Quality of life instruments for caregivers of patients with cancer : A review of their psychometric properties

The quality of life of caregivers of patients with cancer is an important construct given the substantial impact of caring on the physical, psychological, social, and financial well-being of caregivers. Moreover, caring for patients with cancer also affects family functioning and places burdens on caregivers. The reliability and validity of instruments used to assess the quality of life of caregivers of patients with cancer were reviewed to aid in the selection of the most appropriate measures For research and practice. MEDLINE (1980-2000) and c/NAHL (1982-2000) searches located relevant quality of life instruments using the keywords "cancer and quality of Iife" and "caregiver or spouse or partner." The search identified the following instruments: the Caregiver Quality of life Index-Cancer Scale, the 'Caregiver Quality of Life Index, the Quality of Life Tool, and the Quality of life Index-Cancer Version. Quality of life instruments developed specifically to measure the quality of life of caregivers of patients with cancer had the best psychometric properties. The Caregiver Quality of Life Index-Cancer Scale, in particular, met or exceeded minimum psychometric criteria for reliability and validity. The development of reliable and valid caregiver quality of life measures is an important factor in developing interventions to enhance quality of life of caregivers of patients with cancer.

The health-related quality of life of overweight and obese adolescents - a study measuring body mass index and adolescent-reported perceptions

Objective. To determine whether the health-related quality of life (HRQOL) of overweight and obese adolescents is significantly lower than that of their healthy weight counterparts, and if so, whether any demographic trends exist and the relative contribution of each HRQOL dimension.

Methods. Cross-sectional analysis of 2,890 students participating in the Pacific Obesity Prevention in Communities Project, Australia. HRQOL was measured using the Pediatric Quality of Life Inventory (PedsQL) adolescent module. Adolescent height and weight were measured by trained field workers and weight categories assigned according to the International Obesity Task Force BMI cut-off points for adolescents. Multivariate linear regression analyses were undertaken to estimate the mean differences in HRQOL scores between (i) overweight and healthy weight, and (ii) obese and healthy weight adolescents, whilst adjusting for gender, age and socioeconomic status quartile.

Results. The sample had a mean age of 14.6 years (range 11–18), 56.2% boys, 20.2% overweight and 6.3% obese. Higher weight status categories were associated with lower HRQOL scores (mean PedsQL scores: healthy weight: 79.1, overweight: 77.7 and obese: 73.7). Relative to the healthy weight group, and after adjustments, overweight and obese adolescents reported 1.44 (p = 0.005) and 5.55 (p < 0.001) lower HRQOL summary scores, respectively. Overweight adolescents reported significantly lower scores in physical and social functioning, whilst obese adolescents reported significantly lower scores in the same dimensions plus emotional functioning. Girls and younger (< 15 years) adolescents reported greater mean negative HRQOL differences associated with excess weight.

Conclusions. Overweight and obesity in adolescents are associated with significantly lower HRQOL scores.

Changes in body mass index and health related quality of life from childhood to adolescence

Objective . To determine longitudinal relationships between body mass index (BMI) and health-related quality of life (HRQoL) in an adolescent population sample.
Design. Data collected in 2000 and 2005 within the Health of Young Victorians longitudinal cohort study.
Setting. Originally a community sample of elementary school students in Victoria, Australia. Follow-up occurred in either secondary schools or individuals homes.
Participants. Cohort recruited in 1997 via a random sampling design from Victorian elementary schools. Originally comprising 1 943 children, 1 569 (80.8%) participated in 2000 (wave 2, 8 – 13 years) and 851 (54%) in 2005 (wave 3, 13 – 19 years).
Main outcome measures. In both waves participants and their parents completed the PedsQL, a 23-item child HRQoL measure, and BMI z-scores and status (non-overweight, overweight or obese) were calculated from measured height and weight. Associations were tested cross-sectionally and longitudinally (linear regression, adjusted for baseline values)
Results. A total of 81.6% remained in the same BMI category, while 11.4% and 7.0% moved to higher and lower categories, respectively. Cross-sectional inverse associations between lower PedsQL and higher BMI categories were similar to those for elementary school children. Wave 2 BMI strongly predicted wave 3 BMI and wave 2 PedsQL strongly predicted wave 3 PedsQL. Only parent-reported Total PedsQL score predicted higher subsequent BMI, though this effect was small. Wave 2 BMI did not predict wave 3 PedsQL.
Conclusions. This novel study confi rmed previous cross-sectional associations, but did not provide convincing evidence that
BMI is causally associated with falling HRQoL or vice versa across the transition from childhood to adolescence.

The effect of gender and age on the association between weight status and health-related quality of life in Australian adolescents

Evidence suggests an inverse relationship between excess weight and health-related quality of life (HRQoL) in children and adolescents, however little is known about whether this association is moderated by variables such as gender and age. This study aimed to investigate these relationships.

Adulthood fracture and quality of life : A population-based study of Australian men

Background: Our objective was to investigate associations between adulthood fracture and quality of life (QOL) in men. Methods: For 448 men aged 50-85 years and enrolled in the Geelong Osteoporosis Study, we measured QOL using the validated (Australian) World Health Organization Quality of Life-Brief Version (WHOQOL-Bref) in the domains of physical health, psychological health, social relationships, and the environment. Self-reported adulthood fractures were categorized as recent or non-recent ( ≤ 10 years or > 10 years pre-QOL assessment, respectively). Lifestyle and health information were self-reported. Results: One hundred seventy four men (38.8%) sustained at least one fracture, 26% of which had occurred within the last 10 years. Compared with men who had never had an adulthood fracture, a non-recent fracture was more likely associated with poorer QOL in the physical health domain (age-adjusted odds ratio [OR] 0.47, 95% confidence interval [95%CI] 0.27-0.83), but not in any other domain. Men who had sustained a recent fracture reported a lower QOL in the domain of psychological health (age-adjusted OR 0.48, 95%CI 0.24-0.97), with a trend observed for lower QOL in the domains of physical health and environment. No further associations were observed. All results were sustained in further models that were adjusted for smoking, alcohol, physical inactivity, and body mass index. Conclusions: We present novel data examining associations between fracture status and QOL in a populationbased sample of Australian men using the WHOQOL-Bref. Recent fractures were associated with poorer QOL in the domain of psychological health while non-recent fractures were more likely associated poorer QOL for physical health. These findings have important implications for healthcare post-fracture.

Fluoxetine for maintenance of remission and to improve quality of life in patients with Crohn's disease: a pilot randomized placebo-controlled trial.

BACKGROUND AND AIMS: Previous studies have shown that antidepressants reduce inflammation in animal models of colitis. The present trial aimed to examine whether fluoxetine added to standard therapy for Crohn's disease [CD] maintained remission, improved quality of life [QoL] and/or mental health in people with CD as compared to placebo. METHODS: A parallel randomized double-blind placebo controlled trial was conducted. Participants with clinically established CD, with quiescent or only mild disease, were randomly assigned to receive either fluoxetine 20 mg daily or placebo, and followed for 12 months. Participants provided blood and stool samples and completed mental health and QoL questionnaires. Immune functions were assessed by stimulated cytokine secretion [CD3/CD28 stimulation] and flow cytometry for cell type. Linear mixed-effects models were used to compare groups. RESULTS: Of the 26 participants, 14 were randomized to receive fluoxetine and 12 to placebo. Overall, 14 [54%] participants were male. The mean age was 37.4 [SD=13.2] years. Fluoxetine had no effect on inflammatory bowel disease activity measured using either the Crohn's Disease Activity Index [F(3, 27.5)=0.064, p=0.978] or faecal calprotectin [F(3, 32.5)=1.08, p=0.371], but did have modest effects on immune function. There was no effect of fluoxetine on physical, psychological, social or environmental QoL, anxiety or depressive symptoms as compared to placebo [all p>0.05]. CONCLUSIONS: In this small pilot clinical trial, fluoxetine was not superior to placebo in maintaining remission or improving QoL. [ID: ACTRN12612001067864.].

Environmental Assessment of Rammed Earth Construction Systems

Present concerns for sustainable development have led to a revival of traditional building practices using natural or recycled resources. There is a perception that buildings constructed from such materials are environmentally benign. This perception is questionable, as often no evaluation is undertaken to assess the associated environmental impacts. Rammed earth is one such construction technology that has seen renewed interest in recent years. The energy required to manufacture materials (i.e. embodied energy) is a significant component of the life cycle energy associated with buildings. This paper assesses the embodied energy of rammed earth construction relative to brick veneer and cavity brick construction. Rammed earth was found to have significantly less embodied energy than cavity brick construction (to which it is closer in thermal performance), but was approximately equivalent to brick veneer construction. Topics of further research identified include thermal performance and strategies for reducing the embodied energy of cement used for earth stabilisation.

Quality of life and multiple sclerosis: comparison between people with multiple sclerosis and people from the general population

This paper evaluated the quality of life (QOL) of people with multiple sclerosis (MS) and people from the general population. Gender differences between the 2 groups of respondents and the influence of coping style on adjustment were also evaluated. The participants were 381 (144 males, 237 females) people with MS, and 291 (101 males, 190 females) people from the general population. The results demonstrated that people with MS experienced lower levels of QOL than people from the general population for both the objective and subjective dimensions of all domains (physical health, psychological adjustment, social relationships, environmental adjustment). All coping strategies (problem-focused, focusing on the positive, detachment, wishful thinking, seeking social support) were important predictors of QOL for both males and females with MS, with wishful thinking being the strongest predictor of poor QOL. These results are discussed in terms of the various factors that impact on QOL among people with MS, and the types of coping strategies that are most adaptive in improving the QOL of people with this illness.

An investigation of psychological, social and environmental correlates of obesity and weight gain in young women

Objectives: This study explored the biological, psychological, social and environmental correlates of young women's current weight and retrospective 2-year weight change. Methods: A total of 790 young women (mean age 26.8 years), sampled from the Australian Longitudinal Study on Women's Health, provided self-reported data on their height and weight, sociodemographics and a range of biological, psychological, social and environmental variables. Results: Several variables from all domains (biological, psychological, social support and environmental) were correlated with higher body mass index, and less strongly greater 2-year weight change. Key correlates included the tendency to never put on weight, no matter what; self-efficacy for avoiding weight gain, and for healthy eating; attention paid to weight; family support and friends' support/sabotage of physical activity/healthy eating; and perceived difficulty of taking the stairs rather than the elevator as part of the daily routine. Conclusions: Intervention strategies aimed at reducing weight gain and obesity may need to focus on social and environmental, as well as psychological factors; however, further research is necessary to confirm these findings given that a number of hypothesized associations were not observed.

A longitudinal study of coping strategies and quality of life among people with multiple sclerosis

The current study was designed to examine the role of coping strategies on quality of life (QOL) of people with multiple sclerosis (MS) over a period of 12 months. Respondents were 321 people with MS and 239 people from the general population who completed measures of QOL on two occasions, 12 months apart. People with MS also completed measures of how they coped with their illness. The results demonstrated that people with MS experienced lower levels of QOL at both points in time. For people with MS, QOL domains strongly predicted other QOL domains at both time 1 and time 2. The coping strategies of social support, focusing on the positive and wishful thinking were consistent predictors of physical QOL, psychological QOL, social QOL and environmental QOL. These findings indicate that coping strategies play an important role in predicting the QOL of people with MS.
Keywords Coping - Multiple sclerosis - Quality