The clinical features of EDNOS: Relationship to mood,health status and general functioning

Study purposeEating disorder not otherwise specified (EDNOS) remains poorly evaluated in terms of eating disorder features and relationship to mood, health status and general functioning. This study investigated the clinical profiles of a sample of EDNOS patients, and how they compared to patients with anorexia nervosa (AN) and bulimia nervosa (BN).MethodThe sample consisted of 178 patients. All completed the Eating Disorder Examination, Beck Depression Inventory, Work and Social Adjustment Scale and Sf-36. ANOVAs were conducted to explore group differences.ResultsNo differences were found for depression. No differences were found between BN and EDNOS on measures of health status and general functioning. AN patients reported greater role limitations due to physical health and experienced greater physical pain compared with BN or EDNOS patients, and reported poorer social functioning, lower vitality and higher functional impairment compared with EDNOS patients.ConclusionEDNOS patients are generally no less clinically impaired than those with BN. However AN patients may be more impaired in some aspects of general functioning compared with BN or EDNOS patients.     

School Performance in a Longitudinal Cohort of Children at Risk of Maltreatment

Objective: Previous research has suggested that child maltreatment is associated with poor school performance. However, previous studies have largely been cross-sectional or, if longitudinal, have had small sample sizes, short follow-up periods, or have not adequately controlled for confounders. The objective of this study is to determine the relationship between child maltreatment and school performance in a cohort of children at risk of maltreatment and followed since birth. Method: This prospective study followed children born at risk for maltreatment with semi-annual reviews of the North Carolina Central Registry of Child Abuse and Neglect. At ages six and eight years, children's teachers were surveyed using the Achenbach Teacher Report Form and project-developed questions regarding peer status. This information, along with control variables from maternal interviews, was used in logistic regression models to determine the impact of maltreatment on academic performance, peer status, and adaptive functioning. The generalized estimating equations (GEE) method was applied to adjust variance estimates for within-person correlations of school performance measures at two points in time. Results: A substantiated maltreatment report is significantly associated with poorer academic performance (p < 0.01) and poorer adaptive functioning (p < 0.001) but not with peer status. Conclusions: Understanding the consequences of maltreatment, including poor academic performance and adaptive functioning, is important in planning educational, health, and social service interventions that may help abused or neglected children succeed in school and later in life. Longitudinal analysis is the best way to establish a causal relationship between maltreatment and subsequent school problems.     

Functional status,health problems,age and comorbidity in primary care patients

Objectives: To determine the relationship between functional status and health problems, age and co-morbidity in primary care patients. Methods: Patients from 60 general practitioners who visited their general practitioner were recruited and asked to complete a written questionnaire, including a list of 25 health problems and the SF-36 to measure functional status. The response rate was 67% (n = 4112). Differences between subgroups were tested with p < 0.01. Results: Poorer functional status which was associated with increased age (except for vitality) and increased co-morbidity. Patients with asthma/bronchitis/COPD, severe heart disease/infarction, chronic backpain, arthrosis of knees, hips or hands, or an ‘other disease’ had poorer scores on at least five dimensions of functional status. Patients with hypertension, diabetes mellitus or cancer did not differ from patients without these conditions on more than one dimension of functional status. In the multiple regression analysis age, had a negative effect on functional status (standardised β-coefficients between −0.03 and −0.34) except for vitality. Co-morbidity had a negative effect on physical role constraints (−0.15) and bodily pain (−0.09). All health problems had effects on dimensions of functional status (coefficients between −0.04 and −0.13). General health and physical dimensions of functional status were better predicted by health problems, age and co-morbidity (between 6.4 and 16.5% of variation explained) than mental dimensions of functional status (between 1.1 and 3.2%). Conclusion: Higher age was a predictor of poorer functional status, but there was little evidence for an independent effect of co-morbidity on functional status. Health problems had differential impact on functional status among primary care patients. This revised version was published online in June 2006 with corrections to the Cover Date.     

Quality of life of persons with onychomycosis

Onychomycosis is a fungal infection of the nails which, although unsightly in appearance, is often considered to be a cosmetic problem. This research reports on the development and performance of a quality-of-life instrument to measure the impact of this disease on the patients' mental and general health, social functioning, pain, and self-confidence. In telephone interviews, 680 members of a health maintenance organization (299 with onychomycosis and 381 without) were asked a battery of items regarding quality of life (mental and social functioning, self-esteem, pain) and specific problems and symptoms related with one's nails. Persons with onychomycosis had significantly poorer ratings compared with the healthy persons with respect to general health (p=0.02) and bodily pain p<0.001). Persons with onychomycosis also had significantly (p<0.05) poorer ratings for mental health, social functioning, health concern, physical appearance, and functional limitations associated with activities involving standing on one's feet or working with one's fingers. This study is the first to document the impact of onychomycosis on an individual's quality of life. Persons with onychomycosis may adapt to this condition, but they continue to experience embarrassment and discomfort that reduces their quality of life.This research was supported through a research grant from Sandoz Research Institute to Technology Assessment Group, Inc.     

Social support and health-related quality of life in hip and knee osteoarthritis

OBJECTIVE: To document the association between social support and health-related quality of life (HRQoL) in hip and knee osteoarthritis (OA). METHODS: A prospective survey including the SF-36 and the Social Support questionnaire (SSQ) was administered to 108 hip and knee OA patients attending an outpatient physical rehabilitation and rheumatology clinic. Multiple regression analysis were performed to study the relation between social support and each dimension of the SF-36, controlling for age, sex, body mass index, number of comorbid conditions, socioeconomic status, site of survey completion and severity of OA which was gauged with the pain dimension of the WOMAC, an OA-specific health status instrument. RESULTS: Greater social companionship transactions were associated with higher physical functioning (standardized regression coefficients: beta = 0.26, p < 0.01), general health (beta = 0.32, p < 0.001), mental health (beta = 0.25, p < 0.01), social functioning (beta = 0.20, p < 0.05) and vitality (beta = 0.25, p < 0.05). Satisfaction with problem-oriented emotional support was related to better physical functioning (beta = 0.22, p < 0.01), mental health (beta = 0.38, p < 0.001), role-emotional (B = 0.23, p < 0.01), social functioning (beta = 0.19, p < 0.05) and vitality (beta = 0.26, p < 0.01). CONCLUSION: Social support components significantly account for HRQoL. Health interventions in OA, primary dedicated to pain and physical disability, could be supplemented with social support component to enhance health outcomes.     

强直性脊柱炎患者生存质量及影响因素分析

目的了解强直性脊柱炎（ankylosing spondylitis,AS）患者的生存质量现状,探索影响AS患者生存质量的因素,为指导临床治疗,评价预后提供依据。方法整群抽取2010年6月～2011年6月年安徽医科大学第一附属医院风湿科门诊确诊的AS患者129人,采用SF-36量表对这些患者的生存质量进行评价,并对影响AS患者生存质量的因素进行分析。结果与一般人群相比,AS患者的生存质量下降,与活动性AS患者组bath AS疾病活动性指数（bath AS disease activity index,BASDAI）≥4相比稳定性强直性脊柱炎患者组（BASDAI〈4）的各维度得分除社会功能维度外,其余均升高,差异均有统计学意义（均有P〈0.05）;功能状态较好bath AS功能指数（bath ASfunctional index,BASFI）〈5的AS患者与功能状态较差（BASFI≥5）的AS患者相比,前者的SF-36得分除社会功能维度外,其余均高于后者,差异均有统计学意义（均有P〈0.05）;多因素分析结果显示对治疗前景的态度、BASDAI、BASFI可能影响AS患者的生存质量。结论 AS患者的生存质量与一般人群相比下降。针对影响AS患者生存质量的因素进行宣传教育及积极治疗对改善AS患者的生存质量至关重要。     

Health-related and overall quality of life of patients with chronic hip and knee complaints in general practice

Background: Information about quality of life of patients with chronic hip or knee complaints in general practice is scarce. This study describes the health-related and overall quality of life (HRQL) of these complaints. Methods: Data were obtained from a cohort study in general practice. HRQL at three months follow-up was analysed. HRQL was measured as: symptoms, physical, psychological and social functioning, and general health perceptions, using the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) and the MOS 36-item short-form-health survey (SF-36). Overall quality of life was measured using a 5-point rating scale. Results: The results show that patients with chronic hip or knee complaints have a substantial lower HRQL compared to patients who had recovered from baseline hip or knee complaints. The largest effect was found on symptoms and physical functioning: up to 2.9 standard deviations below patients who had recovered from baseline hip or knee complaints. Scores of patients with both chronic hip and knee complaints were significantly worse than scores of patients with only knee complaints on most subscales. Conclusion: In patients with chronic hip or knee complaints the worst scores were seen on scales that measure symptoms and physical functioning, but still a substantially lower score was obtained for overall quality of life. Quality of life was poorer for patients with both chronic hip and knee complaints compared to those with chronic hip or knee complaints only.     

Nutritional status and its relationship to quality of life in a sample of chronic hemodialysis patients.

OBJECTIVE: To assess the relationship between nutritional status and quality of life in a sample of chronic hemodialysis patients. DESIGN: Cross-sectional study. SETTING: Haemodialysis Units of St Vincent's and St George Hospitals, Sydney, Australia. PATIENTS: Sixty-four patients participated in the nutritional assessment, of which 53 completed the quality of life questionnaire. INTERVENTION: Nutritional status was assessed using subjective global assessment in addition to a number of anthropometric and biochemical parameters. Quality of life was assessed by means of a patient questionnaire and assessment of physical functioning. MAIN OUTCOME MEASURES: Nutrition status, 6 quality of life subscales related to general well-being, health and functioning, social and economic, psychological/spiritual well-being, and family life, employment status, income, participation in recreational/sports activities, the number of hospital admissions, days of hospitalization, and lengths of hospital stay. RESULTS: Sixty-four percent of patients were well nourished, 23% were moderately malnourished, and 13% were severely malnourished. Malnutrition was associated with poorer subjective quality after controlling for the affects of sociodemographic and medical variables. Severe malnutrition was also independently associated with poorer physical function, and resulted in significantly more hospital admissions, more days of hospitalization, and longer average lengths of hospital stay. CONCLUSION: Malnutrition is common in chronic hemodialysis patients and is associated with poorer quality of life when the degree of malnutrition becomes severe. Prospective studies are required to determine whether improving the nutritional status of these patients will result in meaningful improvements in quality of life and other medical outcomes.     

Perceptions of Chronic Pain’s Interference with Sexual Functioning: The Role of Gender,Treatment Status,and Psychosocial Factors

The relation between self-reported pain and sexual functioning was investigated in a national sample of adults between the ages of 25–80. Although it is believed that pain generally has a deleterious effect on sexual functioning, relatively little data are available about the psychosocial correlates of the pain-sexuality link, the pain-sexuality relation among persons not in treatment for pain, or the role of gender as a potential moderator of the relation between psychosocial factors and pain-related interference. The present study involved the screening of chronic pain via the Profile of Chronic Pain: Screen (PCP: S) and the assessment of psychosocial correlates of pain’s interfering effects on sexual performance by means of responses on the Profile of Chronic Pain: Extended Assessment Battery (PCP: EA). Results revealed that, although pain did not interfere with sexual functioning in 37% of the respondents, several psychosocial variables from the PCP: EA were linked to pain’s interference with sexual activity controlling for the effects of pain severity. Pain-induced fear, impatience, and tangible support all yielded significant main effects. Moreover, the effects of five variables (ignoring, self-talk, task persistence, belief in a medical cure, and control) varied significantly by gender, and the effects of two PCP: EA dimensions (catastrophizing and belief in a medical cure) varied by treatment status. The assessment and treatment implications of the present findings were considered.

A comparison of health status between rural and urban adults

The objective of the study was to examine and compare health status between rural and urban adults. The data are from a 1993 statewide probability-based telephone survey of adult Kentuckians (n=662). Metropolitan Statistical Area (MSA) residents (n=264) and nonMSA residents (n=398) were compared using the Medical Outcomes Study, Short Form Health Survey (SF-20). Self-perceived urban (n=406) and rural (n=256) residents were also compared. Additional analyses were stratified by the age categories of 18–44, 45–64, and 65 years of age. Few differences in health status existed between rural and urban adults. However, rural elders (65 years) had significantly poorer health status than urban elders. After controlling for demographic variables in multiple regressions, rural elders had significantly poorer functioning (all p<.05) than urban elders as measured by the SF-20 subscales of a) physical functioning, b) role functioning, c) social functioning, d) general mental health, and e) general health perceptions. No differences between rural and urban residents were noted for the pain subscale. Although the health status of rural and urban adults is generally similar, the rural elderly have significantly worse health status than their urban counterparts.     

Gender differences in psychosocial influence and rehabilitation outcomes for work-disabled individuals with chronic musculoskeletal pain

Introduction: This study aimed to investigate gender differences in rehabilitation outcomes and how psychosocial factors may interact to influence rehabilitation outcome in work-disabled with chronic musculoskeletal pain. Methods: One hundred and sixty eight (n=168) persons (mean age = 45.5/SD=9.0) participating in a multidisciplinary rehabilitation program, were included. Data on pain, functional health and psychosocial factors were collected previous to treatment, after 5 week intensive training and after 52 week follow-up period. Demographics, socio-economics and data on personal characteristics were also collected. Results: Significant (p<.05) gender differences were found on sleeplessness, meaningfulness and manageability. No significant gender differences were found on pain or functional health status variables. Gender differences (p<.001) were found in how socio-demographic and psychosocial factors influence rehabilitation outcomes in terms of functional health status. Conclusions: These data suggests that knowledge of gender differences and the way psychosocial factors influence rehabilitation outcomes must be taken into account in designing rehabilitation intervention.     

Predicting quality of life impairment in chronic schizophrenia from cognitive variables

Background The aim of this study was to see whether and how cognition deficit predicts quality of life impairments in schizophrenia patients. Method The Computerized Cambridge Automated Neuropsychological Test Battery, the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) and the Quality of Life Scale (QLS) were used to assess 62 patients with chronic schizophrenia. Step-wise multiple regression analysis was used in order to determine cognitive variables that would predict the scores of each Q-LES-Q and QLS domain scores. Results Regression analysis revealed a significant association of the cognitive deficits with both general and domain-specific quality of life impairment measured with Q-LES-Q and QLS. Deficits in executive functions, visual sustained attention, memory and motor skills have been found to be valid predictors both before and after controlling for the severity of symptoms, emotional distress, side effects, age, education, and illness duration. Conclusions This study suggests that deficits in executive functioning, attention, memory and motor skills substantially contributes to predicting impairments across a wide range of HRQL domains, and, consequently, to quality of life appraisal in schizophrenia. Cognitive predictors cannot be attributed to illness-related and background variables. It can be concluded that, when aiming at the improvement of quality of life in schizophrenia patients, cognitive functioning should be targeted.     

Treatment- and cost-effectiveness of early intervention for acute low-back pain patients: a one-year prospective study

In an attempt to prevent acute low-back pain from becoming a chronic disability problem, an earlier study developed a statistical algorithm which accurately identified those acute low-back pain patients who were at high risk for developing such chronicity. The major goal of the present study was to evaluate the clinical effectiveness of employing an early intervention program with these high-risk patients in order to prevent the development of chronic disability at a 1-year follow-up. Approximately 700 acute low-back pain patients were screened for their high-risk versus low-risk status. On the basis of this screening, high-risk patients were then randomly assigned to one of two groups: a functional restoration early intervention group (n = 22), or a nonintervention group (n = 48). A group of low-risk subjects (n = 54) who did not receive any early intervention was also evaluated. All these subjects were prospectively tracked at 3-month intervals starting from the date of their initial evaluation, culminating in a 12-month follow-up. During these follow-up evaluations, pain disability and socioeconomic outcomes (such as return-to-work and healthcare utilization) were assessed. Results clearly indicated that the high-risk subjects who received early intervention displayed statistically significant fewer indices of chronic pain disability on a wide range of work, healthcare utilization, medication use, and self-report pain variables, relative to the high-risk subjects who do not receive such early intervention. In addition, the high-risk nonintervention group displayed significantly more symptoms of chronic pain disability on these variables relative to the initially low-risk subjects. Cost-comparison savings data were also evaluated. These data revealed that there were greater cost savings associated with the early intervention group versus the no early intervention group. The overall results of this study clearly demonstrate the treatment- and cost-effectiveness of an early intervention program for acute low-back pain patients.     

Neurocognitive complaints and functional status among patients with chronic fatigue syndrome and fibromyalgia

Purpose

The purpose of this study was to conduct a longitudinal examination of cognitive complaints and functional status in patients with chronic fatigue syndrome (CFS) alone and those who also had fibromyalgia (CFS/FM).

Methods

A total of 93 patients from a tertiary care fatigue clinic were evaluated on four occasions, each 6 months apart. Each evaluation included a tender point assessment, and self-reported functional status and cognitive complaints.

Results

Patients with CFS/FM reported significantly worse physical functioning, more bodily pain, and more cognitive difficulties (visuo-perceptual ability and verbal memory) than patients with CFS alone. Over time, bodily pain decreased only for participants with CFS alone. Verbal memory problems were associated with more bodily pain for both patient groups, whereas visuo-perceptual problems were associated with worse functional status for patients with CFS alone.

Conclusions

This study adds to the literature on functional status, longitudinal course, and cognitive difficulties among patients with CFS and those with CFS and FM. The results suggest that patients with CFS/FM are more disabled, have more cognitive complaints, and improve more slowly over time than patients with CFS alone. Specific cognitive difficulties are related to worse functional status, which supports the addition of cognitive difficulties to the FM case criteria.

     

Models of health-related quality of life in a population of community-dwelling Dutch elderly

Objective: Though health-related quality of life (HRQoL) is now commonly measured as an outcome in clinical trials, the relationships between its components remain unclear. The relation of physical symptoms, physical function, and psychological symptoms to each other and to overall quality of life is of special interest. Method: Cross-sectional data from 5279 community-dwelling elders who participated in the Groningen Longitudinal Aging Study were analyzed using structural equation modeling techniques. Three models were examined. One “Linear” model included: number of chronic medical conditions, physical symptoms, physical functioning, activity interference, social function, perceived health and overall quality of life in a simple linear progression. Another ‘non-linear’ model included these variables, but allowed effects between non-adjacent variables. A third ‘non-linear’ model included these variables plus anxiety and depressive symptoms. Results: The Linear Model did not satisfactorily account for the observed data [X ²(15_df) = 2946.96], so the saturated Non-Linear Model, incorporating paths between non-adjacent components, is described. When anxiety and depressive symptoms were added to this Non-Linear Model, they fit best in a position mediating the relation between perceived health and overall quality of life [X ²(5_df) = 136.78]. Conclusions: Overall quality of life appears to be related to symptom status as directly as it is related to functional status. Anxiety and depressive symptoms appear to mediate the relation between general health perceptions and overall quality of life. Quality of life measures should therefore include assessments of physical and psychological symptom severity as well as functional status if they are to truly reflect what matters to patients. The disability-adjusted life year (DALY) measure used by the WHO may inadequately reflect the effect of symptoms on patient's quality of life. This revised version was published online in June 2006 with corrections to the Cover Date.     

EDITORIAL

We investigated the effects of physical, psychological, and sexual violence on the health status of women attending antenatal clinics at two tertiary hospitals in rural Thailand. We asked 421 pregnant women at 32 weeks gestation or later to complete a survey questionnaire. Participants reported high rates of psychological abuse (53.7%); threats, acts of physical abuse, or both (26.6%); and sexual violence (19.2%). Women abused during pregnancy had poorer health compared with nonabused women, in role emotional functioning, vitality, bodily pain, mental health, and social functioning. Given the high prevalence of violence and poor health status, routine screenings by maternity services is urgently required.     

Consecuencias del dolor crónico en la infancia y la adolescencia

Objective

Our aim was to examine and map the consequences of chronic pain in children and adolescents.