Comparison of diagnostic validity of two autism rating scales for suspected autism in a large Chinese sample

BACKGROUND Autism is the most common clinical developmental disorder in children.The childhood autism rating scale(CARS)and autistic autism behavior checklist(ABC)are the most commonly used assessment scales for diagnosing autism.However,the diagnostic validations and the corresponding cutoffs for CARS and ABC in individuals with suspected autism spectrum disorder(ASD)remain unclear.Furthermore,for suspected ASD in China,it remains unclear whether CARS is a better diagnostic tool than ABC.Also unclear is whether the current cutoff points for ABC and CARS are suitable for the accurate diagnosis of ASD.AIM To investigate the diagnostic validity of CARS and ABC based on a large Chinese sample.METHODS A total of 591 outpatient children from the ASD Unit at Beijing Children’s Hospital between June and November 2019 were identified.First,the Clancy autism behavior scale(CABS)was used to screen out suspected autism from these children.Then,each suspected ASD was evaluated by CARS and ABC.Receiver operating characteristic(ROC)curve analysis was used to compare diagnostic validations.We also calculated the area under the curve(AUC)for both CARS and ABC.RESULTS We found that the Cronbach alpha coefficients of CARS and ABC were 0.772 and 0.426,respectively.Therefore,the reliability of the CARS was higher than that of the ABC.In addition,we found that the correlation between CARS and CABS was 0.732.Next,we performed ROC curve analysis for CARS and ABC,which yielded AUC values of 0.846 and 0.768,respectively.The cutoff value,which is associated with the maximum Youden index,is usually applied as a decision threshold.We found that the cutoff values of CARS and ABC were 34 and 67,respectively.CONCLUSION This result indicated that CARS is superior to ABC in the Chinese population with suspected ASD.

Effect of Rating Scales and Test Parts of Body on the Evaluation Results of Fabric-evoked Prickle

The effect of rating scales and test parts of body on the fabric-evoked prickle evaluation results are studied by carrying out subjective evaluation tests under controlled environment conditions （24 4±1）℃, （65 =l= 5） %RH. Ten college female students aged about 20 were chosen as the subjects, who have participated a preliminary training on subjective prickle evaluation. The prickle of a range of 9 light-weight worsted woven wool and wool blend fabrics and a cotton fabric were tested by using a 1 - 5 rating scale and using a 0 - 10 rating scale respectively at different test parts of body respectively such as forearm, upper arm ball and neck back. The test results were statistically analyzed. It is found that there is a significant correlation coefficient between the evaluation results of using the 1 - 5 rating scale and of using the 0- 10 rating scale. It is also found that there are highly significant correlation coefficients between the evaluation results of using the forearm prickle test and the neck back prickle test, between the evaluation results of using the neck back prickle test and the upper arm ball prickle test, and between the evaluation results of using the forearm prickle test and the upper arm ball prickle test. It is suggested that the forearm prickle test is preferable in evaluating fabric-evoked prickle for its convenience and sensitivity.

Using dementia rating scales in the diagnosis of Alzheimer’s disease

Objective： To study the significance of dementia rating scales in the diagnosis of Alzheimer＇ s disease（AD）. Methods： Probable AD patients（118 cases） diagnosed according to NINCDS-ADRDA criteria and the normal controls（100 cases） were examined with a battery of neuropsychological tests and the dementia severity of AD patients was determined with clinical dementia rating （CDR）. Changed neuropsychological characteristics of different AD dementia severities were analyzed. The discriminant analysis and ROC curve analysis were perfomed to analyze the specificity, the sensitivity, and the general accuracy of various dementia rating scales in the diagnosis of AD, and the area under the ROC curve. Results： The total cognition function in mild （CDR = 1 ）, moderate（CDR = 2） and severe stages（CDR=3） of AD had an obvious trend of continuous decline, with the MMSE values 17.44±2.64, 13.90±4.32, and 5.50 ± 3.90 respectively. The trend of decline of the verbal fluency function in AD was same as that of total cognition function. The visuospatial function was reduced in early stage of AD （CDR = 1 ） and completely lost in moderate and severe AD. Delay memory function began to show decline in the early stage of AD, and the decline turned apparent in moderate and severe AD. Immediate memory function showed unchanged in early stage of AD, while showed decline in moderate AD, and the decline became very quick in severe AD. The impairment of daily living ability and social activity function developed with the severity degree of AD. But the decline of social activity function was very quick in moderate stage of AD. In general, the leading scale to diagnose AD was FOM, followed by RVR, POD, MMSE, BD,ADL and DS. When MMSE was combined with one or more of FOM, RVR, BD, DS, the general accuracy in distinguishing AD from the normal controls was improved. Conclusion： Neuropsychological test is useful in the diagnosis of AD, especially in the early stage. The validity is improved when dementia rating scales are combined correctly.

The laparoscopic rating scale for the evaluation of working conditions for surgical treatment of super-obesity

In this technical note,a novel rating scale(abdominal integral index)was introduced for assessing the conditions of the working laparoscopic space based on linear measurements to select the optimal one or two-stage surgical treatment for super-obesity.Patients with the same height and similar BMI values had different rating scale scores,reflecting different conditions of laparoscopic bariatric surgery.The rating scale helps surgeons and patients make a safe option for surgery,depending on the experience of the surgeon and technical laparoscopic conditions.

Study on the impact of comprehensive geriatric assessment on anxiety and depression in chronic obstructive pulmonary disease patients

BACKGROUND Psychological factors such as anxiety and depression will not only aggravate the symptoms of chronic obstructive pulmonary disease(COPD)patients and reduce the quality of life of patients,but also affect the treatment effect and long-term prognosis.Therefore,it is of great significance to explore the clinical application of senile comprehensive assessment in the treatment of COPD and its influence on psychological factors such as anxiety and depression.AIM To explore the clinical application of comprehensive geriatric assessment in COPD care and its impact on anxiety and depression in elderly patents.METHODS In this retrospective study,60 patients with COPD who were hospitalized in our hospital from 2019 to 2020 were randomly divided into two groups with 30 patients in each group.The control group was given routine nursing,and the observation group was given comprehensive assessment.Clinical symptoms,quality of life[COPD assessment test(CAT)score],anxiety and depression Hamilton Anxiety Rating Scale(HAMA)and Hamilton Depression Rating Scale(HAMD)were compared between the two groups.RESULTS CAT scores in the observation group decreased from an average of 24.5 points at admission to an average of 18.3 points at discharge,and in the control group from an average of 24.7 points at admission to an average of 18.3 points at discharge.The average score was 22.1(P<0.05).In the observation group,HAMA scores decreased from 14.2 points at admission to 8.6 points at discharge,and HAMD scores decreased from 13.8 points at admission to 7.4 points at discharge.The mean HAMD scores in the control group decreased from an average of 14.5 at admission to an average of 12.3 at discharge,and from an average of 14.1 at admission to an average of 11.8 at discharge.CONCLUSION The application of comprehensive geriatric assessment in COPD care has a significant effect on improving patients'clinical symptoms and quality of life,and can effectively reduce patients'anxiety and depression.

Assessment of Stress Cognitive Control and Executive Function with Stress Control Rating Scale (ECOSTRESS) and Low Resolution Brain Electromagnetic Tomography (LORETA) (In Portuguese People in Situations of Unemployment and Economic Insufficiency)

This article reviews the constructs of stress, appraisal, coping, according to a transactional perspective, and executive function, and presents a stress control rating scale (ECOSTRESS), which design is founded in these constructs. This psychometric tool is useful in the assessment of cognitive control of stress, correlated with the function of dorsolateral prefrontal cortex. It has been validated for its use in the assessment of Portuguese people in situations of stress related to unemployment and economic insufficiency. Also, within the context of the cognitive control of stress, it is highlighted the usefulness of low resolution brain electromagnetic tomography (LORETA).

Introduction to cognitive assessment scales in screening for mild cognitive impairment after stroke: A review

Objective:In order to improve the quality of life of patients more effectively,this paper introduces the types and usages of scales for screening mild cognitive dysfunction after stroke and provides a basis for early identification of mild cognitive impairment.Methods:Read,analyze,summarize,and sort out relevant literature.Results:The mild cognitive impairment assessment scales are broadly divided into two categories:the comprehensive rating scales and the special assessment scales.There are 7 comprehensive assessment scales for the comprehensive rating scales,among which the Mini-mental State of Examination and the Montreal Cognitive Assessment Scale are the most widely used.The special assessment scales are mainly evaluated by the symptoms of cognitive dysfunction and can be divided into five types.Conclusion:Early diagnosis and intervention in patients with cognitive dysfunction will help improve the prognosis of patients.Each assessment scale has its advantages and limitations in both sensitivity and discrimination.Effective use of appropriate scales to diagnose cognitive dysfunction and to screen early,to prevent early,to treat early can effectively improve the quality of life of elderly patients.

Assessment of hindlimb motor recovery affer severe thoracic spinal cord injury in rats: classification of CatWalk XT■ gait analysis parameters

Assessment of locomotion recovery in preclinical studies of experimental spinal cord injury remains challenging. We studied the CatWalk XT■gait analysis for evaluating hindlimb functional recovery in a widely used and clinically relevant thoracic contusion/compression spinal cord injury model in rats. Rats were randomly assigned to either a T9 spinal cord injury or sham laminectomy. Locomotion recovery was assessed using the Basso, Beattie, and Bresnahan open field rating scale and the CatWalk XT■gait analysis. To determine the potential bias from weight changes, corrected hindlimb(H) values(divided by the unaffected forelimb(F) values) were calculated. Six weeks after injury, cyst formation, astrogliosis, and the deposition of chondroitin sulfate glycosaminoglycans were assessed by immunohistochemistry staining. Compared with the baseline, a significant spontaneous recovery could be observed in the CatWalk XT■parameters max intensity, mean intensity, max intensity at%, and max contact mean intensity from 4 weeks after injury onwards. Of note, corrected values(H/F) of CatWalk XT■parameters showed a significantly less vulnerability to the weight changes than absolute values, specifically in static parameters. The corrected CatWalk XT■parameters were positively correlated with the Basso, Beattie, and Bresnahan rating scale scores, cyst formation, the immunointensity of astrogliosis and chondroitin sulfate glycosaminoglycan deposition. The CatWalk XT■gait analysis and especially its static parameters, therefore, seem to be highly useful in assessing spontaneous recovery of hindlimb function after severe thoracic spinal cord injury. Because many CatWalk XT■parameters of the hindlimbs seem to be affected by body weight changes, using their corrected values might be a valuable option to improve this dependency.

Effect of non-pharmacological treatment on the full recovery of social functioning in patients with attention deficit hyperactivity disorder

BACKGROUND Long-term treatment of attention deficit/hyperactivity disorder(ADHD)is associated with adverse events,such as nausea and vomiting,dizziness,and sleep disturbances,and poor maintenance of late ADHD medication compromises treatment outcomes and prolongs the recovery of patients’social functioning.AIM To evaluate the effect of non-pharmacological treatment on the full recovery of social functioning in patients with ADHD.METHODS A total of 90 patients diagnosed with ADHD between May 2019 and August 2020 were included in the study and randomly assigned to either the pharmacological group(methylphenidate hydrochloride and tomoxetine hydrochloride)or the non-pharmacological group(parental training,behavior modification,sensory integration therapy,and sand tray therapy),with 45 cases in each group.Outcome measures included treatment compliance,Swanson,Nolan,and Pelham,Version IV(SNAP-IV)scores,Conners Parent Symptom Questionnaire(PSQ)scores,and Weiss Functional Impairment Rating Scale(WFIRS)scores.RESULTS The non-pharmacological interventions resulted in significantly higher compliance in patients(95.56%)compared with medication(71.11%)(P<0.05).However,no significant differences in SNAP-IV and PSQ scores,in addition to the learning/school,social activities,and adventure activities of the WFIRS scores were observed between the two groups(P>0.05).Patients with non-pharmacological interventions showed higher WFIRS scores for family,daily life skills,and self-concept than those in the pharmacological group(P<0.05).CONCLUSION Non-pharmacological interventions,in contrast to the potential risks of adverse events after longterm medication,improve patient treatment compliance,alleviate patients’behavioral symptoms of attention,impulsivity,and hyperactivity,and improve their cognitive ability,thereby improving family relationships and patient self-evaluation.

Sociopsychological impact factors of depression patients during the COVID-19 epidemic period

Objective:To investigate the impact factors of the COVID-19 epidemic on the mental health of patients with depression.Methods:The relevant data of 242 residents aged 18-50 years in a certain area were collected,118 patients and 124 healthy people were analyzed by general information questionnaire,the PsychoSocial Index(PSI)questionnaire,Social Support Rating Scale(SSRS)and Symptom Checklist 90(SCL-90).Compare the differences in social and psychological factors between the two groups.Then use logistic regression to evaluate the social and psychological influencing factors of depression patients during the epidemic.Results:Two results of logistic regression analysis showed that marital status,occupational status,abnormal pathological behavior,and utilization of support were still significantly associated with depression.Compared to working,unemployed/unemployed/retired,students are closely related to depression,followed by abnormal pathological behavior and utilization of support.Conclusion:Under the epidemic,depression groups lacking social relationships should actively pay attention to their mental health status and comprehensively enhance their social and psychological support.To avoid the exacerbation of psychological and psychological symptoms caused by the epidemic.

Efficacy and safety of thermobalancing therapy with Dr Allen’s Device for chronic low back pain:A randomised controlled trial

BACKGROUND Lumbar disc herniation and non-specific low back pain are common conditions that seriously affect patients’health-related quality of life(HRQoL).Although empirical evidence has demonstrated that novel Thermobalancing therapy and Dr Allen’s Device can relieve chronic low back pain,there have been no randomised controlled trials for these indications.AIM To evaluate the efficacy of Dr Allen’s Device in lumbar disc herniation(LDH)and non-specific low back pain(NSLBP).METHODS A randomised clinical trial was conducted investigating 55 patients with chronic low back pain due to LDH(n=28)or NSLBP(n=27),out of which 15 were randomly assigned to the control group and 40 were assigned to the treatment group.The intervention was treatment with Dr Allen’s Device for 3 mo.Changes in HRQoL were assessed using the Numerical Pain Rating Scale and the Japanese Orthopedic Association Back Pain Questionnaire.RESULTS Thermobalancing therapy with Dr Allen’s Device showed a significant reduction in pain in the treatment group(P<0.001),with no recorded adverse effects.Both pain assessment scales showed a significant improvement in patients’perception of pain indicating improvement in HRQoL.CONCLUSION The out-of-hospital use of Thermobalancing therapy with Dr Allen’s Device for Low Back Treatment relieves chronic low back pain significantly and without adverse effects,improves the level of activity and HRQoL among patients with LDH and NSLBP.This study demonstrates the importance of this safe first-line therapy that can be used for effective at-home management of chronic low back pain.

Clinical Study on Treatment of Senile Vascular Dementia by Acupuncture

63 patients with senile vascular dementia were randomly divided into the treatment group (treated by acupuncture) and the control group (treated with piracetam). The authors observed the changes in the score of Hasegawa's dementia scale (HDS), p300, rheoencephalogram, topographic EEG, superoxide dismutase (SOD) activity in erythrocytes, and lipid peroxide (LPO) level in plasma before and after treatment. The statistical data showed that the total effective rate in the treatment group (80.6%) was significantly higher than that in the control group (25%), and the differences in the observed indexes before and after treatment were significant (P 0.05), indicating that the acupuncture treatment was superior in immediate therapeutic effect on senile vascular dementia to drug treatment.

TeachingmA Way of Implementing Statistical Methods for Ordinal Data to Researchers

The use of questionnaires, rating scales and other kinds of ordered classifications is unlimited and interdisciplinary, so it can take long time before novel statistical methods presented in statistical journals reach researchers of applied sciences. Therefore. teaching is an effective way of introducing novel methods to researchers at an early stage. Assessments on scales produce ordinal data having rank-invariant properties only, which means that suitable statistical methods are non-parametric and often rank-based. These limited mathematical properties have been taken into account in the research regarding development of statistical methods for paired ordinal data. The aim is to present a statistical method for paired ordinal data that has been successfully implemented to researchers from various disciplines together with statisticians attending interactive problem solving courses of biostatistics.

CLINICAL OBSERVATION ON POSTHERPETIC NEURALGIA OF HIV CARRIERS TREATED WITH ARRANGED ELECTRO ACUPUNCTURE

cases of postherpetic neuralgia were treated with arranged electro acupuncture and 30 cases with medicine as control. All cases were HIV carriers. The 6 point behavioral rating scale (BRS 6) was used to observe the effect before and after treatment. The results indicate arranged electro acupuncture can cure or reduce the severe pain of postherpetic neuralgia of HIV carriers and the effect was better than medicine.

Predictive power of abnormal electroencephalogram for post-cerebral infarction depression

Electroencephalography is a sensitive indicator for measuring brain condition, and can reflect early changes in brain function and severity of cerebral ischemia. However, it is not yet known whether electroencephalography can predict development of post-cerebral infarc- tion depression. A total of 321 patients with ischemic stroke underwent electroencephalography and Hamilton Depression Rating Scale assessment to analyze the relationship between electroencephalography and post-cerebral infarction depression. Our results show that electroencephalograms of ischemic stroke patients with depression exhibit low-amplitude alpha activity and slow theta activity. In con- trast, electroencephalograms of ischemic stroke patients without depression show fast beta activity and slow delta activity. ＂Ihese findings confirm that low-amplitude alpha activity and slow theta activity can be considered as independent predictors for post-cerebral infarction depression.

Electroacupuncture promotes the recovery of motor neuron function in the anterior horn of the injured spinal cord

Acupuncture has been shown to lessen the inflammatory reaction after acute spinal cord injury and reduce secondary injury.However,the mechanism of action remains unclear.In this study,a rat model of spinal cord injury was established by compressing the T8-9 segments using a modified Nystrom method.Twenty-four hours after injury,Zusanli（ST36）,Xuanzhong（GB39）,Futu（ST32）and Sanyinjiao（SP6）were stimulated with electroacupuncture.Rats with spinal cord injury alone were used as controls.At 2,4 and 6 weeks after injury,acetylcholinesterase（ACh E）activity at the site of injury,the number of medium and large neurons in the spinal cord anterior horn,glial cell line-derived neurotrophic factor（GDNF）m RNA expression,and Basso,Beattie and Bresnahan locomotor rating scale scores were greater in the electroacupuncture group compared with the control group.These results demonstrate that electroacupuncture increases ACh E activity,up-regulates GDNF m RNA expression,and promotes the recovery of motor neuron function in the anterior horn after spinal cord injury.

Early prediction of major depression in chronic hepatitis C patients during peg-interferon α-2b treatment by assessment of vegetative-depressive symptoms after four weeks

AIM: To study the predictive value of the vegetative- depressive symptoms of the Zung Depression Rating Scale for the occurrence of depression during treatment with peg-interferon α-2b of chronic hepatitis C (CHC) patients. METHODS: The predictive value of vegetative- depressive symptoms at 4 wk of treatment for the occurrence of a subsequent diagnosis of major depressive disorder (MDD) was studied in CHC patients infected after substance use in a prospective, multi- center treatment trial in Belgium. The presence of vegetative-depressive symptoms was assessed using the Zung Scale before and 4 wk after the start of antiviral treatment. RESULTS: Out of 49 eligible patients, 19 (39%) developed MDD. The area under the ROC curve of the vegetative Zung subscale was 0.73, P = 0.004. The sensitivity at a cut-point of > 15/35 was 95% (95% CI: 74-100). The positive predictive value equalled 44% (95% CI: 29-60). CONCLUSION: In this group of Belgian CHC patients infected after substance use, antiviral treatment caused a considerable risk of depression. Seven vegetativedepressive symptoms of the Zung scale at wk 4 of treatment predicted 95% of all emerging depressions, at a price of 56% false positive test results.

Constipation, hard stools, fecal urgency, and incomplete evacuation, but not diarrhea is associated with diabetes and its related factors

AIM: To determine the bowel symptoms associated with diabetes and diabetes-related factors after excluding gastrointestinal (GI) organic diseases.METHODS: Participants were 4738 (603 diabetic and 4135 non-diabetic) patients who underwent colonoscopy and completed a questionnaire. On the day of pre-colonoscopy, 9 symptoms (borborygmus, abdominal distension, increased flatus, constipation, diarrhea, loose stools, hard stools, fecal urgency, and incomplete evacuation) were prospectively evaluated on a 7-point Likert scale. The test-retest reliability of the bowel symptom scores from the baseline and second questionnaires was analyzed using kappa statistics. Associations between bowel symptom scores and diabetes or diabetes-related factors were analyzed by a rank-ordered logistic model adjusted for related confounders, and odds ratios (ORs) were estimated.RESULTS: In multivariate analysis, constipation [adjusted odds ratio (AOR) = 1.57, CI: 1.33-1.85, P &#x0003c; 0.01] and hard stools (AOR = 1.56, CI: 1.33-1.84, P &#x0003c; 0.01) were associated with diabetes, and fecal urgency (AOR = 1.16, CI: 0.99-1.37, P = 0.07) and incomplete evacuation (AOR = 1.16, CI: 1.00-1.36, P = 0.06) were marginally associated with diabetes. These symptoms remained associated even after excluding organic GI diseases on colonoscopy. Test-retest reliability of symptom score with a mean duration of 3.2 mo was good (mean kappa, 0.69). Associations of symptoms with diabetes-related factors were found; constipation with HbA1c &#x02265; 8.0% (AOR = 2.11, CI: 1.19-3.73), body mass index (BMI) &#x0003c; 25 (AOR = 2.11, CI: 1.22-3.66), and insulin use (AOR = 1.90, CI: 1.08-3.36); hard stools with diabetes duration (AOR = 1.03, CI: 1.00-1.07); fecal urgency with BMI &#x0003c; 25 (AOR = 1.73, CI: 1.00-2.98); and incomplete evacuation with BMI &#x0003c; 25 (AOR = 2.60, CI: 1.52-4.43), serum creatinine level (AOR = 1.27, CI: 1.10-1.47), and insulin use (AOR = 1.92, CI: 1.09-3.38).CONCLUSION: Diabetes is associated with constipation, hard stools, fecal urgency, and incomplete evacuation, and poor glycemic control, duration, leanness, and nephropathy affect the risk of these symptoms.

A new direction for Alzheimer's research

Despite decades of research, at present there is no curative therapy for Alzheimer＇s disease. Changes in the way new drugs are tested appear to be necessary. Three changes are presented here and will be discussed. The first change is that Alzheimer＇s disease must be considered a disease of four major pathological processes, not one. The four processes are： 1） vascular hy- poperfusion of the brain with associated mitochondrial dysfunction, 2） destructive protein inclusions, 3） uncontrolled oxidative stress, and 4） proinflammatory immune processes second- ary to microglial and astrocytic dysfunction in the brain. The second change recommended is to alter the standard cognitive measurement tools used to quantify mental decline in test patients. Specifically the Dementia Severity Rating Scale （DSRS） should supersede Mini-Mental State Examination （MMSE） and other popular tests, and a measurement scale developed in research should be used to produce a linear and non-irregular baseline. Finally, accepting the concept that four etiologies cause Alzheimer＇s disease leads to the last necessary change, that new thera- pies must be employed directed against all four causes, likely as a combination. There are drugs ready to be employed in such a combinations which are available and used clinically for other purposes so can be used ＂offlabel＂ and one such combination is suggested.

Health-related quality of life in Parkinson's disease patients in northeastern Sicily, Italy An ecological perspective

Parkinson＇s disease has a negative impact on health-related quality of life in Parkinson＇s disease patients. Depression, cognitive impairment, coping strategies, dyskinesia, gait disorders and complications of dopaminergic drugs are the variables that most affect health-related quality of life. The ecological model of human development focuses attention on both individual and social environmental factors as targets for health interventions. From this perspective, the aim of this cross-sectional survey was to evaluate the influence of gender, family size and perceived autonomy on health-related quality of life in Parkinson＇s disease patients in nOrtheastern Sicily, Italy. Ninety Parkinson＇s disease patients, attending the Movement Disorders Clinic at IRCCS Centro Neurolesi ＂Bonino-Pulejo＂ （Messina）, were consecutively enrolled. The Unified Parkinson Disease Rating Scale motor subscale （UPDRS-Ⅲ） scores, the Parkinson Disease Questionnaire-39 Item scores （as a disease-specific measure of health-related quality of life）, scores on the Short Form （36） Health Survey Questionnaire （as a generic measure）, and answers to a brief checklist were recorded. A total of 85 Parkinson＇s disease patients （49% males and 51% females; mean age 70.8 ± 8.6 years mean UPDRS-Ⅲ 24.15 ± 6.55; mean disease duration 5.52 ± 4.65 years） completed the booklet of questionnaires. In the multivariate regression analysis, we included clinical and social variables as independent predictors of health-related quality of life. Our results suggest a potential compounding effect of ecological intrapersonal and interpersonal levels on health-related quality of life outcomes. Gender, self-evaluated autonomy and family size significantly impacted health-related quality of life. If quality of life is used as an indicator of treatment outcomes, an ecological perspective of the case history will be important to disclose relevant prognostic information and trigger personalized health care interventions.