Quality of sleep and health-related quality of life in haemodialysis patients.

BACKGROUND: Sleep complaints are common in haemodialysis patients. In the general population, insomnia impacts negatively on health-related quality of life (HRQoL). The objective of this study was to examine the association between quality of sleep and HRQoL in haemodialysis patients independent of known predictors of HRQoL. METHODS: Quality of sleep was measured using the Pittsburgh Sleep Quality Index (PSQI) and HRQoL was measured using the Medical Outcomes Study 36-item Short Form (SF-36) in 89 haemodialysis patients. RESULTS: Sixty-three (71%) subjects were 'poor sleepers' (global PSQI >5). The SF-36 mental component summary (MCS) and physical component summary (PCS) correlated inversely with the global PSQI score (MCS, r = -0.28, P < 0.01; PCS, r = -0.45, P < 0.01). The PCS score also correlated with age (r = -0.24, P = 0.02), haemoglobin (r = 0.21, P = 0.048) and comorbidity (r = -0.40, P < 0.01), and mean PCS was lower in depressed subjects (26.2 vs 35.9, P = 0.02). Subjects with global PSQI >5 had a higher prevalence of depression, lower haemoglobin and lower HRQoL in all SF-36 domains. The global PSQI score was a significant independent predictor of the MCS and PCS after controlling for age, sex, haemoglobin, serum albumin, comorbidity and depression in multivariate analysis. CONCLUSIONS: Poor sleep is common in dialysis patients and is associated with lower HRQoL. We hypothesize that end-stage renal disease directly influences quality of sleep, which in turn impacts on HRQoL.     

Differences in health-related quality of life between elderly and younger patients on hemodialysis

BACKGROUND: It has been demonstrated that elderly patients have a great capacity of adaptation to renal replacement therapy (RRT). The aim of this study was to assess the health-related quality of life (HRQoL) of a cohort of patients at 3 and 12 months after the start of hemodialysis, searching for differences between elderly (aged>or=65 years) and younger (aged <65 years) patients. METHODS: This was a longitudinal prospective study of 93 patients starting RRT. HRQoL was assessed using the SF-36 health survey and the physical symptom dimension of the Kidney Disease Questionnaire (KDQ) at 3 and 12 months from the start of RRT. Physical component summary (PCS), mental component summary (MCS) and standardized scores, in which a lower score indicated lower HRQoL, by age and sex were obtained. RESULTS: Mean (SD) age was 66 years (12.26 years). At 3 months, differences between younger patients and elderly ones were statistically significant in the general health dimension, and at 12 months in physical functioning, role physical, general health dimensions and PCS, indicating less loss of HRQoL in elderly patients. At 3 months it was found that the functional state measured on the Karnofsky scale was independently associated with PCS (p=0.003), and hematocrit to MCS (p=0.036). At 1 year, PCS was independently associated with age (p=0.043) and Karnofsky score (p=0.039). CONCLUSIONS: Using scores standardized by age and sex, elderly patients had less loss of HRQoL in the physical aspects, than younger patients at 1 year from the start of hemodialysis.     

Assessment of health-related quality of life in patients treated with hemodialysis in Serbia: influence of comorbidity, age, and income

The importance of measuring health-related quality of life (HRQoL) in patients on maintenance hemodialysis (HD) is being increasingly recognized, but few studies, especially from the Balkan region, have addressed this issue. The aims of this study were (i) to evaluate HRQoL in an outpatient university-affiliated dialysis facility in South Serbia; (ii) to determine the effects of age, presence of comorbidity, primary kidney disease, dose of HD, and family income; and (iii) to make comparisons of the HRQoL in Serbian patients on chronic HD with that reported by others previously. The study enrolled 192 patients on HD for more than 3 months. Comorbidity was assessed using the index of coexistent diseases (ICED), including two subindexes: index of disease severity (IDS) and index of physical impairment (IPI). Patient's self-assessment of HRQoL was measured by the 36-item short form health survey questionnaire (SF-36), encompassing eight summary scales and two summary dimensions. Ten of the baseline variables had significant associations with parameters of HRQoL. Fitting these variables in linear regression models resulted in 41.9% variance for physical dimension of HRQoL (physical component summary score [PCS]), and 32.5% for mental dimension of HRQoL (mental component summary score [MCS]). However, statistically significant effect had only IDS, IPI, and age for PCS, and income of patients for MCS. We found that an increase in IDS score for one unit is associated with a decrease of PCS by 13.2%, and SF-36 score (total quality of life) by 15.2%. The increase of IPI score by one unit decreases PCS by 16.1% and SF-36 score by 17.5%. A 5-year increase in age is associated with a decrease of PCS by 3.1%, and SF-36 score by 3.8%. The monthly income increase of 10 euros per family member increases MCS by 5.2% and SF-36 score by 3.0%. HRQoL in patients on HD was found markedly impaired. Comorbid conditions have negative and statistically significant correlation with parameters of HRQoL, and could explain poor HRQoL to a remarkable extent. Older age and poor income substantially reduce HRQoL in HD patients.     

Health-related quality of life in patients on peritoneal dialysis in Serbia: comparison with hemodialysis

Abstract:  Patients' health-related quality of life (HRQoL) is an important indicator of the effectiveness of the medical care they receive. Patients who reach end-stage renal disease are older and have a considerable extent of comorbidity. The objectives of this study were (i) to evaluate HRQoL in patients at the initiation of continuous ambulatory peritoneal dialysis (CAPD) treatment (incident cohort) and in patients on long-term CAPD therapy (prevalent cohort), and (ii) to compare influence of comorbidity on HRQoL in CAPD and hemodialysis (HD) patients. In a cross-sectional study we enrolled 99 CAPD and 192 HD patients. HRQoL was assessed with the 36-item Short Form Health Survey Questionnaire (SF-36). HRQoL summary scales in both incident and prevalent groups of CAPD patients were similar for physical component summary score (PCS) and for mental component summary score (MCS). Generally, higher values were found in mental health domains in comparison to PCS. In the incident group of patients, 1 year of peritoneal dialysis treatment was associated with a slight improvement in both PCS and MCS, but statistical significance ( P  < 0.05) was found in the role-physical limitation (RP), bodily pain (BP), and vitality (VT) scales only. CAPD patients with the highest disease severity (Index of Disease Severity [IDS]-3) and physical impairment (Index of Physical Impairment [IPI]-2) scored significantly higher parameters of HRQoL than HD patients. Comorbidity had negative influence on HRQoL, but statistically significant correlation has been found in HD patients only. In conclusion, comorbid conditions had negative correlation with parameters of HRQoL in both CAPD and HD patients. One year after starting CAPD, patients reported better scores in some domains, especially in RP, BP, and VT scales. Assessment of HRQoL and comorbidity might be useful in clinical practice in the follow-up of patients treated with both CAPD and HD.     

Self-assessed quality of life in peritoneal dialysis patients.

BACKGROUND/AIMS: Studies comparing quality of life (QOL) between peritoneal and hemodialysis patients have yielded inconsistent results. Physical (PCS) and mental component summary (MCS) scales of Short Form 36 (SF-36) health survey are highly validated measures of self-assessed QOL. We sought to evaluate these indices in PD patients: (1) as measures of QOL, (2) predictors of QOL, (3) to study change in QOL over time, and (4) to compare QOL in PD vs. hemodialysis patients. METHODS: SF-36 questionnaires were administered every 3 months to patients over a 2-year period and PCS and MCS were calculated. Mean follow-up was 15.3 +/- 6.6 months for PD and 14.5 +/- 5.7 months for HD. RESULTS: Average PCS in PD (31.8 +/- 7.8) was lower than HD (36.9 +/- 9.8) (p < 0.02), while MCS was similar in the groups (p = NS). The prevalence of depression was 26.1% in PD and 25.4% in HD patients (p = NS). Serum albumin was the only significant predictor of PCS among PD patients and explained much of the decrease in PCS in them. The number of hospitalizations and in-hospital days were significantly lower for PD compared to HD patients (p < 0.05). PCS as well as MCS remained stable in both groups throughout the observation period. CONCLUSION: Self-assessed physical function is diminished, while mental function is similar in PD compared to HD patients. When corrected for serum albumin, this difference is eliminated. Over time, QOL in patients treated with PD remained stable.     

Impact of recent fracture on health-related quality of life in postmenopausal women.

The effect of fractures other than hip and spine on HRQoL in younger and older women has not been extensively studied. In a cohort of 86,128 postmenopausal women, we found the impact of recent osteoporosis-related fractures on HRQoL to be similar between women < 65 compared with those > or = 65 years of age. The impact of spine, hip, or rib fractures was greater than that of wrist fractures in both age groups. INTRODUCTION: Health-related quality of life (HRQoL) after vertebral and hip fractures has been well studied. Less is known about HRQoL after fractures at other sites. We studied the effect of recent clinical fractures on HRQoL, using Short Form-12 (SF-12). MATERIALS AND METHODS: This study included 86,128 postmenopausal participants in the National Osteoporosis Risk Assessment (NORA) who responded to two follow-up surveys during a 2-year interval. At each survey, they completed the SF-12 HRQoL questionnaire and reported new fractures of the hip, spine, wrist, and rib. The effect of recent fracture on HRQoL was assessed by comparing Physical Component Score (PCS) and Mental Component Score (MCS) means for women with and without new fractures at the second survey. Analyses were by fracture type and by age group (50-64 and 65-99) and were adjusted for PCS and MCS at the first survey. RESULTS: New fractures (320 hip, 445 vertebral, 657 rib, 835 wrist) occurring during the interval between the first and second follow-up surveys were reported by 2257 women. The PCS was poorer in both older and younger women who had fractured the hip, spine, or rib (p < or = 0.001). Wrist fractures had an impact on PCS in women < or = 65 years of age (p < 0.001), but not older women (p > 0.10). These differences in PCS by fracture status were similar to those reported for other chronic diseases such as asthma, chronic obstructive pulmonary disease (COPD), and osteoarthritis. MCS was less consistently changed by fracture status, but younger and older women with vertebral fracture (p < 0.004), older women with hip fracture (p < 0.004), and younger women with rib fracture (p < 0.004) had poorer MCS compared with those who did not fracture within their age cohort. CONCLUSIONS: Recent osteoporosis-related fractures have significant impact on HRQoL as measured by SF-12. The impact of recent fracture on HRQoL was similar for older and younger postmenopausal women. Fracture prevention and postfracture interventions that target the subsequent symptoms are needed for postmenopausal women of any age.     

Health-related quality of life in morbidly obese patients: effect of gastric bypass surgery

Background: The effect of gastric bypass on the health-related quality of life (HRQoL) of morbidly obese patients was investigated in a cross-sectional study. Methods: A postoperative group of 78 patients on average 13.8 years after gastric bypass was compared with a preoperative control group of 110 patients. The SF-36 was used to assess HRQoL. In preoperative patients, the SF-36 was self-administered, while in the postoperative group, telephone interviews were conducted. In the postoperative sample, multiple stepwise linear regression analyses were carried out to examine putative predictors of the physical (PCS) and the mental (MCS) composite scores of the SF-36. Results: Significant differences between the preand postoperative group were found for all subscales except Mental Health, in favor of the postoperative group. On average 13.8 years after gastric bypass, most of the sub-scales were similar to the US norm values. However, the Bodily Pain and the overall Physical Composite scale (PCS) scores were lower (more impaired) in the postoperative group compared with the US norms. Female patients, patients who were hospitalized since the surgery, and those who had lost less weight had more impaired values on the PCS and patients who reported binge-eating disorder (BED) at follow-up had more impaired values on the Mental Composite Scale (MCS) of the SF-36. Conclusion: HRQoL was significantly better in postoperative gastric bypass patients in comparison to a sample of preoperative patients. However, HRQoL, specifically the physical domain of the SF-36, was more impaired in long-term follow-up patients compared with US norm values. The reoccurrence of BED after surgery negatively influenced the mental domain of the SF-36.     

Self-assessed physical and mental function of haemodialysis patients.

BACKGROUND: Physical (PCS) and mental (MCS) component summary scales of the Short Form 36 (SF-36) health survey are validated measures of quality of life (QOL) and functional status. We sought to evaluate the PCS and MCS in haemodialyis patients as compared to the general population and other chronic diseases. METHODS: A cohort of 134 haemodialysis patients (mean age 60.9+/-14.3 years, males 63.4%, Caucasians 66.4%) was followed from January 1996 to December 1998 (mean follow up 14.5+/-5.7 months). SF-36 questionnaires were administered every 3 months and PCS and MCS were calculated. Results were compared to the general population and other chronic diseases. Correlators of PCS and MCS, change in QOL over time, and the correlators of this change were determined. RESULTS: Mean PCS was 36.9+/-8.8 and mean MCS was 47+/-10.7. Compared to the general US population, these represent a decline of 8.7+/-0.8 for PCS (P<0.0001) and 2.7+/-0.8 for MCS (P<0.001). PCS and MCS in end-stage renal disease (ESRD) were lower than in most other chronic diseases studied. Univariate correlators of PCS in haemodialysis patients included age, male sex, haematocrit, serum albumin, and severity of comorbid cardiac and pulmonary illnesses. Multivariate analysis demonstrated independent correlators of PCS to be male sex, serum albumin and severity of comorbid cardiac and pulmonary diseases. Univariate as well as multivariate correlators of MCS included: serum albumin, KT/V(urea), and status living alone. A trend analysis revealed that both PCS and MCS tended to decline in the initial months of dialysis but stabilized over time. Status living alone was a significant predictor of improvement in MCS by univariate as well as multivariate analysis. CONCLUSIONS: Self assessed physical and mental health of haemodialysis patients is markedly diminished compared to the general population and other chronic diseases.     

Quality of life and emotional responses in cadaver and living related renal transplant recipients.

BACKGROUND: The specific impact of transplantation on living related donor (LRD) and cadaver (CAD) kidney transplant recipients and their health-related quality of life (HQoL) has received little attention. This study examined the role of sociodemographic, medical and psychological factors in these two groups. METHODS: A total of 347 transplant recipients (76 LRD and 271 CAD patients) completed the Short Form 36 Health Survey and Transplant Effects Questionnaire. RESULTS: Overall, transplant patients showed satisfactory HQoL particularly with respect to emotional well being. HQoL levels were found to be equivalent in both transplant groups. ANCOVAs showed that LRD recipients expressed more guilt in relation to the donor (P<0.001). Multivariate analysis revealed that worry about the viability and functioning of the transplant alone predicted 15.1% of the variance in the SF-36 mental composite score (MCS) whereas age, income, comorbidities and time on dialysis explained 37.8% of the variance in the SF-36 physical composite score (PCS). Multiple regression analyses performed separately for LRD and CAD patients showed that predictors of MCS and PCS between the two groups were similar. CONCLUSIONS: Our results indicate that different forms of transplantation (LRD vs CAD) may lead to different emotional responses albeit with no apparent quality of life differences. In particular, feelings of guilt appear to be prominent in LRD transplantation.     

Organ quality and quality of life after liver transplantation

Not only is there a limited supply of organs for liver transplantation, but the quality of the available organs is not uniform. Risk factors such as donor age and cause of death are known to predict graft failure, but their impact on the recipient's quality of life (QOL) has not been reported. We sent a QOL survey to 299 adults at our institution who had received a liver transplant 1 to 7 years before the study. For the 171 patients (57%) who completed the Medical Outcomes Study Short Form 36 (SF-36), the mean Physical Composite Score (PCS) and the mean Mental Composite Score (MCS) were 61 and 66, respectively; the highest scores were for the Social Functioning subscale, and the lowest scores were for the Role Functioning/Physical and Energy/Fatigue subscales. The mean donor risk index (DRI) of the organs that the subjects received was 1.4 (range = 0.8-2.4). There was no correlation between the SF-36 scores and the DRI [there were changes of -4.8 and -2.8 in the PCS and MCS per unit increase in the DRI (P = 0.4 and 0.6, respectively)], even though we controlled for potential confounders such as age, sex, hospitalization before transplantation, the Model for End-Stage Liver Disease score at transplantation, years since transplantation, previous transplantation, and the Charlson comorbidity index. In conclusion, we found no association between organ quality and QOL after liver transplantation. If this finding is confirmed in prospective, multicenter studies, it will be useful in counseling patients about the decision to accept or not accept high-risk organ offers.     

Quality of life of patients with chronic renal allograft rejection and anemia

BACKGROUND: The treatment with recombinant human erythropoietin (rHuEPO) of anemia associated with renal insufficiency (RI) improves the health-related quality of life (HRQOL) of those patients. The objective of this study was to evaluate the HRQOL of patients with chronic allograft nephropathy (CAN) and anemia associated to RI, and the effect of rHuEPO treatment on the HRQOL. METHODS: This prospective study consisted of 17 kidney transplant patients with RI caused by CAN and anemia who received rHuEPO. The hemoglobin (Hb) target was 12 g/dL. Serum Hb, hematocrit (Hct) and creatinine clearance (CrCl) were collected. HRQOL was evaluated with the Kidney Disease Quality of Life Short-Form 36 (SF-36) questionnaire at the start, at the 3rd and 6th month and at the end of the follow-up. SF-36 scores (eight scales, physical component summary (PCS) and mental component summary (MCS) were standardized by age and gender using the Spanish population norms. The "effect size" was also calculated for each score. RESULTS: Hb and Hct statistically improved from the start to the 3rd month and to the end of the study (p<0.01). Although the CrCl remained stable during most of the follow-up, it worsened (p=0.002) around the 13th month. SF-36 scores at the beginning were worse than that of the general population. Three SF-36 scales statistically improved; role-physical, vitality and mental health. The effect size was moderate for pain (0.41), role-emotional (0.39) and MCS (0.42); and large for role-physical (0.65), vitality (0.81) and mental health (0.74). CONCLUSIONS: The poor HRQOL of patients with CAN and anemia improves with rHuEPO treatment, the effect size varying from moderate to large.     

Correlation between SF-36 and six-minute walk distance in liver donors

Objective

We employed the 36-item short-form health survey (SF-36) and 6-minute walk distance (6MWD) to assess the quality of life (QoL) of donors after living-donor liver transplantation (LDLT).

Methods

This longitudinal prospective study had data collection via an interview and test or a mailed survey. Fifty-one liver LDLT donors underwent testing before and after donation using the SF-36 questionnaire and 6MWD.

Results

The physical component summary (PCS) of the SF-36 declined (P < .0001) and the mental component summary (MCS) increased significantly (P = .04) at 1 month after donation. The 6MWD declined significantly at 2 weeks after donation (P < .0001). After standardization, there was a high correlation between PCS and 6MWD (r² = 0.766).

Conclusions

Liver donation had a moderate impact on donor physical status, but enhanced mental status. Similar decreasing trends were observed in 6MWD and PCS. After donation, real physical performance predicted PCS but not MCS.     

315例终末期肾病血液透析患者生活质量的调查分析

目的对315例血液透析患者的生活质量进行调查研究,确定相关影响因素,为采取措施提高患者的生活质量提供参考。 方法采用血液透析患者生活质量调查表对苏州市区3家三级甲等医院315例终末期肾病维持性血液透析患者进行调查。 结果多因素分析发现年龄大者生理健康得分(PCS)和总体健康得分(SF－6D)低(P<0.05),已婚或同居者的PCS、SF－6D、肾脏疾病总分(KDCS)比未婚或独居者高(P<0.05),随患者学历的增加,心理健康得分(MCS)、SF－6D和KDCS提高(P<0.05),有合并症者的MCS、KDCS较低(P<0.05),有并发症者的PCS亦较低(P<0.05)。PCS和SF－6D随透析龄的增加而降低(P<0.05),每周透析≤2次者SF－6D较低(P<0.05)。 结论影响苏州市血液透析患者生活质量的相关因素为年龄、婚姻状况、文化程度、合并症、并发症和透析龄,应采取措施对高危人群进行干预。     

Important determinants of quality of life in a peritoneal dialysis population in Turkey

Background: Patients' health-related quality of life (HRQoL) is an important indicator for predicting the effectiveness of treatment, morbidity, and mortality. The aim of this study was to determine the level of HRQoL and the most important factors affecting HRQoL in patients receiving peritoneal dialysis (PD). Methods: This cross-sectional study was performed with 156 patients, 30 of whom (19.2%) had automated PD (APD), were over 18 years of age, and were followed up at the Erciyes University Continuous Ambulatory Peritoneal Dialysis (CAPD) Unit during the previous year. HRQoL, depression, and fatigue were measured by means of the Short Form-36 (SF-36), Beck Depression Inventory (BDI), and Fatigue Severity Scale (FSS), respectively. Results: The mean mental component summary (MCS) score was 42.1 ± 11.9 and physical component summary (PCS) score was 39.1 ± 11.2, which was lower than MCS. Depression was the strongest predictor for both diminished mental (β = ?24.4, p < 0.001) and physical (β = ?16.5, p < 0.001) HRQoL. Fatigue was the next strongest predictor for diminished physical HRQoL only (β = ?7.74, p < 0.001). Depression and fatigue accounted for 37% of physical HRQoL impairment. Depression as a sole factor was responsible for 31% of mental HRQoL impairment. Age, hospitalization, total cholesterol, serum albumin levels, and Kt/V urea had affected the SF-36 in some domains score but not in all. Conclusion: HRQoL in our PD patients can be evaluated at a slightly poor level compared to the results of previous studies. Impaired HRQoL is more closely associated with depression and fatigue. Depression was the strongest predictor of both mental and physical HRQoL. Fatigue was the next strongest predictor for physical HRQoL only.     

Predicting quality of life six months after traumatic injury

BACKGROUND: Many factors are known to impact quality of life (QoL) after injury, but predictors of diminished QoL and the time course of recovery remain incompletely understood. This study examines predictors and correlates of QoL measured by the Short Form-36 (SF-36) one and six months postinjury. METHODS: Adults with nonneurologic blunt injury were prospectively enrolled. Demographic, injury, and socioeconomic data were collected. Patients were assessed with functional and psychologic measures. In all, 196 patients had 1-month data and 123 had 6-month data available. Scores were compared at each time point and also to population norms using t-tests. Multiple regression techniques were used to identify associations between the physical and mental component scores (PCS & MCS) of the SF-36 and patient characteristics. RESULTS: PCS scores improved significantly (32.8 +/- 0.9 versus 41.3 +/- 1.0, p < 0.05) whereas MCS scores (47.5 +/- 1.1 versus 47.2 +/- 1.1, p = NS) did not. Both remained significantly below population norms. Functional Independence Measure (FIM) at one month was predictive of PCS at 6 months. Posttraumatic stress disorder (PTSD) was predictive of lower MCS, and depression was associated with poor MCS. Injury Severity Score was not associated with PCS or MCS. CONCLUSIONS: Overall physical and mental QoL measured by the SF-36 remains significantly below population norms 6 months after traumatic injury. It is possible to identify patients at risk for diminished QoL early during recovery by screening for functional status, PTSD, social support, and depression. Interventions to address these areas should be further studied with respect to their impact on long-term QoL.     

Health-related quality of life of family caregivers of dialysis patients

BACKGROUND: This study aimed to evaluate the health-related quality of life (HRQOL) and burden on family caregivers of chronic dialysis patients and to analyze which factors were associated with it. METHODS: A cross-sectional multicentric study was carried out with 221 patient/caregiver pairs. General population Short Form 36 (SF-36) norms were used to estimate gender and age standardized physical component summary (PCS) and mental component summary (MCS) scores. The Duke-UNC Functional Social Support Questionnaire (FSS), the Zarit Burden Interview (ZBI), and sociodemographic and clinical data were also collected. RESULTS: The PCS and MCS of caregivers were slightly worse than that of the Spanish population. Multiple regression analysis showed that: (1) lower PCS was associated with younger age and higher ZBI of the caregiver (R2=0.15); (2) lower MCS was associated with higher ZBI and lower FSS of the caregiver, and lower MCS of the patient (R2=0.29); (3) higher ZBI was associated with lower FSS, PCS and MCS of the caregiver, and to older age and lower PCS and MCS of the patient (R2=0.49). Of caregivers 28.3% had a MCS < or = 42; logistic regression analysis showed that a MCS < or = 42 was associated to higher ZBI and lower FSS scores (p<0.001). CONCLUSIONS: The HRQOL of dialysis patient family caregivers is slightly worse than that of the Spanish population of the same age and gender. Younger family members, who are the primary carers of older dialysis patients with poor HRQOL, experienced a higher burden, had a worse HRQOL and had a higher risk of clinical depression; this was worse if low social support was perceived.     

Health-related quality of life one month after thrombolysis or primary PCI in patients with ST-elevation infarction. A DANAMI-2 sub-study

OBJECTIVES: To evaluate the health-related quality of life (HRQoL) following Primary percutaneous coronary intervention (PCI) or thrombolytic treatment for ST-elevation myocardial infarction (STEMI). DESIGN: A questionnaire based study on patients randomised in the DANAMI-2 study to Primary PCI or thrombolysis for STEMI. A total of 1 351 patients (93.2% response rate) randomised in the DANAMI-2 study completed the HRQoL questionnaire one month after the infarction. RESULTS: With respect to the primary end-points (SF-36 physical component score, angina pectoris, and dyspnoea), patients randomised to primary PCI scored better on the SF-36 physical component score (PCS) (p=0.007), and reported significantly less angina pectoris (p=0.010) and dyspnoea (p=0.010). Higher scores among PCI patients were also found on the SF-36 scales physical functioning (p=0.015), role-physical (p=0.017), and general health (p=0.009). CONCLUSION: The results in this study support the hypothesis that primary PCI is superior to thrombolysis in treating STEMI, not only in clinical outcome, but also in quality of life outcome.     

The association between mental health,physical function,and hemodialysis mortality

BACKGROUND: Mortality rates for individuals on chronic hemodialysis remain very high; therefore, strategies are needed to identify individuals at greatest risk for mortality so preventive strategies can be implemented. One such approach is to stratify individuals by self-reported mental health and physical function. Examining these parameters at baseline, and over time, may help identify individuals at greater risk for mortality. METHODS: We enrolled 14,815 individuals with end-stage renal disease (ESRD) and followed these individuals for up to 2 years. The mean age was 61.0 +/- 15.4 years (range, 20 to 96 years) and 31% were African Americans. The SF-36 Health Survey was administered 1 to 3 months after hemodialysis initiation and 6 months later. We examined the associations between the initial SF-36 Health Survey mental component summary (MCS) and physical component summary (PCS) scores and mortality during the follow-up period, and examined the associations between 6-month decline in PCS and MCS scores and subsequent mortality. We also examined the interactions between age and MCS and PCS scores. The general population-based mean of each of these scores was 50 with a standard deviation of 10. The main outcome measurement was death. RESULTS: Self-reported baseline mental health (MCS score) and physical function (PCS score) were both independently associated with increased mortality, and 6-month decline in these parameters was also associated with increased mortality. The multivariate hazard ratios for 1-year mortality for MCS scores of less than 30, 30 to 39, and 40 to 49 were 1.48 (95% CI, 1.32 to 1.64), 1.23 (95% CI, 1.14 to 1.32) and 1.18 (95% CI, 1.10 to 1.26) compared with a MCS score of 50 or more. The hazard ratios for PCS scores of less than 20, 20 to 29, and 30 to 39 were 1.97 (95% CI, 1.64 to 2.36), 1.62 (95% CI, 1.36 to 1.92), and 1.32 (95% CI, 1.11 to 1.57) compared with a PCS score of 50 or more. Six-month decline in self-reported mental health (hazard ratio, 1.07; 95% CI, 1.02 to 1.12, per 10-point decline in MCS score) and physical function (hazard ratio, 1.25; 95% CI, 1.18 to 1.33, per 10-point decline in PCS score) were also both significantly associated with an additional increase in mortality beyond baseline risk. We also found a significant interaction between age and physical function (P = 0.02). Specifically, there was a graded response between the PCS score category and mortality in most age strata, but this relationship was not observed in the oldest age (85 years old or older). CONCLUSION: In individuals newly initiated on chronic hemodialysis, self-reported baseline mental health and physical function are important, independent predictors of mortality, and there is a graded relationship between these parameters and mortality risk. Following these parameters over time provides additional information on mortality risk. One must also consider age when interpreting the relationship between physical function and mortality.     

The short form-12 and the measurement of health status in patients with cerebral aneurysms: performance, validity, and reliability

OBJECT: Cerebral aneurysms can affect a patient's health status by rupture and stroke, impingement on neural structures, treatment side effects, or psychological stress. The authors assessed the performance, validity, and reliability of the Short Form-12 (SF-12), a self-administered written survey instrument, to assess health status in patients with cerebral aneurysms. METHODS: A cohort of 170 patients with cerebral aneurysms who were seen at a neurosurgery clinic underwent structured interviews including measurement of their health statuses (SF-12 physical component summary [PCS] and mental component summary [MCS]), functional status (Glasgow Outcome Scale score, modified Rankin Scale score, and Barthel Index), and mental health (Hospital Anxiety and Depression Scale score). The SF-12 scores were compared with US population norms by performing t-tests with unequal variances. The validity of the SF-12 was assessed by comparing the PCS and MCS scores with each patient's functional status and mental health scores by using rank-order methods. Inter-item reliability was assessed using the Cronbach alpha statistic. Patients with cerebral aneurysms had decreased health status PCS and MCS scores when compared with population norms (p < 0.001 for all). A history of subarachnoid hemorrhage (SAH) (p = 0.006) and previous surgical or endovascular treatment (p = 0.047) was associated with worse PCS scores. The validity of the SF-12 was supported by the relationship between the PCS and MCS scores and the patient's functional status and mental health (p < 0.001 for all). The reliability of the SF-12 was documented by the Cronbach alpha statistic (alpha = 0.76). CONCLUSIONS: Patients with cerebral aneurysms have a diminished physical and mental health status as measured using the SF-12. The presence of SAH and aneurysm treatment are associated with a worse physical health status. The SF-12 is a valid and reliable instrument for measuring health status in patients with cerebral aneurysms.