of Life questionnaire in Hindi (WHOQOL-Bref Hindi). RESULTS: One hundred and sixty patients were studied. Spirometry was abnormal in 92.7% patients, 42% had COPD, and the majority (88.6%) had advanced disease (stage III and IV). Patients scored poorly in all QOL domains, with social domain faring worst. Karnofsky Performance status (KPS) correlated significantly with all QOL domains. No significant differences were found in clinical profile, KPS, or QOL scores between patients with and without COPD. Chest pain and dyspnoea severity (assessed by Medical Research Council) grading and visual analogue scale correlated with physical QOL domain. CONCLUSION: Patients with lung cancer have a poor QOL that is affected by the severity of respiratory profile and KPS. The presence of COPD does not significantly affect QOL in lung cancer patients.     

Gastrointestinal symptoms in patients with liver cirrhosis: Associations with nutritional status and health-related quality of life

Objective. Gastrointestinal symptoms can lead to decreased food intake and thereby increased morbidity. There is a general lack of data on the prevalence of gastrointestinal symptoms and their potential association with malnutrition and health-related quality of life (QoL) in cirrhosis. Our aim was to prospectively evaluate gastrointestinal symptoms, malnutrition, and QoL in patients with cirrhosis. Material and methods. Two validated questionnaires were used to measure gastrointestinal symptoms (gastrointestinal symptom rating scale (GSRS)) and health-related QoL (SF-36) in 128 consecutive cirrhotics (mean age 57 years, Child-Pugh score 8.6, MELD score 13.2) at a tertiary referral center. The results were compared with those of controls from the general population. Nutritional status was assessed by anthropometry and estimation of recent weight change. Results. Compared to controls, cirrhotic patients showed higher gastrointestinal symptom severity (total GSRS score: 1.53, 95% CI 1.50–1.55 versus 2.21, 95% CI 2.04–2.38) and profound reductions in the SF-36 physical (47.0 95% CI 45.0–49.0 versus 37.9, 95% CI 35.7–40.1) and mental component summary scores (51.0 95% CI 49.0–53.0 versus 39.2 95% CI 36.7–41.6). There were no significant differences in any GSRS domain between patients with and those without malnutrition. Multivariate analysis showed that gastrointestinal symptom severity was associated with the Child-Pugh score (beta?=?0.10, r<0.05), daily lactulose use (beta?=?0.65, p<0.005), and the presence of gastrointestinal comorbidities (beta?=?0.51, p<0.05). Negative weight change (beta?=???0.72, p<0.05) and the SF-36 physical (beta?=???4.26, p<0.005) and mental (beta?=???4.53, p<0.005) summaries were independently related to gastrointestinal symptom severity. Conclusions. Patients with cirrhosis show increased severity of gastrointestinal symptoms, which are associated with recent weight loss and impaired health-related QoL. The severity of gastrointestinal symptoms seems to be related to the severity of cirrhosis.     

The impact of an adaptation course on health-related quality of life and functional capacity of patients with inflammatory bowel disease

Abstract

Background: Inflammatory bowel disease (IBD) has a substantial impact on patients health-related quality of life (HRQoL). In this study, we examined the impact of adaptation courses on HRQoL, psychological well-being, depression and number of sick-leave days of IBD patients.

Methods: The study recruited 142 IBD patients attending an adaptation course of 5–12 days. The courses were specially designed for IBD patients and included multidisciplinary information about IBD, peer support, group activities and encouragement for adequate physical exercise. The participants completed the study questionnaire at the beginning and the end of the course and after six and 12 months of follow-up. HRQoL was assessed with the generic 15-dimensional (15D) tool and depression with Beck’s Depression Inventory (BDI). Utilization of health care services and work absenteeism was also assessed. Visual analog scales were used for assessing psychological functioning.

Results: 15D, BDI scores and scores describing psychological well-being were significantly better at the end of the course when compared to baseline (15D 0.82 vs. 0.84, p?p?p?=?.01). No significant change in health care utilization or number of sick-leave days was observed.

Conclusion: Adaptation training appears to have a positive impact on the psychological well-being of IBD patients. Peer support appears to be an important factor.     

CIK细胞维持治疗40例晚期肺癌患者的免疫状况及生活质量的改善分析

目的探讨CIK细胞维持治疗40例晚期肺癌患者的免疫状况以及生活质量影响。方法选取2014年11月至2015年12月在我院接受治疗的40例晚期肺癌患者,按照随机数表法将40例患者分为观察组和对照组各20例,观察组患者采用CIK细胞维持治疗,对照组采用单纯化疗治疗,比较两组患者治疗效果。结果化疗后,观察组患者的免疫功能以及生活质量均高于对照组,两组患者进行比较,差异具有统计学意义(P0.05),观察组患者临床治疗效果良好。结论 CIK细胞维持治疗40例晚期肺癌患者,可以改善患者的免疫状况,提高患者的生活质量,临床疗效好,值得推广。