Health Related Quality of Life and Mental Health in ICU Survivors: Post-Intensive Care Syndrome Follow-Up and Correlations between the 36-Item Short Form Health Survey (SF-36) and the General Health Questionnaire (GHQ-28)

We investigated the relationship between health-related quality of life (HRQOL) and psychological distress in intensive care unit (ICU) survivors 12 months after ICU discharge. The purpose of this study, conducted and completed before the onset of the COVID-19 pandemic, was to find correlations among psychiatric symptoms detected by a screening tool as the General Health Questionnaire-28 (GHQ-28) and the different domains of HRQOL measured with the SF-36 health survey (SF-36), in order to identify ICU survivors with Post-Intensive Care Syndrome (PICS) who need a specific psychiatric intervention to improve their HRQOL. Among 298 ICU survivors who stayed in the ICU for at least 72 hours, 48 patients were enrolled one year after discharge undergoing a clinical interview to assess their functional impairment (Barthel index), mental health (GHQ-28), and health-related quality of life (SF-36). 19% of those subjects had a GHQ-28 ≥ 5 and were identified as “psychiatric cases”, and they were older and experienced a greater impairment in HRQOL. Anxiety, insomnia, and depressive symptoms seemed to be particularly involved in the impairment of HRQOL. A negative correlation between GHQ-28 total scores and subscales and SF-36 subscales was found. Our findings highlighted that psychological distress in ICU survivors may negatively impact physical health recovery and quality of life;conversely, physical impairment and functional disability may trigger the onset of psychiatric symptoms after discharge. The present study is firstly to investigate the correlations between HRQOL and psychological distress in ICU survivors through the GHQ-28, and then affirms the need to carry out follow-up checks for psychiatric symptoms in ICU survivors.

Health Related Quality of Life among Osteoarthritis Patients: A Comparison of Traditional Non-Steroidal Anti-Inflammatory Drugs and Selective COX-2 Inhibitors in the United Arab Emirates Using the SF-36

Objectives: Osteoarthritis (OA) has a dramatic impact on patients’ health related quality of life (HRQoL). Chronic use of analgesics and anti-inflammatory medications for pain management may improve symptoms but on long term may affect HRQoL negatively. The objective of the present study was to compare the impact of two different classes of analgesics, traditional non-steroidal anti-inflammatory drugs (NSAIDs) and selective cyclo-oxygenase-2 (COX-2) inhibitors on HRQoL among osteoarthritis patients using the SF-36 questionnaire. Methods: Clinic based cross-sectional study conducted at Al-Qassimi Hospital, Sharjah, United Arab Emirates (UAE), over a period of six months. Ethical Approval was obtained from the ethics committee at Al-Qassimi Clinical Research Center. Total of 200 osteoarthritis patients fulfilling the inclusion and exclusion criteria were involved in the study. Patients’ demographics were collected from their medical records. The Medical Outcome Study Short-Form 36 (SF-36) questionnaire was used to measure patients’ HRQoL. SF-36 data were scored using health outcomes scoring software 4.5. Results: Mean age of the subjects was 62.19 ± 9.81 years with females constituting 151 (75.5%) of the patients. In general, females scored lower in most of the HRQoL domains compared to males and there was significant difference between the two groups in the mental health (p = 0.005) & mental component (p = 0.042) domains. Compared to selective COX-2 inhibitors, patients on NSAIDs scored higher on all domains of SF-36 except physical functioning. There was significant difference in mental health domain for patients treated with NSAIDs (p = 0.02). Celecoxib was only better than NSAIDs in osteoarthritis patients with more than one musculoskeletal disorders in the domain of bodily pain (p = 0.009). Conclusion: NSAIDs-treated patients did not differ significantly from celecoxib-treated patients in all domains of the SF-36 except for the mental health domain.

Smoking and Health-Related Quality of Life(SF-36).A Population-Based Study in Campinas,SP,Brazil

Introduction: Smoking persists as a global and relevant health problem being one of the major risk factors to non-communicable diseases and early death. Studies on the association between smoking and health related quality of life (HRQL) are scarce in Brazil and Latin America. The aim of this study was to analyze the HRQL according to smoking status on adults aged 20 to 59 years, living in Campinas, Brazil. Method: It is a population-based cross-sectional study, carried out with data from the Campinas Health Survey developed in 2008/2009. The dependent variables were the eight scales and the two components—physical (PCS) and mental component summary (MCS) of the instrument SF-36, version 2. Means and confidence intervals of the SF-36 scale scores and components were estimated according to smoking (never smokers, former smokers, current smokers) and nicotine dependence (mild, moderate, heavy). Results: The sample comprised 957 individuals (mean age of 37.5 years). Comparing with never smokers, smokers had lower score means in all SF-36 scales, except in physical functioning and role-physical;among the former smokers, lower scores were observed in vitality and mental health. A reduction of the MCS score was observed among smokers and former smokers among men;but in the female population, this reduction was observed only in smokers compared with never smokers. According to the nicotine dependence, it was observed an increasing reduction in MCS scores from mild, to moderate and heavy smokers. Conclusion: Smoking is significantly and negatively associated with HRQL in the studied population. The results point out the importance of the strategic policies against smoking, to reduce morbidity and premature death, but also to increase the quality of life and well-being. It is also important to consider the mental health dimension, since that best mental health can be relevant to promote healthier behaviors.

Impact of Post Hepatitis C Chronic Liver Disease and Hepatocellular Carcinoma on Health Related Quality of Life

Background: Post hepatitis C virus chronic liver disease (CLD) is prevalent among the Egyptian population with a bad impact upon their quality of life (QOL). Hepatocellular carcinoma (HCC) is one of the long term and fatal complications of CLD and it also has its negative impact on patient’s quality of life. Aim: To assess impact of CLD and HCC on the quality of life of group of hospitalized elderly patients. Methodology: Ninety elderly patients were divided into three groups: 30 elderly with post hepatitis C virus CLD, 30 elderly with HCC and 30 others free of liver disease as control group (Cn), all were recruited from the in-patient ward and the outpatient clinic of the Geriatric Department, Ain-Shams University Hospital. After giving consent, comprehensive geriatric assessment was done with assessment of their quality of life by using the Short Form-36 health survey (SF-36). Investigations including liver enzymes, serum albumin, serum bilirubin and abdominal ultrasound were done. Results: All QOL domains were the highest among control group, followed by HCC group and the least among CLD group. The differences were statistically significant in most subscales and total score [Mean of Cn = 81.9 ± 12.4, Mean of CLD = 47.5 ± 21.9, Mean of HCC = 62.3 ± 16.1;P Cn/CLD ≤ 0.001, P Cn/HCC ≤ 0.001, P CLD/HCC = 0.004]. Albumin was the only biochemical marker correlated positively with total SF score and two subscales (PF and EF) [r = 0.408;P = 0.025]. Conclusion & Recommendation: Our study showed a decrease in the QOL of Egyptian post hepatitis C virus CLD and HCC patients compared with Egyptian population norms. The results showed that CLD were more affected than HCC patients. This had a particularly serious negative impact on their life. The findings indicate a need for updated counseling and educational materials designed to provide adequate information and consistent healthcare service to this patient setting.

Influence of Metabolic Syndrome versus Musculoskeletal Disorders on Saudi Health-Related Quality of Life

Aim: This work aimed to study the influence of two chronic health conditions, metabolic syndrome (MetS) and musculoskeletal disorders (MSDs), on the health-related quality of life (HRQoL) of Saudis. Method: The Medical Outcomes Study Short Form-36 (SF-36) health status questionnaire was used to measure the HRQoL and compare the mean scores of the questionnaire subscales and physical and mental component summaries (PCS and MCS) of 33 patients with MetS, 18 patients with MSDs, and 30 apparently healthy (AH) subjects. Regression analysis was used to measure the prediction power of the study group, age and gender of the participants in estimating the HRQoL. Results: Results showed that the mean scores of the physical subscales, the PCS, the mental subscales and MCS were arranged in descending order from AH subjects, patients with MetS, to patients with MSDs. The mean scores difference among the 3 study groups were statistically significant with the only exception for the general mental health (GMH) subscale (P = 0.404). The study group and age accounted for 41.8% of the variability of PCS while the study group accounted for 19.6% of the variability in the MCS. The resulted equation to estimate the PCS score was as follows: PCS = 113.18 - 12.85 (Group: 0 for AH, 1 for MetS, and 2 for MSDs) - 0.67 age. On the other hand the resulted equation to estimate the MCS score was as follows: MCS = 76.203 - 10.426 (Group: 0 for AH, 1 for MetS, and 2 for MSDs). Conclusion: Patients with MetS and patients with MSDs had lower HRQoL than AH subjects. All the physical and mental dimensions of HRQoL are negatively influenced with MetS and with MSDs with the only exception for the GMH subscale. The physical and mental burden of MSDs is more dominant. The study group and age can be used to predict the PCS while the study group can be used to predict the MCS.

Physical Activity Level and Adult Saudi Health Related Quality of Life

Purpose: Physical inactivity in Saudi Arabia is a growing challenge to public health. This study aimed to define the relationship between the physical activity level (PAL) and adult Saudi health-related quality of life (HRQoL). Methods: Participants of this study were 100 Saudi adult aged from 18 - 70 years. The 36-Item Short-Form Health Status Survey (SF-36) was used to measure the participant’s HRQoL. The SF-36 is comprised of 8 domains. The electronic version of the General Practice Physical Activity Questionnaire was used to categorize participants in terms of physical activity level into;inactive, moderately inactive, moderately active, and active. Descriptive and inferential statistical tests were used to treat the collected data. Results: Results showed that only 17% of the Saudi adults had active PAL. The PAL had significantly positive relationship with 4 domains of HRQoL including: physical functioning (P = 0.004), role limitations caused by physical health problems (P = 0.048), vitality (P = 0.009), and general health (P = 0.044). Results also confirmed that the younger the subject, the higher the PAL (P = 0.0001) and the better the HRQoL. This is true for all domains except the role limitations caused by emotional problems and emotional wellbeing. Conclusion: The poor physical activity level of adult Saudi negatively impacts their HRQoL.

Quantities of comorbidities affects physical, but not mental health related quality of life in type 1 diabetes with confirmed polyneuropathy

BACKGROUND A large number of adults with long-term type 1 diabetes are affected by symmetrical peripheral neuropathy.These complications increase socioeconomic expenses and diminish the individual quality of life.The 36-Item Short Form Health Survey(SF-36)is a generic patient reported questionnaire,measuring mental and physical health related quality of life.We hypothesized that diabetic neuropathy would decrease physical and mental quality of life measured with SF-36,and that clinical appearance may be associated with the decline.AIM To investigate if diabetic neuropathy would decrease physical and mental quality of life measured with SF-36,and if clinical appearance may be associated with the decline.METHODS Forty-eight adults[age 50±9 years,10 females,disease duration 32(14-51)years]with verified diabetic symmetrical peripheral neuropathy and 21 healthy participants(age 51±6 years,6 females)underwent standardised nerve conduction testing and completed the SF-36 questionnaire.Furthermore,disease duration,number of comorbidities,both diabetes related and nondiabetes related,vibration perception threshold,number of hypoglycaemic events,HbA1c and administration way of insulin was notified.RESULTS In comparison to healthy subjects,patients’mental composite score was not significantly diminished(51.9±8.9 vs 53.1±5.5,P=0.558),while the physical composite score was(46.3±11.7 vs 54.6±3.3,P=0.002).As expected,the overall physical health related symptoms in patients were associated to total number of comorbidities(P<0.0001),comorbidities relation to diabetes(P=0.0002)and HbA1c(P=0.005)as well as comorbidities not related to diabetes(P=0.0006).CONCLUSION The finding of this study emphasises the importance of focusing on quality of life in adults with diabetes and especially in those with multiple comorbidities as well as the possibility of HbA1c as a biomarker for severe complication.

Functional and clinical outcome with modified lateral approach total hip arthroplasty in stiff hips with ankylosing spondylitis

BACKGROUND Ankylosing spondylitis at total hip arthroplasty(THA)has significant hip stiffness with flexion deformity,restricted mobility,and function.Range of movement(ROM)improvement with good functional outcome is seen following THA in these hips.The modified Hardinge approach without abductor compromise is helpful in these stiff hips with associated flexion deformity.AIM To assess improvement in ROM and functional outcomes with a modified lateral approach THA in ankylosing spondylitis with stiff hips.METHODS A total of 69 hips that underwent THA with a modified Hardinge approach in 40 patients were evaluated at a mean follow-up of 38.33 mo.All individuals ambulated with weight-bearing as tolerated and ROM exercises from the 1st postoperative day.Modified Harris hip score and ROM were assessed during follow-up.Quality of life assessments using the 36-item and 12-item short form health surveys were done along with clinical and functional outcomes at followup.SPSS 22.0 was used for statistical analysis.The correlation of ROM and functional score change was performed using Pearson’s correlation coefficient.RESULTS Sixty-nine hips with a significant decrease in ROM preoperatively with 32 clinically fused hips showed significant improvement in flexion range.The mean flexion in 69 hips improved from 29.35±31.38 degrees to 102.17±10.48 degrees.The mean difference of 72.82 with a P value<0.0001 was significant.In total,45 out of 69 hips had flexion deformity,with 13 hips having a deformity above 30 degrees.The flexion during the follow-up was below 90 degrees in 3 hips.Eleven hips had flexion of 90 degrees at follow-up,while the remaining 55 hips had flexion above 100 degrees.Modified Harris hip score improved from 17.03±6.02 to 90.66±7.23(P value<0.0001).The 36-item short form health survey at the follow-up indicated health status in 40 patients as excellent in 11,very good in 20,good in 5,fair in 3,and poor in 1.The mean mental health score was 84.10±11.58.Pain relief was good in all 69 hips.Altogether,28/40 patients(70%)had no pain,9 patients(22%)had occasional pain,and 3 patients(8%)had mild to moderate pain with unusual activity.Heterotopic ossification was seen in 21 hips with Brooker class 1 in 14 hips.CONCLUSION Modified Hardinge approach THA in ankylosing spondylitis with stiff hips with flexion deformity significantly improved ROM,Harris hip score,and quality of life indicated by the 36-item and 12-item short form health surveys.

On Practice of the Effect of Systematic Family Nursing Guidance on the Quality of Life of Elderly Patients with Implanted Cardiac Pacemaker

Objective: To inquire into the effect of systematic family nursing guidance on improving the Quality of Life for elderly patients with implanted cardiac pacemaker. Methods: 41 elderly patients in accordance with the corresponding requirements were studied after offering systematic family nursing guidance and surveyed through the questionnaires about the QOL (quality of life) respectively 1 month, 3 months and 6 months after leaving hospital. Results: Compared with that of 1 month and 3 months after the operation, the questionnaire scores for 6 months after the operation were found to have significant improvement, and the differences were statistically significant. Conclusion: Systematic family nursing guidance can effectively improve the QOL for elderly patients with implanted cardiac pacemaker, which makes them spend their old age in comfort and happiness.

Acupuncture and moxibustion for the elderly patients with depression:A randomized controlled trial

Objective:To identify the effects of acupuncture and moxibustion therapy by soothing liver and regulating mind on the quality of life among the elders with depression.Methods:This was a single-blind,randomized,controlled trial of 75 elders with depression conducted in Guangdong Province,China,in January to December 2010.Eligible patients were randomly divided into three treatment groups.22 patients received acupuncture and moxibustion treatment of soothing liver and regulating mind[group A,in acupuncture procedure:Hegu(合谷L14),Taichong(太冲LR3),Baihui(百会GV20)and Yinting(印堂GV29)were selected,in moxibustion procedure,bilateral Geshu(膈俞BL17)and Danshu(胆俞BL19)were selected,the moxibustion cones was placed on the acupoints,five cones were given to each point.In intradermal needling procedure,Xinshu(心俞BL15),and Ganshu(肝俞BL18)were selected].28 patients received acupoint shallow puncturing treatment(group B,patients received the same acupoints as in the group A,with a 2-3 mm needling depth and no needle sensation was required.A shorter duration of moxibustion and only 1-2 mm of needle body was inserted into the points when intradermal needling).25 patients received non-acupoint shallow puncturing treatment(group C,patients received non-acupoint shallow puncturing at points 10 mm lateral to LI4 and LR3,10 mm left side of GV20 and GV29 in acupuncture procedure;10 mm lateral to BL17 and BL19 in moxibustion procedure;10 mm lateral to BL15 and BL18 in intradermal needling procedure,with the same manipulation method as that in the group B).In all three groups,the treatment was given twice a week for 12 weeks.The Short Form(36)Health Survey(SF36)and TCM Symptom Scale Score as clinical efficacy and quality of life were used to quantitatively assess patients'outcomes before and after treatment.Results:The TCM Symptom Scale scores showed significant differences between the group A and C,and between group B and C(both P<0.05),while there was no significant difference between group A and B(P>0.05).An item-by-item analysis of the SF36 showed the elders in group A obtained the highest scores at each time point after treatment(all P<0.05).Among the results,mental health and report health transition items showed no significant differences between the group A and group B at time point of after treatment(all P>0.05).Vitality and social functioning items at a month after treatment time point,social functioning and report:health transition items at 3 months after treatment time point,role emotional item at after treatment time point showed no significant differences between the group B and group C(all P>0.05).Conclusions:The therapeutic effect of acupuncture and moxibustion by soothing liver and regulating mind can obviously improve the quality of life of depression elders.