Subjective quality of life in severely disabled long-stay schizophrenic patients

In the controversy about severely chronic mental patients, who still reside in the psychiatric hospital after decades of deinstitutionalization, their quality of life (QoL) has become a main topic. On the basis of a critique of the dominant, mere standardized approach to QoL this method is compared with a qualitative approach in such a schizophrenic "residual" patient group (n = 144). While in the standardized approach a high level of subjective QoL could be found that correlated positively with the duration of hospitalisation, the open interviews yielded specific experiences of deficiencies. The appraisal of the quality of life especially of chronic or hospitalized patients is reconsidered.     

Sleep quality and quality of life among the elderly people

ObjectiveTo determine sleep quality and the quality of life of the elderly people.Materials and methodsThis study sample consisted of 187 elderly people. Data were collected with a personal information form, Pittsburgh Sleep Quality Index and Turkish Version of WHOQOL-BREF-quality of life scale.ResultsIt was found out that sleep quality of the elderly people was poor. It was noted that there was a close correlation between age and sleep quality and quality of life of the elderly people, and sleep quality and quality of life decreased as the age of the elderly people increased. It was explored that there was a significant difference between gender, marital status, educational status, the person with whom the elderly people lived, presence of a physical disease, diagnosis of a disease and sleep quality and quality of life (p < 0.05).ConclusionsThe elderly people have a low sleep quality and there is a close relationship between sleep quality and the quality of life. The quality of sleep should be continued by ensuring sleep hygiene among the elderly people and thus the quality of life should be increased.     

Pain affects the quality of life of neuropathic patients

Abstract The aim of this study was to verify the extent to which the presence of pain affects the quality of life (QoL) of neuropathic patients. The patients were selected in our Department of Peripheral Nervous System Diseases. We enrolled 120 consecutive patients with chronic polyneuropathy who had not received continuous pain therapy during the two months preceding study entry, and administered them the Total Neuropathy Score (TNS), the official Italian version of the SF-36 and the Italian Pain Questionnaire (QUID). Our main finding was that the QoL is affected not only by the presence of neuropathy, but also by the presence and intensity of pain: the physical aspect of the QoL correlated only weakly with the TNS, but pain was closely related to a worsening in this parameter; moreover, the mental domains of the SF-36 were only correlated with pain. Pain per se worsens the QoL of neuropathic patients, regardless of disease severity.     

Cumulative impact of comorbidity on quality of life in MS

Marrie RA, Horwitz R, Cutter G, Tyry T. Cumulative Impact of Comorbidity on Quality of Life in MS.
Acta Neurol Scand: 2012: 125: 180–186.

© 2011 John Wiley & Sons A/S. Background – Little is known about the impact of comorbidity on health‐related quality of life (HRQOL) in multiple sclerosis (MS). We investigated the association of comorbidity and health‐related HRQOL among participants in the North American Research Committee on Multiple Sclerosis (NARCOMS). Materials and Methods – In 2006, we queried NARCOMS participants regarding physical and mental comorbidities and HRQOL, using the Short‐Form 12. We summarized physical HRQOL using the aggregate Physical Component Scale (PCS‐12) score and mental HRQOL using the aggregate Mental Component Scale (MCS‐12) score. We assessed multivariable associations between comorbidity and HRQOL using a general linear model, adjusting for potential confounders. Results – Among 8983 respondents, the mean (SD) PCS‐12 was 36.9 (11.8) and MCS‐12 was 45.6 (11.6). After adjustment for sociodemographic and clinical factors, participants with any physical comorbidity had a lower PCS‐12 (37.2; 95% CI: 36.4–38.1) than those without any physical comorbidity (40.1; 95% CI: 39.0–41.1). As the number of physical comorbidities increased, PCS‐12 scores decreased (r = ?0.25; 95% CI: ?0.23 to ?0.27) indicating lower reported HRQOL. Participants with any mental comorbidity had a lower MCS‐12 (40.7; 95% CI: 39.8–41.6) than those without any mental comorbidity (48.5; 95% CI: 47.7–49.4). Conclusions – Comorbidity is associated with reduced HRQOL in MS. Further research should evaluate whether more aggressive treatment of comorbidities improves the HRQOL of MS patients.     

Association of factors influencing health-related quality of life in MS

As results regarding associative demographic and disease-specific factors on health-related quality of life (HRQoL) in patients with multiple sclerosis (MS) are partially inconsistent and contradictory, we reinvestigated this question on a large Austrian MS dataset. Patients received a questionnaire covering demographic and disease-specific characteristics and the Nottingham health profile (NHP) for assessing HRQoL. In order to estimate the risk for suboptimal HRQoL, adjusted odds ratios were calculated from logistic regression models including gender, age, expanded disability status scale (EDSS), disease course, disease duration and walking ability as covariates. The EDSS was the only factor contributing to both physical and mental dimensions (P < 0.001), whereas disease course, gender and age showed a significant effect on all physical, but not consistently on mental dimensions. The regression models fitting better for physical than for mental dimensions, clearly indicate a lack of explanation of demographic and disease-specific factors in these dimensions of HRQoL.     

The impact of disabilities on quality of life in people with multiple sclerosis

OBJECTIVE: People with Multiple Sclerosis (MS) experience lower levels of quality of life (QOL) than people from the general population. We examined the relative impact of MS-related disabilities on QOL. METHOD: Data were obtained from a sample of 530 patients who completed the Multiple Sclerosis Impact Profile (MSIP), a disability measure based on the International Classification of Functioning, Disabilities and Health (ICF) and two generic health-related QOL measures, the Medical Outcome study Short Form Questionnaire (SF-36) and the World Health Organization Quality Of Life-BREF (WHOQOL-BREF). The impact of disabilities on QOL was estimated using hierarchical multiple regression analyses after controlling for the clinical course of MS. RESULTS: Disabilities contributed to a unique and substantial extent to QOL variance. "Impairments in mental functions" was the most important QOL predictor. "Fatigue" showed the highest prevalence and severity scores, while the impact on QOL was limited. The estimated impact on QOL appeared to be dependent on the applied QOL measure: the WHOQOL-BREF was sensitive to disabilities related to all four ICF components, while the SF-36 was only sensitive to disabilities belonging to the 'body functions' and 'activities' components. CONCLUSION: Treatment programmes should target impairments in cognitive functioning, emotional functioning and sleep. Interventions are best evaluated using the WHOQOL-BREF.     

老年人生活质量与心理健康的相关性研究

目的　了解老年人的生活质量与心理健康水平的相关性 ,为老年人的心理卫生服务提供目标依据。方法　采用一般情况问卷、生活质量综合评定问卷、症状自评量表 (SCL 90 )对社区 6 0岁以上老人 10 85人进行问卷调查。结果　老年人的生活质量与家庭关系、经济收入、躯体健康有关。而影响心理健康的因素依次有经济状况、躯体健康、社会支持、婚姻家庭、性别。结论　在社区服务中 ,不仅要重视老年人躯体疾病的防治 ,更要重视老年人的精神卫生教育和健康宣传。帮助老年人学会积极的心理防御能力 ,关心老人的生活起居和情感需求 ,最终提高老年人的生活质量     

Classroom interactions of mildly intellectually disabled children in special and regular classrooms

The nature and conduct of learning activities in reading and mathematics was surveyed in eight special classes for mildly intellectually disabled children, and eight regular classes, each of which contained a midly intellectually disabled child. It was found that the children attending special classes spent most instructional time in individualized activities whereas mildly intellectually disabled children in regular classes spent conspicuously little time in individualized activities. In all cases, the reading and maths programs were judged to be appropriate (by independent judges) for the mildly intellectually disabled children concerned, and the mode of interaction of the disabled children with both teachers and peers was similar in special and regular ciasses. While the percentage of individual learning time during which pupil interactions with teachers occurred, was lower for the special class pupils than for the disabled children attending regular classes, the special class pupils still spent substantially more actual individualized learning time interacting with their teachers than did their regular class counterparts. The findings provide some support for the continued usefulness of special classes (or resource-rooms) as a mode of special educational service delivery for mildly intellectually disabled children in New Zealand schools.     

A qualitative study of the health-related quality of life of disabled children

This qualitative study investigated what disabled children thought most important in their lives and examined how well their priorities are represented in KIDSCREEN, a generic health-related quality of life (HRQoL) instrument. Participants were a subgroup of families who had previously taken part in a study of quality of life and participation in children with cerebral palsy (CP) using KIDSCREEN. This subgroup was sampled purposively, using children's scores on KIDSCREEN and demographic characteristics. Twenty-eight children (15 males, 13 females; age range 8y 3mo-13y 5mo) and 35 parents were interviewed. Ten children were at Gross Motor Function Classification System Level I, 15 were at Levels II or III, and three were at Levels IV or V. Eleven children had unilateral spastic CP, 16 had bilateral spastic C P, and one child had dyskinetic C P. Interviews were audio-recorded and transcribed verbatim. The analysis was based on the constant comparative method and focused largely on the children's data, though the parent data were drawn upon to illuminate the children's data. Four overarching areas of HRQoL were identified: social relationships; home and school environment; self and body; and recreational activities and resources. These generally mapped well to the dimensions and items in KIDSCREEN. The precedence children gave to environmental, social, interpersonal, health, and functional concerns corresponded well with the balance of these items in KIDSCREEN. However, children had some specific priority areas that were not represented in KIDSCREEN. These included: relationships with family members other than parents; inclusion and fairness; home life and neighbourhood; pain and discomfort; environmental accommodation of needs; and recreational resources other than finances and time. We recommend that further consideration be given to inclusion of these areas in the assessment of HRQoL of disabled children.     

The quality of life of people with dementia and their family carers

Background: We aimed to identify factors associated with the quality of life (QoL) of 'persons with dementia' (PWDs) and their family carers. Method: Two-hundred and thirty dyads of PWDs and their family carers were included. The PWDs were assessed with the Neuropsychiatric Inventory (NPI-Q), two Activities of Daily Living (ADL) scales, the Cornell Scale and the QoL-Alzheimer's Disease scale (QoL-AD; self- and proxy-reported scores). The carers were assessed with the QoL-AD and the Geriatric Depression Scale. Results: Factors associated with self-reported QoL were depression (β = -0.26, p < 0.001) and impaired ADL (β = -0.26, p < 0.001) and with proxy-rated QoL were NPI (β = -0.18, p = 0.02), depression (β = -0.32, p < 0.001) and impaired ADL (β = -0.43, p < 0.001). Factors associated with QoL in carers living together with the PWDs were depression (β = -0.56, p < 0.001) and having a hobby (β = 0.19, p = 0.01), whereas depression was associated with QoL in those who lived separately from the PWD (β = -0.60, p < 0.001). Conclusion: Depression and impaired ADL were associated with the self- and proxy-rated QoL of the PWDs, whereas depression in the carers negatively affected their QoL.     

Determinants of quality of life in people with epilepsy in Serbia

PurposeThis study aimed at finding determinants of quality of life in people with epilepsy (PWE) living in Belgrade, Serbia.MethodIn this study, we recruited consecutive adults with epilepsy attending our outpatient department. Adult patients (age range: 18–65 years) of normal intelligence and without any progressive neurological disease or psychiatric disorder were included in the study. They completed the following questionnaires: QOLIE-31 Inventory (Serbian version), Beck's Depression Inventory-II, Beck's Anxiety Inventory, Symptom Check List-90, and Neurotoxicity Scale-II. Hierarchical multiple regression analysis was performed to assess the predictive effects of some factors on QOLIE-31 Inventory.ResultsThe mean QOLIE-31 score of 203 patients who completed the questionnaires was 70.64 ± 17.74. Sociodemographic factors (age, sex, education, and employment) did not significantly predict QOLIE-31 score. Significant determinants of quality of life were clinical characteristics – seizure severity and etiology of epilepsy – accounting for 30.9% of the variance, depressive and anxiety symptoms accounting for 42.8% of the variance, and cognitive effects of antiepileptic drugs, accounting for 1.5% above other variables.ConclusionsThe results suggest that seizure severity and etiology of epilepsy, depressive and anxiety symptoms, and cognitive adverse medication effects are main determinants of quality of life in this population of PWE.     

The relationship of plantar cutaneous sensation and standing balance post-stroke

Objectives: Stroke rehabilitation best practices recommend interventions to address individual deficits, guided by a comprehensive assessment to identify specific impairments. The relationship of motor impairments to balance has been well investigated, but the role of impaired plantar cutaneous sensation is less understood, despite the fact that 41% of individuals post-stroke have this deficit. The study objectives were to (1) characterize the relationship between plantar sensation and measures of standing balance control and (2) determine the threshold of sensory impairment related to balance impairment post-stroke.

Methods: Monofilament test scores, force plate measures of standing balance control and Berg Balance Scale (BBS) scores were extracted from 52 inpatient rehabilitation charts. Spearman correlations were conducted between sensation and balance measures. Receiver operator characteristic (ROC) analysis was completed to determine the monofilament score that best discriminates between individuals with impaired and unimpaired balance (as defined by variability of center of pressure [COP] in the mediolateral direction).

Results: Plantar sensation of the affected foot was correlated with anteroposterior COP variability in standing with eyes closed and BBS scores. ROC analysis determined that a monofilament cut-off of 4.31 log(mg) discriminated individuals with impaired balance with 73% sensitivity and 70% specificity.

Discussion: The present results suggest that plantar cutaneous sensation deficits contribute to balance impairment post-stroke. The monofilament cutoff score may help clinicians determine whether impaired plantar cutaneous sensation is a contributing factor to a patient’s balance deficits.     

The influence of comorbid depression on quality of life for people with epilepsy

The impact of depression on health-related quality of life (HRQOL) for people with epilepsy was evaluated using a postal survey that assessed HRQOL, depression, and seizure severity (N=501). QOLIE-89 scores were significantly reduced by comorbid depression (all P<0.0001) for all types of seizures. People with predominantly major, partial, and minor seizures had significantly poorer HRQOL if they had mild-moderate or major depression (all P<0.0001). People with any type of recent seizure had significantly poorer HRQOL in all domains than people who were seizure-free for 3 months. Differences between groups by depression category were clinically significant (>12 points). Depression (r=-0.72), seizure bothersomeness (r=-0.54), seizure severity (r=-0.37), and days disabled with seizures (r=-0.65) were significantly correlated with poorer HRQOL in all domains than found for nondepressed patients (all subscales P<0.0001). Clinical depression is significantly associated with poorer HRQOL among people with all types of seizures.     

Clinical approach to improve quality of life of disabled children: introductory remarks

This symposium, discussed clinical approaches to improve the quality of life for severely disabled children including the management of feeding and breathing problems, school life and grief care. Pediatric neurologists should be health care professionals for them, consider improving their quality of life at both home and school, help them to decide which information from different professionals is appropriate. In order to improve their quality of life, feeding and breathing problems are often the most important. Furthermore, we have to promote discussion and co-operation with school teachers, especially about so-called medical care.