Effects of tibolone on health-related quality of life in menopausal women.

OBJECTIVE: The present study assessed improvements in health-related quality of life (HRQOL) in menopausal women using tibolone. METHODS: One hundred women who underwent surgical menopause for various benign gynecological conditions were advised to take tibolone (2.5 mg) daily. The Menopause Rating Scale (MRS II) was used to assess the change in HRQOL after 3 months and 12 months of treatment. RESULTS: Sixty-two women returned for follow-up after 3 months, while only 15 returned for after 12 months. Significant improvements in HRQOL were found after 3 months, and further improvements were obtained after 12 months, although at a slower rate. Among the three subscales of MRS, maximum improvement in the somatovegetative component and lesser improvements in the other two subscales were found. CONCLUSION: Tibolone is effective in improving the overall HRQOL of menopausal women. Somatovegetative symptoms show most improvement.     

Comorbidities and predictors of health-related quality of life in Dravet syndrome

Purpose: Health‐related quality of life (HRQOL) has emerged as a widely accepted measure to evaluate how chronic disease impacts on an individual’s physical, social, and mental well‐being. There is a paucity of data focusing on HRQOL in specific epilepsy syndromes and their associated needs. In this study our aim was to describe the comorbidities and disease‐related predictors for HRQOL in Dravet syndrome, an epileptic encephalopathy, with defined genetic etiology. We anticipate that this will help us to better recognize and understand the needs of children and families and aid treatment planning in this severe epilepsy syndrome. Methods: One hundred sixty‐three individuals with Dravet syndrome and their families participated in the study. Detailed clinical and demographic information was available for each case. HRQOL was evaluated with two epilepsy‐specific instruments, the Impact of Pediatric Epilepsy Scale (IPES) and the Epilepsy & Learning Disabilities Quality of Life Questionnaire (ELDQOL); a generic HRQOL instrument; the Pediatric Quality of Life Inventory (PedsQL); and a behavioral screening tool, the Strength and Difficulties Questionnaire (SDQ). Key Findings: HRQOL was significantly lower for children with Dravet syndrome compared to normative data (p < 0.001). A cross‐sectional evaluation of measures across different age groups revealed that PedsQL generic core and cognitive function scales decreased in older age categories, indicating worse HRQOL (p < 0.001). Assessment of epilepsy severity demonstrated that symptoms were rated very severe in 10 (6%) of 162 cases, somewhat severe in 78 (48%) of 162, moderate in 51 (32%) of 162, and mild in 23 (14%) of 162 cases. The epilepsy severity correlated significantly with the IPES total impact score (r = 0.466, p < 0.001, n = 162). The IPES total impact scores in the Dravet group (n = 162) were significantly higher than scores measured in the original validation sample of epileptic children with and without learning difficulties (± SD) (21.0 ± 8.7 vs. 11.6 ± 5.4, t = 8.95, p < 0.001, n = 46). On the SDQ, 35% of children scored in the abnormal range for “conduct problems,” 66% for “hyperactivity/ inattention,” and 76% for “peer relationships.” Regression analysis revealed that young age at seizure onset (p = 0.019), presence of myoclonic seizures (p = 0.029), motor disorder (p = 0.048), learning difficulties (p = 0.002), epilepsy severity (p < 0.001), and behavioral difficulties (p < 0.001) each independently predicted poorer HRQOL. Behavioral problems such as hyperactivity/inattention were the strongest predictors of poorer HRQOL. Significance: This is the first comprehensive study of HRQOL in an etiologically well‐defined epilepsy syndrome. HRQOL in Dravet syndrome depends on a series of independent factors including seizure control, behavior, cognitive, and motor problems. Identification of specific comorbidities in Dravet syndrome will facilitate a distinct and multidisciplinary approach to management, addressing seizure control, behavior problems, cognitive difficulties, and motor impairment.     

Health‐related quality of life in patients with inflammatory bowel disease five years after the initial diagnosis

Background: Health‐related quality of life (HRQOL) has become an important tool in evaluating patient satisfaction in inflammatory bowel disease (IBD). So far, few prospective follow‐up studies have been done to identify variables that influence HRQOL. We aimed to identify demographic and clinical variables that influence HRQOL 5 years after diagnosis in patients with ulcerative colitis (UC) or Crohn disease (CD) included in a prospective follow‐up study from 1990 to 1994 (the IBSEN study). Methods: All patients completed the Inflammatory Bowel Disease Questionnaire (IBDQ), a disease‐specific quality‐of‐life questionnaire translated into Norwegian and validated. We present data from 497 patients (328 UC patients and 169 CD patients, mean age 43.3 years, 48% female). The impact of age, gender, smoking, symptom severity, disease distribution, rheumatic symptoms and surgery on IBD patients' HRQOL was analysed. Results: Women had a reduction in IBDQ total score of 10 points compared to men, CD patients had a reduction of 7.5 compared to UC patients. The patients with moderate/severe symptoms had a 50 points lower score than the patients without symptoms. The patients with rheumatic symptoms had a 10 points lower total score than the patients without these symptoms. All differences were statistically significant. The multiple regression analysis showed that symptom severity, rheumatic symptoms and female gender were the strongest predictors of reduction in HRQOL for both diagnosis groups. Conclusion: IBD symptoms, rheumatic symptoms and female gender have a significant influence on patients' HRQOL as measured by IBDQ. This was confirmed by the regression analysis.     

The relationship between mental disorders, quality of life, and pregnancy: findings from a nationally representative sample

BACKGROUND: The present study examined health-related quality of life (HRQOL) and the prevalence of mental disorders in pregnant and past-year pregnant women compared to non-pregnant women. METHOD: Data came from the National Epidemiologic Survey on Alcohol and Related Conditions. Three groups of women (ages 18-44) were compared: currently pregnant (n=451), past-year pregnant (n=1061), and not pregnant (n=10,544). Past-year mood, anxiety and substance use disorders were assessed by the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV version. HRQOL was measured by the Medical Outcomes Study Short Form (SF-12). All analyses included sociodemographics as covariates. RESULTS: Multiple logistic regression analyses showed that pregnant women were less likely than non-pregnant women to have depression and alcohol abuse or dependence; and less likely than past-year pregnant women to have depression and mania. Past-year pregnant women were less likely than non-pregnant women to have social phobia and alcohol dependence or abuse. Multiple linear regression analyses demonstrated that pregnant and non-pregnant women had higher mental component scores than past-year pregnant women. Physical component scores were lower in pregnant women than in non-pregnant and past-year pregnant groups. LIMITATIONS: This was a cross-sectional survey and the causality of relationships cannot be inferred. CONCLUSIONS: Results suggest that pregnant women have a lower likelihood of mental disorder than both non-pregnant and past-year pregnant women.     

Evaluation of health-related quality of life using EQ-5D in Takamatsu,Japan

Objectives  

Healthy Japan 21 (Japanese National Health Promotion in the 21st Century) was started in 2000 to promote extension of healthy life expectancy and improve health-related quality of life (HRQOL). The present study aims to describe HRQOL of Japanese subjects using the EuroQol questionnaire (EQ-5D) and investigate the influence of social background, health-related behaviors, and chronic conditions on HRQOL using representatives in Takamatsu, Japan.     

Psychometric Evaluation of the Brunei-Malay SF-36 version 2 Health Survey

Objectives: To culturally adapt the Short Form Health-36 version 2 (SF-36v2) into the Brunei-Malay context anddetermine its reliability and validity for measuring health-related quality of life (HRQOL) in healthy individuals andpatients with chronic kidney disease in Brunei Darussalam. Methods: An iterative multistep strategy involving setting upa bilingual expert panel, pretesting, text revision and back translation was used to prepare the Brunei-Malay SF-36v2 asan adaptation from the Malaysian-Malay SF-36v2. The Brunei-Malay SF-36v2 was then self-administered to a sample ofhealthy individuals (n=95) and predialysis chronic kidney disease outpatients (n=95) resident in Brunei. The mean(SD) age of the participants was 46.6 (17.8) years. Results: Data completion rate was 100% with minimal floor effects(≤0.21) in all the 8 domains and >15% ceiling effects in 3 of the 8 domain scales. Cronbach’s alpha was >0.70 for allthe 8 domain scales. Scaling success was 100% for convergent validity, with 100% item discriminant validity for alldomain scales except Social Functioning (94%), Mental Health (85%) and General Health (85%). Principal componentanalysis of the two-factor dimension explained 68% overall variance and accounted for 81% reliable variance, but theexact SF-36 two-factor summary constructs in the standard algorithm were not replicated in the Bruneian population.Conclusions: The Brunei-Malay SF-36v2 is a valid and reliable instrument for measuring HRQOL in healthy individualsand patients with chronic kidney disease in Brunei. The summary scales should, however, be interpreted with caution.Further studies should be carried out to assess additional psychometric properties of the Brunei-Malay SF-36v2.