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.

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.

Health-related quality of life in patients that have undergone liver resection:A systematic review and meta-analysis

BACKGROUND Mortality after hepatectomy has decreased,and the quality of various surgical approaches to hepatectomy have been evaluated.Various assessments of quality of life(QOL)after hepatectomy have been developed and investigated in different clinical settings.AIM To conduct a systematic review and meta-analysis to examine two clinical topics:Laparoscopic hepatectomy vs open hepatectomy,and preoperative QOL status vs postoperative QOL status.METHODS A systematic literature search was performed using PubMed and MEDLINE,including the Cochrane Library Central.The following inclusion criteria were set for inclusion in this meta-analysis:(1)Studies comparing preoperative QOL and postoperative QOL;and(2)Studies comparing QOL between laparoscopic hepatectomy and open hepatectomy.RESULTS A total of 8 articles were included in this meta-analysis.QOL was better after laparoscopic hepatectomy than after open hepatectomy.CONCLUSION The outcomes of evaluations of QOL after hepatectomy can depend on the type of questionnaire used,the timing of the assessment,and the etiology of the hepatic disease.

Mental health in a Canadian Old Order Mennonite community

This paper presents the results of a 2010 survey exploring the determinants of rural mental health in two farming groups in Waterloo, Ontario, Canada: Old Order Mennonites (OOMs) and non-OOM farmers. Comparing these two groups reduces the likely impact of many contextual features impacting both groups, such as local economic conditions. We explore a comprehensive list of health determinants to assess their relative importance and thus enable policy action to focus on those having the greatest impact. The mental component summary (MCS) of the short- form health survey (SF-12) was used to measure mental health. We compare mental health in the two populations and use multiple regression to determine the relative importance of the determinants in explaining mental health. The results show that OOMs experience better mental health than non-OOMs, in part due to the strong mental health of OOM women. Coping, stress and social interaction shape mental health in both groups, reflecting the broader determinants literature and suggesting these are important across many populations with different life circumstances. Other determinants are important for one group but not the other, underscoring the diversity of rural populations. For example, different social capital measures shape mental health in the two groups, and sense-of-place is associated with mental health in only one group (OOMs). The results are discussed in terms of their implications for future health determinants research and policy action to address rural mental health.

Health related quality of life of university students in Lebanon: Lifestyles behaviors and socio-demographic predictors

Measuring and monitoring health related quality of life (HRQoL) in youth are important for both researchers and decision makers. During the time that young people are at university, many will encounter a number of academic, as well as social, emotional and psychological difficulties. The aims of this study are to: 1) assess the health related quality of life of youths using SF-36 questionnaire and its factor determinants, and 2) provide an objective basis for a health promotion structure. Methods: This is a cross-sectional study in South Lebanon, in a population of 282 young university students attending a public university which is the largest and most widespread institution of higher education in Lebanon. Socioeconomic and lifestyle behaviors data were collected. Students’ HRQoL was measured using the SF-36 Health Survey. Results: The mean age of the respondents was 18.7 years (SD = 1.16), 80.1% were women, 64.5% were living in rural area. The proportion of current smokers was significantly greater among men than women (26.8% vs. 11.5%, p < 0.01). Water pipe was the main type of smoking. Education of the fathers had negatively influenced HRQoL. Younger age scored higher in Social Functioning and Role-Emotional;the area of residence had no influences on SF-36 scales scores. Females had poorer HRQoL than males especially in mental health scales. Smokers had low Vitality and Mental Health scores. Sedentary lifestyle was linked to a lower score of Physical Functioning (β = -5.16, 95% CI = -7.67 -2.65), and Vitality ( β= -5.85, 95% CI = -10.24 -1.45). The HRQoL of the students studying business and economics was higher than those studying health. Conclusion: Youths’ HRQoL is affected by socio-demographic and behavioral characteristics. Effective health-promoting actions, social support, and counseling services should be implemented in the campus and are a necessary step towards the main goal of improving the overall HRQoL of the university young students in Lebanon.

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.

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.

Effects of Biologics on Mental Health and Health-Related Quality of Life in Patients With Psoriasis:A Repeated Cross-Sectional Survey in Chinese Population

Objective:Psoriasis is a chronic inflammatory systemic disease that severely impacts patients’ quality of life (QoL) and psychological health.While biologics have been shown to be effective in treating psoriatic lesions,thus improving QoL,real-life data regarding such effects remain scant.We administered a repeated cross-sectional survey to assess the effects of 8 weeks of biologics treatment on the QoL and mental health status of patients with moderate-to-severe plaque psoriasis.Methods:From March to May 2022,patients with moderate-to-severe plaque psoriasis were enrolled and treated with biologics in the outpatient clinic at the Dermatology Hospital of Southern Medical University.Assessments were performed before treatment and after 4 and 8 weeks of treatment with biologics.Psoriasis severity,QoL,and mental health status were evaluated using the Psoriasis Area and Severity Index (PASI),Dermatology Life Quality Index (DLQI),36-Item Short-form Health Survey (SF-36),and Hospital Anxiety and Depression Scale (HADS).A multivariate generalized estimating equations (GEE) analysis was used to account for repeated measures and to determine the effects of treatment duration and type of biological agent on relevant indicators.Results:Among the 78 enrolled patients,the ranges of pretreatment scores were 4.6 to 46.8 for the PASI,1 to 30 for the DLQI,31.5 to 100.0 for the physical component score (PCS) of the SF-36,16.6 to 100.0 for the mental component score (MCS) of the SF-36,0 to 15 for the HADS-A,and 0 to 17 for the HADS-D.After 8 weeks of biologics treatment,98.7% (77/78) of patients had obtained PASI 75.All assessed scores changed over time (GEE,P < 0.001).Moreover,there were group-by-time interaction effects for the DLQI score (GEE,P = 0.023) and PCS (GEE,P = 0.029).The HADS-A and HADS-D scores were both decreased at week 8 compared with pretreatment values.Correlation analyses revealed that higher DLQI scores were associated with lower levels of QoL and higher levels of anxiety or depression.Conclusion:Biologics are not only effective in the treatment of skin lesions but also exert beneficial effects upon the QoL and mental health of patients with psoriasis as determined in the short-term assessments conducted in this study.

内镜下球囊扩张术对贲门失弛缓症患者生活质量的影响

目的探讨内镜下球囊扩张术对贲门失弛缓症(AC)患者生活质量的影响。方法采用自身前后对照研究,选择北京电力医院2009年1月—2011年1月因AC行内镜下球囊扩张术的75例患者,采用《AC患者症状计分》和汉化版简明健康调查量表(SF-36)分别对患者的症状和生活质量进行评价。术后定期随访症状评分、食管钡餐检查,以及并发症等。随访1年后,采用SF-36量表再次对患者的生活质量进行评价。结果内镜下球囊扩张术前,93.3%(70/75)的患者症状评分≥3分,经内镜下治疗后,38例患者的症状得以完全改善(完全改善组),20例患者的症状得以部分改善(部分改善组),内镜下球囊扩张术的总有效率为77.3%(58/75)。AC组SF-36量表生活质量各维度的评分值均显著低于中国常模组(P值分别<0.01、0.05)。内镜下球囊扩张术后,患者在SF-36量表生理功能、生理职能、躯体疼痛、总体健康、活力、社会功能、情感职能和精神健康8个维度上的评分值均较术前显著升高(P值均<0.01),完全改善组的SF-36量表生活质量各维度评分值与中国常模组间的差异均无统计学意义(P值均>0.05)。AC患者症状评分与SF-36量表中的生理功能(r=-0.261,P<0.05)、生理职能(r=-0.416,P<0.01)、躯体疼痛(r=-0.526,P<0.01)、总体健康(r=-0.419,P<0.01)、活力(r=-0.517,P<0.01)、社会功能(r=-0.564,P<0.01)、情感职能(r=-0.522,P<0.01)和精神健康(r=-0.511,P<0.01)8个维度上的评分均呈负相关。结论 AC患者的生活质量较健康者显著下降,经内镜下球囊扩张术治疗后,患者的症状得以明显改善,生活质量得以明显提高。

PDCA nursing in improving quality management efficacy in endoscopic submucosal dissection

BACKGROUND Endoscopic submucosal dissection(ESD) is a common surgical strategy for the treatment of early gastrointestinal tumors and precancerous lesions.PDCA nursing can effectively prevent potential risks in the nursing process,protect patient privacy,and improve patient satisfaction,nursing integrity,and service quality.AIM To explore the effects of PDCA nursing model on the quality management of gastrointestinal ESD,the 36-item Shot-Form Health Survey(SF-36) score,and negative emotions.METHODS A total of 178 patients who underwent ESD between January 2020 and January 2021 were divided into two groups.The usual care mode was the control group,with 80 cases from January to July 2020;from July 2020 to January 2021,98 patients were enrolled in the PDCA care mode as the research group.The length of hospital stay and the costs of the two groups were statistically analyzed.The visual analog scale(VAS),SF-36 score,Zung self-rating scale for anxiety and depression,and postoperative complications were also assessed.RESULTS The length of hospitalization and cost in the research group were lower than in the control group(P < 0.05),and the VAS scores were lower than those before care(P < 0.05).Moreover,the VAS score of the research group was lower than that of the control group(P < 0.05).The SF-36 scores for physical function,role status,social function,pain,mental health,and physical strength were higher in the research group than in the control group(P < 0.05).Depression and anxiety scores of the research group were lower than those of the control group(P < 0.05).The postoperative complication rate in the research group(6.12%) was lower than in the control group(32.50%)(P < 0.05).CONCLUSION PDCA nursing can improve the quality of management of ESD surgery,shorten the length of hospital stay and cost,reduce the VAS and Zung scale scores to alleviate adverse emotions,improve the SF-36 score,and reduce postoperative complications.

Surgical resection of esophagogastric junction stromal tumor: How to protect the cardiac function

BACKGROUND Various surgical procedures have been described for gastrointestinal stromal tumors(GISTs)at the esophagogastric junction(EGJ)close to the Z-line.However,surgery for EGJ-GIST involving Z-line has been rarely reported.AIM To introduce a novel technique called conformal resection(CR)for open resection of EGJ-GIST involving Z-line.METHODS In this retrospective study,43 patients having GISTs involving Z-line were included.The perioperative outcomes of patients receiving CR(n=18)was compared with that of proximal gastrectomy(PG)(n=25).RESULTS CR was successfully performed in all the patients with negative microscopic margins.The mean operative time,time to first passage of flatus,and postoperative hospital stay was significantly shorter in the CR group(P<0.05),while the intraoperative blood loss was similar in the two groups.The postoperative gastroesophageal reflux as diagnosed by esophageal 24-h pH monitoring and quality of life at 3 mo were significantly in favor of CR compared to PG(both P<0.001).The 5-year disease-free survival between the two groups was similar(P=0.163).The cut-off value for the determination of CR or PG was 7.0 mm above the Z-line(83.33%sensitivity,84.00%specificity,83.72%accuracy).CONCLUSION CR is safe and feasible for EGJ-GIST located within 7.0 mm above the Z-line.

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.

Quality of Life (QOL) in Long-Term Survivors of Osteosarcoma

We conducted this study to analyze the quality of life using the SF-36 health questionnaire and the MSTS scores depending on surgical method and the primary site of occurrence. On the surgical method, the limb salvage had more excellent outcomes (60.9) than the amputation (46.3). The tumor prosthetic replacement had notably higher scores (62.5) than any other methods. For the correlation coefficients on the MSTS and SF-36, the Physical Function had the highest degree of correlation. Excellent functions of the extremities would lead to a good quality of life.

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.