Classifying Socially-Valued Role Functioning Among Community Residents with Psychiatric Disorders

An increased emphasis on community-based care has not ensured that people recovering from psychiatric disorders return to active and valued roles in their local communities. Although clinical recovery remains a priority for mental health services there is increasing recognition of the need for functional recovery to be attained and demonstrated in roles valued by the wider community. With this need in mind, a method for classifying socially-valued role functioning among people with schizophrenia or schizoaffective disorder was developed and trialed. Participants (n = 104) were recruited via mental health, psychosocial rehabilitation, and other community support services. Socially-valued roles were investigated via participation in five categories: (1) self-care and home duties; (2) caring for others; (3) self-development, voluntary work or rehabilitation; (4) formal education or training; and (5) employment. Activities were classified by primary role type and role status level at baseline, six, and 12 months. Current role status was assessed along with highest and lowest status in the previous year. Preliminary psychometric results were favorable. Research applications are now recommended for monitoring socially-valued role functioning in community settings.

Psychosocial functioning in patients with alcohol-related liver disease post liver transplantation

Emotional and role functioning difficulties are associated with chronic alcohol use and liver disease. Little is known about prospective changes in psychological and psychosocial functioning following orthotopic liver transplantation (OLT) amongst patients with alcoholic liver disease (ALD). We aimed to assess the functioning of this patient group post liver transplantation. Comprehensive psychosocial assessment of depression (Beck Depression Inventory [BDI]), anxiety (State-Trait Anxiety Inventory-Form X [STAI]) and psychosocial adjustment (Psychosocial Adjustment to Illness Scale-Self-Report version [PAIS-SR]) was conducted with 42 ALD patients available for pre and post OLT testing. Dependence severity was assessed by the Brief Michigan Alcoholism Screening Test (bMAST). Significant reductions in average anxiety and depression symptoms were observed 12-months post-OLT. Significant improvements in psychosocial adjustment to illness were also reported. Patients with higher levels of alcohol dependence severity pre transplant assessment improved comparably to those with lower levels of dependence. In summary, the study found that OLT contributed to reducing overall levels of mood and anxiety symptoms in ALD patients, approximating general (non-clinical) population norms. Psychosocial adjustment also improved significantly post liver transplantation.

Role of common mental and physical disorders in partial disability around the world

Background Mental and physical disorders are associated with total disability, but their effects on days with partial disability (i.e. the ability to perform some, but not full-role, functioning in daily life) are not well understood. Aims To estimate individual (i.e. the consequences for an individual with a disorder) and societal effects (i.e. the avoidable partial disability in the society due to disorders) of mental and physical disorders on days with partial disability around the world. Method Respondents from 26 nationally representative samples (n=61 259, age 18+) were interviewed regarding mental and physical disorders, and day-to-day functioning. The Composite International Diagnostic Interview, version 3.0 (CIDI 3.0) was used to assess mental disorders; partial disability (expressed in full day equivalents) was assessed with the World Health Organization Disability Assessment Schedule in the CIDI 3.0. Results Respondents with disorders reported about 1.58 additional disability days per month compared with respondents without disorders. At the individual level, mental disorders (especially post-traumatic stress disorder, depression and bipolar disorder) yielded a higher number of days with disability than physical disorders. At the societal level, the population attributable risk proportion due to physical and mental disorders was 49% and 15% respectively. Conclusions Mental and physical disorders have a considerable impact on partial disability, at both the individual and at the societal level. Physical disorders yielded higher effects on partial disability than mental disorders.

Quality of life in chronic fatigue syndrome

Whilst the debilitating fatigue experienced in patients suffering from Chronic Fatigue Syndrome (CFS) results in a subjective marked impairment in functioning, little research has investigated the impact of this disorder on quality of life. Forty-seven subjects with a confirmed diagnosis of CFS and 30 healthy controls were compared using the Sickness Impact Profile (SIP). A subgroup of subjects were interviewed regarding the impact CFS has had on their social and family relationships, work and recreational activities. Results from both the SIP and the interview revealed that CFS subjects had significantly impaired quality of life, especially in areas of social functioning. These findings highlight the importance of addressing the social isolation and loss of role functioning experienced by CFS sufferers.

Quality of life changes during conformal radiation therapy for prostate carcinoma

BACKGROUND: The objective of this study was to describe prospectively quality of life (QOL) before and after radiotherapy for patients with prostate carcinoma. METHODS: Forty-three patients with T1-T3 prostate carcinoma who underwent conformal external beam radiation therapy were randomized either to the complete European Organization for Research and Treatment of Cancer (EORTC) QOL questionnaire (EORTC QLQ-C30) or the Medical Outcomes Study Group Short Form Health Survey (SF-36) at baseline, at 3 weeks and 6 weeks after initial treatment, and at 6 weeks and 5 months after the completion of radiotherapy. The measures were self-reported patient QOL, and values are given as the mean +/- standard error of the mean. Changes in QOL are described from baseline to the end of treatment in both questionnaire groups. RESULTS: Emotional role functioning, as measured with the SF-36 questionnaire, significantly improved from 68.2 +/- 9.9 at baseline to 93.3 +/- 5.2 at the end of therapy (P = 0.02). The EORTC QLQ-C30 questionnaire revealed consistent values of emotional functioning during treatment (72.7 +/- 5.9 at baseline) but showed a significant improvement 6 weeks after therapy (89.0 +/- 4.4; P = 0.01). Role functioning deteriorated from 80.1 +/- 6.5 at baseline to 62.5 +/- 8.8 at the end of radiotherapy (P = 0.02). Symptoms of fatigue were shown to increase significantly from 26.9 +/- 6.0 at baseline to 37.7 +/- 7.6 at the end of therapy (P = 0.02). No significant changes in the other dimensions were observed in either questionnaire. CONCLUSIONS: After radiotherapy for prostate carcinoma, patients experience a temporary deterioration of fatigue and role functioning, as measured with the EORTC QLQ-C-30. Despite physical deterioration, the authors observed an improvement in emotional functioning scores with both questionnaires. This may have been due to psychological adaptation and coping.

Terveyteen liittyvä elämänlaatu laitoskuntoutuksen vaikuttavuuden arvioinnissa : RAND-36-mittarin soveltuvuus työikäisten laitoskuntoutuksen ongelmaprofiilin määrittämiseen ja kuntoutuksen vaikutusten arvioimiseen

The aim of the present research was to examine the validity of the RAND-36 measure of health-related quality of life among the working age rehabilitation clients. The research included two cross-sectional studies and one follow-up study. The subjects of the first study (n = 794) participated in the first period of the five following types of rehabilitation: occupationally oriented medical rehabilitation, musculoskeletal rehabilitation, medical rehabilitation for job burnout, rehabilitation for supporting the work ability and capacity of disabled subjects (vocational rehabilitation) and individualized rehabilitation between October 2000 and October 2001. The subjects of the second study (n = 990) participated in the same rehabilitation during their first rehabilitation period between May 2007 and May 2008. The first subjects participated in a follow-up period no later than May 2003 with the exception of the individual rehabilitation clients (n = 588). Based on the ICF classification, the RAND-36 provides a diverse measure of the health-related quality of life and of the capacity for subjective, perceived physical and psycho-social functioning. The construct properties of the RAND-36 measure proved to be very consistent on the basis of both the cluster and confirmatory factor analyses. At the group level, the RAND-36 measure was shown to be illustrative and sensitive in differentiating the clients’ rehabilitation needs. The results of cluster analyses with the two cross-sectional data indicated a consistent five-cluster solution of rehabilitation groups on the basis of the eight subscales of health-related quality of life. Each of these clusters represented a clear difference in their need for rehabilitation. The RAND-36 measure proved to be sensitive to change. The changes observed in the pre- and post-conditions in relation to all the subscales of quality of life were statistically significant. Depending on the rehabilitation type, different changes in the subscales of the measure were observed, and these changes corresponded to the different emphasis and goals of the specific type of rehabilitation intervention. Similarly, changes in the subscales of the measure were observed in relation to the RAND groups formed by cluster analysis, which were logical and corresponded to the problem profiles of these groups. The confirmatory factor analysis indicated a two-factor solution: an index of the capacity for physical functioning (self-rated general health, bodily pain, physical functioning, physical role functioning) and an index of the capacity for psycho-social functioning (psychological well-being, social functioning, psychological role functioning and energy). These two indices describing functional capacity proved also to be sensitive to change. This two-factor solution seems to be usable for group level analyses when assessing the effects of rehabilitation. The moderately strong correlation between the RAND-36 and work ability index suggests that they partly measure the same phenomenon: perceived health-related quality of life, subjective capacity for activity and perceived work ability have strong links. As expected, the capacity for physical functioning had a stronger correlation with work ability index than with the capacity for psycho-social functioning. According to the present research, the RAND-36 measure can be considered as a screening method for rehabilitation orientation in relation to rehabilitation needs and as a follow-up measure for the health-related quality of life among the working age clients. The RAND-36 measure is also shown to be a useful instrument in estimating the benefits of rehabilitation as well as in effectiveness research.

Baseline health-related quality-of-life data as prognostic factors in a phase III multicentre study of women with metastatic breast cancer.

The potential value of baseline health-related quality-of-life (HRQOL) and clinical factors in predicting prognosis was examined using data from an international randomised phase III trial which compared doxorubicin and paclitaxel with doxorubicin and cylophosphamide as first line chemotherapy in 275 women with metastatic breast cancer. The European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 and the related breast module (QLQ-BR23) were used to assess baseline HRQOL data. The Cox proportional-hazards regression model was used for both univariate and multivariate analyses of survival. In the univariate analyses, performance status (P<0.001) and number of sites involved (P=0.001) were the most important clinical prognostic factors. The HRQOL variables at baseline most strongly associated with longer survival were better appetite, physical and role functioning, as well as less fatigue (P<0.001). The final multivariate model retained performance status (P<0.001) and appetite loss (P=0.005) as the variables best predicting survival. Substantial loss of appetite was the only independent HRQOL factor predicting poor survival and was strongly correlated (/r/>0.5) with fatigue, role and physical functioning. In addition to known clinical factors, appetite loss appears to be a significant prognostic factor for survival in women with metastatic breast cancer. However, the mechanism underlying this association remains to be precisely defined in future studies.

Quality of life in men receiving radiotherapy and neo-adjuvant androgen deprivation for prostate cancer:Results from a prospective longitudinal study

Aim. To report a study measuring the quality of life and side effects in men receiving radiotherapy and hormone ablation for prostate cancer up to 1year after treatment. Background. Prostate cancer incidence is increasing with the result that more men are living longer with the disease and the side effects of treatment. It is important to know the effects this has on their quality of life. Design. Survey. Method. Between September 2006-September 2007, all men who were about to undergo radical conformal radiotherapy ± neo-adjuvant androgen deprivation for localized prostate cancer were invited to participate in the study; 149 men were recruited. They completed the European Organization on Research and Treatment of Cancer quality of life questionnaire C-30 and Prostate Cancer module PR25 at four time-points. Results. At 4-6weeks after radiotherapy, participants experienced the biggest relative decline in global quality of life, social, physical, and role functioning and an increase in treatment side effects. At 6months postradiotherapy the majority of men experienced an improvement in their side effects. However, a minority of men were experiencing severe side effects of radiotherapy at 1year post-treatment. Single men and men who had a low quality of life prior to radiotherapy, reported a lower quality of life at 1year after treatment in comparison to married men. Conclusion. Men with prostate cancer suffer limitations due to the symptoms they experience and disruption to their quality of life. It is essential that nurses develop and deliver follow-up care which is flexible and appropriate to the individual needs of these men. © 2012 Blackwell Publishing Ltd.

A terapia de grupo na doença oncológica

Existem milhões de sobreviventes de cancro da mama no mundo, em exponencial crescimento. Esta população pode apresentar preocupações relevantes acerca do futuro, depressão, ansiedade, sintomas pós-traumáticos, e comprometimento da qualidade de vida. As intervenções de grupo breves, estruturadas, especialmente as que incluem estratégias cognitivo-comportamentais, têm sido indicadas para esta população. O presente trabalho surge neste contexto, em que os estudos são escassos, especialmente em Portugal. Um conjunto de 5 estudos foi conduzido com o intuito de avaliar a eficácia de dois programas de intervenção de grupo breves e estruturadas de inspiração cognitivo-comportamental, um de tipo psicopedagógico e outro de terapia cognitivo-comportamental, em sobreviventes de cancro da mama. Nos primeiros dois estudos procedeu-se ao estudo das caraterísticas psicométricas de dois instrumentos de avaliação, o Questionário de Formas de Lidar com o Cancro (CCQ) e o Questionário de Saúde do Paciente (PHQ-9).Os dois estudos seguintes referem-se ao desenvolvimento dos programas de intervenção de grupo, acompanhados dos resultados preliminares. No último estudo avaliou-se a eficácia dos dois programas de intervenção na promoção do ajustamento psicossocial de 62 sobreviventes de cancro da mama, num estudo quasi-experimental, com pré e pós-testes e duas avaliações de seguimento (3 e 6 meses após a intervenção). Foram utilizados os seguintes instrumentos de avaliação: o CCQ; o PHQ-9; a Escala de Controlo Emocional (CEC); a Escala de Ansiedade e Depressão Hospitalar (EADH); o questionário de qualidade de vida da Organização Europeia de Investigação e Tratamento de Cancro com o módulo suplementar de cancro da mama (EORTC QLQ-C30 e BR-23); o Inventário Clínico de Autoconceito (ICAC); o Teste de Orientação de Vida - Revisto (TOV-R); o Perfil dos Estados de Humor (POMS); a Subescala de Crescimento Pessoal da Escala de Bem-Estar Psicológico (EBEP); a sub-escala de espiritualidade e o Inventário de estado-traço de ansiedade (STAI). Resultados: As sobreviventes que não tiveram intervenção apresentaram deterioração de dois domínios da qualidade de vida, a função cognitiva e a dor, para além de piores resultados na subescala de vigor. A deterioração dos domínios da qualidade de vida manteve-se aos 3 meses e extendeu-se aos sintomas da mama, o que não se verificou com o vigor. O grupo com intervenção psicoeducativa apresentou melhoria do autoconceito até aos 6 meses. Neste grupo também se observou um aumento do controlo emocional até aos 3 meses. O grupo de terapia cognitivo-comportamental apresentou aumento do estado de ansiedade e diminuição do funcionamento de papel no final da intervenção, diminuição do funcionamento emocional aos 3 meses e aumento na hostilidade e na confusão aos 6 meses. Ambos os grupos com intervenção apresentaram diminuição do traço de ansiedade aos 6 meses. Foram encontradas diversas correlações significativas destes efeitos com variáveis demográficas, clínicas e psicossociais. Conclusão: As intervenções de grupo breves, de inspiração cognitivo-comportamental, mostraram contribuir para a redução do traço de ansiedade a longo prazo e para a manutenção da função cognitiva, da dor, do vigor, e dos sintomas da mama nas sobreviventes. O programa psicopedagógico parece ser mais indicado para as sobreviventes, pelos efeitos no autoconceito, com maior extensão a longo prazo. São referidas implicações para a prática clínica e para a promoção da saúde mental desta população.

Qualité de vie et communication entre soignant et soignée auprès de femmes atteintes de cancer du sein : approche longitudinale

Introduction : De nos jours, les femmes atteintes de cancer du sein peuvent espérer une survie prolongée et un grand nombre d’entre elles peuvent même entrevoir la guérison. Alors que le dépistage précoce et les traitements rigoureux donnent espoir à de plus en plus de femmes, les chercheurs et les cliniciens doivent maintenant se pencher sur la qualité de vie de ces femmes à chaque phase clinique de la trajectoire de soins. Les difficultés physiques, fonctionnelles, psychologiques et sociales avec lesquelles les femmes vivent peuvent compromettre leur qualité de vie, d’où l’intérêt d’évaluer celle-ci. Peu de chercheurs se sont intéressés au changement longitudinal de la qualité de vie de ces femmes aux différents moments de la trajectoire de soins en oncologie : diagnostic, traitement et suivi. De plus, peu se sont demandés si la perception que les femmes ont de leur communication avec les professionnels de la santé influence leur qualité de vie le long de la trajectoire de soins. Objectifs principaux : 1) Décrire l’évolution de la qualité de vie liée à la santé des femmes atteintes de cancer du sein pendant le diagnostic, les traitements de radiothérapie et le suivi; 2) Décrire l’évolution de la perception que les femmes ont de leur communication avec les médecins, les infirmières et les technologues en radio-oncologie au cours des mêmes phases cliniques; 3) Examiner l’évolution de la relation entre la perception que les femmes ont de leur communication avec les professionnels de la santé et leur qualité de vie liée à la santé durant les phases citées précédemment. Méthodes : L’échantillon se composait de 120 femmes atteintes d’un cancer du sein précoce (stades I et II) qui parlaient le français, âgées de plus de 18 ans (55 ans ± 9,5) qui ont eu une chirurgie conservatrice. Les femmes ont complété des questionnaires à la période entourant le diagnostic (en moyenne six semaines après le diagnostic), à mi-chemin de la radiothérapie (en moyenne 27 semaines après le diagnostic) et de trois à quatre mois après la fin de la radiothérapie (en moyenne 48 semaines après le diagnostic). À chaque temps de mesure, elles ont complété six questionnaires d’une durée totale de 60 minutes au centre hospitalier ou à domicile : un sur les données sociodémographiques, un sur les renseignements médicaux, le MOS SSS, le EORTC QLQ-C30/BR23 et le MCCS. Résultats : Les analyses GEE montrent que la qualité de vie liée à la santé des femmes atteintes de cancer du sein change dans le temps. Elle diminue pendant la radiothérapie, sauf pour le fonctionnement émotionnel et cognitif. Les analyses démontrent aussi que certains facteurs cliniques, intrapersonnels et interpersonnels influencent leur qualité de vie. Précisément, plus les femmes avancent en âge et plus elles perçoivent qu’elles ont eu du soutien social le long de la trajectoire de soins, plus leur qualité de vie est meilleure pour les dimensions génériques et spécifiques du fonctionnement. De plus, celles qui présentent une tumeur de stade II et celles qui ont eu de la radiothérapie et l’hormonothérapie ont des scores plus élevés pour certaines dimensions de qualité de vie comparativement à celles dont le cancer se situe au stade I et à celles qui ont eu la chimiothérapie, la radiothérapie et l’hormonothérapie. Les résultats font état également d’une interaction entre le facteur « temps » et un facteur intrapersonnel pour le fonctionnement « rôle » et le fonctionnement sexuel des femmes. La perception que les femmes ont de leur communication avec les médecins et les autres professionnels de la santé change très peu avec le temps. Ainsi, les femmes se perçoivent plus compétentes dans la recherche d’information avec les radio-oncologues pendant la radiothérapie qu’avec les chirurgiens-oncologues au moment du diagnostic. Elles perçoivent aussi la vérification et la recherche d’information par les radio-oncologues pendant la radiothérapie plus satisfaisante que celle des chirurgiens-oncologues lors de l’annonce du diagnostic. Globalement, les femmes perçoivent leur communication avec les radio-oncologues et les chirurgiens-oncologues comme étant meilleure pendant la radiothérapie et au suivi qu’au moment du diagnostic avec les chirurgiens-oncologues. Les analyses GEE montrent aussi que certains facteurs cliniques (nature des traitements), intrapersonnels et interpersonnels (âge, niveau de scolarité et soutien social perçu) sont des facteurs susceptibles d’influencer la façon dont elles perçoivent leur communication avec les professionnels de la santé. Enfin, la perception des femmes quant à leurs compétences de communication à l’égard des médecins et des autres professionnels de la santé explique davantage leur qualité de vie liée à la santé que celle des compétences des professionnels de la santé. Donc, les femmes ont un meilleur score pour le fonctionnement « rôle », émotionnel et elles ont moins d’effets secondaires et de symptômes pendant la radiothérapie et au suivi lorsqu’elles se perçoivent compétentes envers les médecins (chirurgiens-oncologues et radio-oncologues) pour la recherche d’information et l’aspect socio-affectif d’un entretien aux temps précédents. De plus, l’âge des femmes, le soutien social perçu, le stade de la maladie et la nature des traitements ont une influence sur le lien entre leur qualité de vie et leur communication avec les professionnels de la santé. Enfin, une interaction est présente entre le facteur « temps » et un facteur clinique ou intrapersonnel pour les dimensions de qualité de vie suivantes : rôle, émotionnel et fonctionnement sexuel. Conclusion et retombées : Les résultats de la présente thèse soulignent l’importance d’évaluer de façon longitudinale la qualité de vie liée à la santé des femmes atteintes de cancer du sein à différents moments de la trajectoire de soins, particulièrement pendant la radiothérapie, et, pour les intervenants psychosociaux, de s’occuper des jeunes femmes diagnostiquées et de celles qui ne perçoivent pas recevoir un soutien social. Ainsi, de meilleures ressources psychosociales pourront être mises sur pied pour aider ces groupes de femmes. Les résultats montrent également qu’il est essentiel d’informer les chirurgiens-oncologues de l’importance d’établir une communication satisfaisante avec les femmes atteintes de cancer du sein lors de l’annonce du diagnostic afin de favoriser une perception positive par les femmes de leur communication avec les chirurgiens-oncologues. Enfin, les résultats obtenus soulignent les avantages pour les femmes atteintes de cancer du sein d’être proactives et de se sentir compétentes pour la recherche d’information et l’aspect socio-affectif d’une relation avec les chirurgiens-oncologues et les radio-oncologues dans le maintien d’une bonne qualité de vie liée à la santé.

Dornase alfa improves the health-related quality of life among Brazilian patients with cystic fibrosis - A one-year prospective study

Background: Health-related quality of life (HRQOL) measurements provide valuable information about the psychological and social impact of treatment on patients with cystic fibrosis (CF). This study evaluated the HRQOL of Brazilian patients with CF and assessed the changes in HRQOL domains over 1 year after dornase alfa (Pulmozyme) introduction. Patients and Methods: One hundred fifty-six stable patients with CF and 89 caregivers answered the Portuguese-validated version of the Cystic Fibrosis Questionnaire-Revised (CFQ-R) at baseline (T 0), and at 3 (T 1), 6 (T 2), 9 (T 3), and 12 (T 4) months of follow-up. Eighteen patientswere excluded because they did not fulfill the inclusion criteria. The patients were analyzed in two groups: those aged 6-11 years and those aged 14 years and older. ANOVA for observed repeated results and the last observation carried forward (LOCF) method for missing data were used for the statistical analysis. Results: After 1 year of follow-up, there was significant improvement in respiratory symptoms (T 4-T 0=8.1; 95% confidence interval (95% CI)=[2.1;14.0]; effect size (ES)=0.35; P<0.001), Emotional Functioning (T 4-T 0=5.6; 95% CI=[1.1;10.1]; ES=0.31; P<0.05), Social Functioning (T 4-T 0=6.0; 95% CI=[1.3;11.7]; ES=0.31; P<0.05), Body Image (T 4-T 0=11.9; 95% CI=[4.1;19.7]; ES=0.42; P<0.05), and Treatment Burden (T 4-T 0=5.3; 95% CI=[0.3;10.3]; ES=0.24; P<0.05) domains in the younger group. A significant improvement in Role Functioning (T 4-T 0=6.1; 95% CI=[1.1;11.1]; ES=0.40; P<0.05), Body Image (T 4-T 0=12.6; 95% CI=[3.5;21.7]; ES=0.46; P<0.05), and Weight (T 4-T 0=11.7; 95% CI=[1.8;21.6]; ES=0.40; P<0.05) was obtained in the older group. The caregivers' CFQ-R showed improvements in the Digestive Symptoms (T 4-T 0=5.5; 95% CI=[1.5;9.4]; ES=0.30; P<0.05), Respiratory Symptoms (T 4-T 0=7.6; 95% CI=[3.9;11.4]; ES=0.48; P<0.05), and Weight (T 4-T 0=10.1; 95% CI=[1.6;18.6]; ES=0.26; P<0.05) domains. Conclusion: The introduction of dornase alfa improved the HRQL of the patients with CF during the first year of treatment. © 2010 Wiley-Liss, Inc.

Impacto do exercício físico combinado na função diastólica de pacientes com insuficiência cardíaca e fração de ejeção reduzida

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

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.

The impact of antibiotic associated diarrhea on health related quality of life in hospitalized patients

Objective. To determine the impact of antibiotic associated diarrhea (AAD) on health related quality of life (HRQOL) in hospitalized patients compared to matched controls without diarrhea. ^ Methods. This is a hospital-based, matched case-control study using secondary data from a prospective cohort trial of patients receiving broad-spectrum antibiotics. One hundred and seventy-eight patients were recruited of whom 18 (10%) reported having antibiotic associated diarrhea. Two non-diarrhea controls were selected for each case with diarrhea giving a final sample of 18 cases and 36 controls. Responses from Short Form (SF) 36 questionnaire were aggregated into eight domains including physical functioning (PF), role-functioning physical (RP), bodily pain (BP), general health (GH), social functioning (SF), vitality (VT), role-functioning emotional (RE), and mental health (MH). The eight domains were compared between cases and controls. A GI targeted HRQOL measure was administered to 13 patients with AAD. Responses from the disease-specific instrument were combined in eight subscale scores: dysphoria, interference with activity, body image, health worry, food avoidance, social reaction, sex, and relationships. ^ Results. The sample consisted of 41 females (75.9%) and 13 males (24.1%) aged 53.5 ± 14.4 years (range: 21-76 years). Twenty five patients (46%) were Caucasian, 15 (27%) were African American, 13(24%) were Hispanic and 1(2%) was Asian. In univariate analysis, no significant differences in quality of life outcomes were observed in each of the SF36 domains between the case patients and matched controls. There were trends for decreased scores on the role-functioning physical, bodily pain, general health, social functioning, mental health, and mental summary domains. In total, 7 of 8 domain scores were lower in patients with AAD and 5 of 8 domain scores were lower by more than 5 points (considered clinically significant). Controlling for age, patients with antibiotic associated diarrhea had significantly lower general health, vitality, and mental health scale scores (p<0.05 each). The disease-specific scores were significantly lower in patients with AAD than those in published norms for irritable bowel syndrome patients. ^ Conclusion. In this small sample, several areas of decreased QOL in patients with AAD compared to matched controls were noted. A larger sample size to validate these results is necessary.^