The effect of complete decongestive therapy on the quality of life of patients with peripheral lymphedema

Lymphedema is a chronic disorder which can adversely affect quality of life (QOL). The purpose of this study was 1) to evaluate whether QOL was improved in patients with lymphedema following Complete Decongestive Therapy (CDT), and 2) whether limb volume change as a result of treatment correlated with change in QOL. Thirty-six patients with peripheral lymphedema from varying causes were enrolled in the study. The QOL of each participant, with regard to physical, functional, and psychosocial concerns, was measured by pre- and post-treatment questionnaires. Percent edema volume reduction was calculated for each patient with only one affected limb. QOL pre- and post-treatment scores were assessed by multivariate repeated measures analysis. QOL scores differed significantly (p<0.05) between pre- and posttreatment in all areas of inquiry. Patients with lower extremity lymphedema had significantly greater mean improvement in QOL scores compared with patients with upper extremity lymphedema (p=0.02). There was no correlation between percent edema volume reduction and post-treatment QOL improvement. This study suggests that significant improvements are made in the QOL of patients exhibiting peripheral lymphedema following CDT, which is not necessarily correlated with limb volume reduction.     

Quality of life and lymphedema following breast cancer

The aim of the study was to compare Quality of Life (QOL) of breast cancer patients with and without secondary lymphedema (SLE) using a cross-sectional design with a convenience sample. Research packets were mailed to 2088 breast cancer patients (BrCaPt). The QOL component of the study used the Quality of Life Instrument --Breast Cancer Patient Version for data collection. The sample (n = 537) was 12.9% African-American/Hispanic/Other (AA) and 87.1% European-American (EA). One hundred and twenty-two women (22.7%) reported SLE. Overall and subscale means were computed and ANOVA was determined for seven variables: age, marital status, educational level, race, type of surgery, time since diagnosis, and SLE. Women without SLE had a higher overall mean QOL score compared to women with SLE (p= 0.02). Women with a greater than high school education had a higher mean QOL score compared to women with high school or less education (p=0.05). SLE patients had poorer QOL in the physical (p<0.001), and social (p=0.004) subscales. Older women had a higher overall QOL compared to younger women (p<0.001). These results provide insight into the impact of SLE on women's QOL and pinpoint that physical and social well being are negatively influenced by SLE.     

Time perspective and quality of life among HIV-infected patients in the context of HAART

We explored associations between time perspective (TP) and quality of life (QOL) among HIV-infected patients. With the French validated version of the Zimbardo Time Perspective Inventory, we evaluated the TP of patients. A self-administered questionnaire gathered information about QOL (WHOQOL-HIV), TP, relationship with medical staff and self-reported side effects of HAART. Six scores of QOL - physical, psychological, social relationship, environment, patient independence and spirituality were used as dependent variables in the linear regressions to identify factors associated with QOL. The sample (n=72) for this study was recruited from a hospital department specialising in HIV care and consisted of 48 (67%) HIV-infected women and 24 (33%) HIV-infected men with a mean age of 42 years. Using hierarchical regression analysis adjusted on socio-demographic characteristics, clinical characteristics and co-factors, significant relationships were observed between the several TP orientations and an impaired physical, environmental QOL as well as level-of-independence QOL. Specific dimensions of QOL are influenced by specific orientations of TP, which provides information on self-perception and subjective evaluation of QOL. The TP construct provides keys to managing HIV infection in order to improve QOL.     

The influence of coronary artery disease on quality of life after mechanical valve replacement

BACKGROUND AND AIM OF THE STUDY: Coronary artery disease (CAD) is known to impact negatively on long-term survival following valve replacement (VR). However, its influence on quality of life (QOL) remains undefined in patients with mechanical VR. METHODS: A total of 318 consecutive patients undergoing VR with the St. Jude Medical (SJM) mechanical valve were matched for age and gender with 318 patients who had VR (SJM valve) and coronary artery bypass grafting (VR+CABG). The VR group comprised 197 men and 121 women; the VR+CABG group also comprised 197 men and 121 women. The mean age of all patients was 66.0 +/- 8.0 years (range: 40-87 years). The Short Form-36 (SF-36) health survey was administered to all survivors at follow up examination. RESULTS: Operative mortality was comparable between groups (4.7% for VR, 7.5% for VR+CABG; p = 0.186). Hospital complications were also similar, except for reoperation for bleeding (p = 0.049). The mean follow up was 6.0 years for VR patients and 4.7 years for VR+CABG patients. Actuarial survival was significantly better in VR patients than VR+CABG patients (79.4 +/- 2.4% versus 75.0 +/- 2.7% at five years; 58.6 +/- 4.3% versus 47.5 +/- 4.5% at 10 years; p = 0.018). The equality of survival distribution was significantly different (p = 0.008). Multivariate analysis identified CABG as a predictor of late mortality (p = 0.003) but not of late QOL. QOL was similar on the eight health scales and physical health (44.5 +/- 10.3 versus 45.5 +/- 10.7) and mental health (52.4 +/- 9.8 versus 52.5 +/- 10.1) summary components, respectively. Age (p = 0.004), time from surgery to SF-36 administration (p = 0.007) and gender (p = 0.029), but not CABG, were significantly associated with QOL as assessed by the SF-36. CONCLUSION: CAD is a predictor of late mortality after mechanical VR. However, provided CABG is performed concomitantly with VR, the patient's longterm QOL appears to return to that expected for the general population.     

Comparative analysis of lymphoscintigraphy between lipedema and lower limb lymphedema

Lipedema is characterized by bilateral enlargement of the legs due to abnormal deposition of fat tissue from pelvis to ankles. It is seen most frequently in obese women. Lipedema appears to be a distinct clinical entity but may be confounded with lymphedema. AIM OF THE STUDY: To analyze and to compare between lipedema and lymphedema the qualitative and quantitative aspects of lymphoscintigraphy. METHODS: Fifteen women with lipedema were recruited. Mean age of onset of lipedema was 31.5 +/- 15 years. Body mass index was 35.1 +/- 7.9 kg/m2, 13 women were obese. Lipedema was compared to 15 cases of primary lymphedema (women: 13, men: 2) of the lower limbs (unilateral: 13, bilateral: 2), with a mean age at onset of 28.7 +/- 12.6 years. Lymphoscintigraphy of the lower limbs with morphologic (visualization of inguinal lymph nodes) and kinetic (half-life, lymphatic speed of the colloid) studies was performed in all cases. RESULTS: Absence of visualization of inguinal lymph nodes was observed in 14/15 cases of lymphedema and in 1/15 cases of lipedema (p<0.001). In the 13 cases of unilateral lymphedema, colloid half-life was higher in the pathologic limb than in the controlateral limb (230 +/- 92 vs 121 +/- 36 minutes, p<0.01) and lymphatic speed of the colloid was slower (6.91 +/- 0.86 vs 8.16 +/- 1.02 cm/min, p<0.001). The two patients with bilateral lymphedema had an increased half-life and decreased lymphatic speed of the colloid. Colloid half-life was significantly higher in lipedema than in controlateral limbs of lymphedema (154 +/- 23 vs 121 +/- 36 minutes, p<0.01) with no difference in lymphatic speed of the colloid. Colloid half-life was significantly higher in lymphedema than in lipedema (230 +/- 92 vs 154 +/- 23 minutes, p<0.01) and the lymphatic speed of the colloid was slower (6.91 +/- 0.86 vs 8.10 +/- 0.45 cm/min, p<0.001). CONCLUSION: Lower limb lymphoscintigraphy showed lymphatic insufficiency in lipedema without morphologic abnormality as seen in lymphedema. Lymphoscintigraphy is not indispensable but is a useful tool when diagnosis is doubtful. Treatment is difficult and may include weight loss and possible surgery.     

Role of gender and personality on quality-of-life impairment in intermittent atrial fibrillation

Patients with atrial fibrillation (AF) report impaired health-related quality of life (QOL). Differences between men and women with AF have not been described and personality attributes such as somatization (tendency to amplify benign bodily sensations) may mediate potential gender differences in QOL. Patients with AF (n = 264, 59% men) who participated in the Canadian Trial of Atrial Fibrillation (n = 403) completed validated QOL questionnaires at baseline, 3 months, and 12 months after antiarrhythmic drug treatment. Women were significantly older than men and a greater proportion had hypertension, but other cardiac variables did not differ between women and men. At baseline, after controlling for significant clinical and demographic factors, women reported worse physical health (p = 0.002) and functional capacity (p < 0.001), but not mental health or general well-being. Women also had more frequent and severe cardiac symptoms than men (both p < 0.001). Physical health improved significantly from baseline to 3 months for women (p = 0.002), but not for men (p = 0.066). Conversely, mental health improved for men (p = 0.007), but not for women. Cardiac symptom frequency and severity improved over time for women and men (all p < 0.001). Tendency to somatize predicted poor QOL, and women had higher scores than men (p = 0.023). However, after controlling for somatization, women still had worse physical function, functional capacity, and symptom burden than men. Independent of cardiac disease severity and age, women with AF had significantly more impaired QOL than men, specifically on domains related to physical rather than emotional functioning. Personality attributes may have a role in influencing QOL outcomes.     

Effect of complex decongestive therapy on edema and the quality of life in breast cancer patients with unilateral leymphedema

There is increasing interest in the health-related quality of life (QOL) of patients with chronic lymphedema. The aim of this study was to ascertain whether complex decongestive therapy (CDT) for upper limb lymphedema results in long-term changes in lymphedema and QOL, and to determine whether the treatment-induced change in the percentage excess volume (PCEV) is correlated with any changes in QOL. Fifty-three patients who had lymphedema were treated with CDT. PCEV and QOL were recorded before and 1 month after CDT, and at a 6-month follow-up visit. PCEV was significantly (p<0.05) decreased at 1 month, but significantly (p<0.05) increased at 6 months compared to 1 month [but still significantly reduced (p<0.05) from baseline]. The QOL scores at 1 and 6 months were significantly higher than the score at baseline, indicating an improvement in the QOL. Significant changes were evident in the single domains of physical functioning, role-physical, mental health, and general health. The change in PCEV was associated with a change in physical functioning, vitality, bodily pain, and general health at 1 and 6 months (p<0.05). This study suggests that QOL significantly improved with upper limb lymphedema during the maintenance phase, which was necessarily correlated with the reduction in limb volume.     

Gender differences in health-related quality of life among stroke patients

Background:   To determine whether differences in health-related quality of life (HRQOL) exist between male and female stroke patients and, if present, to identify factors influencing these differences.
Methods:   A questionnaire assessing HRQOL, measured by the EuroQol questionnaire, and functional outcome was mailed to 792 stroke patients and responded by 604 patients 39.6 ± 18.4 (mean ± standard deviation) months after stroke onset. A total of 480 patients who lived at home after discharge were considered eligible for the analysis.
Results:   The mean quality of life (QOL) utility score for men (0.79 ± 0.22) was significantly higher than that for women (0.69 ± 0.26; P  < 0.001). At discharge, men had a significantly better ability to walk than women ( P  < 0.001). The ability to perform activities of daily living (ADL) was also better among men than women after discharge ( P  < 0.01). A close relationship was observed between QOL utility scores and performance of ADL in both genders. A higher proportion of women were found to be in a state of anxiety or depression. Multiple regression analysis revealed that the QOL utility scores for men and women were influenced by functional changes, and the ADL items walking and dressing ability after discharge. In addition, the score for women was influenced by walking ability at discharge.
Conclusions:   HRQOL among men was significantly better than that among women. The difference in QOL scores appears to be influenced by the poorer outcome of ADL and the higher proportion of post-stroke anxiety and depression among women.     

Questionnaire survey on lower urinary tract symptoms (LUTS) for patients attending general practice clinics

OBJECTIVES: We investigated the incidence of lower urinary tract symptoms (LUTS) in people consulting a general practice (GP) clinics. MATERIALS AND METHODS: The questionnaire included 7 questions regarding LUTS and 1 question regarding QOL (QOL index) based on the International Prostate Symptom Score (I-PSS), 3 questions on the Overactive Bladder Symptom Score (OABSS) and 4 questions on the International Conference of Incontinence Questionnaire Short-form (ICIQ-SF) and the survey was conducted among 1,120 people aged 50 or older who consulted a GP clinic. RESULTS: Questionnaires were collected from 958 persons (86%) and the data from 822 (73%) who completed all the above questions were analyzed. There were 364 men (mean age: 67 year-old) and 458 women (68 year-old). Moderate or severe grades on I-PSS and OABSS were indicated in 99 (27%) and 43 (12%), respectively, for men, and 55 (12%) and 40 (9%) for women. Moderately or severely impaired QOL was indicated in 206 (57%) men and 193 (42%) women. Fifty-five (15%) men and 185 (40%) women indicated that they had some type of urinary incontinence. There were 138 (38%) men and 165 (36%) women showing both moderate or severe I-PSS and moderate or severe impairment of QOL, and/or with an ICIQ-SF score greater than 1. CONCLUSION: When I-PSS and QOL score were used for LUTS screening, 38% of men and 36% of women aged over 50, consulting a GP clinic, had some LUTS which should be assessed to determine whether they need treatment.     

Is the St. Jude Medical mechanical valve an appropriate choice for elderly patients?: A long-term retrospective study measuring quality of life

BACKGROUND AND AIM OF THE STUDY: The selection of a suitable valve substitute in patients requiring valvular heart surgery is an important element in the preoperative decision-making process between cardiologist, surgeon, and patient. Controversy persists regarding the use of mechanical valves in the elderly. With the population living longer, reoperative risk becomes of paramount importance. Quality of life (QOL) considerations are often as important to the patient as longevity. The influence of mechanical valve replacement on QOL in elderly patients has not been well documented. METHODS: Between June 1981 and December 1999, a total of 1,125 consecutive patients aged > or = 65 years (582 men, 543 women; mean age 71.4 +/- 4.9 years) underwent valve replacement with at least one St. Jude Medical (SJM) mechanical valve. Preoperatively, 138 patients (12.3%) were in NYHA class II, 775 (68.9%) in class III, and 212 (18.8%) in class IV. In 535 patients (47.6%), coronary artery disease required surgical intervention. Survivors were administered the Short Form (SF)-36 QOL Survey at follow up, which was 96.1% complete. RESULTS: Hospital mortality was 7.6% (85/1,125). Mean follow up was 5.9 years (range: 9 months to 18.4 years). Mean (+/- SEM) actuarial survival was 70.6 +/- 1.4% at five years, and 40.6 +/- 2.0% at 10 years. Male patients scored significantly higher on the SF-36 than controls in physical (p = 0.012) and mental health (p = 0.004). Comparing female patients with controls revealed no significant difference in physical health; however, they scored higher in mental health than controls (p = 0.001). CONCLUSION: The study results clearly demonstrate that heart surgery in the elderly with the SJM mechanical valve can be accomplished with acceptable hospital mortality, morbidity, and excellent long-term results. Moreover, long-term QOL in elderly patients with a SJM valve can be expected to meet or exceed that of age- and gender-matched controls.     

Factors associated with the development of arm lymphedema following breast cancer treatment: a match pair case-control study

We examined factors that may influence the development of arm lymphedema following breast cancer treatment including the specific mode of therapy, patient occupation and life style. Medical record data and a questionnaire were used to collect information after surgery concerning such issues as wound seroma, infection, adjuvant treatment, vessel string (phlebitis), body mass index, smoking habits and stress. Occupational workload was assessed after surgery whereas housework, exercise, hobbies and body weight were assessed both before and after surgery. Seventy-one breast cancer treated women with arm lymphedema lasting more than 6 months but less than 2 years were matched to women similarly treated for breast cancer but without arm lymphedema (controls). The matching factors included axillary node status, time after axillary dissection, and age. In the lymphedema group, there was a higher body mass index at time of surgery (p=0.03) as well at time of study (p=0.04). No differences were found in occupational workload (n=38) or housework, but the lymphedema group reduced their spare time activities including exercise after surgery compared with the controls (p<0.01). In conclusion, women treated for breast cancer with axillary node dissection with or without adjuvant radiotherapy could maintain their level of physical activity and occupational workload after treatment without an added risk of developing arm lymphedema. On the other hand, a higher BMI before and after operation increases the lymphedema risk.     

The impact of heart failure clinic in the improvement on quality of life of heart failure patients in Mexico

Heart failure clinic (HFC) has emerged as an innovative strategy to improve prognosis and Quality of Life (QOL) of Heart Failure (HF) patients. Unfortunately, there is no-evidence of such benefit on HF patients by HFC in Latin-America. We undertake a research to investigate the impact of HFC on QOL in HF patients in Mexico. From October 2004 to July 2005 all patients that attended for the first time the HFC of the Specialties Hospital No 14 in Veracruz, Mexico were analysed. The study group included patients with HF and left ventricular systolic dysfunction (LVSD). QOL was measured by the Minnesota Living with Heart Failure Questionnaire (MLHFQ). MLHFQ score was compared between basal vs 6 months follow-up. Every patient served as his/her own control. Forty-five HF patients were included and 34 completed 6 months follow-up. Four patients died within 6 months (mortality rate 12% [95% CI 2-22%]). Of the 30 remaining patients, median age was 61 years (range 37-74 years) and 47% was women with a mean left ventricular ejection fraction of 34%. The MLHFQ had a significant reduction at 6 months compared with basal condition from the first evaluation (Basal vs 6 months: mean [SD], 50 [26] vs 31 [19]; p = 0.0001) with a strong correlation between the MLHFQ score and NYHA functional class (p = 0.001; r = 0.59). HFC improves QOL of HF patients in Mexico. This disease management strategy would be considered for widely use in Latin-America countries.     

Hepcidin is not a marker of chronic inflammation in atherosclerosis.

OBJECTIVE: To investigate the relationship between atherosclerosis, an inflammatory disease and hepcidin, which is reported as an indicator of inflammation. METHODS: A total of 75 subjects between 40 and 70 years of age were included in the study. The patient group consisted of 40 stable patients who had previously experienced an atherosclerotic event (18 women, 22 men; mean age 56.4+/-7.1 years). There were two control groups. The first control group consisted of 19 healthy subjects (11 women, 8 men; mean age 52.6+/- 7.4 years), while the second group included 16 patients (11 women, 5 men; mean age 56.5+/-9.3 years) with rheumatoid arthritis and anemia (diseased control group). Hepcidin measurement was performed using Hepcidin Prohormone ELISA (Solid Phase Enzyme-Linked Immunosorbent Assay) test kit. RESULTS: Mean serum hepcidin levels were 243.2+/-48.8 ng/ml, 374.5+/-86.4 ng/ml, and 234+/-59.9 ng/ml in the patient group, in diseased controls, and in healthy controls, respectively. Hepcidin levels were higher in diseased controls compared to the patient group and healthy controls (p=0.001). There were no significant differences between the patient group and healthy controls. CONCLUSION: These findings did not support the hypothesis that hepcidin levels could be increased in atherosclerotic cardiovascular diseases as a marker of chronic inflammation.     

Management of lymphedema: experience of the Cognacq-Jay Hospital

Treatment of lymphedema includes practical advices, manual lymph drainage, bandaging, self-bandaging, elastic compression garment, skin care and physical exercises. Weight loss may be useful if obesity. Surgery is indicated in genital lymphedema more than in limb lymphedema. In 2001, in Lymphology Unit, 248 women were treated for secondary upper limb lymphedema after breast cancer. Excess of volume of lymphedema was reduced by 31.3% after a mean time of 2.1 weeks. For lower limb lymphedema (primary or secondary), 136 patients were treated with a mean reduction of excess of lymphedema by 29.8% after a mean time of 2.2 weeks. After this treatment, long term follow-up is necessary to maintain results and the motivation of the patient.     

Independent association of joint space narrowing and osteophyte formation at the knee with health‐related quality of life in Japan: A cross‐sectional study

Objective

To clarify the individual associations of joint space narrowing (JSN) and osteophytosis at the knee with quality of life (QOL) in Japanese men and women using a large‐scale population‐based cohort from the Research on Osteoarthritis Against Disability (ROAD) study.

Methods

The associations of minimum joint space width (JSW) and osteophyte area in the medial compartment of the knee with QOL parameters, such as the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), were examined. Minimum JSW and osteophyte area in the medial compartment of the knee were measured using a computer‐aided system for the diagnosis of knee osteoarthritis.

Results

Of the 3,040 participants in the ROAD study, the present study included 2,039 participants age 40 years or older who completed the questionnaires (741 men and 1,298 women with a mean ± SD age of 68.6 ± 10.9 years). Multiple regression analysis after adjustment for age and body mass index showed that minimum JSW was significantly associated with scores on the pain domains of the WOMAC in men and women, while osteophyte area was significantly associated with scores on the physical function domains of the WOMAC in men and women.

Conclusion

The findings of this cross‐sectional study using a large‐scale population from the ROAD study indicate that JSN and osteophytosis are independently associated with QOL.

     

Impact of knee and low back pain on health-related quality of life in Japanese women: the Research on Osteoarthritis Against Disability (ROAD)

Although knee and low back pain are major public health issues, little information is available on their impact on the quality of life (QOL). We have investigated the impact of knee and low back pain on the QOL in Japanese women by assessing the associations between knee pain and low back pain and various QOL domains using measures such as the Medical Outcomes Study Short Form-8, EuroQOL, and the Western Ontario and McMaster Universities Osteoarthritis Index. From the 3,040 Japanese women participating in the Research on Osteoarthritis Against Disability (ROAD) study, we analyzed data on 1,369 women >40 years old (mean age 68.4 years). We further examined the associations of Kellgren–Lawrence (KL) grade at the knee and lumbar spine and the presence of vertebral fracture (VFx) with the magnitude of QOL loss in women with knee pain and low back pain, respectively. Knee pain and low back pain were found to be significantly associated with lower QOL scores among the women comprising the study cohort. In women with knee pain KL = 4, knee osteoarthritis was strongly associated with the magnitude of QOL loss. For women with low back pain, no significant associations were found between KL grade and magnitude of QOL loss, while there was a moderate association between the latter and VFx.     

Impact of knee and low back pain on health-related quality of life in Japanese women: the Research on Osteoarthritis Against Disability (ROAD)

Abstract

Although knee and low back pain are major public health issues, little information is available on their impact on the quality of life (QOL). We have investigated the impact of knee and low back pain on the QOL in Japanese women by assessing the associations between knee pain and low back pain and various QOL domains using measures such as the Medical Outcomes Study Short Form-8, EuroQOL, and the Western Ontario and McMaster Universities Osteoarthritis Index. From the 3,040 Japanese women participating in the Research on Osteoarthritis Against Disability (ROAD) study, we analyzed data on 1,369 women >40 years old (mean age 68.4 years). We further examined the associations of Kellgren–Lawrence (KL) grade at the knee and lumbar spine and the presence of vertebral fracture (VFx) with the magnitude of QOL loss in women with knee pain and low back pain, respectively. Knee pain and low back pain were found to be significantly associated with lower QOL scores among the women comprising the study cohort. In women with knee pain KL = 4, knee osteoarthritis was strongly associated with the magnitude of QOL loss. For women with low back pain, no significant associations were found between KL grade and magnitude of QOL loss, while there was a moderate association between the latter and VFx.     

Quality of life, nutritional status, physical activity, and their interrelationships of elderly living on an underpopulated island in Japan

Background:   The objectives of this study were to assess the quality of life (QOL), nutritional and health status, physical fitness and daily physical activity level (PAL) of elderly residents living on a remote island in Japan and to reveal factors associated with QOL scores and PAL.
Methods:   This was a cross-sectional study that targeted elderly residents dwelling on an island whose population is aging and rapidly decreasing. Fifty-two subjects (20 men and 32 women; mean age, 74 years) were evaluated for anthropometry (nutritional status), blood pressure (health status) and handgrip strength (physical fitness). QOL was investigated using the World Health Organization-QOL questionnaire. In addition, 24-h acceleration monitoring was conducted in eight subjects on 3 consecutive days to determine PAL.
Results:   Women tended to be obese compared with men (BMI, 25.6 vs 23.6 kg/m², P  < 0.05). Of the four QOL domains, the score for "social relationships" was significantly higher in women. Significant correlations were found between handgrip strength and QOL scores. A significant negative relationship was found between BMI and PAL ( r _s =−0.90, P  < 0.005). In contrast, a positive association was observed between handgrip strength and PAL ( r _s = 0.77, P  < 0.05).
Conclusion:   The results suggest that social communication is an important factor for a high QOL of women in the remote island society. The results of the correlation analyses suggest that walking, maintaining an ideal body weight and promoting physical fitness have important roles in maintaining and increasing PAL in the elderly.     

Quality-of-life and body image impairments in patients with lymphedema

The psychological and social consequences of chronic lymphedema are still often overlooked, as is the frequency with which they occur. Secondary lymphedema after mastectomy or breast-conservation procedures following the diagnosis of breast cancer is especially common and represents a substantial problem for those affected. The aim of this study was to investigate differences in body image and quality of life (QOL) between female lymphedema patients and trauma patients and to further monitor the changes in female lymphedema patients during three weeks of rehabilitation. This survey was conducted on 80 female patients at the State Hospital of Wolfsberg/Carinthia, Austria, 40 were trauma patients and the other 40 patients had some type of lymphedema, 20 of these patients were located in the general lymphedema ward and 20 in rehabilitation. The Frankfurt Body Image Questionnaire was used to determine body image, and the German version of the Short Form-36 Health Survey was used to determine QOL. The results indicate that female lymphedema patients are greatly affected in various areas of body image and QOL. Lymphedema patients show significantly lower body image scores in seven of nine areas compared to trauma patients. Female lymphedema patients also describe their QOL as being lower in the areas of general health perception, vitality and mental well-being. After rehabilitation, there were improvements in the evaluation of physical functioning and an increased acceptance of the body. Patients also showed a significant increase in health perception, vitality and mental health.     

Young adults with juvenile arthritis in remission attain normal peak bone mass at the lumbar spine and forearm

OBJECTIVE: To assess the impact of disease activity on acquired peak bone mass and bone turnover in young adult patients with either persistent juvenile arthritis (JA) or a history of JA (JA in remission). METHODS: Two hundred twenty-nine patients with JA were studied after a mean +/- SD of 15.6 +/- 2.4 years in women and 14.9 +/- 2.1 years in men since disease onset. One hundred forty-five women and 84 men were over the age of 20 at the time of examination (mean +/- SD age 24.9 +/- 2.9 years for women and 25.2 +/- 3.1 years for men). Forty-one healthy women (mean +/- SD age 27.4 +/- 3.1 years) and 55 healthy men (mean +/- SD age 25.7 +/- 3.1 years) served as a reference group. Bone mineral density (BMD) was analyzed by dual x-ray absorptiometry. Serum osteocalcin concentrations and urinary concentrations of deoxypyridium (D-Pyd) were measured. Linear regression analyses were performed to evaluate the impact of disease on BMD. RESULTS: Patients with persistent disease had significantly lower BMD compared with healthy subjects (P < 0.001 for women at all measured sites and for men at the femoral neck and total body; P < 0.05 for men at the radius and lumbar spine). Of the patients with a history of JA, only women had significantly lower BMD at the femoral neck and total body (P < 0.05). Patients with persistent JA had significantly more osteopenia and osteoporosis than healthy subjects, while patients with a history of JA had more frequent osteopenia only in the total body. Weight, urinary concentration of D-Pyd, and belonging to the patient group significantly affected BMD at all measured sites in the entire study population, while analysis of all patients found that only the number of months taking corticosteroids significantly affected BMD at all measured sites. However, the impact of the variables differed from site to site. CONCLUSION: Our findings imply that most young adults with JA attain the same BMD as healthy subjects if the disease goes into remission, while young adults with active disease have increased risk for osteopenia and osteoporosis.