A Comparison of SF-36 and SF-12 Composite Scores and Subsequent Hospitalization and Mortality Risks in Long-Term Dialysis Patients

Background and objectives: The Short Form 12 (SF-12) has not been validated for long-term dialysis patients. The study compared physical and mental component summary (PCS/MCS) scores from the SF-36 with those from the embedded SF-12 in a national cohort of dialysis patients.Design, setting, participants, & measurements: All 44,395 patients who had scorable SF-36 and SF-12 from January 1, 2006, to December 31, 2006, and were treated at Fresenius Medical Care, North America facilities were included. Death and first hospitalization were followed for up to 1 year from the date of survey. Correlation and agreement were obtained between PCS-36 and PCS-12 and MCS-36 and MCS-12; then Cox models were constructed to compare associated hazard ratios (HRs) between them.Results: Physical and mental dimensions both exhibited excellent intraclass correlation coefficients of 0.94. Each incremental point for both PCS-12 and PCS-36 was associated with a 2.4% lower adjusted HR of death and 0.4% decline in HR for first hospitalization (both P < 0.0001). Corresponding improvement in HR of death for each MCS point was 1.2% for MCS-12 and 1.3% for MCS-36, whereas both had similar 0.6% lower HR for hospitalization per point (all P < 0.0001).Conclusions: The use of the SF-12 alone or as part of a larger survey is valid in dialysis patients. Composite scores from the SF-12 and SF-36 have similar prognostic association with death and hospitalization risk. Prospective longitudinal studies of SF-12 surveys that consider responsiveness to specific clinical, situational, and interventional changes are needed in this population.The medical outcome survey Short Form 36 (SF-36) has been widely used and validated as a quality of life (QoL) assessment tool for the general population and in various subpopulations (1), including patients who have ESRD and are on dialysis (2–14). These studies have shown that physical (PCS) and mental component summary (MCS) scores from the SF-36 are significantly associated with clinical indicators (e.g., hemoglobin, albumin, dialysis dosage), morbidity, and mortality in the dialysis population, even after adjustment for case mix and other factors; however, Ware et al. (15) have since used regression methods to select 12 of the 36 items that are covered by the SF-36 to reproduce the PCS and MCS scores. The shortened questionnaire, known as the SF-12, required only one third of the usual time for completion of the SF-36, with the trade-off being loss of information from eight domain scores, namely general health, vitality, physical functioning, role-physical, bodily pain, social functioning, role-emotional, and mental health (1,16). Direct comparisons between both PCS-36 and PCS-12 and between MCS-36 and MCS-12 have indicated very good correlation and agreement in the general population (15,17), the elderly (18), and some specific subpopulations, including patients with rheumatoid arthritis (19) and ischemic stroke (20) and after myocardial infarction (21).The SF-12 has not been validated specifically for patients who are on long-term dialysis, although it was used in lieu of the SF-36 in two small studies (22,23). We also found a study that reported mean SF-12 component scores from 38 dialysis patients (from a larger cohort of patients with chronic kidney disease) as part of the recently developed Kidney Disease Quality of Life-36 (KDQoL-36) (24). Furthermore, information regarding any association between morbidity and mortality rates with SF-12 component scores in this population is lacking. This cross-sectional study aimed to measure agreement between the SF-36 and the embedded SF-12 in a large, contemporary, nationally distributed population of long-term dialysis patients. In addition, we compared implications of PCS and MCS derived from both methods on the basis of their respective associations with hazard rates for hospitalization and death.     

Quality of life in patients with chronic pancreatitis

INTRODUCTION: Health-related quality of life is becoming a major issue in the evaluation of any therapeutic intervention in patients with chronic or hard to cure diseases. AIMS: To assess the quality of life in patients with chronic pancreatitis, the majority of whom have had the disease for a long time, and to evaluate which factors linked to the disease are able to influence the quality of life. SUBJECTS AND METHODS: A total of 190 consecutive patients (157 males, 33 females; mean age 58.6+/-12.7 years, range 18-92 years) with proven chronic pancreatitis were enrolled. The SF-36 questionnaire was used for assessing the health-related quality of life. RESULTS: The z-scores of the eight domains of the patients with chronic pancreatitis were significantly negative indicating an overall impairment of the quality of life when compared to the Italian normative sample. Pancreatic pain was the unique clinical variable able to significantly impair all eight domains of the SF-36, while Wirsung dilation and diabetes were negatively related to some physical and mental domains. The body mass index was the unique variable positively related with some SF-36 domains. CONCLUSIONS: Pain may be considered the most important factor affecting the quality of life of chronic pancreatitis patients; moreover, alimentary and metabolic factors deserve more attention in improving the quality of life of these subjects.     

Reliability and validity of the Italian version of the Chronic Pain Grade questionnaire in patients with musculoskeletal disorders

The aim of this study is to analyse the psychometric properties of the Italian version of the Chronic Pain Grade (CPG) questionnaire within a population of chronic musculoskeletal pain patients. The CPG questionnaire was adapted following the translation and back-translation methodologies. There were 576 patients with chronic musculoskeletal pain. Internal consistency was checked by the Cronbach's alpha coefficient. Construct validity was analysed by performing principal component factor analysis and by comparing CPG dimensions and subscales with the SF-36 questionnaire. Discriminant validity was assessed by comparing the CPG and SF-36 dimensions in patients with and without other health conditions. Factor analysis yielded two factors which accounted for 76.4% of the variance of the questionnaire. Both subscales of the CPG showed satisfying to good internal consistency. Cronbach's alpha was 0.89 for the first factor 'Disability Score' (58.72% of the explained variance) and 0.81 for the second factor 'Characteristic Pain Intensity' (17.70% of the explained variance). Item-total correlations for the subscales were moderate up to high (from 0.500 to 0.771). In comparison with the SF-36, the expected correlations were found when comparing items measuring similar constructs, supporting the concepts of convergent construct validity. Discriminant validity, assessed by comparing the CPG dimensions in patients with and without other health conditions, showed that the CPG shows moderate association with the presence of co-morbidities. Furthermore, the CPG Disability Score was inversely correlated (p=0.01) to years of formal education. In conclusion, the Italian version of the CPG questionnaire has shown to be valid and reliable for evaluating the severity of chronic musculoskeletal pain, with metric properties in agreement with the original, widely used version.     

Limitations of the SF-36 in a sample of nursing home residents

OBJECTIVE: to assess test characteristics of the Medical Outcomes Study SF-36 (Short-Form 36) with residents of nursing homes. RESEARCH DESIGN: nursing home residents with 17 or more points on the Mini-Mental State Examination (MMSE) and > or = 3 months residence (128 of 552 screened) were selected randomly. Interviewers administered the SF-36 (repeated after 1 week), Geriatric Depression Scale and MMSE. We recorded activities of daily living and medication data from medical records. Data analysis included test-retest intraclass correlations, item completion, score distributions and SF-36 correlations with measures of physical and mental functioning. RESULTS: 97 nursing home residents (75.8%) consented. Test-retest intraclass correlation coefficients were good to excellent (range = 0.55 to 0.82). Convergent validity between SF-36 physical health scales and the activities of daily living index was modest (r range = -0.37 to -0.43). About 25% of residents scored zero (lowest score) on at least one SF-36 physical function measure. SF-36 mental health scales correlated strongly with the Geriatric Depression Scale (r range = -0.63 to -0.71) and modestly with bodily pain (r = -0.35). No SF-36 scales correlated strongly with the MMSE. CONCLUSION: only one in five nursing home residents met minimal participation criteria, suggesting limited utility of the SF-36 in nursing homes. Reliability and validity characteristics were fairly good. Skewed scores were noted for some SF-36 scales. The utility of the SF-36 may be limited to assessments of subjects with higher cognitive and physical functioning than typical nursing home residents. The SF-36 might benefit from modification for this setting, or by tests of proxy ratings.     

Characteristics and predictive value of quality of life in a French cohort of angina patients

The study of quality of life (QoL) in a French cohort of patients suffering from angina pectoris was one of the objectives of the ELAN longitudinal study. It concerned 3,954 subjects (76% males) mean age: 67 +/- 11 years, followed up by 613 cardiologists which were invited to complete a series of baseline sociodemographic and clinical data and to answer a series of questions upon one year outcome (3,261 medical records available). QoL was assessed at baseline via a self-administered 12-item general questionnaire, the Short-Form 12 (SF-12), enabling to compute a mental component summary (CS-12) and a physical component summary (PCS-12) score. Mean MCS-12 in the ELAN cohort (49 +/- 7.5) was very close to the standards derived from general American population (50 +/- 10) or to the data available in a general French population (51.2 +/- 7.4). Whereas mean PCS-12 was hardly lower (about one standard deviation) in comparison with general American population (50 +/- 10) or with a general French population (48.4 +/- 9.4). QoL was higher in males and linked to age in a contrasted way (higher MCS-12 and lower PCS-12 in elderly; p < 0.0001). It depended on the clinical condition (lower MCS-12 associated with mixed-type angina pectoris or with more severe angina and with persistent smoking; lower PCS-12 associated with mixed type or more severe angina, with cardiac failure episodes, arteritis obliterans, stroke antecedents or left ventricular hypertrophy). Both scores were negatively correlated, in multivariate regression analysis, with the severity of persisting angina at one year, after controlling for the severity of baseline angina and the other confounding variables. Above all, MCS-12 and especially PCS-12, predicted major coronary events at one year (death, myocardial infarction, angioplasty, coronary by-pass surgery). In a multivariate logistic regression analysis, low baseline PCS-12 was associated with higher risk for cardiovascular death at one year (OR = 2.44; 95% CI = 1.25-4.74; p < 0.01). These results confirm the clinical validity of SF-12 (cross sectional stage of the study) and stress its prognostic value independent from the other risk factors (longitudinal stage of the study).     

Using the SF-36 with older adults: a cross-sectional community-based survey

OBJECTIVES: To assess the practicality and validity of using the 36-item short-form health survey (SF-36) in a community-dwelling population over 65, and to obtain population scores in this age group. DESIGN: Postal survey, using a questionnaire booklet containing the SF-36 and other health-related items, of all those aged 65 or over registered with 12 general practices in Sheffield. Non-respondents received up to two reminders at 3-weekly intervals. SAMPLE: 9897 subjects, aged 65-104 years. MAIN OUTCOME MEASURES: Scores for the eight dimensions of the SF-36 and a modified version of the physical functioning dimension. RESULTS: The SF-36 achieved a response rate of 82% (n=8117) and dimension completion rates of 86.4-97.7%. Internal consistency measured by Cronbach's alpha exceeded 0.80 for all dimensions except social functioning. These results compare favourably with postal surveys of younger adults. We calculated scores for older adults by age and sex. Comparison with data from younger people showed how physical health declines steeply with age, in marked contrast to mental health. CONCLUSIONS: The SF-36 is a practical and valid instrument for use in postal surveys of older people living at home. The population scores provided here may facilitate its use in future surveys of older adults.     

Assessment of the quality of life in chronic pancreatitis using Sf-12 and EORTC Qlq-C30 questionnaires

BACKGROUND: SF-12 Health Survey, and European Organisation for Research and Treatment of Cancer Quality of life Questionnaire-C30 are the two main questionnaires proposed and validated for assessing the quality of life in chronic pancreatitis. AIMS: To evaluate the role of the information furnished by both the SF-12 Health Survey and European Organisation for Research and Treatment of Cancer Quality of life Questionnaire-C30 questionnaires, and to determine which of these two questionnaires may be considered more efficacious, in clinical practice, in describing the quality of life of patients with chronic pancreatitis. PATIENTS: We studied 163 consecutive patients with proven chronic pancreatitis. METHODS: The Italian version of the SF-12 Health Survey and the Italian neutral version of the European Organisation for Research and Treatment of Cancer Quality of life Questionnaire-C30 Version 3.0 questionnaires were administered. RESULTS: Pancreatic pain was the only clinical variable able to significantly impair the SF-12 Health Survey component summaries as well as all domains of the European Organisation for Research and Treatment of Cancer Quality of life Questionnaire-C30, while body mass index was positively related to the physical component summary-12 and to the domains of the European Organisation for Research and Treatment of Cancer Quality of life Questionnaire-C30. A high level of reliability of the domains/scores of the two questionnaires in evaluating the quality of life in patients with chronic pancreatitis was found and two main factors were identified. These two factors were mainly related to the two SF-12 Health Survey summary components. CONCLUSIONS: From a practical point of view, the SF-12 Health Survey is more reliable and easier to use in routine clinical practice than the European Organisation for Research and Treatment of Cancer Quality of life Questionnaire-C30.     

Measuring health status in Israeli patients with fibromyalgia syndrome and widespread pain and healthy individuals: utility of the short form 36-item health survey (SF-36)

OBJECTIVES: To examine the usefulness of the Medical Outcomes Study Short Form-36 (MOS SF-36) in measuring health-related quality of life (QOL) in fibromyalgia syndrome (FMS) patients, and to determine whether subscale scores of SF-36 could distinguish patients with FMS from patients with widespread pain alone, and from healthy individuals. METHODS: The study population included three groups of women: 90 patients with FMS, 96 patients with widespread pain, and 50 healthy controls. In all subjects, health-related QOL was assessed by SF-36. The Health Assessment Questionnaire was used to evaluate functional disability, helplessness and psychological status. FMS-related symptoms and tenderness also were assessed. RESULTS: The 8 subscales of SF-36 showed a consistent pattern for physical function, physical role functioning, body pain, general health, vitality, and social function, with the lowest scores in patients with FMS, intermediate scores in patients with widespread pain alone, and the highest scores in healthy subjects. Emotional role functioning and mental health scores were significantly higher among healthy controls than among patients. The SF-36 subscales of physical functioning, bodily pain, and social functioning were highly correlated with another measure of functional disability (from the Health Assessment Questionnaire) in all patient groups. Most of the subscales were associated with psychological variables (helplessness, depression, and anxiety). All eight subscales of SF-36 were strongly correlated with the mean score of another measure of quality of life, QOL-16. CONCLUSIONS: Most of the SF-36 subscales represent health dimensions relevant to patients with FMS and widespread pain alone. The severity of functional impairment as assessed by the SF-36, distinguishes patients with FMS and widespread pain alone from healthy individuals, and also discriminates between patients with widespread pain alone and FMS patients.     

Evaluation of the short-form 36-item questionnaire to measure health-related quality of life in patients with idiopathic pulmonary fibrosis

OBJECTIVE: To validate the use of the 36-item short-form questionnaire (SF-36) for measuring health-related quality of life (HRQL) in patients with idiopathic pulmonary fibrosis (IPF). DESIGN:: Observational data at a single point in time. SETTING:: A specialized outpatient respiratory clinic. PARTICIPANTS: Thirty-four patients (mean +/- SE age, 58.29 +/- 1.87 years) with IPF and no significant comorbidity. A matched control group for HRQL measurements was composed of 34 normal subjects (mean age, 58.00 +/- 1.89 years). MEASUREMENTS AND RESULTS: Dyspnea was measured by the baseline dyspnea index (BDI). Respiratory function evaluation included FVC, FEV(1), and resting arterial blood gases. IPF patients showed a mean BDI score of 5.21 +/- 0.46. The mean FVC and FEV(1) values were 62.41 +/- 2.96% and 66.41 +/- 3.33%, respectively. The mean PaO(2) was 67 +/- 2.51 mm Hg, and the mean PaCO(2) was 37 +/- 1. 05 mm Hg. Patients scored significantly worse than control subjects with respect to the SF-36 domains of physical functioning, physical role, general health perceptions, vitality, social functioning, emotional role, and mental health index. BDI scores were significantly correlated with five SF-36 components, and FVC and FEV(1) were significantly correlated with two SF-36 components. Significant negative correlations were found between arterial pH and four SF-36 domains. CONCLUSIONS: Patients with IPF have a significant impairment of HRQL in both physical and psychological functioning. Dyspnea is the most important factor influencing the quality of life in these subjects. The SF-36 questionnaire is a valid instrument to evaluate HRQL in IPF patients.     

The value of SF-36 questionnaire for the measurement of life quality in chronic obstructive pulmonary disease

This study was performed in chronic obstructive pulmonary disease (COPD) patients to compare the SF-36 questionnaire with pulmonary function tests and non-functional parameters. Fourty-five COPD patients diagnosed according to GOLD 2004 criteria were included in the study. The stable patients were evaluated by spirometry, static lung volumes, diffusion capacity, 6 MWD, BORG scale, MMRC dyspnea measurement and SF-36 life questionnaire performed on the same day. The mean age of the patients was 66 +/- 10 years and the female/male ratio was 4/41. The mean FEV1/FVC ratio was 0.49 (moderate COPD n = 18, severe COPD n = 27). The RV/TLC ratio was 0.52. Walking distance was less than normal, with a mean of 375 +/- 119 m. All the SF-36 scale except pain index are low compared to normal. General health perceptions, physical functioning, role physical, role emotional, social functioning, energy and mental health index are as follows: 47 +/- 24, 50 +/- 30, 35 +/- 38, 49 +/- 37, 63 +/- 33, 49 +/- 20, 59 +/- 20, respectively. When the general health scale compared with FVC and FEV1 revealed moderate correlation was found (r = 0.56, r = 0.55, respectively). Physical functioning compared with FVC, FEV1, RV/TLC and IC revealed moderate correlation (r = 0.62, r = 0.67, r = -0.54, r = 0.65, respectively). General health and physical functioning scales correlated with the non-functional parameters (MMRC, 6 MWD) (r = -0.51, r = 0.53, r = -0.61, r = 0.64 respectively). The SF-36 general quality of life questionnaire is a useful measurement instrument for the evaluation of therapeutic efficiency and follow up of COPD patients.     

Validity and reliability of the SF-36 in Chilean older adults: the ALEXANDROS study

To validate short-form-36 health survey (SF-36) with specific scoring algorithm obtained in a large sample of Chilean older people and to associate quality of life in this sample with social and health related factors. A cross-sectional study on 2,143 community-living subjects aged 60–92 years (33 % men and 67 % women) conducted in Santiago, Chile. Scores in 8 scales of SF-36-physical function (PF), role physical (RP), bodily pain (BP), general health (GH), vitality (VT), social functioning (SF), role emotional (RE) and mental health (MH)-, were calculated. Factor analysis was used to extract two principal factors and logistic regression model was applied to estimate its association with socio-demographic and health variables. The internal consistency of scales was high (Cronbach’s alpha 0.86–0.87). Factor analysis retained two factors: mental (MCS) and physical (PCS) components accounting for 65.3 % of total variance (55.3 and 10.0 % respectively). High correlations (0.61–0.94) between MCS and MH, V, RE and SF were obtained. PCS correlated highest (0.72–0.86) with RP, PF and BP. Self-perceived symptoms of depression (GDS-15 ≥5) was the main variable explaining low scores in both MCS and PCS (adjusted OR = 26.9; 95 % CI: 15.3–47.2; OR = 3.4; 95 % CI: 2.1–5.5, respectively). We have demonstrated the reliability and validity of SF-36 questionnaire to evaluate health related quality of life, reporting Chilean-Specific factor score coefficients for MCS and PCS based in national Chilean means and standard deviations for older people. After adjusting by age and gender, the main predictors of low health related QoL in Chilean older people were self-perceived symptoms of depression, the presence of two or more chronic diseases and illiteracy. Important gender inequalities were observed in all of these results, being consistently less favorable in women than in men.     

Health-related quality of life in older adults with symptomatic hip and knee osteoarthritis: a comparison with matched healthy controls

BACKGROUND AND AIMS: Health-related quality of life (HRQOL) assessment is receiving increasing attention as an outcome measure in osteoarthritis (OA). The aims of this study were to compare HRQOL among older adults aged 55 to 78 years with hip and/or knee OA with those without OA, and to assess the influence of selected variables (sex, body mass index, radiographic OA severity, educational level, comorbidities) on HRQOL. METHODS: The generic Medical Outcome Study Short Form-36 item health status questionnaire (SF-36) was administered to a cohort of 264 OA patients (105 with hip OA alone, 108 with knee OA alone, and 51 with both hip and knee OA) and 112 healthy controls. RESULTS: Compared with the healthy controls, OA of the lower extremities has a detrimental effect on the eight-scale profile score, as well as on physical and mental summary measures of the SF-36. The most striking impact was seen in the physical measures "physical functioning", "physical role" and "pain" (p<0.0001). No statistically significant differences in SF-36 scores were found among the three groups of OA patients. The physical and mental summary scales of the SF-36 were closely correlated (p<0.0001). One hundred and forty-five patients (54.9%) reported at least one chronic coexisting disease. There was a significant inverse association with measures of comorbidity (number of comorbidities and comorbidity index score) and both physical and mental summary scores of the SF-36 questionnaire. In patients with OA of the knee alone (but not in hip OA alone or hip and knee OA), the SF-36 pain score was inversely correlated with years of formal education (p=0.016). In addition, the impact of hip and knee SF-36 dimensions was not influenced by the degree of radiographic severity. CONCLUSIONS: Older adults with OA of the lower extremities undergo a significant impact on multiple dimensions of HRQOL, compared with healthy controls. The use of a generic measure of HRQOL such as the SF-36, in studies of OA where comorbidity is common, should be useful in characterizing the global burden of this disease.     

Patient-reported outcomes in subjects with neuroendocrine tumors of the pancreas

AIM: To assess the patient-reported outcomes (PROs) of pancreatic neuroendocrine tumor (PNET) patients. METHODS: Fifty-one consecutive patients (21 male,30 female, 61.0 ± 10.3 years) with proven PNETs were studied. An SF-12 questionnaire capable of exploring the physical (PCS) and mental (MCS) aspects of daily life was used. Four questionnaires were also used [12 items General Health Questionnaire (GHQ-12) for nonpsychotic psychiatric disorders, State Trait Anxiety Inventory (STAI) Y-1 and Y-2 for anxiety and BDI-Ⅱ for depressive symptoms] to explore the psychological aspects of the disease. Forty-four sex- and age-matched Italian normative subjects were included and evaluated using the SF-12, STAI Y-1 and Y-2 questionnaires.RESULTS: Seven patients refused to participate to the study; they were clinically similar to the 44 participants who agreed to complete the questionnaires. PNET patients had a PCS score (44.7 ± 11.0) were not significantly different from the norms (46.1 ± 9.9, P = 0.610), whereas the MCS score was significantly lower in patients (42.4 ± 13.0) as compared to the norms (48.2 ± 9.8, P = 0.036). GHQ-12 identified 11 patients (25.0%) as having non-psychotic psychiatric disorders. The STAI scores were similar in the patients and in the normative population. Finally, BDI-Ⅱ identified eight patients (18.2%) with moderate depression and 9 (20.5%) with mild depression whereas 27 patients (61.4%) had no depression. CONCLUSION: The PNET patients had a good physical but an impaired mental component of their quality of life; in addition, mild or moderate depressive symptoms are present in about 40% of PNET patients.     

Patient-reported outcomes in subjects with neuroendocrine tumors of the pancreas

AIM: To assess the patient-reported outcomes (PROs) of pancreatic neuroendocrine tumor (PNET) patients. METHODS: Fifty-one consecutive patients (21 male,30 female, 61.0 ± 10.3 years) with proven PNETs were studied. An SF-12 questionnaire capable of exploring the physical (PCS) and mental (MCS) aspects of daily life was used. Four questionnaires were also used [12 items General Health Questionnaire (GHQ-12) for nonpsychotic psychiatric disorders, State Trait Anxiety Inventory (STAI) Y-1 and Y-2 for anxiety and BDI-Ⅱ for depressive symptoms] to explore the psychological aspects of the disease. Forty-four sex- and age-matched Italian normative subjects were included and evaluated using the SF-12, STAI Y-1 and Y-2 questionnaires.RESULTS: Seven patients refused to participate to the study; they were clinically similar to the 44 participants who agreed to complete the questionnaires. PNET patients had a PCS score (44.7 ± 11.0) were not significantly different from the norms (46.1 ± 9.9, P = 0.610), whereas the MCS score was significantly lower in patients (42.4 ± 13.0) as compared to the norms (48.2 ± 9.8, P = 0.036). GHQ-12 identified 11 patients (25.0%) as having non-psychotic psychiatric disorders. The STAI scores were similar in the patients and in the normative population. Finally, BDI-Ⅱ identified eight patients (18.2%) with moderate depression and 9 (20.5%) with mild depression whereas 27 patients (61.4%) had no depression. CONCLUSION: The PNET patients had a good physical but an impaired mental component of their quality of life; in addition, mild or moderate depressive symptoms are present in about 40% of PNET patients.     

Evaluation of Patient-Reported Outcome in Subjects Treated Medically for Acute Pancreatitis: A Follow-Up Study

Aims: To explore the quality of life in patients treated medically during the acute phase of pancreatitis as well as at 2 and 12 months after discharge from the hospital. Patients: 40 patients were studied. The etiology of the pancreatitis was biliary causes in 31 patients and non-biliary causes in 9; mild disease was present in 29 patients and severe disease in 11. 30 patients completed the two surveys at 2 and 12 months after hospital discharge. Methods: The SF-12 and EORTC QLQ-C30 questionnaires were used for the purpose of the study. Results: The two physical and mental component summaries of SF-12, all the domains of EORTC QLQ-C30 (except for physical functioning and cognitive functioning) and some symptom scales of EORTC QLQ-C30 (fatigue, nausea/ vomiting, pain, and constipation) were significantly impaired during the acute phase of pancreatitis. There was a significant improvement in the SF-12 physical component summary, and global health, role functioning, social functioning, nausea/vomiting, pain, dyspnea, and financial difficulties (EORTC QLQ-C30) at 2 months after discharge as compared to the basal evaluation. Similar results were found after 12 months except for the mental component score at 12-month evaluation, which was significantly impaired in acute pancreatitis patients in comparison to the norms. The physical functioning of the EORTC QLQ-C30 at basal evaluation was significantly impaired in patients with severe pancreatitis in comparison to patients with mild pancreatitis. Conclusions: Two different patterns can be recognized in the quality of life of patients with acute pancreatitis: physical impairment is immediately present followed by mental impairment which appears progressively in the follow-up period.     

Impact of oral cyclophosphamide on health-related quality of life in patients with active scleroderma lung disease: results from the scleroderma lung study

OBJECTIVE: To assess the impact of cyclophosphamide (CYC) on the health-related quality of life (HRQOL) of patients with scleroderma after 12 months of treatment. METHODS: One hundred fifty-eight subjects participated in the Scleroderma Lung Study, with 79 each randomized to CYC and placebo arms. The study evaluated the results of 3 measures of health status: the Short Form 36 (SF-36), the Health Assessment Questionnaire (HAQ) disability index (DI), and Mahler's dyspnea index, and the results of 1 preference-based measure, the SF-6D. The differences in the HRQOL between the 2 groups at 12 months were calculated using a linear mixed model. Responsiveness was evaluated using the effect size. The proportion of subjects in each treatment group whose scores improved at least as much as or more than the minimum clinically important difference (MCID) in HRQOL measures was assessed. RESULTS: After adjustment for baseline scores, differences in the HAQ DI, SF-36 role physical, general health, vitality, role emotional, mental health scales, and SF-36 mental component summary (MCS) score were statistically significant for CYC versus placebo (P < 0.05). Effect sizes were negligible (<0.20) for all of the scales of the SF-36, HAQ DI, and SF-6D at 12 months. In contrast, a higher proportion of patients who received CYC achieved the MCID compared with placebo in the HAQ DI score (30.9% versus 14.8%), transitional dyspnea index score (46.4% versus 12.7%), SF-36 MCS score (33.3% versus 18.5%), and SF-6D score (21.3% versus 3.8%). CONCLUSION: One year of treatment with CYC leads to an improvement in HRQOL in patients with scleroderma lung disease.     

活动性强直性脊柱炎患者生活质量及影响因素分析

目的分析活动性强直性脊柱炎(AS)患者的生活质量及影响因素。方法采用SF-36量表对52例活动性AS患者的生活质量进行评价,并与我国一般人群进行对比,并探讨临床评价指标BASDAI、BASFI、BASMI、脊柱痛、夜间痛、脊柱炎症、患者总体评估指数、肌腱端指数、整体关节肿胀指数等与患者生活质量的相关性。结果活动性AS患者SF-36量表各个维度的得分均明显小于一般人群,生理健康的得分要小于心理健康；BASFI是与SF-36量表各维度相关最为密切的临床参数,其次为BASDAI和PGA,而BASMI、脊柱痛只与生理健康的3个维度相关；多元逐步回归分析显示BASFI是影响活动性AS患者生活质量较为重要的临床指标,它可以解释患者生理健康得分50．3%的变异,心理健康得分35．2%的变异以及生活质量综合得分47．9%的变异。结论活动性AS患者的生活质量较一般人群明显下降,生理健康方面更为严重；患者的功能状态与活动性AS患者生活质量密切相关。     

Factors associated with generic health-related quality of life in adult asthma patients in Germany: Cross-sectional study

Objectives: Given a 9% lifetime prevalence of asthma in Germany and the impairment of health-related quality of life (HRQOL) that goes along with it, it is important to understand parameters affecting HRQOL in asthma patients. Objective of this study was therefore to determine factors associated with generic HRQOL in asthma patients. Methods: Data for cross-sectional analyses were obtained from the baseline of an ongoing cohort study. Inclusion criteria: physician-diagnosed asthma; age ≥18 years; disease duration ≥3 months; no acute psychiatric/neurological disease; sufficient knowledge of German. HRQOL was assessed by the Short Form 12 Health Survey Questionnaire (SF-12), which comprises a physical (PCS-12) and a mental component (MCS-12). Information on a broad range of parameters potentially influencing HRQOL was collected by examining the patients' medical records and via a self-administered questionnaire. Those parameters were of socio-demographic, disease-specific, treatment-related or psychosocial nature. We conducted multivariable linear regression analyses to assess determinants of HRQOL. Results: In total, 196 asthma patients participated in the study (mean age: 48 years (range: 18–90); 60.2% females). In multivariable analysis, PCS-12 was negatively associated with older age, being female, insufficient disease control, higher number of medications in tablet form and reporting symptoms of depression. MCS-12 was negatively associated with being female, living alone, insufficient disease control, and reporting symptoms of anxiety or depression. Conclusions: Focusing on disease control and screening for depression and anxiety may be promising approaches to improve HRQOL in adult asthma patients. If a patient shows alarming symptoms of anxiety and/or depression, the patient should then be referred for psychiatric treatment.     

Body mass index and health status in diabetic and non-diabetic individuals

Background/Objectives:

There is controversy regarding the existence of a body mass index (BMI) mortality paradox in diabetes, whereby the optimal BMI category is higher than it is in non-diabetic persons. To explore possible pathways to a mortality paradox, we examined the relationship of BMI with physical and mental health status in diabetic and non-diabetic persons.

Subjects/Methods:

We examined adjusted SF-12 Physical and Mental Component Summary (PCS-12 and MCS-12) scores by BMI (kg m⁻²) category (underweight, <20; normal weight, 20 to <25; overweight, 25 to <30; obese, 30 to <35; severely obese ⩾35) in adult diabetic and non-diabetic respondents to the 2000–2011 United States national Medical Expenditure Panel Surveys (N=119 161). Adjustors were age, sex, race/ethnicity, income, health insurance, education, smoking, comorbidity, urbanicity, geographic region and survey year.

Results:

In non-diabetic persons the adjusted mean PCS-12 score was highest (that is, most optimal) in the normal-weight category, whereas for diabetic persons the optimal adjusted mean PCS-12 score was in the overweight category (adjusted difference between non-diabetic and diabetic persons in the difference in PCS-12 means for overweight versus normal-weight category=0.8 points, 95% confidence interval; CI 0.1, 1.6; P=0.03). This paradoxical pattern was not evident for the MCS-12, and the adjusted difference between non-diabetic and diabetic persons in the difference in MCS-12 means for overweight versus obese persons was not significant (−0.3 points, 95% CI −0.9, 0.4; P=0.43). The findings were not significantly moderated by smoking status, cancer diagnosis or time period.

Conclusions:

The optimal BMI category for physical health status (but not mental health status) was higher among diabetic than non-diabetic persons. The findings are consistent with a BMI physical health status paradox in diabetes and, in turn, a mortality paradox.