Anthropometrically predicted visceral adipose tissue and blood-based biomarkers: a cross-sectional analysis

Purpose

We hypothesized that anthropometrically predicted visceral adipose tissue (apVAT) accounts for more variance in blood-based biomarkers of glucose homeostasis, inflammation, and lipid metabolism than body mass index (BMI), waist circumference (WC), and the combination of BMI and WC (BMI + WC).

Methods

This was a cross-sectional analysis of 10,624 males and females who participated in the Third National Health and Nutrition Examination Survey (NHANES III; 1988–1994). apVAT was predicted from a validated regression equation that included age, height, weight, waist, and thigh circumferences. Bootstrapped linear regression models were used to compare the proportion of variance (R ²) in biomarkers explained by apVAT, BMI, WC, and BMI + WC.

Results

apVAT accounted for more variance in biomarkers of glucose homeostasis than BMI (?R ² = 8.4–11.8 %; P < 0.001), WC (?R ² = 5.5–8.4 %; P < 0.001), and BMI + WC (?R ² = 5.1–7.7 %; P < 0.001). apVAT accounted for more variance in biomarkers of inflammation than BMI (ΔR ² = 3.8 %; P < 0.001), WC (ΔR ² = 3.1 %; P < 0.001), and BMI + WC (ΔR ² = 2.9 %; P < 0.001). apVAT accounted for more variance in biomarkers of lipid metabolism than BMI (ΔR ² = 2.9–9.2 %; P < 0.001), WC (ΔR ² = 2.9–5.2 %; P < 0.001), and BMI + WC (ΔR ² = 2.4–4.1 %; P ≤ 0.01).

Conclusions

apVAT, estimated with simple and widely used anthropometric measures, accounts for more variance in blood-based biomarkers than BMI, WC, and BMI + WC. Clinicians and researchers may consider utilizing apVAT to characterize cardio-metabolic health, particularly in settings with limited availability of imaging and laboratory data.

     

Sustained quality of life improvement after intracoronary injection of autologous bone marrow cells in the setting of acute myocardial infarction: results from the BONAMI trial

Purpose

Cardiac cell therapy is a promising treatment for acute myocardial infarction (AMI), leading to cardiac function improvement. However, whether it translates into quality of life (QoL) improvement is unclear. We hypothesized that administration of bone marrow cells (BMC) to patients with AMI improves QoL.

Methods

In the multicenter BONAMI trial (NCT00200707), patients with reperfused AMI and decreased myocardial viability were randomized to intracoronary autologous BMC infusion (n = 52) or state-of-the-art therapy (n = 49). QoL data, derived from the Minnesota Living with Heart Failure questionnaire (MLHFQ), were obtained 1, 3, and 12 months after AMI and analyzed using a Rasch-family model.

Results

Using this model, QoL improved over time in the BMC group (p = 0.025) but not in the control group. Furthermore, the BMC-group patients displayed a better QoL than the control-group patients at 3 and 12 months post-AMI (p = 0.034 and p = 0.003, respectively). These findings were not detected when analyzing MLHFQ data using a standard method. Cardiac function, myocardial viability, mortality, and number of major adverse cardiac events did not differ between treatment groups.

Conclusion

Our results suggest that BMC therapy can improve QoL, stressing the need for confirmation trials and for systematic QoL assessment in cardiac cell therapy trials .

     

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

Purpose

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

Methods

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

Results

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

Conclusions

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

     

Perceived family functioning,adolescent psychopathology and quality of life in the general population: a 6-month follow-up study

Purpose

The aim of the study was to investigate whether perceived family functioning of adolescent is moderating or mediating the longitudinal association of adolescent internalizing and externalizing psychopathology with quality of life (QoL) after 6 months in the general population.

Methods

Using a cluster sampling technique in one Norwegian county 1331, 10- to 16-year-old students were included in the study (51 % girls). Parents completed the Child Behavior Checklist for the assessment of adolescent psychopathology at Time 1. The students completed the General Functioning Scale of the McMaster Family Assessment Device and the Inventory of Life Quality in Children and Adolescents at time 2 6 months later. Psychopathology, family functioning and QoL were treated as latent variables in a structural equation model adjusted for sex, age and parent education.

Results

The regression coefficients for paths from psychopathology decreased (β = .199 for the internalizing and β = .102 for the externalizing model) in each case when including the indirect path via family functioning compared with the direct path from psychopathology to QoL. The sum of indirect effects on QoL via family functioning was significant for internalizing β = 0.093 (95 % CI 0.054–0.133) and externalizing β = 0.119 (95 % CI 0.076–0.162) psychopathology.

Conclusions

Family functioning significantly mediated the longitudinal association between psychopathology and QoL. Because the family remains an important social domain for adolescents, it must be an important consideration when attempting to reduce or alleviate psychopathology in youth and improve the quality of their life experience throughout this period.

     

The impact of living arrangements on quality of life among Korean elderly: findings from the Korean Longitudinal Study of Aging (2006–2012)

Purpose

To investigate the impact of different living arrangements on quality of life (QoL) and health-related quality of life (HRQoL) in the elderly.

Methods

We used data from the first to fourth wave of the Korean Longitudinal Study of Aging. Using the first wave as a baseline, the data included 5050 individuals aged 60 years and older with at least one living child. QoL and HRQoL were measured using a visual analogue scale developed by the Korean Labor Institute that bears similarity to the EQ-VAS. Living arrangements were categorized based on household composition (single household, one-generation household, two-generation household, and three-generation household) and the marital status of a cohabiting adult child. A generalized estimating equation was used to examine the association between living arrangements and QoL/HRQoL.

Results

Compared to elderly individuals living in three-generation families with a married child, those in a single household (QoL: β = ?2.67 [P = 0.001]; HRQoL: β = ?2.24 [P = 0.007]), those living in a three-generation family with an unmarried adult child (QoL: β = ?5.19 [P < 0.0001]; HRQoL: β = ?3.41 [P < 0.0001]), and those living in a two-generation family with an unmarried adult child (QoL: β = ?2.88 [P < 0.0001]; HRQoL: β = ?2.80 [P < 0.0001]) were more likely to have lower QoL and HRQoL. These associations were particularly strong for women and individuals in the lowest equivalent household income group.

Conclusion

It is necessary to devise government programs not only for elderly individuals living alone, but also for those living with an unmarried adult child; elderly persons who are female and part of the lowest equivalent household income group must receive particular attention.

     

Improvement in the quality of life following cholecystectomy: a randomized multicenter study of health status (RAND-36) in patients with laparoscopic cholecystectomy versus minilaparotomy cholecystectomy

Purpose

The assessment of the quality of life (QoL) in minilaparotomy cholecystectomy (MC) versus laparoscopic cholecystectomy (LC) with the ultrasonic dissection in both groups has not been addressed earlier.

Methods

Initially, 109 patients with non-complicated symptomatic gallstone disease were randomized to undergo either MC (n = 59) or LC (n = 50). RAND-36 survey was conducted preoperatively and at 4 weeks and 6 months postoperatively. The end point of our study was to determine differences in health status in MC versus LC groups.

Results

QoL improved significantly in both groups, and the recovery was similar in the two groups, except from the higher score in ‘health change’ subscale at 4 weeks in MC group [MC score 75.0 (25.0) vs. LC score 56.5 (23.2), p = 0.008]. The MC and LC groups combined, RAND-36 scores increased significantly in ‘physical functioning’ [combined mean (SD) preoperative score 80.5 (23.9) vs. 6-month postoperative score 86.5 (21.7), p = 0.015], ‘vitality’ [64.5 (19.2) vs. 73.5 (18.3), p = 0.001], ‘health change’ [43.0 (21.6) vs. 74.6 (25.4), p = 0.0001] and ‘bodily pain’ scores [57.7 (26.3) vs. 75.5 (25.5), p = 0.001], respectively. Four RAND-36 domains indicated statistically significant health status differences in comparing the preoperative and postoperative RAND-36 scores in LC and MC groups combined.

Conclusions

Four RAND-36 domains indicated a significant positive change in QoL after cholecystectomy.

     

Quality of life among adolescents living in residential youth care: do domain-specific self-esteem and psychopathology contribute?

Purpose

Many adolescents living in residential youth care (RYC) institutions perceive their quality of life (QoL) to be low. Enhancing QoL is thus important, but little is known about the potential contributors to their QoL. Early interpersonal trauma and subsequent removal from home and repeated relocations to new placements are expected to affect mental health and self-esteem. We therefore investigated if domain-specific self-esteem contributed to QoL among adolescents living in RYC institutions over and beyond their levels of psychopathology.

Methods

All youth in Norwegian RYC institutions between the ages 12–23 years were invited to participate. Of a total of 98 RYC institutions, 86 participated, and 400 of 601 eligible youths were examined. The participants’ primary contact completed the Child Behavior Checklist to assess psychopathology. The adolescents completed a revised version of the Self-Perception Profile for Adolescents and the questionnaire for measuring health-related quality of life in children and adolescents (KINDL-R).

Results

After adjusting for psychopathology, age, and gender, self-esteem domains uniquely explained 42% of the variance in Qol, where social acceptance (β = 0.57) and physical appearance (β = 0.25) domains significantly predicted concurrent QoL.

Conclusions

The self-esteem domains, social acceptance and physical appearance, add substantially to the explained variance in QoL among adolescents living in RYC institutions, over and beyond the levels of psychopathology. These self-esteem domains may be targets of intervention to improve QoL, in addition to treating their psychopathology.

     

Associations between daily physical activity,handgrip strength,muscle mass,physical performance and quality of life in prefrail and frail community-dwelling older adults

Purpose

The aim of this study was to examine the associations between daily physical activity (DPA), handgrip strength, appendicular skeletal muscle mass (ASMM) and physical performance (balance, gait speed, chair stands) with quality of life in prefrail and frail community-dwelling older adults.

Methods

Prefrail and frail individuals were included, as determined by SHARE-FI. Quality of life (QoL) was measured with WHOQOL-BREF and WHOQOL-OLD, DPA with PASE, handgrip strength with a dynamometer, ASMM with bioelectrical impedance analysis and physical performance with the SPPB test. Linear regression models adjusted for sex and age were developed: In model 1, the associations between each independent variable and QoL were assessed separately; in model 2, all the independent variables were included simultaneously.

Results

Eighty-three participants with a mean age of 83 (SD: 8) years were analysed. Model 1: DPA (ß = 0.315), handgrip strength (ß = 0.292) and balance (ß = 0.178) were significantly associated with ‘overall QoL’. Balance was related to the QoL domains of ‘physical health’ (ß = 0.371), ‘psychological health’ (ß = 0.236), ‘environment’ (ß = 0.253), ‘autonomy’ (ß = 0.276) and ‘social participation’ (ß = 0.518). Gait speed (ß = 0.381) and chair stands (ß = 0.282) were associated with ‘social participation’ only. ASMM was not related to QoL. Model 2: independent variables explained ‘overall QoL’ (R ² = 0.309), ‘physical health’ (R ² = 0.200), ‘autonomy’ (R ² = 0.247) and ‘social participation’ (R ² = 0.356), among which balance was the strongest indicator.

Conclusion

ASMM did not play a role in the QoL context of the prefrail and frail older adults, whereas balance and DPA were relevant. These parameters were particularly associated with ‘social participation’ and ‘autonomy’.

     

Associations of infant milk feed type on early postnatal growth of offspring exposed and unexposed to gestational diabetes in utero

Purpose

Infants on prolonged breastfeeding are known to grow slower during the first year of life. It is still unclear if such effects are similar in offspring exposed to gestational diabetes (GDM) in utero. We examined the associations of infant milk feeding on postnatal growth from birth till 36 months of age in offspring exposed and unexposed to GDM.

Methods

Pregnant mothers undertook 75 g 2-h oral glucose tolerance tests at 26–28 weeks of gestation for GDM diagnosis. Up to 9 measurements of offspring weight and length were collected from birth till 36 months, and interviewer-administered questionnaires were used to ascertain the duration of breastfeeding.

Results

There was a statistically significant interaction between GDM status and breastmilk intake by any (p _interaction = 0.038) or exclusive/predominant breastfeeding (p _interaction = 0.035) for the outcome of conditional weight gain. In offspring of non-GDM mothers (n = 835), greater breastmilk intake (BF ≥ 4 milk months) was associated with lower conditional gains in weight [B (95 % CI) ?0.48 (?0.58, ?0.28); p < 0.001] within the first year of life, as well as decreasing weight SDS velocity [?0.01 (?0.02, ?0.005); p < 0.001] and BMI SDS velocity [?0.008 (0.01, ?0.002); p = 0.008] across age in the first 36 months. In offspring of GDM mothers (n = 181), however, greater breastmilk intake was associated with increased conditional gains in weight [0.72 (0.23, 1.20); p = 0.029] and BMI SDS [0.49 (0.04, 0.95); p = 0.04] in the first 6 months and did not demonstrate the decreasing weight and BMI SDS velocity observed in offspring of non-GDM mothers.

Conclusions

The reduced weight gain in the first year of life conferred by greater breastmilk intake in non-GDM children was not observed in GDM children.

Clinical trial registration

This study is registered under the Clinical Trials identifier NCT01174875; http://www.clinicaltrials.gov/ct2/show/NCT01174875?term=GUSTO&rank=2.

     

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

Purpose

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

Methods

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

Results

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

Conclusions

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

     

Quality of life in aphasic patients 1 year after a first stroke

Purpose

This study had twofold objective: (1) assessing change and dynamic processes over time between severity of aphasia and functional autonomy and (2) examining the temporal relationships between functional autonomy, depressive mood and quality of life in stroke patients with aphasia.

Method

Prospective study of patients with aphasia consecutively included after a first stroke and examined 1 year later at home (n = 101). Assessment included a visual analogical scale assessing QoL, a functional autonomy scale, a severity of aphasia scale, a communication questionnaire and a depression scale. Structural equation modeling was used to estimate competitive models, in which depressive mood or QoL was the ultimate endogenous variable (i.e., vulnerability vs. scar model).

Results

One year after stroke, there were a slight improvement in language impairment (stability coefficient = .61, p < .001) and a moderate improvement in functional autonomy (stability coefficient = .44, p < .001). There were prospective reciprocal effects between severity of aphasia and functional autonomy, i.e., each state exerted a temporal dynamic prediction on the other over time. Cross-sectional results from path analysis showed that depressive mood negatively predicted QoL (i.e., scar model); there was no evidence of the reverse association.

Conclusion

Results and their practical relevance in treatment were discussed. Predicting as soon as possible which factors would be related to late QoL in stroke patients with aphasia is of major importance.

     

Effects of 12-week supplementation of <Emphasis Type="Italic">Citrus bergamia</Emphasis> extracts-based formulation CitriCholess on cholesterol and body weight in older adults with dyslipidemia: a randomized,double-blind,placebo-controlled trial

Backgrounds

Recent experiments suggest that Citrus bergamia extracts could benefit people with dyslipidemia and obesity but this needs to be further validated.

Methods

A total of 98 people age-matched older adults (65 years) with elevated blood lipids were enrolled to receive 12-week supplementation of a Citrus bergamia extracts-based formulation (CitriCholess)(n?=?48) and placebo (n?=?50).

Results

No group differences were found in baseline bodyweight, body mass index (BMI), blood cholesterol (TC), triglycerides (TG), low density lipoprotein cholesterol (LDL-C) and glucose levels. CitriCholess supplementation resulted in lower levels than placebo in TG (1.83?±?0.92 vs. 1.95?±?1.34 mmol/L, P?=?0.612), TC (5.14?±?0.98 vs. 5.44?±?0.77 mmol/L, P?=?0.097), and LDL-C (3.13?±?0.74 vs. 3.43?±?0.62 mmol/L, P?=?0.032). Compared to placebo, CitriCholess also resulted in greater reductions in body weight (?0.604?±?0.939 vs. 0.06?±?0.74 kg, P?<?0.01), waist circumferences (?0.60?±?1.349 cm vs. -0.16?±?1.503 cm, P?<?0.01) and BMI (?0.207?±?0.357 vs. 0.025?±?0.274, P?<?0.01). Additionally, females had a significantly higher level of HDL-C than males. TC was significantly correlated with LDL-C, and to a less degree, with TG. TG was inversely correlated with HDL-C. Body weight and waist circumference were negatively correlated with HDL-C and positively correlated with glucose.

Conclusion

12-week supplementation of CitriCholess could benefit lipid metabolism and weight management in old adults with dyslipidemia.

     

Using Electronic Health Record Alerts to Increase Safety Planning with Youth At-Risk for Suicide: A Non-randomized Trial

Background

No study to date has examined the effectiveness of integrating clinical decision support tools, like electronic health record (EHR) alerts, into the clinical care of youth at-risk for suicide.

Objective

This study aimed to examine the feasibility and acceptability of using an EHR alert to increase clinicians’ use of safety planning with youth at-risk for suicide in an outpatient pediatric psychiatry clinic serving an urban low-income Latino community.

Methods

An alert intervention was developed to remind clinicians to complete a safety plan whenever they documented that their patient endorsed suicidal ideation, plan, or attempt during a visit in EHR notes. The alert appeared as a separate window containing a reminder message to complete a safety plan once a clinician finished visit documentation.

Results

There were 69 at-risk patients between the ages of 13–21 in the intervention period (M = 15.71; SD = 1.86; 66.7% female) and 64 (M = 15.38; SD = 1.93; 68.6% female) in the control period. Logistic regression analyses indicated that patients in the intervention period were significantly more likely than patients in the control period to receive a safety plan (p < .01). The pattern of results remained the same after adjusting for demographic variables (p = .01). Forty clinicians also completed a questionnaire assessing their satisfaction with the EHR alert, indicating moderate satisfaction (M = 3.01; SD = 0.63; range = 1.11–4.11).

Conclusions

EHR alerts are associated with changes in clinicians’ behavior and improved compliance with best clinical practices for at-risk youth.

     

Gender,race, BMI,and social support in relation to the health-related quality of life of cancer survivors: a report from the American Cancer Society’s Study of Cancer Survivors II (SCS-II)

Purpose

We examined the main and interactive effects of race, BMI, and social support on physical and mental health-related quality of life (HRQoL) among male and female cancer survivors using the stress and coping theory to inform findings.

Methods

HRQoL issues among 1768 cancer survivors were examined using the American Cancer Society’s cross-sectional Study of Cancer Survivors II. Two-step multiple linear regressions were conducted to assess the physical and mental HRQoL of male and female cancer survivors, respectively.

Results

The average age of participants was 67.36 (SD = 11.51); the majority were female (53.3 %; n = 941) and non-Hispanic White (85.9 %; n = 1517). The average BMI measurement for participants was 28.33 (SD = 5.90), with 41.3 % (n = 729) overweight and 30.3 % (n = 535) obese. Higher BMI was significantly associated with lower physical HRQoL across gender, while social support had significant main effects on physical and mental HRQoL across gender. Race moderated the relationship between social support and physical HRQoL among female cancer survivors and between BMI and mental HRQoL for both genders.

Conclusions

The results of this study contribute a unique gender- and racial-specific perspective to cancer survivorship research. While the buffering hypothesis of the stress and coping theory was not supported, the main effects of BMI and social support on HRQoL were different across gender and race.

     

Adaptation and validation of the “tolerability and quality of life” (TOOL) questionnaire in Chinese bipolar patients

Background

It is well known that the antipsychotic drugs impact the health-related quality of life (HRQoL) of the bipolar patients. The side effects had been assessed only from the doctors’ perspective and neglected the patients’ subjective feeling. The aim of the study is to validate the specific instrument “tolerability and quality of life” (TOOL) into Chinese to describe and grade the impact of antipsychotic drugs on HRQoL from patients’ view.

Methods

A psychometric study was conducted with euthymic bipolar disorder patients (N = 105) under antipsychotic treatment. The psychometric properties of the TOOL, including internal consistency, retest reliability, concurrent validity, content validity, discriminative validity, item analysis, confirmatory factor analysis and feasibility, were analyzed.

Results

The internal consistency and intraclass correlation coefficient (ICC) were adequate (Cronbach’s alpha = 0.80 and ICC = 0.81). A confirmatory factor analysis (CFA) validated the one-factor model. Significant Spearman’s rank correlations between the TOOL and both Bref QoL.BD (Brief version of Quality of Life in Bipolar Disorder) (r = ?0.33, P < 0.01) and UKU (Udvalg for Kliniske Undersogelser side effects scale) (r = 0.13, P < 0.05) were found.

Limitations

Small sample size and no specific self-report instrument in Chinese to evaluate the criterion validity.

Conclusions

TOOL appears to be a reliable and valid measure to assess the impact of adverse events of antipsychotic drugs on HRQoL from the patients’ perspective.

     

Quality of life in patients with a permanent stoma after rectal cancer surgery

Aim

Health-related quality of life (HRQoL) assessment is important in understanding the patient’s perspective and for decision-making in health care. HRQoL is often impaired in patients with stoma. The aim was to evaluate HRQoL in rectal cancer patients with permanent stoma compared to patients without stoma.

Methods

711 patients operated for rectal cancer with abdomino-perineal resection or Hartman’s procedure and a control group (n = 275) operated with anterior resection were eligible. Four QoL questionnaires were sent by mail. Comparisons of mean values between groups were made by Student´s independent t test. Comparison was made to a Swedish background population.

Results

336 patients with a stoma and 117 without stoma replied (453/986; 46 %). A bulging or a hernia around the stoma was present in 31.5 %. Operation due to parastomal hernia had been performed in 11.7 % in the stoma group. Mental health (p = 0.007), body image (p < 0.001), and physical (p = 0.016) and emotional function (p = 0.003) were inferior in patients with stoma. Fatigue (p = 0.019) and loss of appetite (p = 0.027) were also more prominent in the stoma group. Sexual function was impaired in the non-stoma group (p = 0.034). However in the stoma group, patients with a bulge/hernia had more sexual problems (p = 0.004). Pain was associated with bulge/hernia (p < 0.001) and fear for leakage decreased QoL (p < 0.001). HRQoL was impaired compared to the Swedish background population.

Conclusion

Overall HRQoL in patients operated for rectal cancer with permanent stoma was inferior compared to patients without stoma. In the stoma group, a bulge or a hernia around the stoma further impaired HRQoL.

     

Correlation of emotional labor and cortisol concentration in hair among female kindergarten teachers

Objectives

The purpose of this study was to explore whether two types of emotional labor, surface acting and deep acting, are related to hair cortisol concentration among kindergarten teachers.

Methods

Surface acting and deep acting over the last month were measured with the Chinese version of the emotional labor scale in 43 kindergarten teachers. Hair samples with 1 cm in length were cut from their posterior vertex region to represent cortisol excretion over one month. Cortisol concentrations were analyzed with high-performance liquid chromatography–tandem mass spectrometry.

Results

Positive association of emotion labor with hair cortisol concentration was significant for surface acting (r = 0.34, p < 0.05) and not significant for deep acting (r = 0.14, p > 0.05).

Conclusions

More surface acting showed to be associated stronger with stress responses or higher HPA axis activity.

     

Different healthy habits between northern and southern Spanish school children

Aim

Healthy habits are influenced by several factors such as geographical location. The aims of this study were to describe and compare healthy habits within two populations of sixth-grade primary school children (aged 11–12 years) from northern and southern Spain.

Subjects and methods

A cross-sectional study using two representative samples of school children was conducted. Participants came from Logroño (n = 329) in the north and Granada (n = 284) in the south of Spain. Socio-demographic and anthropometric variables, adherence to the Mediterranean diet, aerobic fitness, and healthy lifestyles were recorded.

Results

Boys reported a higher level of physical activity and aerobic fitness than girls (p = 0.000). Southern school children reported significantly higher adherence to the Mediterranean diet (♀: p = 0.041; ♂: p = 0.008), lower aerobic fitness (♀: p = 0.000; ♂: p = 0.042) and hours of nightly sleep (♀: p = 0.008, ♂: p = 0.007) than northern school children. Southern boys also reported lower levels of physical activity (p = 0.013). There were slight or moderate correlations among all habits measured (physical activity, diet, screen and sleep time). Additionally, the physical activity level was inversely related to weight status. Overweight and obese northern boys reported less physical activity than healthy-weight northern boys (p = 0.020) and overweight and obese southern girls reported less physical activity than healthy-weight southern girls (p = 0.024).

Conclusions

Results showed differences in physical activity, eating and sleep habits, and aerobic fitness according to geographical location. The relationships found among lifestyle habits indicate the need for health promotion interventions nationally and considering the differences discussed here.

     

Correlates of health-related quality of life in young-old and old–old community-dwelling older adults

Purpose

This study aimed (1) to examine the role of potential correlates of HRQoL in a large representative sample of older adults, and (2) to investigate whether the relationships between HRQoL and potential factors differ as a function of HRQoL component (physical vs. mental) and/or age cohort (young-old vs. old–old).

Methods

This cross-sectional study included 802 older adults aged 60–79 years old. HRQoL was assessed using the SF-36 questionnaire. Functional fitness was assessed using the Senior Fitness Test. Physical activity was measured via the Baecke questionnaire. Demographic information, mental and health features were obtained through questionnaires.

Results

A multiple regression analysis showed that BMI (β = ?0.15, p?=?0.001), body strength (β =?0.21, p?<?0.001), aerobic endurance (β =?0.29, p?<?0.001), physical activity (β =?0.11, p?=?0.007), depressive symptoms (β = ?0.19, p?<?0.001), falls (β = ?0.19, p?<?0.001), and living alone (β = ?0.16, p?<?0.001) were all significantly related to HRQoL-SF-36 total score. The positive relation with aerobic endurance was significantly higher for the physical component of HRQoL, while the negative relation with living alone was significantly higher for the mental component. The positive relation of HRQoL with physical activity was significantly higher in old–old compared to young-old adults.

Conclusion

This data suggest that body composition, functional fitness, psycho-social factors, and falls are important correlates of HRQoL in old age. There are HRQoL-component and age-cohort differences regarding these correlates, underlying the need for specific strategies at the community level to promote HRQoL in older adults.

     

The association between post-diagnosis health behaviors and long-term quality of life in survivors of ductal carcinoma in situ: a population-based longitudinal cohort study

Purpose

Women diagnosed with ductal carcinoma in situ (DCIS) often experience adverse changes in health-related behaviors following diagnosis. The impact of health behaviors on long-term quality of life (QoL) in DCIS survivors has not been investigated.

Methods

We examined the association of post-diagnosis body mass index (BMI), physical activity, alcohol, and smoking with QoL among 1448 DCIS survivors aged 20–74 enrolled in the population-based Wisconsin in situ Cohort from 1997 to 2006. Health behaviors and QoL were self-reported during biennial post-diagnosis interviews. Physical and mental QoL were measured using the validated SF-36 questionnaire. Generalized linear regression was used to determine the association between behaviors and QoL with adjustment for confounders. Lagged behavior variables were used to predict QoL during follow-up and avoid reverse causation.

Results

Women reported 3,536 QoL observations over an average 7.9 years of follow-up. Women maintaining a healthy BMI had on average a significantly higher summary measure score of physical QoL than obese women (normal versus obese: β?=?3.02; 2.18, 3.85). Physical QoL scores were also elevated among those who were physically active (5?+?h/week vs. none: β?=?1.96; 0.72, 3.20), those consuming at least seven drinks/week of alcohol (vs. none; β?=?1.40; 0.39, 2.41), and nonsmokers (vs. current smokers: β?=?1.80; 0.89, 2.71). Summary measures of mental QoL were significantly higher among women who were moderately physically active (up to 2 h/week vs. none: β?=?1.11; 0.30, 1.92) and nonsmokers (vs. current smokers: β?=?1.49;0.45, 2.53).

Conclusions

Our results demonstrate that maintaining healthy behaviors following DCIS treatment is associated with modest improvements in long-term QoL. These results inform interventions aimed at promoting healthy behaviors and optimizing QoL in DCIS survivors.