Burden of care and its impact on health-related quality of life of caregivers of individuals with spinal cord injury

Objective: to analyze the impact and burden of care on the Health-Related Quality of Life (HRQOL) of caregivers of individuals with a spinal cord injury (SCI). Method: cross-sectional observational study carried out by reviewing medical records and applying questionnaires. The scale Short Form 36 (SF-36) was used to assess HRQOL and the Caregiver Burden Scale (CBScale) for care burden. Results were analyzed quantitatively. Most patients with SCIs were male, aged 35.4 years old on average, with a predominance of thoracic injuries followed by cervical injuries. Most caregivers were female aged 44.8 years old on average. Results: tetraplegia and secondary complications stand out among the clinical characteristics that contributed to greater care burden and worse HRQOL. Association between care burden with HRQOL revealed that the greater the burden the worse the HRQOL. Conclusion: Preventing care burden through strategies that prepare patients for hospital discharge, integrating the support network, and enabling access to health care services are interventions that could minimize the effects arising from care burden and contribute to improving HRQOL.

Loss of interest, depressed mood and impact on the quality of life: Cross-sectional survey

Abstract Background Depressive symptoms and chronic disease have adverse effects on patients' health-related quality of life (H-RQOL). However, little is known about this effect on H-RQOL when only the two core depressive symptoms - loss of interest and depressed mood - are considered. The objective of this study is to investigate H-RQOL in the presence of loss of interest and depressed mood at a general medical outpatient unit. Methods We evaluated 553 patients at their first attendance at a general medical outpatient unit of a teaching hospital. H-RQOL was assessed with the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36). Depressed mood and loss of interest were assessed by the Primary Care Evaluation of Mental Disorders (PRIME-MD)-Patient Questionnaire. A physician performed the diagnosis of chronic diseases by clinical judgment and classified them in 13 possible pre-defined categories. We used multiple linear regression to investigate associations between each domain of H-RQOL and our two core depression symptoms. The presence of chronic diseases and demographic variables were included in the models as covariates. Results Among the 553 patients, 70.5% were women with a mean age of 41.0 years (range 18-85, SD ± 15.4). Loss of interest was reported by 54.6%, and depressed mood by 59.7% of the patients. At least one chronic disease was diagnosed in 59.5% of patients; cardiovascular disease was the most prevalent, affecting 20.6% of our patients. Loss of interest and depressed mood was significantly associated with decreased scores in all domains of H-RQOL after adjustment for possible confounders. The presence of any chronic disease was associated with a decrease in the domain of vitality. The analysis of each individual chronic disease category revealed that no category was associated with a decrease in more than one domain of H-RQOL. Conclusion Loss of interest and depressed mood were associated with significant decreases in H-RQOL. We recommend these simple tests for screening in general practice.

Quality of life of patients with paucibacillary leprosy

BACKGROUND: Leprosy, an infectious disease caused by Mycobacterium leprae, can affect the skin and the peripheral nervous system and, depending on the level of involvement, it can lead to severe deformities. Leprosy is classified into two major groups: paucibacillary (up to five lesions) and multibacillary (more than five lesions). The deformities that appear during the progress of the disease can affect the quality of life. OBJECTIVE: To assess quality of life of patients with paucibacillary leprosy diagnosed and treated early in the outpatients' clinic. METHODS: The Dermatology Life Quality Index questionnaire and ShortForm36 were applied to 49 outpatients undergoing treatment at the Leprosy Multidisciplinary Group of the Hospital das Clínicas of the Faculdade de Medicina of the Universidade de São Paulo. RESULTS: The majority of the patients (63%) did not show impairment of the quality of life, according to the results obtained by the Dermatology Life Quality Index questionnaire. In the questionnaire Short Form-36, the scores assessed showed slight impairment of the quality of life. CONCLUSION: On this study, we can conclude that this group of patients, with paucibacillary leprosy, did not show important impairment of the quality of life. Therefore we can conclude that the earlier the diagnosis and the treatment the lesser the influence on the quality of life.

Charakterisierung von apoFNR, einer weiteren Form des Sauerstoffsensors FNR aus Escherichia coli und von NreB, einem potentiellen Sauerstoffsensor aus Staphylococcus carnosus

FNR (Fumarat Nitratreduktase Regulator) ist der Sauerstoffsensor aus Escherichia coli. Bisher waren zwei Formen von FNR bekannt, der aktive Zustand, ein Dimer mit je einem [4Fe4S]-Zentrum und ein inaktiver Zustand, in dem FNR als Monomer mit je einem [2Fe2S]-Zentrum vorliegt. Die Untersuchungen dieser Arbeit geben nun Hinweise, dass es mit apoFNR eine dritte physiologische Form von FNR gibt. Es wurde die Entstehung von apoFNR aus [4Fe4S]•FNR untersucht und die biochemischen Eigenschaften von apoFNR charakterisiert. ApoFNR konnte in vitro zu [4Fe4S]•FNR rekonstituiert werden, hierbei konnte die Lagphase der Rekonstitution durch Zusatz von Glutaredoxinen zum Rekonstitutionsansatz verkürzt werden. FNR, dessen Cysteinreste in vivo unter aeroben bzw. anaeroben Bedingungen mit 4-Acetamido-4´-Maleimidylstilbene-2,2´Disulfonsäure markiert wurden, zeigt auf SDS-Gelen einen Shift zu einer höheren Masse im Vergleich zu unmarkiertem FNR. Allerdings trat in aeroben Zellen eine zusätzliche Bande bei einer niedrigeren Masse auf. Es waren hier also weniger Cysteinreste markierbar. Weiterhin wurde mit NreB ein potentieller Sauerstoffsensor aus Staphylococcus carnosus untersucht. Es wurden Hinweise auf ein Eisen-Schwefel-Zentrum vom FNR-Typ als Cofaktor gefunden. Der Einbau dieses Cofaktors war abhängig von der Anwesenheit der Cysteinreste in NreB, von der Cysteindesulfurase NifSAV und von Eisenionen. Der Cofaktor war sauerstoffempfindlich und beeinflusste die Autophosphorylierung von NreB.

Asymmetric aminocatalysis: a modern strategy for molecules, challenges and life

The studies conducted during my Phd thesis were focused on two different directions: 1. In one case we tried to face some long standing problems of the asymmetric aminocatalysis as the activation of encumbered carbonyl compounds and the control of the diastereoisomeric ratio in the diastero- and enantioselective construction of all carbon substituted quaternary stereocenters adjacent a tertiary one. In this section (Challenges) was described the asymmetric aziridination of ,-unsaturated ketones, the activation of ,-unsaturated -branched aldehydes and the Michael addition of oxindoles to enals and enones. For the activation via iminium ion formation of sterically demanding substrates, as ,-unsaturated ketones and ,-unsaturated -branched aldehydes, we exploited a chiral primary amine in order to overcome the problem of the iminium ion formation between the catalyst and encumbered carbonylic componds. For the control of diastereoisomeric ratio in the diastero- and enantioselective construction of all carbon substituted quaternary stereocenters adjacent a tertiary one we envisaged that a suitable strategy was the Michael addition to 3 substituted oxindoles to enals activated via LUMO-lowering catalysis. In this synthetic protocol we designed a new bifunctional catalyst with an amine moiety for activate the aldehyde and a tioureidic fragment for direct the approach of the oxindole. This part of the thesis (Challenges) could be considered pure basic research, where the solution of the synthetic problem was the goal itself of the research. 2. In the other hand (Molecules) we applied our knowledge about the carbonylic compounds activation and about cascade reaction to the synthesis of three new classes of spirooxindole in enantiopure form. The construction of libraries of these bioactive compounds represented a scientific bridge between medicinal chemistry or biology and the asymmetric catalysis.

Eine neue Form der Pyruvatkinase in Säugerspermien

Nach Homogenisation ejakulierter Eberspermien und Zentrifugation des Homogenates blieben mehr als 60% der Aktivität des glykolytischen Enzyms Pyruvatkinase (PK) an Zellfragmenten im Sediment gebunden. Diese strukturgebundene PK wurde als PK-S bezeichnet. Das Detergenz Triton X-100 führte nicht zur Ablösung der PK-S; mit Trypsin konnten jedoch rund 80% der PK-S ohne Verlust an Aktivität von den Strukturen gelöst und durch kombinierte Kationenaustausch- und Hydrophobizitätschromatographie gereinigt werden (spezifische Aktivität: 116,7 U/mg Protein). Die lösliche PK aus Eberspermien konnte ebenfalls durch ein ähnliches Verfahren angereichert werden. Im Gel (SDS-PAGE) zeigten die Untereinheiten der PK-S mit 64.400 eine geringfügig größere relative Molekülmasse als die der PK-M1 aus Kaninchenmuskel (62.000). Die kinetischen Eigenschaften der abgelösten PK-S als auch der noch an Spermienstrukturen gebundenen PK-S und der löslichen PK aus Eberspermien waren sehr ähnlich und entsprachen der M1-Isoform der PK. Antikörper gegen Kaninchenmuskel-PK (Anti-PK-M1) reagierten auch mit der löslichen PK und der PK-S aus Eberspermien. Edman-Abbau der ersten 19 Aminosäuren zeigte, dass die tryptisch abgelöste PK-S am N-Terminus um 5 Aminosäuren gegenüber nativer PK-M1 verlängert ist, während der C-Terminus der erhaltenen PK-S-Sequenz mit einem meist nahe dem N-Terminus gelegenen Sequenzabschnitt der PK-M1 und -M2 übereinstimmt. Die N-terminale Verlängerung der nativen PK-S enthält sicherlich mehr als die nach tryptischer Lyse nachgewiesenen 5 Aminosäuren. Vergleiche der Aminosäure- und übersetzten Nukleotidsequenzen sowie die kinetischen Eigenschaften lassen vermuten, dass die PK-S, wie die PK-M1 und PK-M2, vom PKM-Gen codiert wird. Gegen die gereinigte PK-S wurden Antikörper in Kaninchen produziert. Da das Antiserum nicht ausreichend spezifisch für PK-S war, wurden aus ihm affinitätschromatographisch Antikörper (Anti-PK-S) isoliert, die hohe Affinität zu einem synthetisierten PK-S-Peptid (13 N-terminale Aminosäuren der tryptisch abgelösten PK-S) hatten. Dieses Anti-PK-S-Präparat war spezifisch für PK-S; es reagierte weder mit Kaninchenmuskel-PK noch mit löslicher PK oder anderen Proteinen aus Eberspermien. Anti-PK-S und Anti-PK-M1 wurden zur Lokalisierung von PK-S und löslicher PK in Spermien von Eber, Bulle und Mensch sowie in Schnitten von Eberhoden eingesetzt. Mit Anti-PK-S wurden der Bereich des Akrosoms und das lange flagellare Hauptstück sowie der Übergangsbereich zwischen Kopf und Mittelstück von Eberspermien fluoreszenzmarkiert, wogegen das kurze, die Mitochondrien enthaltende Mittelstück des Flagellums und der postakrosomale Kopfbereich nur mit Anti-PK-M1 markiert wurden. Immunogoldmarkierung in elektronenmikroskopischen Bildern bestätigte die Lokalisierung von PK-S im Akrosombereich. Im Hauptstück banden Anti-PK-M1 und Anti-PK-S an die fibröse Scheide. Glyzerinaldehyd-3-phosphat Dehydrogenase (GAPDH) konnte von mir ebenfalls im Akrosombereich, im Übergangsbereich zwischen Kopf und Mittelstück und an der fibrösen Scheide detektiert werden. Auch an Bullen- und Humanspermien konnte über Immunogoldmarkierung PK und vermutlich GAPDH an der fibrösen Scheide gezeigt werden. Im Akrosombereich dieser Spermien waren die Nachweise von PK und GAPDH jedoch nicht sicher. In Eberhodenschnitten war die PK-S erstmals, oder zumindest vermehrt, in den elongierenden Spermatiden über Fluoreszenzmarkierung nachweisbar, während andere, vermutlich somatische PK vermehrt in den früheren Stadien (Spermatogonien, aber auch in den Spermatozyten und runden Spermatiden) auftrat. Für die GAPDH zeigte sich ein ähnlicher Entwicklungsverlauf. Die Ergebnisse zeigen, dass in Eberspermien zwei Isoformen der PK auftreten: eine N-terminal verlängerte, strukturgebundene Form, die PK-S, und eine lösliche Form, die beide der PK-M1 ähneln. Der ungewöhnliche N-Terminus der PK-S dient vermutlich der spezifischen räumlichen Anordnung der PK-S im Akrosombereich und an der fibrösen Scheide, nicht aber der Modulation kinetischer Eigenschaften. Meine Untersuchungen stützen die Hypothese, dass in bestimmten Kompartimenten von Säugerspermien die Glykolyse durch Verankerung einiger ihrer Enzyme strukturell hochgeordnet ist. Dadurch wird vermutlich die Versorgung der Mitochondrien-freien Regionen mit ATP sichergestellt. Man kann diese Organisation als Anpassung des Stoffwechsels von Spermien deuten, bei denen die Mitochondrien in einem kleinen Bereich (Mittelstück) hinter dem Spermienkopf kompartimentiert sind. Im Hauptstück des Flagellums könnte die Glykolyse ATP für die Spermienmotilität liefern, im Akrosombereich für die Verhinderung einer vorzeitigen Akrosomreaktion. Somit käme der strukturierten Glykolyse eine essentielle Bedeutung für die Befruchtungsfähigkeit von Säugerspermien zu.

Quality of life in high-risk patients: comparison of transcatheter aortic valve implantation with surgical aortic valve replacement

OBJECTIVES To compare health-related quality of life (QoL) in patients undergoing transcatheter aortic valve implantation via transapical access (TA TAVI) with patients undergoing surgical aortic valve replacement (SAVR). METHODS One hundred and forty-four high-risk patients referred for aortic valve replacement underwent TAVI screening and were assigned to either TA TAVI (n = 51, age 79.7 ± 9.2 years, logistic EuroSCORE 26.5 ± 16.1%, 51% males) or SAVR (n = 93, age 81.1 ± 5.3 years, logistic EuroSCORE 12.1 ± 9.3%, 42% males) by the interdisciplinary heart team. QoL was assessed using the Short Form 36 (SF-36) Health Survey Questionnaire and the Hospital Anxiety and Depression Scale. Furthermore, current living conditions and the degree of independence at home were evaluated. RESULTS Patients undergoing TA TAVI were at higher risk as assessed by EuroSCORE (26.5 ± 16 vs. 12.1 ± 9, P < 0.001) and STS score (6.7 ± 4 vs. 4.4 ± 3, P < 0.001) compared with SAVR patients. At the 30-day follow-up, the rate of mortality was similar and amounted to 7.8% for TA TAVI and 7.5% for SAVR patients and raised to 25.5% in TA TAVI and 18.3% in SAVR patients after a follow-up period of 15 ± 10 months. Assessment of QoL revealed no differences in terms of anxiety and depression between TA TAVI and SAVR patients. The SF-36 mental health metascore was similar in both groups (65.6 ± 19 vs. 68.8 ± 22, P = 0.29), while a significant difference was observed in the physical health metascore (49.7 ± 21 vs. 62.0 ± 21, P = 0.015). After adjustment for baseline characteristics, this difference disappeared. However, every added point in the preoperative risk assessment with the STS score decreased the SF-36 physical health dimension by two raw points at the follow-up assessment. CONCLUSIONS Selected high-risk patients undergoing TAVI by using a transapical access achieve similar clinical outcomes and QoL compared with patients undergoing SAVR. Increased STS scores predict worse QoL outcomes.

Health-related quality of life in long-term survivors of relapsed childhood acute lymphoblastic leukemia

Background Relapses occur in about 20% of children with acute lymphoblastic leukemia (ALL). Approximately one-third of these children can be cured. Their risk for late effects is high because of intensified treatment, but their health-related quality of life (HRQOL) was largely unmeasured. Our aim was to compare HRQOL of ALL survivors with the general population, and of relapsed with non-relapsed ALL survivors. Methodology/Principal Findings As part of the Swiss Childhood Cancer Survivor Study (SCCSS) we sent a questionnaire to all ALL survivors in Switzerland who had been diagnosed between 1976–2003 at age <16 years, survived ≥5 years, and were currently aged ≥16 years. HRQOL was assessed with the Short Form-36 (SF-36), which measures four aspects of physical health and four aspects of mental health. A score of 50 corresponded to the mean of a healthy reference population. We analyzed data from 457 ALL survivors (response: 79%). Sixty-one survivors had suffered a relapse. Compared to the general population, ALL survivors reported similar or higher HRQOL scores on all scales. Survivors with a relapse scored lower in general health perceptions (51.6) compared to those without (55.8;p=0.005), but after adjusting for self-reported late effects, this difference disappeared. Conclusion/Significance Compared to population norms, ALL survivors reported good HRQOL, even after a relapse. However, relapsed ALL survivors reported poorer general health than non-relapsed. Therefore, we encourage specialists to screen for poor general health in survivors after a relapse and, when appropriate, specifically seek and treat underlying late effects. This will help to improve patients’ HRQOL.

Applied Developmental Psychology as an Implementation of the Life-Span View of Human Development

Application of knowledge about psychological development should, ideally, be theory based. As such, these applications represent “natural ontogenetic experiments”; the results of the evaluation of such interventions feed back to the theory, helping to support, falsify, or refine the ideas from the theory which led to the particular application. Such applied developmental intervention research is central within a currently popular perspective of life-span human development. Thus, applied developmental intervention research provides critical tests of such key concepts within this life-span perspective as: plasticity; multidirectionality; the synthesis of continuous and discontinuous processes across ontogeny; contextual embeddedness; and the role of individuals as agents in their own development. This paper elucidates some of the major features of the dynamic linkage between applied developmental psychology and this view of life-span human development. Key elements of this life-span perspective and the facts of developmental intervention, as seen from this perspective, are specified. Finally, the doctoral training program at the authors' institution is presented as one example of how this link may be institutionalized in the form of graduate education.

Mental Health and Mental Illness in Later Life: The Ecology of Theory and Practice

Theoretical and practical concerns shape our conceptualizations of mental health and mental illness later in life. Together, these concerns form an ecology of theory and practice, shaping our expectations of later life and our efforts with an din behalf of older adults. Introduces a series of article which highlights several aspects of mental health and mental illness in later life to provide an understanding of the challenges faced by the aged in maintaining mental health.

Effects of a comprehensive rehabilitation program on quality of life in patients with chronic heart failure

This evaluation was performed to assess the effects of a new, comprehensive outpatient rehabilitation program on generic and disease-specific quality of life related to exercise tolerance in stable chronic heart failure patients. Fifty-one patients (aged 59+/-11 years; 84% men) were treated for 12 weeks. Patients underwent optimized drug treatment, exercise training, and counseling and education. At baseline and at the end of the program, functional status, exercise capacity, and quality of life were assessed using the Medical Outcomes Study 36-item Short-Form Health Survey and the Minnesota Living with Heart Failure Questionnaire. Left ventricular ejection fraction and New York Heart Association functional class, as well as measures of physical fitness and walking distance covered in 6 minutes, improved significantly (by 11%-20% and by 58% on average, respectively). Physical functioning (effect size, 0.38; p<0.0001), role functioning (effect size, 0.17; p<0.05), and mental component score (effect size, 0.47; p<0.0001) on the questionnaire improved significantly. Disease-specific quality of life improved in sum score (effect size, 0.24; p<0.0001) and physical component score (effect size, 0.35; p<0.0001). The latter was inversely correlated to improvement in peak power output (r= -0.31; p<0.05). In patients with stable chronic heart failure, significant improvements in both generic and disease-specific quality of life related to improved exercise tolerance can be achieved within 12 weeks of comprehensive rehabilitation.

[Stress tolerance and quality of life--effect of a comprehensive ambulatory rehabilitation program for patients with chronic heart failure]

Chronic heart failure (CHF) impairs quality of life (QoL) much stronger than other chronic diseases. The objective of this evaluation was to assess the effect of a new integrated comprehensive outpatients rehabilitation program on somatic parameters and quality of life in 51 patients with stable CHF. After rehabilitation, left ventricular ejection fraction, NYHA class, and parameters of sub-maximum and maximum exercise capacity improved significantly between 11 and 20%, and 6-minute walking distance by 58% on average (p < 0.0001). Non-disease specific QoL (Short Form-36 questionnaire) improved in only 2 of 8 subscales (physical functioning [effect size 0.38, p < 0.001], and role functioning [effect size 0.17, p < 0.05]), and a mental component score [effect size 0.47, p < 0.0001]. Disease-specific QoL (Minnesota Living with Heart Failure questionnaire) improved in terms of sum score [effect size 0.24, p < 0.0001], and physical component score [effect size 0.35, p < 0.0001]. Improvement in exercise capacity correlated significantly with improvements in parameters of disease-specific QoL.

Psychometric properties of the MacNew heart disease health-related quality of life instrument in patients with heart failure

RATIONALE, AIMS AND OBJECTIVES: Heart failure (HF) is a severe chronic disease and impairs health-related quality of life (HRQL). While validated specific HRQL instruments are required for evaluation of treatment and rehabilitation in patients with HF, a single validated measure to document changes in HRQL for patients with different heart disease diagnoses would be invaluable. The purpose of this analysis was the psychometric analysis of the German MacNew Heart Disease Questionnaire (MacNew) in HF patients, which has previously been shown to be reliable and valid in patients with myocardial infarction, angina pectoris and arrhythmia. METHODS: We recruited 89 patients (61.7+/-11.5 years; 84.3% male) in two Austrian and one Swiss cardiology department with documented HF (effect sizes 28.9+/-10.1%). The self-administered MacNew, the Short Form-36 (SF-36) and the Hospital Anxiety and Depression Scale were completed. Internal consistency reliability (Cronbach's alpha), discriminative and evaluative validity were assessed. RESULTS: Cronbach's alpha exceeded 0.80. Each MacNew scale differentiated between patients with and without anxiety (3.9+/-1.0 vs. 5.3+/-0.8, all P<0.001), with and without depression (4.2+/-1.2 vs. 5.2+/-0.9 all P<0.03) and by the SF-36 health transition item (deteriorate=4.39, no change=4.95, improve=5.45, all P<0.02). Evaluative validity was demonstrated with effect sizes >0.70 for a subsample attending a 12-week outpatient rehabilitation programme. CONCLUSIONS: The German language version of the MacNew demonstrates consistently acceptable psychometric properties of reliability, validity and responsiveness in patients with documented HF. Together with previous documentation of reliability, validity and responsive, these findings strengthen the argument for the MacNew as a potential 'core' HRQL measure, at least in the German language.

Life-patterns on the periphery : a humanities base for development imperatives and their application in the Chicago city-region

Life-Patterns on the Periphery: A Humanities Base for Development Imperatives and their Application in the Chicago City-Region is informed by the need to bring diverse fields together in order to tackle issues related to the contemporary city-region. By honouring the long-term economic, social, political, and ecological imperatives that form the fabric of healthy, productive, sustainable communities, it becomes possible to setup political structures and citizen will to develop distinct places that result in the overlapping of citizen life patterns, setting the stage for citizen action and interaction. Based in humanities scholarship, the four imperatives act as checks on each other so that no one imperative is solely honoured in development. Informed by Heidegger, Arendt, deCerteau, Casey, and others, their foundation in the humanities underlines their importance, while at the same time creating a stage where all fields can contribute to actualizing this balance in practice. For this project, theoretical assistance has been greatly borrowed from architecture, planning theory, urban theory, and landscape urbanism, including scholarship from Saskia Sassen, John Friedmann, William Cronon, Jane Jacobs, Joel Garreau, Alan Berger, and many others. This project uses the Chicago city-region as a site, specifically the Interstate 80 and 88 corridors extending west from Chicago. Both transportation corridors are divided into study regions, providing the opportunity to examine a broad variety of population and development densities. Through observational research, a picture of each study region can be extrapolated, analyzed, and understood with respect to the four imperatives. This is put to use in this project by studying region-specific suggestions for future development moves, culminating in some universal steps that can be taken to develop stronger communities and set both the research site specifically and North American city-regions in general on a path towards healthy, productive, sustainable development.

Thoracic endovascular aortic repair: impact of urgency on outcome and quality of life

OBJECTIVES: Endovascular repair of the descending thoracic aorta is a very promising technique in elective and, particularly, emergency situations. This study assessed the impact of urgency of the procedure on outcome and mid-term quality of life in surviving patients. METHODS: Post hoc analysis of prospectively collected data of 58 consecutive patients (January 2001-December 2005) with surgical pathologies of the descending thoracic aorta treated by endovascular means. Six patients were excluded due to recent operations on the ascending aorta before thoracic endovascular repair. The remaining patients (n=52) were 69+/-10 years old, and 43 were men (83%). Twenty-seven had been treated electively, and 25 for emergency indications. Reasons for emergency were acute type B aortic dissections with or without malperfusion syndrome in 14, and aortic ruptures in 11 cases. Follow-up was 29+/-16 months. Endpoints were perioperative and late morbidity and mortality rates and long-term quality of life as assessed by the short form health survey (SF-36) and Hospital Anxiety and Depression Scale questionnaires. RESULTS: Cohorts were comparable regarding age, sex, cardiovascular risk factors, and comorbidities. Perioperative mortality was somewhat higher in emergency cases (12% vs 4%, p=0.34). Paraplegia occurred in one patient in each cohort (4%). Overall quality of life after two and a half years was similar in both treatment cohorts: 72 (58-124) after emergency, and 85 (61-105) after elective endovascular aortic repair (p=0.98). Normal scores range from 85 to 115. Anxiety and depression scores were in the normal range and comparable. CONCLUSIONS: Thoracic endovascular aortic repair is an excellent and safe treatment option for the diseased descending aorta, particularly in emergency situations. Early morbidity and mortality rates can be kept very low. Mid-term quality of life was not affected by the urgency of the procedure. Similarly, mid-term anxiety and depression scores were not increased after emergency situations.