Impact of obesity on quality of life and depression in patients with heart failure

BACKGROUND: The effect of obesity on health related quality of life (HRQOL) and depression in a number of disease states is well documented, but its impact in heart failure (HF) patients remains speculative. We therefore examined the relationship between obesity, HRQOL, and depression in 358 patients with HF. METHODS AND RESULTS: Comparative analyses were conducted to determine if body mass index (BMI) was associated with HRQOL and depression in three groups of patients with HF-normal weight (BMI 18.5-24.9 kg/m2, n = 100), overweight (BMI 25-29.9 kg/m2, n = 141), and obese (BMI > or = 30 kg/m2, n = 117). Obese patients were younger than normal and overweight participants; all other demographic and clinical characteristics were similar. HRQOL and depression scores were significantly higher (worse) for obese patients. Body mass index was significantly correlated with all 3 scales of HRQOL (overall, r2 = .160; physical, r2 = .162; and mental, r2 = .217) as well as with depression (r2 = .166). CONCLUSION: Obese patients with HF are more likely to have poorer HRQOL, physical health, emotional well-being and depressive symptoms. Poorer HRQOL is predictive of worse outcomes in patients with HF; however, given the apparent obesity paradox in HF, further investigation of the impact of obesity in HF is urgently required.     

慢性乙型肝炎患者远期生存质量研究

目的 对慢性乙型肝炎患者远期生存质量进行研究,为其预后判断,药物疗效的分析及药品经济学评估提供依据。 方法 采用补充修订的SF-36健康相关生存质量量表调查101例6～l 8年前经肝穿活组织检查诊断的慢性乙型肝炎和105例门诊体检的普通人群。 结果 慢性乙型肝炎患者在生理机能、生理职能、总体健康、精神健康、肝病特有症状5个方面的远期生存质量低于普通人群,差异有显著性(μ≥2.10,P<0.05)。 结论 慢性乙型肝炎患者远期生存质量差。     

Impact of pain on health-related quality of life in patients with inflammatory bowel disease

AIM: To evaluate intensity, localization and cofactors of pain in Crohn’s disease and ulcerative colitis patients in connection with health-related quality of life (HRQOL) and disease activity. METHODS: We reviewed and analyzed the responses of 334 patients to a specifically designed questionnairebased on the short inflammatory bowel disease questionnaire (SIBDQ) and the German pain questionnaire. Pain intensity, HRQOL, Crohn’s disease activity index (CDAI) and colitis activity index (CAI) were correlated a...     

Oral and general health-related quality of life among young patients with haemophilia

Summary.  The clinical diagnosis of dental diseases may indicate their cause and prognosis, however it gives little information about resulting levels of impairment from the patients' perspective. In this study, we aimed to investigate oral and general health-related quality of life (OHRQoL-HRQoL) in patients with haemophilia; and to test whether haemophiliacs would have worse or better OHRQoL compared with the general population. Data were collected from haemophiliacs (age range 14–35; mean 23 ± 6.58, n  = 71) and age/sex-matched controls (age range 14–35; mean 21.00 ± 6.45, n  = 60) through face-to-face interviews including nine questions and using oral health impact profile (OHIP)-14, oral health-related quality of life-UK (OHQoL-UK), short-form general measure of health (SF)-36 to measure self-rating oral health status, perceived dental treatment needs, tooth brushing frequencies, OHRQoL-HRQoL. In the field of self-rating oral health status, perceived dental treatment needs, tooth brushing frequencies and OHIP, OHQoL-UK, SF-36 scores – except the subscales including vitality, role emotional and mental health – the control group is in better conditions compared with the haemophilia group. At the same time, both the two groups are in good conditions in dental attendance, vitality, role emotional and mental health. Life quality is related with the perceived discrepancy between the reality of what a person has and the concept of what that person wants, needs or expects. In order to eliminate the dilemma in the field of health, we should facilitate the haemophiliacs' lives by serving the health care in a multidisciplinary view.     

Influence of hepatic encephalopathy on health-related quality of life in patients with cirrhosis

Cirrhosis is associated with decrements in health-related quality of life (HRQOL), but the specific effects of encephalopathy, especially subclinical, on quality of life are incompletely understood. Therefore, the aim of our study was to define the effects of encephalopathy on specific domains of HRQOL in a sample of patients with advanced liver disease. The sample consisted of 160 patients with cirrhosis presenting for liver transplantation evaluation. Health-related quality of life was measured with the Short Form-36 questionnaire. Clinical, demographic, and laboratory data were collected. The presence and degree of encephalopathy was ascertained clinically and by the use of the Reitan trail test. HRQOL scores were compared according to liver disease severity and to the presence and degree of encephalopathy. In addition, scores were compared to US population norms. Data were obtained from 148 patients. Compared to the US general population, the physical and mental component summary scores were lower in patients with cirrhosis. Among patients with cirrhosis, there were no significant differences in the physical and mental component summary scores according to age, gender, ethnicity, and etiology (hepatocellular versus/ cholestatic and HCV versus non-HCV). Increasing severity of liver disease (based on the Child-Pugh score), a history of hospitalizations, and a history of ascites were associated with decreased physical component summary scores but not mental component summary scores. Patients with encephalopathy (overt and subclinical) had decreased physical and mental component summary scores compared to patients without encephalopathy. Compared to patients without encephalopathy, those with subclinical encephalopathy had a lower mental component summary score. In conclusion, cirrhosis is associated with a decreased HRQOL, especially at advanced stages. Increased severity of liver disease is associated with decreased physical aspects of quality of life. Overt hepatic encephalopathy negatively affects both physical and mental aspects of quality of life, whereas subclinical encephalopathy affects mainly the mental aspects, independently of liver disease severity.     

Cardiac autonomic dysfunction and health-related quality of life in patients with chronic obstructive pulmonary disease

Background and objective: COPD is associated with impaired health‐related quality of life (HRQL) and cardiac autonomic dysfunction. Data describing the association between these factors in patients with COPD are mostly lacking. The objective of this study was to evaluate whether there is an association between cardiac autonomic dysfunction and HRQL in COPD. Methods: We studied 60 patients with COPD (37 women, mean (SD) age 65.20 (7.73) years, FEV₁ % pred. 46.58 (18.53) %) and measured HRQL, as assessed by the Chronic Respiratory Disease Questionnaire, and cardiac autonomic dysfunction, as assessed by heart rate variability (HRV). Analysis of HRV was performed using a Holter‐ECG device during a recording period of 5 min. To evaluate a possible association between these factors, univariate and multivariate analyses were used. Results: There was a significant correlation between Chronic Respiratory Disease Questionnaire total score and both variables of HRV reflecting parasympathetic tone; root mean square successive difference of RR intervals (rMSSD) (r = 0.34, P = 0.012) and the density of the beat‐to‐beat oscillation in the N‐N interval of HRV in the high‐frequency band (HF power) (r = 0.35, P = 0.01). In a multivariate analysis rMSSD was found to be independently associated with HRQL after correcting for FEV₁, carbon monoxide transfer coefficient (DL_CO), 6MWD and CRP. Conclusions: Resting parasympathetic tone, as measured by HRV, is independently associated with HRQL, which emphasizes the role of cardiac autonomic dysfunction on HRQL in patients with COPD.     

我国女性慢性丙型肝炎患者远期生存质量评估

目的 了解我国女性慢性丙型肝炎患者生存质量并分析其影响因素。 方法 对河北省固安县1988年～1993年41例女性输血后丙型肝炎患者的现状进行调查。采用SF-36健康相关生存质量量表对女性慢性丙型肝炎患者和51例当地女性非丙型肝炎人群进行评估。 结果 41例女性内型肝炎患者平均年龄(40.0±7.0)岁,随访时间10～15年,自然阴转率为19.51％(8/41)。女性慢性丙型肝炎患者在生理职能、身体疼痛、活力、情感职能、社会职能、总体健康、精神健康7个方面的远期生存质量低于非丙型肝炎普通女性人群,差异有显著性。 结论 平均感染13年的女性输血后慢性丙型肝炎患者远期生存质量差。慢性丙型肝炎是影响生存质量的一个独立因素。     

Impact of sleep-related breathing disorders on health-related quality of life in patients with chronic heart failure

BACKGROUND: Quality of life in patients with chronic heart failure (HF) is often severely compromised. Sleep-related breathing disorders (SRBD) like Cheyne-Stokes Respiration (CSR) or obstructive sleep apnea (OSAS) are often observed in patients with severe HF resulting in fragmentation of sleep, excessive daytime sleepiness and an increased mortality. While an apnea/hypopnea-index (AHI) >30/h represents an independent predictor of poor prognosis, clinical relevance of even minor SRBD with an AHI <30/h remains unclear with respect to quality of life, exercise capacity or depression rate. METHODS: Sixty-nine consecutive ambulatory patients with stable HF (NYHA II-III, EF 25%) underwent two night polygraphies with a six-channel ambulatory recording. Spiroergometry was performed, and patients were examined for sleep quality (PSQI), depressed mood (BDI) and health-related quality of life (SF-36). The data were compared to 10 age-matched healthy controls and 11 patients with OSAS (AHI 14-29/h) not suffering from HF. RESULTS: Fifty-one patients completed follow up. 52% were positively diagnosed for SRBD (AHI 16-30/h: 12 patients CSR, 5 patients OSAS, 9 patients mixed); 25 patients (48%) showed no relevant SRBD. Patients with HF and SRBD had lower quality of life than patients without SRBD and HF. The severity of SRBD as indicated by the AHI significantly correlated with quality of life measures: Bodily pain, physical functioning and social functioning showed largest impairment in patients with HF and SRBD. Furthermore, elevated depression rates in correlation to the AHI were only observed in patients with SRBD similar to patients with OSAS without HF. CONCLUSION: Even minor SRBD in patients with HF independently influence quality of life and correlate with estimation of depression and sleep disturbances.     

核苷和核苷酸类药物治疗对慢性乙型肝炎患者生活质量的影响

目的分析核苷和核苷酸类药物治疗对慢性乙型肝炎(CHB)患者生活质量的影响,并探讨相应护理措施。方法选取2010年3月-2014年7月于南方医科大学南方医院感染内科临床研究的102例CHB患者,分为持续治疗组(n=54)与停药组(n=48),以SF-36表测量生活质量。治疗组于治疗前与治疗96周接受评估,停药组于停药点与停药48周接受评估。计量资料组间比较采用t检验,组内比较采用配对t检验;计数资料组间比较采用χ2检验。单因素及多因素分析采用Logistics回归分析。结果与抗病毒前比较,持续治疗组患者抗病毒治疗96周后,其生理功能、生理职能、躯体疼痛、总体健康均明显升高(94.91±7.11 vs 92.13±10.58,81.94±24.96 vs 71.76±34.01,87.72±8.64 vs 82.85±12.88,59.63±14.59 vs 53.52±16.79,t=-3.786~-2.623,P值均0.05)。但心理质量除精神健康由67.30±18.94提高至75.56±15.53(t=-3.883,P0.001)外,其余维度均无明显改善。停药组在停药后48周生理职能、总体健康与精神健康均有显著提高(84.20±18.97 vs 72.49±24.38,69.28±22.94 vs 56.41±18.27,75.02±16.03 vs 68.94±14.07,t=-3.206~-2.078,P值均0.05)。多因素相关分析提示婚姻状况与抗病毒治疗后生存质量改善相关(比值比=11.61,95%可信区间:2.28~59.00,P=0.003)。未婚患者生活质量改善优于已婚患者,尤其是生理功能(t=-2.176,P=0.034)、生理职能(t=-2.173,P=0.034)与情感职能(t=-2.811,P=0.007)。结论抗病毒治疗能改善CHB患者的生理质量及精神健康,有效的心理干预对CHB患者尤其是已婚患者非常必要。     

Gender-associated differences in dyspnoea and health-related quality of life in patients with chronic obstructive pulmonary disease

BACKGROUND AND OBJECTIVES: Recent studies have reported several gender-associated differences among patients with COPD, but gender-associated differences in health-related quality of life (HRQoL) in patients with COPD have not yet been clarified. This study evaluated gender differences in dyspnoea and HRQoL in patients with COPD. METHODS: Study participants were 156 patients with COPD (men 117, women 39); men were individually matched to women by age and FEV(1)% predicted to give a ratio of 3:1 (male : female). Study participants were evaluated for dyspnoea and completed HRQoL questionnaires. An oxygen cost diagram (OCD) was used to assess the degree of dyspnoea and Morale Scale was used to assess subjective well-being. St. George's Respiratory Questionnaire (SGRQ) and SF-36 were used for HRQoL evaluation. The findings in the male and female groups were compared. RESULTS: The OCD and Morale Scale showed significantly lower values for female patients with COPD. Disease-specific HRQoL assessed by SGRQ was significantly worse, except for symptoms, in female patients with COPD. Generic HRQoL assessed by SF-36 was also significantly worse, except for general health and social functioning. Stepwise multiple regression showed OCD, Morale Scale and 6-min walking distance to be significantly associated with total SGRQ score in the male group, and Morale Scale and 6-min walking distance were significant associations in the female group. CONCLUSIONS: Gender differences exist in dyspnoea and HRQoL in patients with COPD. These need to be considered when designing treatment strategies for COPD patients.     

Periodontal surgery improves oral health-related quality of life in chronic periodontitis patients in Asian population

The effect of periodontal surgery on patients' quality of life was investigated. Sixty patients received regenerative surgery or resective osseous surgery. Oral health-related quality of life and health-related quality of life instruments were used to assess the participants' quality of life before surgery and 4 weeks after surgery. Periodontal surgery can improve patients' quality of life by alleviating the physical pain and psychological discomfort. The scores were lower (more favorable) in the regenerative surgery group, and the functional limitations of the regenerative surgery group improved substantially compared with those of the resective osseous surgery group (P = 0.0421). The patients' oral health-related quality of life scores improved significantly after periodontal surgery. Clinicians can take advantage of the positive functional oral health-related quality of life impacts of regenerative surgery.     

Clinically important changes in health-related quality of life for patients with chronic obstructive pulmonary disease

OBJECTIVE: Without clinical input on what constitutes a significant change, health-related quality of life (HRQoL) measures are less likely to be adopted by clinicians for use in daily practice. Although standards can be determined empirically by within-person change studies based on patient self-reports, these anchor-based methods incorporate only the patients' perspectives of important HRQoL change, and do not reflect an informed clinical evaluation. The objective of this study was to establish clinically important difference standards from the physician's perspective for use of 2 HRQoL measures among patients with chronic obstructive pulmonary disease (COPD). DESIGN: We assembled a 9-person expert panel of North American physicians familiar with the use of the Chronic Respiratory Questionnaire (CRQ), a disease-specific HRQoL measure, or the generic Medical Outcomes Study Short-Form 36-Item Health Survey (SF-36, Version 2.0) among patients with COPD. RESULTS: Using 2 rounds of the Delphi process, 1 in-person meeting, and an iterative improvement process for circulating and correcting the final report, the expert panel established small, moderate, and large clinically important change levels for the CRQ and SF-36. CONCLUSIONS: For this expert physician panel, levels for detecting clinically important differences on the CRQ were equal to or slightly higher than previous studies based on patient-reported differences. Clinically important differences on the SF-36, Version 2.0, were noticeably larger than previous estimates based on cross-sectional differences between clinically defined patient groups.     

慢性咳嗽对生活质量的影响

慢性咳嗽可以对患者的生理、心理和社会生活产生严重影响,医师能轻易发现慢性咳嗽对患者生理方面的并发症,而患者在心理和社会生活方面的影响却往往被忽视.近年来.国外一些学者陆续研究制定了咳嗽特异性生活质量问卷、Leicester咳嗽问卷和慢性咳嗽影响问卷等与咳嗽相关的生活质量问卷,用于评价咳嗽的严重度和咳嗽的治疗效果.     

Health status and health-related quality of life associated with hemophilia

The hemophilias are a group of disorders associated with a chronic burden of morbidity and early mortality. Improvements in these adverse features have been achieved by the use of clotting factor concentrates within comprehensive centers of specialized care providing home infusion programs. Offsetting effects from transfusion-transmitted hepatitis and HIV infection are in recent decline. The net impact of these changes merits assessment. To test the a priori hypotheses that increasing severity of factor VIII deficiency would be associated with an increasing burden or morbidity and that hepatitis and HIV positivity would impair health status further, a cross-sectional study of a population-based cohort was undertaken in a regional hemophilia program in Ontario, Canada. A survey was made of mild, moderate, and severe hemophiliacs over 13 years of age who self-reported their health status using a standard 15-item questionnaire. The responses were converted to levels in the Health Utilities Index Mark 2 (HUI2) and Mark 3 (HUI3) health status classification systems to form multi-element vectors from which single-attribute morbidity and overall health-related quality of life utility scores were determined. The burden of morbidity was greater in hemophiliacs than in the general population and correlated with the category of disease (mild < moderate < severe). Hepatitis and HIV positivity conferred additional burdens of morbidity, which were mainly in the attributes of mobility (HUI2), ambulation (HUI3), and pain (HUI2/3), all of these differences reaching levels of statistical significance. Despite demonstrable improvements in the safety, effectiveness, and utilization of clotting factor concentrates, hemophiliacs continue to experience an important burden of morbidity. Measurement of this burden, as reported here, provides a basis for future economic evaluation of the costs and consequences of health care interventions provided to this population.     

Effects of depressive symptoms on health-related quality of life in asthma patients

OBJECTIVE: To assess the effects of depressive symptoms on asthma patients’ reports of functional status and health-related quality of life. DESIGN: Cross-sectional study. SETTING: Primary care internal medicine practice at a tertiary care center in New York City. PATIENTS: We studied 230 outpatients between the ages of 18 and 62 years with moderate asthma. MEASUREMENTS AND MAIN RESULTS: Patients were interviewed in person in English or Spanish with two health-related quality-of-life measures, the disease-specific Asthma Quality of Life Questionnaire (AQLQ) (possible score range, 1 to 7; higher scores reflect better function) and the generic Medical Outcomes Study SF-36 (general population mean is 50 for both the Physical Component Summary [PCS] score and Mental Component Summary [MCS] score). Patients also completed a screen for depressive symptoms, the Geriatric Depression Scale (GDS), and a global question regarding current disease activity. Stepwise multivariate analyses were conducted with the AQLQ and SF-36 scores as the dependent variables and depressive symptoms, comorbidity, asthma, and demographic characteristics as independent variables. The mean age of patients was 41 ± SD 11 years and 83% were women. The mean GDS score was 11 ± SD 8 (possible range, 0 to 30; higher scores reflect more depressive symptoms), and a large percentage of patients, 45%, scored above the threshold considered positive for depression screening. Compared with patients with a negative screen for depressive symptoms, patients with a positive screen had worse composite AQLQ scores (3.9±SD 1.3 vs 2.8±SD 0.8, P<.0001) and worse PCS scores (40±SD 11 vs 34±SD 8, P<.0001) and worse MCS scores (48±SD 11 vs 32±SD 10, P<.0001) scores. In stepwise analyses, current asthma activity and GDS scores had the greatest effects on patient-reported health-related quality of life, accounting for 36% and 11% of the variance, respectively, for the composite AQLQ, and 11% and 38% of the variance, respectively, for the MCS in multivariate analyses. CONCLUSIONS: Nearly half of asthma patients in this study had a positive screen for depressive symptoms. Asthma patients with more depressive symptoms reported worse health-related quality of life than asthma patients with similar disease activity but fewer depressive symptoms. Given the new emphasis on functional status and health-related quality of life measured by disease-specific and general health scales, we conclude that psychological status indicators should also be considered when patient-derived measures are used to assess outcomes in asthma. This project was supported by a Robert Wood Johnson Foundation Generalist Physician Faculty Scholar’s Award to Dr. Mancuso.