The 12-item medical outcomes study short form health survey version 2.0 (SF-12v2): a population-based validation study from Tehran, Iran

Increasing cardiovascular medication adherence: A medical research council complex mhealth intervention mixed-methods feasibility study to inform global practice

AIMS

To evaluate a mHealth intervention to increase medication adherence among Iranian coronary heart disease patients.

DESIGN

Quantitative-dominant mixed-methods study.

DATA SOURCE

Iranian coronary heart disease patients' responses and most recent clinical documents as well as responses from Iranian cardiac nurses who participated in this study.

METHODS

The study was conducted between September 2015-April 2016 drawing on the Medical Research Council's Framework. Phase one comprised of a patients' survey and focus groups with cardiac nurses. The automated short message service reminder was piloted in phase two. We recruited 78 patients and randomized to receive either 12-week daily reminders or usual care. The primary outcome was the effect on medication adherence; secondary outcomes were self-efficacy, ejection fraction, functional capacity, readmission rate and quality of life.

RESULTS

Feasibility was evidenced by high ownership of mobile phones and high interest in receiving reminders. Participants in the intervention group showed significantly higher medication adherence compared with the control group.

CONCLUSION

The mHealth intervention was well accepted and feasible with early evidence of effectiveness that needs to be confirmed in a fully powered future randomized clinical trial.

Stroke symptoms impact on mental and physical health: A Lebanese population based study

BACKGROUND/OBJECTIVE

Stroke symptoms in the absence of diagnosed stroke are common worldwide and associated with stroke risk factors and great impact on the physical and mental health functioning. The aim of this study was to assess, at the national level, the association of stroke symptoms with mental and physical health.

METHODS

Quality of life was assessed using physical and mental component summary scores (PCS and MCS) of the Short Form 12v2 Health Survey in the Lebanese population. We assessed the differences in the mean PCS and MCS scores among asymptomatic individuals with no stroke/transient ischemic attack (TIA) history (n=1167), symptomatic individuals with no stroke/TIA history (n=125) and those with stroke/TIA history (n=46). Psychometric properties of the Lebanese version of the SF- 12v2 were evaluated using principal component analysis.

RESULTS

Symptomatic individuals had an average PCS scores of 2.31 (95%CI: 0.75-3.88) points lower and those with stroke/TIA history had 3.26 (95%CI: 1.01-5.51) points lower when compared with asymptomatic individuals with no stroke/TIA history. Similarly, MCS scores for symptomatic individuals were 2.58 (95%CI: 1.02-4.13) points lower and those with stroke/TIA history had 3.28 (95%CI: 1.06-5.50) points lower than asymptomatic individuals.

CONCLUSION

Physical and mental health functioning declined among symptomatic individuals and those with stroke/TIA history. Thus, frequent monitoring for the early detection of stroke symptoms may be recommended.

At the height of the storm: Healthcare staff's health conditions and job satisfaction and their associated predictors during the epidemic peak of COVID-19

This study reports the physical health, mental health, anxiety, depression, distress, and job satisfaction of healthcare staff in Iran when the country faced its highest number of total active COVID-19 cases. In a sample of 304 healthcare staff (doctors, nurses, radiologists, technicians, etc.), we found a sizable portion reached the cutoff levels of disorders in anxiety (28.0%), depression (30.6%), and distress (20.1%). Age, gender, education, access to PPE (personal protective equipment), healthcare institutions (public vs. private), and individual status of COVID-19 infection each predicted some but not all the outcome variables of SF-12, PHQ-4, K6, and job satisfaction. The healthcare workers varied greatly in their access to PPE and in their status of COVID-19 infection: negative (69.7%), unsure (28.0%), and positive (2.3%). The predictors were also different from those identified in previous studies of healthcare staff during the COVID-19 crisis in China. This study helps to identify the healthcare staff in need to enable more targeted help as healthcare staff in many countries are facing peaks in their COVID-19 cases.

Associations Between Fear of COVID-19, Mental Health, and Preventive Behaviours Across Pregnant Women and Husbands: An Actor-Partner Interdependence Modelling

The present cross-sectional study examined the actor-partner interdependence effect of fear of COVID-19 among Iranian pregnant women and their husbands and its association with their mental health and preventive behaviours during the first wave of the COVID-19 pandemic in 2020. A total of 290 pregnant women and their husbands (N = 580) were randomly selected from a list of pregnant women in the Iranian Integrated Health System and were invited to respond to psychometric scales assessing fear of COVID-19, depression, anxiety, suicidal intention, mental quality of life, and COVID-19 preventive behaviours. The findings demonstrated significant dyadic relationships between husbands and their pregnant wives' fear of COVID-19, mental health, and preventive behaviours. Pregnant wives’ actor effect of fear of COVID-19 was significantly associated with depression, suicidal intention, mental quality of life, and COVID-19 preventive behaviours but not anxiety. Moreover, a husband actor effect of fear of COVID-19 was significantly associated with depression, anxiety, suicidal intention, mental quality of life, and COVID-19 preventive behaviours. Additionally, there were significant partner effects observed for both the pregnant wives and their husbands concerning all outcomes. The present study used a cross-sectional design and so is unable to determine the mechanism or causal ordering of the effects. Also, the data are mainly based on self-reported measures which have some limitations due to its potential for social desirability and recall biases. Based on the findings, couples may benefit from psychoeducation that focuses on the effect of mental health problems on pregnant women and the foetus.

Household Food Insecurity and Health-related Quality of Life in an Urban Adult Population in Iran

Background:

The relationship between food insecurity and mental and physical components of health-related quality of life (HRQOL) has been less addressed by healthcare professionals.

Objective:

We aimed to investigate the relationship between household food insecurity and mental and physical components of HRQOL in a large sample of urban people and to determine whether household food insecurity has a negative effect on mental and physical components of HRQOL.

Methods:

This cross-sectional study was conducted across twenty-two districts of Tehran (capital of Iran) during 2011. The participants were selected through multistage cluster random sampling. Two questionnaires were used to measure household food insecurity and HRQOL in the study population, while descriptive and inferential statistics were applied to test the relationships between these two parameters.

Results:

The mean age of the study population was 44.5 ± 15.5 years and most were female (64.8%). The results of this study indicated an independent relationship between household food insecurity and different subscales of HRQOL (P<0.001). Household food insecurity had a significant negative relationship with physical (β= -5.93; P<0.001) and mental (β= -6.54; P<0.001) summary scores of HRQOL. Likewise, average scores on all subscales of HRQOL according to household food security status were significantly different (P<0.001).

Conclusion:

Food insecurity was associated with mental and physical components of HRQOL among urban participants and can be considered as a part of comprehensive interventions that target to improve general health.

Effectiveness of a nurse-led multidisciplinary self-management program for patients with coronary heart disease in communities: A randomized controlled trial

OBJECTIVE

To examine the effectiveness of a nurse-led multidisciplinary self-management program (NMSP) on self-management behaviors, self-efficacy, health-related quality of life (HRQoL) and unplanned health service utilization (HSU) among Chinese patients with coronary heart disease (CHD) in communities.

METHODS

A randomized controlled trial with repeated measurements was used. A convenience sample of 144 participants was recruited from a community health center in China. All participants were randomly assigned to an intervention group (n = 72) in the newly developed NMSP or a control group (n = 72) in routine care. Outcome measurement was performed at baseline, 3 months and 6 months using Coronary Artery Disease Self-Management Scale (CADSs), Self-efficacy for Chronic Disease 6-item Scale (SECD6), and Short Form-12 health survey questionnaire (SF-12).

RESULTS

Over the six months, the two groups reported significant differences in disease medical and emotional management of CADSs, confidence in symptom and disease management of SECD6, physical and mental component summary of SF-12, as well as emergency and outpatient visits of unplanned HSU.

CONCLUSIONS

The NMSP improves self-management behaviors, self-efficacy, HRQoL and reduces unplanned HSU among CHD patients in communities.

PRACTICE IMPLICATIONS

This study provides an effective approach to empower CHD patients with emphasizing on collaboration support of health professionals in communities.

Validation of the SF12 mental and physical health measure for the population from a low-income country in sub-Saharan Africa

Introduction

The Short Form Survey 12-item (SF12) mental and physical health version has been applied in several studies on populations from Sub-Saharan Africa. However, the SF12 has not been computed and validated for these populations. We address in this paper these gaps in the literature and use a health intervention example in Malawi to show the importance of our analysis for health policy.

Methods

We firstly compute the weights of the SF12 physical and mental health measure for the Malawian population using principal component analysis on a sample of 2838 adults from wave four (2006) of Malawian Longitudinal Study of Aging (MLSFH). We secondly test the construct validity of our computed and the US-population weighted SF12 measures using regression analysis and Fixed Effect estimation on waves four, seven (2012) and eight (2013) of the MLSFH. Finally, we use a Malawian cash transfer programme to exemplify the implications of using US- and Malawi-weighted SF12 mental health measures in policy evaluation.

Results

We find that the Malawian SF12 health measure weighted by our computed Malawian population weights is strongly associated with other mental health measures (Depression:-0.501, p = < 0.001; Anxiety:-1.755; p = < 0.001) and shows better construct validity in comparison to the US-weighted SF12 mental health component (rs = 0.675 versus rs = 0.495). None of the SF12 measures shows strong associations with other measures of physical health. The estimated average effect of the cash transfer is significant when using the Malawi-weighted SF12 mental health measure (treatment effect: 1.124; p = < 0.1), but not when using the US-weighted counterpart (treatment effect: 1.129; p > 0.1). The weightings affect the size of the impacts across mental health quantiles suggesting that the weighting scheme matters for empirical health policy analysis.

Conclusion

Mental health shows more pronounced associations with the physical health dimension in a Low-Income Country like Malawi compared to the US. This is important for the construct validity of the SF12 health measures and has strong implications in health policy analysis. Further analysis is required for the physical health dimension of the SF12.

Reliability and Validity of the Short-Form 12 Item Version 2 (SF-12v2) Health-Related Quality of Life Survey and Disutilities Associated with Relevant Conditions in the U.S. Older Adult Population

This study aimed to validate the Short-Form 12-Item Survey—version 2 (SF−12v2) in an older (≥65 years old) US population as well as estimate disutilities associated with relevant conditions, using data from the Medical Expenditure Panel Survey longitudinal panel (2014–2015). The physical component summary (PCS) and mental component summary (MCS) scores were examined for reliability (internal consistency, test-retest), construct validity (convergent and discriminant, structural), and criterion validity (concurrent and predictive). The study sample consisted of 1040 older adults with a mean age of 74.09 years (standard deviation: 6.19) PCS and MCS demonstrated high internal consistency (Cronbach’s alpha—PCS: 0.87, MCS: 0.86) and good and moderate test-retest validity, respectively (intraclass correlation coefficient: PCS:0.79, MCS:0.59)). The questionnaire demonstrated sufficient convergent and discriminant ability. Confirmatory factor analysis showed adequate fit with the theoretical model and structural validity (goodness of fit = 0.9588). Concurrent criterion validity and predictive criterion validity were demonstrated. Activity limitations, functional limitations, arthritis, coronary heart disease, diabetes, myocardial infarction, stroke, angina, and high blood pressure were associated with disutilities of 0.18, 0.15, 0.06, 0.07, 0.07, 0.06, 0.09, 0.06, and 0.08, respectively, and demonstrated the responsiveness of the instrument to these conditions. The SF−12v2 is a valid and reliable instrument in an older US population.

The Indonesian version of the Medical Outcome Survey - Short Form 12 version 2 among patients with cardiovascular diseases

AIM

The aim of this study is to examine psychometric properties of the Indonesian version of Medical Outcome Survey Short Form 12 version 2 (SF12v2).

METHODS

A cross-sectional study was conducted in three primary healthcare units in Yogyakarta, Indonesia. Patients with cardiovascular diseases who were able to respond to questionnaires and provide their consent were invited. The validity test included face, content, discriminant, and construct validity. The internal consistency was used as the reliability indicator.

RESULTS

The item and subscale of content validity index were 0.97 and 0.83, respectively. The instrument had 100% for equivalence and clarity outcomes, whereas the readability outcome was 91.7%. More than 80% of participants agreed and considered SF12v2 understandable. The correlations among physical and mental subscales were substantial, supporting discriminant validity. The Bartlett test of sphericity was significant with the Kaiser-Meyer-Olkin test of 0.74. The principal component analysis resulted in eight components, explaining 88.4% of total variance. α coefficients for subscale were ranging from.58 to.81, whereas the physical and mental component summaries were.77 and.67, respectively.

CONCLUSIONS

The Indonesian version of SF12v2 indicated a reliable and valid instrument. The SF12v2, available in a Bahasa Indonesia version, is an applicable instrument to assess quality of life on patients with cardiovascular diseases.

Association of leisure and occupational physical activities and health-related quality of life: Tehran Lipid and Gluycose Study

Background

Little is known about the association between different levels of physical activity (PA) and health-related quality of life (HRQoL) in the general Iranian population across sex groups. The current study aims to investigate the association between PA and HRQoL across sex groups, various types of physical activity (leisure time and occupational) and different dimensions of HRQoL in a large population of Tehranian adults.

Methods

This cross-sectional study was conducted using data from the Tehran Lipid and Glucose Study (TLGS). Data was collected from 7800 adults on their PA habits and HRQoL. Information on PA and HRQoL were assessed using the Modifiable Activity Questionnaire (MAQ) and Short-Form 12-Item Health Survey version 2 (SF-12v2), respectively. Poor HRQoL was defined as the first quartile of HRQoL scores and logistic regression analysis was used to assess the association between physical activity levels and poor HRQoL.

Results

The mean age of participants was 46.4 ± 14.9 years and 45.6% of them were male. Levels of PA were significantly associated with most subscales of HRQoL in both men (p < 0.05) and women (p < 0.01). In both sexes, leisure time PA was significantly correlated to all subscales of HRQoL (p < 0.05) except for bodily pain in both sexes and for social functioning and role emotional in men. In adjusted models, men with both moderate (OR: 1.55, 95%CI: 1.18–2.04; p = 0.002) and low (OR: 1.46, 95%CI: 1.11–1.91; p = 0.007) levels of PA had a significantly higher chance of reporting poor mental component summary (MCS) compared to their counterparts with high levels of PA. Furthermore, women with low levels of PA had a significantly higher chance of reporting poor physical component summary (PCS) (OR: 2.39, 95% CI: 1.63–3.49; p < 0.001) compared to those with high levels of PA.

Conclusion

The findings show an association between PA and both domains of HRQoL in men and mostly the physical domain in women, suggesting a sex-specific pattern for this association, which could be considered to motivate participation in PA programs in future health promotion interventions.

Donors' Quality of Life after Living Donor Liver Transplantation: Shiraz Organ Transplant Center Experience

BACKGROUND

Probable effects of living donor liver transplantation on the wellbeing of the donor and psychological difficulties are necessary to be understood.

OBJECTIVE

To assess the quality of life of living donors after liver donation.

METHODS

140 living donors who underwent hepatectomy between 2012 and July 2015 were enrolled in this study. Donors were asked to complete the Short Form 36-question Health Survey (SF-36) through face to face or by telephone interview.

RESULTS

The mean±SD age of donors at transplantation was 32.1±7.3 years; 83 (59.3%) of donors were female. 134 (95.7%) were married. The mean±SD BMI was 23.8±3.5 (kg/m²). "Mother-to-child" was the most frequent relationship (n=79, 56.4%). 22 (15.7%) complications were reported by participants. The mean±SD score of Physical Component Summary and Mental Component Summary were 48.8±14.6 and 50.1±6.9, respectively.

CONCLUSION

Most living donors sustain a near average quality of life post-donation. It seems that living donation does not negatively affect the quality of life.

Efficacy of guided self-change for smoking cessation in chronic obstructive pulmonary disease patients: A randomized controlled clinical trial

INTRODUCTION

The aim of this study was to examine the efficacy of guided self-change (GSC), nicotine replacement therapy (NRT), and their combination, on smoking cessation among patients with COPD.

METHODS

A total of 60 participants were randomly assigned to three groups for GSC (n=20), nicotine replacement therapy (NRT) (n=20) or their combination (n=20), from December 2016 to November 2017. The quality of life (QoL) questionnaire, clinical assessment test (CAT) and exhaled carbon monoxide (CO), were measured at baseline and post-treatment.

RESULTS

At 6, 12, and 29 weeks, the abstinence rate in the NRT group was 5.3%, 15.8% and 21.1%, in the GSC group 21.1%, 31.6% and 47.4%, and in the combined group 36.8%, 36.8% and 47.4%, respectively. The exhaled CO in the NRT group was greater than the GSC group, however this difference was not statistically significant (3.4; 95% CI: -0.24–7.0; p=0.067), CO levels in the combined group were less than the GSC group, while this difference was also not significant (-0.75; 95% CI : -4.2–2.7; p=0.68). CAT and QoL recovery in the GSC and combined groups were higher than in the NRT group (9.2; 95% CI: 5.0–13.4; p=0.001) and (-4.5; 95% C: -8.1– -0.6; p=0.02), respectively. However, differences between combined and GSC groups were not significant (p=0.24 and p=0.41, respectively). There was a statistically significant difference between the abstinence rate in the GSC or combined group and the NRT group (p=0.001). The GEE model showed that GSC reduced the odds of smoking compared with the NRT group (interaction group effect) (OR=0.31, 95% CI: 0.022–0.545; p=0.001).

CONCLUSIONS

In our context among COPD patients, GSC was more effective in decreasing smoking than NRT alone. Moreover, the recovery of exhaled carbon monoxide, CAT and QoL in GSC was more than in the NRT group. Moreover, since GSC was as effective as GSC plus NRT, the effectiveness of the combination method for smoking cessation in COPD patients may be attributed to GSC.

Clinical trial registration details: IRCT201609271457N11; www.irct.ir

Diabetes in women and health-related quality of life in the whole family: a structural equation modeling

Background

Although several studies indicate the effects of diabetes type 2 on health-related quality of life (HRQoL) in female subjects, the related impact of the disease on HRQoL in their family members has rarely been the focus of the empirical research. In this study we aim to investigate associations between diabetes in women and the HRQoL in these women and their family members, using the structural equation modeling (SEM).

Methods

This family-based study was conducted on 794 women (11.1% with diabetes) as well as their spouses and children who participated in the Tehran Lipid and Glucose Study (TLGS) from 2014 to 2016. Data on HRQoL were collected using the Iranian version of the Short-Form 12-Item Health Survey version 2 (SF-12v2) and the Pediatric Quality of Life Inventory version™ 4.0 (PedsQL). SEM was conducted to evaluate the network of associations among studied variables. Data were analyzed using IBM SPSS Statistics & AMOS version 23 software.

Results

Mean age of women was 41.37 ± 5.32 years. Diabetes in women significantly affected their mental HRQoL (β = − 0.11, P < 0.01) but showed no significant direct associations with physical and mental HRQoL in their spouses or their children. However, poor mental HRQoL in women with diabetes was associated with decrease in both physical (β = − 0.02, P = 0.013) and mental (β = − 0.03, P < 0.01) HRQoL in their spouses and total HRQoL score in children (β = − 0.02, P < 0.01).

Conclusions

Among women with diabetes type 2, beyond its effect on their mental HRQoL per se, demonstrated a negative association with the self-assessment of health status in their spouses and children. Such familial consequences are mainly attributed to the negative effect of the disease on the mental rather than the physical HRQoL in women with diabetes.

Factors Associated With Adherence To Immunosuppressive Therapy And Barriers In Asian Kidney Transplant Recipients

Background

Medication non-adherence is the major risk factor for rejection episodes. The aim of this study was to determine the risk factors associated with adherence to immunosuppressive regimen and its barriers among kidney transplant (KT) recipients.

Methods

A cross-sectional study was performed in two outpatient post-transplant clinics in Mashhad, northeast of Iran. All patients who attended the clinics from August to October 2017 were included. Patients’s knowledge, adherence to immunosuppressive regimen, and quality of life were measured using the Kidney Transplant Understanding Tool, Basel Assessment of Adherence to Immunosuppressive Medications Scale (BAASIS), and SF-12V2 questionnaire, respectively. The barriers in adhering immunosuppressive regimen were investigated by Immunosuppressive Therapy Barriers Scale. Logistic regression was used to screen the significant risk factors of medication non-adherence.

Results

In this study, 244 KT recipients were included with a mean age of 39.6±12.5 years. Based on the BAASIS score, 111 (45.5%) patients were adherent to immunosuppressive regimen. Female patients were more likely to be adherent (OR=0.48, p<0.01). The patients with higher level of quality of life were more likely to follow immunosuppressive medications (OR=1.078, p<0.05). The main barriers were as follows: concurrent use of many immunosuppressants, lack of knowledge about the usefulness of immunosuppressive medications, confusion in medication taking, and difficulty in remembering medication taking.

Conclusion

More than half of the KT recipients were non-adherence to immunosuppressive regimen. These findings highlight the need for designing interventions in order to reduce or eliminate these barriers and consequently increase medication adherence among KT recipients.

The enhancing effects of Biobran/MGN-3, an arabinoxylan rice bran, on healthy old adults' health-related quality of life: a randomized, double-blind, placebo-controlled clinical trial

PURPOSE

The world's older population is growing rapidly and the need to find measures to combat age-associated decline of physical, mental, and cognitive functions and improve their health-related quality of life (HRQOL) is escalating. Biobran/MGN-3, an arabinoxylan rice bran, has been previously reported to improve the quality of life in cancer patients. The objective of the current study was to examine the effect of a low dose of Biobran/MGN-3 supplementation on the HRQOL in a healthy older adult population.

METHODS

Sixty apparently healthy subjects, 40 males and 20 females, over 56 years old were recruited and blindly randomized into two group receiving either placebo or Biobran/MGN-3 (250 mg/day for 3 months). Participants did not take any vitamins or medications during the study and their health was closely monitored. HRQOL was assessed at the initiation and termination of the study using the previously validated Arabic version of SF-12v2 questionnaire.

RESULTS

For all measured HRQOL domains, there was no statistically significant difference in baseline scores between the two groups. Compared to baseline values and placebo-treated subjects, Biobran/MGN-3 supplementation significantly enhanced the levels of physical and mental component summary scores as well as role-physical, bodily pain, vitality, and social functioning subdomain scores.

CONCLUSION

These results show that Biobran/MGN-3 is a promising psychoneuroimmune modulatory agent that could improve the HRQOL in healthy old adults.

The Reliability and Validity of Short Form-12 Health Survey Version 2 for Chinese Older Adults

BACKGROUND

We assessed the information regarding the psychometric properties of the Short Form-12 Health Survey Version 2 (SF-12v2) among older adults in China.

METHODS

A cross-sectional study was conducted on a stratified representative sample of older adults (≥60 years) residing in community and nursing home settings in 2017-18. Reliability was estimated using the internal consistency method. Validity was assessed using convergent and discriminant validity checks, factor analyses (including both exploratory and confirmatory factor analyses [EFA and CFA]), and "known groups" construct validity.

RESULTS

The final sample comprised 1000 older adults (451 community-dwelling and 549 institutional). Cronbach's α was 0.81 for the Physical Component Summary (PCS) and 0.83 for the Mental Component Summary (MCS), showing satisfactory internal consistency for both. Most items were strongly correlated with their represented component (Spearman's correlation coefficient: 0.62-0.87), although the correlation of SF items with PCS was a bit stronger than that with MCS. A two-factor structure (physical and mental health) indicated by EFA jointly accounted for 68.50% of the variance and presented adequate goodness-of-fit indices (GFI=0.98, AGFI=0.92, RMSEA=0.08, 90% Cl RMSEA=0.06 to 0.11, NFI=0.98, and CFI=0.98) in CFA. Known-groups comparison showed that SF-12v2 summary scores did well in differentiating subgroups of older adults by age, marital status, and self-reported health problems (P≤0.05).

CONCLUSION

SF-12v2 is a reliable and valid health-related quality of life instrument for Chinese older adults that works equally well with older adults under institutional care and community-based home care models.

Health-Related Quality of Life of Economically Disadvantaged African American Older Adults: Age and Gender Differences

Background: The association between age and health-related quality of life (HRQoL) is still under debate. While some research shows older age is associated with better HRQoL, other studies show no or negative association between age and HRQoL. In addition, while the association between age and HRQoL may depend on race, ethnicity, gender, and their intersections, most previous research on this link has been performed in predominantly White Middle Class. Objective: To explore gender differences in the association between age and mental and physical HRQoL in a sample of economically disadvantaged African American (AA) older adults. Methods: This cross-sectional survey was conducted in South Los Angeles between 2015 to 2018. A total number of 740 economically disadvantaged AA older adults (age ≥ 55 years) were enrolled in this study, using non-random sampling. This includes 266 AA men and 474 AA women. The independent variable of interest was age. Dependent variables of interest were physical component scores (PCS) and mental component scores (MCS), two main summary scores of the HRQoL, measured using Short Form-12 (SF-12). Gender was the moderator. Socioeconomic status (educational attainment and financial difficulty) were covariates. Linear regression models were used to analyze the data. Results: AA women reported worse PCS; however, gender did not impact MCS. In the pooled sample, high age was associated with better PCS and MCS. In the pooled sample, a significant interaction was found between gender and age on PCS, suggesting a stronger effect of age on PCS for AA men than AA women. In gender-stratified models, older age was associated with better PCS for AA men but not AA women. Older age was similarly and positively associated with better MCS for AA men and women. Conclusions: There may be some gender differences in the implications of ageing for the physical HRQoL of AA older adults. It is unclear how old age may have a boosting effect on physical HRQoL for AA men but not AA women. Future research should test gender differences in the effect of age on physical health indicators such as chronic disease as well as cognitive processes involved in the evaluation of own's health in AA men and women.

Effect of an interactive voice response system on self-management in kidney transplant recipients: Protocol for a randomized controlled trial

INTRODUCTION

Adherence to a complex and ongoing set of therapeutic recommendations significantly determines short and long-term outcomes after kidney transplantation (KT). Interactive voice response system (IVRS) is a novel phone-based platform which is potentially useful to deliver health behavior interventions.

OBJECTIVE

The aims of the study is to describe the development of a theory-driven and educational IVRS investigate the effect of an IVRS on the self-management outcomes in KT recipients as compared with the control group.

METHODS

This study has been designed as a randomized, 2 parallel groups controlled trial. The KT recipients' older than18 years of age with access to a cellphone will be included. A total of 120 patients will be randomly assigned to the control and intervention groups. The participants in the intervention group will receive completely automatic calls in 3 categories: educational, medication adherence, and reminders by the IVRS, whereas those in the control group will receive usual care. The follow up will be performed within 6 months. The primary outcome will be the medication adherence while patients' transplant knowledge, health-related quality of life, and rehospitalization rates will be considered as secondary outcomes.

RESULTS

Thus far, recruitment of participants has not been completed and results will be published in 2019.

DISCUSSION

The IVRS is potentially useful to help KT recipients improve the self-management outcomes. The hypothesis is using an IVRS intervention makes a significant difference between basel assessment of adherence to immunosuppressive medications scale, 12-item short form survey, second version, kidney transplant understanding tool baseline scores, and those obtained at the end of study.

TRIAL REGISTRATION NUMBER

This trial is registered with the Iran Trial Registrar under registration number IRCT20180124038492N1 and registration date 30 January 2018. https://irct.ir/trial/29215.

Health-related quality of life and related factors among elderly persons under different aged care models in Guangzhou, China: a cross-sectional study

PURPOSE

To analyze health-related quality of life (HRQoL) and related factors among elderly persons receiving community-based home care and institutional care in Guangzhou, a large city of mainland China.

METHODS

A representative sample of 1600 subjects aged 60 years and over residing in communities and nursing homes was randomly selected through stratified sampling. The 12-item Short Form Health Survey version 2 (SF-12v2) was used to assess HRQoL.

RESULTS

In total, 1014 elderly persons under different aged care models responded to the survey (response rate 63.4%) and 1000 were eligible for data analyses. Compared with the elderly receiving community-based home care or private institutional care, those in public institutional care had the lowest scores on the physical component summary (PCS, 36.89 ± 10.44) and the mental component summary (MCS, 47.16 ± 11.14). Number of chronic diseases, loneliness, and age were the most common significant factors (P < 0.05) affecting PCS and MCS. The interaction term between aged care model and number of chronic diseases significantly affected PCS (β = - 0.165, P < 0.05), indicating a stronger association between these factors for participants receiving community-based home care than institutional care. The interaction term between aged care model and loneliness had a significant effect on MCS (β = 0.189, P < 0.05), indicating a weaker association between loneliness and MCS for participants receiving community-based home care.

CONCLUSIONS

This study found poor HRQoL among the elderly in Guangzhou. The main factors associated with the physical and mental HRQoL of elderly persons included number of chronic diseases, loneliness, age, and education level. It also revealed the moderating effects of aged care model on HRQoL, suggesting specific health management strategies for elderly in community-based home care and institutional care, respectively.

Which obesity phenotypes predict poor health-related quality of life in adult men and women? Tehran Lipid and Glucose Study

Purpose

This study aimed to explore the association between different obesity phenotypes and health-related quality of life (HRQoL) among Tehranian men and women.

Methods

The participants of this study were 2880 healthy adults (aged>19 years) who participated in Tehran Lipid and Glucose Study (TLGS). To obtain socio-demographic and HRQoL information, participants were interviewed by trained interviewers and were stratified by body mass index categories and metabolic status. Dysmetabolic status was defined as having either metabolic syndrome or diabetes according to the Joint Interim Statement definition and American Diabetes Association. Poor HRQoL was defined as the first quartile of HRQoL scores and logistic regression analysis was used to compare sex-specific odds ratios.

Results

Mean age of participants was 47.7±15.6 and 47.8±14.2 years in men and women respectively. The most and the least common obesity phenotypes were overweight-normal metabolic status and normal weight-dysmetabolic status, respectively. Only mean scores for physical HRQoL were significantly different among obesity phenotypes in both men and women (p<0.05). In addition, after adjusting for age, marital status, level of education, job status and physical activity, the odds of reporting poor physical HRQoL was significantly higher in men (OR: 1.960, 95% CI: 1.037–3.704; p<0.05) and women (OR: 2.887, 95% CI: 1.674–4.977; p<0.001) with obese-dysmetabolic status, compared to their counterparts with normal weight-normal metabolic status. However, except for overweight-normal metabolic women, who were less likely to report poor mental HRQoL (OR: 0.638, 95% CI: 0.415–0.981; p<0.05), none of the phenotypes were associated with poor mental HRQoL in either gender.

Conclusions

Compared to those with normal weight normal metabolic status, only obese dysmetabolic individuals were more likely to report poor physical HRQoL in both genders.

Assessment of Reliability and Validity of SF-12v2 among a Diabetic Population

OBJECTIVES

To validate the Medical Outcomes Study Short Form version 2 (SF-12v2) in diabetic patients.

METHODS

Adults with self-reported diabetes from the Medical Expenditure Panel Survey (2011-2013) were identified. Reliability (internal consistency and test-retest) and validity (construct, concurrent, criterion, and predictive) of the SF-12v2 were assessed. The SF-12v2 consists of two normalized composite scores: the physical component summary score (PCS12) and the mental component summary score (MCS12). Confirmatory factor analysis was conducted to assess the instrument structure. Concurrent (convergent and discriminant) validity was assessed by a multitrait-multimethod matrix using the Patient Health Questionnaire, the Kessler Scale, and perceived health and mental health questions. The predictive validity was assessed by estimating future limitations. The concurrent validity was tested by comparing the MCS12, PCS12, and utility scores (six-dimensional health state short form) across comorbidity scores.

RESULTS

The final sample comprised 2214 diabetic patients with mean normalized (population mean 50; range 0-100) PCS12 and MCS12 scores of 40.81 (standard error 0.33) and 49.82 (standard error 0.26), respectively. The PCS12 and MCS12 scores showed good internal consistency (Cronbach α: PCS12 0.85; MCS12 0.83) and acceptable test-retest reliability (intraclass correlation coefficient: PCS12 0.72; MCS12 0.63) and produced acceptable goodness-of-fit indices (normed fit index 0.95; comparative fit index 0.95; root mean square error of approximation 0.11 [95% confidence interval 0.1017-0.1188]). The PCS12 and MCS12 were moderately correlated with perceived health and perceived mental health. The MCS12 was highly correlated with the Patient Health Questionnaire and the Kessler Scale. Both the PCS12 and the MCS12 could predict the future health limitations. The PCS12, MCS12, and utility scores demonstrated sensitivity to the presence of comorbidity scores.

CONCLUSIONS

The SF-12v2 is a valid generic instrument for measuring quality of life in diabetic patients.

Differentials in health-related quality of life of employed and unemployed women with normal vaginal delivery

Background

The combination of child care and domestic work demands on both housewives and the employed (hired) women may impact their health-related quality-of-life. There is paucity of studies to ascertain this. This study investigated the differences in health-related quality of life of employed and unemployed women with normal vaginal delivery and associated socio-demographic variables.

Methods

This longitudinal study was done from March, 2012 to June, 2013. Modified SF-36v2™ health-related quality of life questionnaire was administered to 234 newly delivered women drawn from six selected hospitals in Enugu, Southeast Nigeria at 6, 12 and 18 weeks postpartum. Respondents were reached for data collection through personal contacts initially at the hospitals of delivery, and subsequently by visits to their homes/workplaces or cell-phone calls. Women were asked to indicate how each of 36 items applied to them at each of the three times. Data collection lasted for six calendar months and 17 days (from September 3rd 2012 to 20th March, 2013).

Results

All the women had their best HrQoL at 12 weeks postpartum. Employed women reported lower health-related quality-of-life than the unemployed at the three time-points, the lowest mean score being at 18 weeks postpartum (Mean = 73.9). Multiple comparison of scores of the two groups using Tukey HSD Repeated Mean showed significant variation on the eight subscales of the health-related quality-of-life. Physical functioning (p = 0.045), Physical role limitation (p = 0.000), bodily pain (p = 0.000), social functioning (p = 0.000) and general health (p = 0.000) were unequal guaranteeing type 1 error. Women with higher education and personal income reported higher health-related quality-of-life (p < 0.05). Employed women have more problems with physical health components and are more negatively affected by increasing age except those with higher education and personal income.

Conclusions

Increased responsibilities combined with increasing age and low socio-economic status reduce women’s health-related quality-of-life post-partum. The traditionally accepted paid 3 months maternity leave should be elongated by extra months to help women balance their daily work with baby care. Gender sensitive employment opportunities in favour of women are necessary to empower more women economically.

Electronic supplementary material

The online version of this article (10.1186/s12905-017-0481-0) contains supplementary material, which is available to authorized users.

Treating osteomyelitis of major limb amputations with a modified Lautenbach technique

INTRODUCTION

Major lower limb amputation significantly increases the energy cost of walking for patients. Complications such as osteomyelitis may require further surgery, and can lead to shortening of the stump. In these cases, the aim should be to treat infection without shortening the limb further. We present a series of patients with established osteomyelitis of the amputation stump, managed using a modified Lautenbach technique.

METHOD

Six patients with either above or below knee amputations, in the practice of a single orthopaedic surgeon, were studied. Ages range from 39 to 64 years, and reasons for amputation included infection, pain, and necrosis. All patients had osteomyelitis in the amputation stump confirmed on MRI.

RESULTS

At a mean follow-up of 3.75 years (range 7 months to 6 years) all six patients had no clinical or haematological evidence of infection, and had returned to independent living. Stump length was preserved in all cases, including in one patient who underwent two procedures to ensure complete debridement.

CONCLUSIONS

We believe that this case series is the largest so far published regarding this modification of the Lautenbach Procedure. This operation treats infection effectively without further loss of bone length, and no patients so far have developed significant complications.

Impact of oral potentially malignant disorders on quality of life

BACKGROUND

Oral potentially malignant disorders (OPMDs) could have a significant psychological impact on patients, principally because of the unknown risk of malignant transformation, while the physical and functional impairments could differ. This study aimed to assess the impact of three different OPMDs and their disease stages on the quality of life (QoL) of affected patients.

METHODS

Oral leukoplakia (OL), oral lichen planus (OLP) and oral submucous fibrosis (OSF) patients who were undergoing treatment at an oral medicine clinic of a dental teaching hospital in India were the study population. All subjects completed the recently developed OPMDQoL questionnaire and a short form 12 item (version 2) health survey questionnaire (SF-12v2). OPMDQoL questionnaire consists of 20 items over four dimensions. A higher score denotes poor OHRQoL. SF-12v2 has two components, a Physical Component Summary (PCS) and Mental Component Summary (MCS).

RESULTS

A total of 150 subjects (50 each of OL, OLP and OSF) participated. OL patients (37.7 ± 7.9) reported significantly better OPMDQoL scores than OLP (47.3 ± 5.8) and OSF (45.4 ± 9.2) patients. OLP patients reported significant problems in obtaining a clear diagnosis for their condition, more so than the other OPMDs. OL patients reported fewer problems for the dimension, "physical impairment and functional limitations" than the OLP and OSF patients. A significant trend was observed with the overall OPMDQoL and MCS, deteriorating as the disease stage increased.

CONCLUSIONS

OLP and OSF have a significant impact on the QoL of affected individuals: OL less so. Increasing stage of the disease is associated with worsening QoL.

Socio-Demographic Determinants of Health-Related Quality of Life in Tehran Lipid and Glucose Study (TLGS)

BACKGROUND

Health-related quality of life (HRQOL) is a multi-dimensional concept that is affected by different variables. A large body of evidence shows that socio-demographic factors have a significant influence on HRQOL. When considering differences in cultural contexts and social values of various countries and the lack of evidence regarding socio-demographic determinants of HRQOL among the Iranian general population, it is important to verify the main socio-demographic determinants of HRQOL in an urban Iranian population.

OBJECTIVES

This study aimed to explore socio-demographic factors associated with HRQOL and to ascertain the determinants of poor HRQOL in participants of the Tehran lipid and glucose study (TLGS).

METHODS

The participants included 3491 adults, aged ≥ 20 years, who had participated in the TLGS. To obtain socio-demographic and HRQOL information, participants were interviewed by trained interviewers. Mean HRQOL scores were compared using the student's t test and analysis of variance (ANOVA). To determine significant determinants of poor HRQOL, multivariate logistic regression analysis was performed.

RESULTS

Mean ages of males and females were 47.7 ± 15.6 and 47.8 ± 14.2 years, respectively and 58.6% of participants were male. Males had significantly higher scores compared to females in both the physical and mental domains of HRQOL (P < 0.001). In males, significant determinants of poor physical HRQOL were older age, being married, being unemployed yet having other sources of income, having literacy levels below high school diploma, and having chronic diseases (P < 0.05). In females, however older age and being housewives were significant determinants of poor physical HRQOL (P < 0.05). In addition, significant determinants of poor mental HRQOL were younger age and being single or divorced/widowed in males and younger age and being illiterate as well as having literacy levels below high school diploma in females (P < 0.05).

CONCLUSIONS

Current findings highlight the importance of socio-demographic determinants of HRQOL in both genders, specifically in the physical domain, and demonstrate their roles to be more prominent in males. These findings highlight gender-specific associations between socio-demographic factors and various aspects of HRQOL among the TLGS population, which could be applied in future research focusing on non-communicable diseases and planning health promotion programs.

Translation, cultural adaptation and validation of the English "Short form SF 12v2" into Bengali in rheumatoid arthritis patients

Background

To develop a culturally adapted and validated Bengali Short Form SF 12v2 among Rheumatoid arthritis (RA) patients.

Methods

The English SF 12v2 was translated, adapted and back translated into and from Bengali, pre-tested by 60 patients. The Bengali SF 12v2 was administered twice with 14 days interval to 130 Bangladeshi RA patients. The psychometric properties of the Bengali SF 12v2 were assessed. Test-retest reliability was assessed by intra-class correlation coefficient (ICC) and Spearman’s rank correlation coefficient and internal consistency by Cronbach’s alpha. Content validity was assessed by index for content validity (ICV) and floor and ceiling effects. To determine convergent and discriminant validity a Bengali Health Assessment Questionnaire (B-HAQ) was used. Factor analysis was done.

Results

The Bengali SF 12v2 was well accepted by the patients in the pre-test and showed good reliability. Internal consistency for both physical and mental component was satisfactory; Cronbach’s alpha was 0.9. ICC exceeded 0.9 in all domains. Spearman’s rho for all domains exceeded 0.8. The physical health component of Bengali SF 12v2 had convergent validity to the B-HAQ. Its mental health component had discriminant validity to the B-HAQ. The ICV of content validity was 1 for all items. Factor analysis revealed two factors a physical and a mental component.

Conclusions

The interviewer-administered Bengali SF 12v2 appears to be an acceptable, reliable, and valid instrument for measuring health-related quality of life in Bengali speaking RA patients. Further evaluation in the general population and in different medical conditions should be done.

Electronic supplementary material

The online version of this article (doi:10.1186/s12955-017-0683-z) contains supplementary material, which is available to authorized users.

The MOTIV-HEART Study: A Prospective, Randomized, Single-Blind Pilot Study of Brief Strategic Therapy and Motivational Interviewing among Cardiac Rehabilitation Patients

Background: Psychological distress, biomedical parameters, and unhealthy lifestyles contribute to a poorer prognosis for cardiac disease. Public health's challenge is to motivate patients to utilize self-care. Objective: This prospective, randomized, single-blind pilot study aimed at testing the incremental efficacy of Brief Strategic Therapy (BST) combined with Motivational Interviewing (MI) in improving selected biomedical and psychological outcomes over and beyond those of the stand-alone BST in a residential Cardiac Rehabilitation (CR) program. Method: Fourty-two inpatients (17 females), enrolled in a 1-month CR program, were randomly allocated into two conditions: (a) Three sessions of BST and (b) Three sessions of BST plus MI. Data were collected at baseline, discharge, and after 3 months through phone interviews. Results: At discharge, no significant between-group difference was found in any outcome variable. Changes from pre- to post-treatment within each condition showed significant improvements only in the BST group, where the level of external regulation diminished, and both the participants' self-regulation (Relative Autonomous Motivation Index, RAI) and willingness to change improved. At the 3-month follow-up, within-group analyses on responders (BST = 9; BST + MI = 11) showed a statistically significant improvement in the level of systolic blood pressure in both groups. Discussion: Findings showed no evidence of the incremental efficacy of combining BST and MI over and beyond BST alone on either selected biomedical or psychological outcomes among CR patients. Conclusions: Ends and limitations from the present pilot study should be considered and addressed in future investigations.

Psychosocial well-being and health-related quality of life in a UK population with Usher syndrome

OBJECTIVES

To determine whether psychosocial well-being is associated with the health-related quality of life (HRQOL) of people with Usher syndrome.

SETTING

The survey was advertised online and through deafblind-related charities, support groups and social groups throughout the UK.

PARTICIPANTS

90 people with Usher syndrome took part in the survey. Inclusion criteria are having a diagnosis of Usher syndrome, being 18 or older and being a UK resident.

PRIMARY AND SECONDARY OUTCOME MEASURES

All participants took part in a survey that measured depressive symptoms, loneliness and social support (predictors) and their physical and mental HRQOL (outcomes). Measured confounders included age-related, sex-related and health-related characteristics. Hierarchical multiple linear regression analyses examined the association of each psychosocial well-being predictor with the physical and mental HRQOL outcomes while controlling for confounders in a stepwise manner.

RESULTS

After adjusting for all confounders, psychosocial well-being was shown to predict physical and mental HRQOL in our population with Usher syndrome. Increasing depressive symptoms were predictive of poorer physical (β=-0.36, p<0.01) and mental (β=-0.60, p<0.001) HRQOL. Higher levels of loneliness predicted poorer mental HRQOL (β=-0.20, p<0.05). Finally, increasing levels of social support predicted better mental HRQOL (β=0.19, p<0.05).

CONCLUSIONS

Depression, loneliness and social support all represent important issues that are linked with HRQOL in a UK population with Usher syndrome. Our results add to the growing body of evidence that psychosocial well-being is an important factor to consider in people with Usher syndrome alongside functional and physical impairment within research and clinical practice.

Identifying associated factors with social capital using path analysis: A population-based survey in Tehran, Iran (Urban HEART-2)

Background: Social capital has been defined as norms, networks, and social links that facilitate collective actions. Social capital is related to a number of main social and public health variables. Therefore, the present study aimed to determine the factors associated with social capital among the residents of Tehran, Iran. Methods: In this large cross-sectional population-based study, 31531 residents aged 20 years and above were selected through multi-stage sampling method from 22 districts of Tehran in 2011. The social capital questionnaire, 28-item General Health Questionnaire (GHQ-28), and Short-Form Health Survey (SF-12) were used. Hypothetical causal models were designed to identify the pathways through which different variables influenced the components of social capital. Then, path analysis was conducted for identifying the determinants of social capital. Results: The most influential variables in 'individual trust' were job status (β=0.37, p=0.02), marital status (β=0.32, p=0.01), Physical Component Summary (PCS) (β=0.37, p=0.02), and age (β=0.34, p=0.03). On the other hand, education level (β=0.34, p=0.01), age (β=0.33, p=0.02), marital status (β=0.33, p=0.01), and job status (β=0.32, p=0.01) were effective in 'cohesion and social support'. Additionally, age (β=0.18, p=0.02), PCS (β=0.36, p=0.01), house ownership (β=0.23, p=0.03), and mental health (β=0.26, p=0.01) were influential in 'social trust/collective relations'. Conclusion: Social capital can be improved in communities by planning to improve education and occupation status, paying more attention to strengthening family bonds, and provision of local facilities and neighborhood bonds to reduce migration within the city.

Early symptom measurement of Post-Stroke Depression (PSD)

BACKGROUND

We reported the factor structure and psychometric properties of a new measure of early symptoms of Post-Stroke Depression (PSD).

METHODS

Cross-sectional survey methods were used to administer the measure to hospitalized post-stroke patients (N=410) in southeast China, 7-30 days after mild to moderate stroke. Factor structure of the measure was evaluated using exploratory factor analysis (EFA) with first and second order confirmatory factor analysis (CFA). Measurement reliability of each factor and the total measure was assessed using Cronbach alpha coefficient, item-total correlation, item-subscale correlation and the composite coefficient. Discriminant validity was tested using the estimated correlation matrix and average variance extracted (AVE).

RESULTS

The EFA extracted a theoretically consistent, clinically interpretable, 29-item, 6-factor model for early symptoms of PSD (dull, guilt, low, wakefulness, emotional, and nervous). A first order CFA retained the 6-factors but deleted 3 underperforming items. The results of a second-order CFA for a 6-factor, 26-item model showed acceptable model fit (χ(2)/df=2.25, CFI=0.973, TLI=0.970, RMSEA=0.055 and WRMR=1.168) with acceptable reliability and discriminant validity.

LIMITATIONS

The study survey methods and purposive sampling procedures resulted in a clinically less homogenous final sample. Separate evaluation of predictive validity, criteria validity, test-retest reliability, and invariance to patient psychosocial characteristics of the measure is planned.

CONCLUSIONS

Our measure detected early symptoms of PSD in primarily first-ever stroke patients, an average of 11.07 days post stroke, well within the 14 day peak benchmark.

Reliability and validity of 12-item Short-Form health survey (SF-12) for the health status of Chinese community elderly population in Xujiahui district of Shanghai

BACKGROUND

The 12-item Short-Form Health Survey (SF-12) is the abridged practical version of SF-36.

AIMS

This cross-sectional study was aimed to assess the reliability and validity of SF-12 for the health status of Chinese community elderly population.

METHODS

The Chinese community elderly people in Xujiahui district of Shanghai were investigated. The internal consistency reliability was assessed using Cronbach's alpha and split-half reliability coefficients. Construct validity was analyzed using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Spearman's correlation coefficient (ρ) was used for the evaluation of criterion, convergent, and discriminant validity with Spearman's ρ ≥ 0.4 as satisfactory. Comparisons of the SF-12 summary scores among populations that differed in demographics were performed for discriminant validity.

RESULTS

Total 1343 individuals aged ≥60 and <85 years old (response rate: 91.3 %) were analyzed. The Cronbach's α value (0.910) and the split-half reliability coefficient (0.812) reflected satisfactory internal consistency reliability of SF-12. EFA extracted a two-factor model (physical and mental health). About 60.7 % of the total variance was explained by the two factors. CFA showed that the two-factor solution provided a good fit to the data. Good convergent validity and discriminant validity of SF-12 were proved by the correction analyses (Spearman's ρ > 0.4) and the comparisons of the SF-12 summary scores among populations (P < 0.05). SF-12 summary scores were significantly correlated with the SF-36 summary scores (Spearman's ρ > 0.4, P < 0.05).

CONCLUSIONS

In conclusion, SF-12 had satisfactory reliability and validity in measuring health status of Chinese community elderly population in Xujiahui district of Shanghai.

A Subtle Threat to Urban Populations in Developing Countries: Low Back Pain and its Related Risk Factors

STUDY DESIGN

A cross-sectional, population-based survey.

OBJECTIVE

The aim of this study was to estimate the prevalence, and biological and psychological correlates of low back pain (LBP) in large, populated urban areas.

SUMMARY OF BACKGROUND DATA

LBP is a common and costly medical problem all around the world. Currently, there are limited data available on prevalence as well as biological and psychological correlates of LBP in large urban populations in developing countries.

METHODS

Here, in a cross-sectional, population-based survey, we analyzed data obtained from 22,952 subjects living in Tehran.

RESULTS

Chronic, 1-year, and point prevalence of LBP among subjects were 12.2%, 42.1%, and 36.2%, respectively. LBP was more prevalent among older population, women, housewives, and obese people after adjustment for confounding factors using logistic regression models. In addition, persons with a general health questionnaire (GHQ-28) score ≥6 were about 2 times more likely to experience LBP in comparison with others. Both subjects with higher educational levels and those who were never married reported significantly less LBP. Furthermore, we could not find any significant correlation between smoking and physical activity level with LBP.

CONCLUSION

LBP is prevalent among the general population of Tehran. Our findings can help health care providers regarding logical assignment of limited resources, in order to create multidimensional prevention plans according to potentially modifiable associated factors.

LEVEL OF EVIDENCE

3.

Challenging future, challenging past: the relationship of social integration and psychological impairment in traumatized refugees

BACKGROUND

Refugees have been shown to present high prevalence rates of trauma-related mental disorders. Despite their psychological impairment, they are expected to meet high functional requirements in terms of social integration into, and financial independence from, the host society.

METHODS

This cross-sectional study examined the relationship of mental health problems, post-migration living difficulties (PMLD), and social integration in a sample of 104 refugees seeking treatment for severe posttraumatic stress and comorbid symptoms in two outpatient clinics in Switzerland.

RESULTS

Despite an average time of residence in Switzerland of over 10 years, participants showed poor integration and a high number of PMLD. Integration difficulties were closely associated with psychological symptoms, but not with socio-demographic parameters such as education or visa status.

CONCLUSIONS

Psychological impairment in treatment-seeking traumatized refugees is associated with poor integration. To foster social integration, it is crucial to better understand and address the specific needs of this highly vulnerable population.

Secondhand smoke exposure (SHS) and health-related quality of life (HRQoL) in Chinese never smokers in Hong Kong

OBJECTIVE

The evidence on the effect of secondhand smoke (SHS) on Health Related Quality of Life (HRQoL) is limited. We examined the relation between SHS and HRQoL among Chinese in Hong Kong.

METHODS

Adult never smokers from a probability sample of three cross-sectional waves (2010, 2012, 2013) of The Hong Kong Family and Health Information Trends Survey who completed the Cantonese-version of Short-Form 12 Health Survey Questionnaire (SF12v2) were included in the data analysis conducted in 2014. Models were used to examine associations of SHS with SF12 domains and summary scores of Physical (PCS12) and Mental Component (MCS12) with subgroups analysis by SHS locations.

RESULTS

After adjustments, SHS was associated with lower scores on all SF12 domains except physical functioning. PCS12 (regress coefficient=-0.76, 95% CI -1.34 to -0.17) and MCS12 (regress coefficient=-1.35, 95% CI -2.06 to -0.64) were lower in those with SHS exposure than those non-exposed. Those exposed to SHS in outdoor public places had lower scores on most SF12 domains and PSC12 and MCS12. SHS exposure in one's home and workplace was associated with lower scores on role physical, body pain and role emotional while SHS exposure in friends' homes was additionally associated with lower social functioning and mental health scores. Lower MCS12 was associated with SHS exposure at all locations except one's home.

CONCLUSIONS

Our study showed that SHS exposure, particularly in outdoor public places, was associated with decreased HRQoL. It can provide new evidence for stronger smoke-free policies on public places and promoting smoke-free homes.

Mental health status of varenicline and bupropion users during a quit attempt compared to current smokers, other quitters, and non-smokers

BACKGROUND

Varenicline and bupropion are commonly prescribed non-nicotine containing smoking cessation agents. Post-marketing reports suggest an increased incidence of psychiatric disturbances associated with varenicline and bupropion. However, pre-existing psychiatric disorders may confound the association between these smoking cessation agents and psychiatric disturbances. We compared the mental health status of individuals using varenicline or bupropion to that of people quitting without medication, current smokers, and non-smokers while controlling for pre-existing conditions.

METHODS

A cross-sectional design was used. Data were from 2006-2011 Medical Expenditure Panel Survey. Mental health status was assessed using the mental component summary (MCS) from the 12-item Short Form survey (SF-12v2), 2-item Patient Health Questionnaire (PHQ-2), and Kessler 6 Scale (K6). Differences in MCS score were compared using linear regression. Logistic regressions were used to compare positive screenings for depression using PHQ-2 and for psychological distress using K6.

RESULTS

Of 578 use episodes, 453 (78.38%) were bupropion and 125 (21.62%) were varenicline. After adjusting for potential confounders, mental health status of varenicline users was not different from current smokers or people who quit smoking without medication, but worse than non-smokers; bupropion was strongly associated with lower mental health status relative to all groups across all three measures.

CONCLUSION

Varenicline was not associated with worse mental health compared to smokers or those who quit without medication, after adjusting for pre-existing psychiatric disorders. Bupropion was associated with worse mental health status than smokers, former smokers who quit without medication, and nonsmokers, even after adjusting for pre-existing psychiatric disorders.

Validity and reliability of the Medical Outcomes Study Short-Form Health Survey version 2 (SF-12v2) among adults with autism

BACKGROUND

The purpose of the study was to assess the validity and reliability of the Medical Outcomes Study Short Form-12 version 2 (SF-12v2) instrument among adults with autism.

METHODS

Study data was collected using a cross-sectional online survey of adults with autism enrolled with the Interactive Autism Network (N=291). Factorial validity was assessed using confirmatory factor analysis technique. Item-scale correlations were examined for convergent validity. Known-groups validity was assessed by examining the variation in Physical Component Summary (PCS) and Mental Component Summary (MCS) scores by autism severity. Cronbach's alpha was determined for internal consistency reliability. Floor and ceiling effects were also assessed.

RESULTS

A two-factor model with correlated error terms was found to have a good fit. The PCS scale strongly correlated with the underlying items representing the scale. The MCS scale had strong to moderate correlation with its underlying items. For known-groups validity, the MCS score varied as expected with lower score observed among adults with high severity as compared to low severity; however, PCS score varied inversely. Internal consistent reliability of the SF-12v2 was good, and there were no floor and ceiling effects.

CONCLUSIONS

Except for known-groups validity, all other psychometric indicators performed well for the SF-12v2.

Effectiveness of mindfulness meditation on pain and quality of life of patients with chronic low back pain

BACKGROUND AND AIM

Recovery of patients with chronic low back pain (LBP) is depended on several physical and psychological factors. Therefore, the authors aimed to examine the efficacy of mindfulness based stress reduction (MBSR) as a mind-body intervention on quality of life and pain severity of female patients with nonspecific chronic LBP (NSCLBP).

METHODS

Eighty-eight patients diagnosed as NSCLBP by physician and randomly assigned to experimental (MBSR+ usual medical care) and the control group (usual medical care only). The subjects assessed in 3 times frames; before, after and 4 weeks after intervention by Mac Gil pain and standard brief quality of life scales. Data obtained from the final sample analyzed by ANCOVA using SPSS software.

RESULTS

The findings showed MBSR was effective in reduction of pain severity and the patients who practiced 8 sessions meditation reported significantly lower pain than patients who only received usual medical care. There was a significant effect of the between subject factor group (F [1, 45] = 16.45, P < 0.001) and (F [1, 45] = 21.51, P < 0.001) for physical quality of life and (F [1, 45] = 13.80, P < 0.001) and (F [1, 45] = 25.07, P < 0.001) mental quality of life respectively.

CONCLUSION

MBSR as a mind-body therapy including body scan, sitting and walking meditation was effective intervention on reduction of pain severity and improvement of physical and mental quality of life of female patients with NSCLBP.

A randomised controlled trial on the effectiveness of a home-based self-management programme for community-dwelling patients with myocardial infarction

AIM

To examine the effectiveness of a four-week home-based self-management rehabilitation programme on health-related quality of life, anxiety and depression levels, cardiac risks and unplanned visits to the health services among community-dwelling patients with myocardial infarction.

METHODS

A randomised controlled trial with repeated measurements was used. A convenience sample of 128 patients with myocardial infarction was recruited from outpatient cardiology clinics at a tertiary hospital in Singapore. Participants were randomly assigned to the intervention group or control group. The outcomes were measured using Short Form 12-item Health Survey Version 2, Myocardial Infarction Dimensional Assessment Scale, and Hospital Anxiety and Depression Scale. The cardiac physiological risk parameters and number of unplanned health service use were also assessed. Data were collected at baseline, and at four weeks and 16 weeks from the baseline.

RESULTS

Over the 16 weeks, the two groups reported significant differences in physical activity (F = 4.23, p = 0.02), dependency (F = 5.16, p = 0.01), concerns over medication (F = 3.47, p = 0.04) on MIDAS, anxiety level (F = 3.41, p = 0.04) and body mass index (F = 3.12, p = 0.04). A significant difference was also found in unplanned cardiac-related emergency room visits (χ(2) = 6.64, p = 0.036) and medical consultation (χ(2) = 9.67, p = 0.046) at the 16-week study point.

CONCLUSION

The study may provide a useful tool to help health care professionals to meet the cardiac rehabilitative care needs of community-dwelling patients with myocardial infarction in Singapore.

Exploring the role of ethnicity on perceptions of cancer and physical health recovery during the first year of survivorship

This study examined the role of ethnicity (Black vs White) in the extent to which patients’ appraisal of the impact of cancer on themselves and their family members relates to their physical health. Colorectal cancer patients provided self-reports for study variables at 2 and 12 months post-diagnosis ( N = 60). Hierarchical regression analysis revealed that African American patients’ perception of the cancer as disruptive to their family, but not to themselves, related to poorer health recovery, which association was absent among Whites ( p < .02). Findings suggest that cancer-related family stress plays a different role between two ethnic groups in elucidating their health recovery during the early survivorship.

Health-related quality of life and its correlates among Chinese migrants in small- and medium-sized enterprises in two cities of Guangdong

Objectives

To explore the relationship between health-related quality of life (HRQOL) status and associated factors among rural-to-urban migrants in China.

Methods

A cross-sectional survey was conducted with 856 rural-to-urban migrants working at small- and medium-size enterprises (SMEs) in Shenzhen and Zhongshan City in 2012. Andersen's behavioral model was used as a theoretical framework to exam the relationships among factors affecting HRQOL. Analysis was performed using structural equation modeling (SEM).

Results

Workers with statutory working hours, higher wages and less migrant experience had higher HRQOL scores. Need (contracting a disease in the past two weeks and perception of needing health service) had the greatest total effect on HRQOL (β = −0.78), followed by enabling (labor contract, insurance purchase, income, physical examination during work and training) (β = 0.40), predisposing (age, family separation, education) (β = 0.22) and health practices and use of health service (physical exercise weekly, health check-up and use of protective equipments) (β = −0.20).

Conclusions

Priority should be given to satisfy the needs of migrant workers, and improve the enabling resources.

Response-oriented measuring inequalities in Tehran: second round of UrbanHealth Equity Assessment and Response Tool (Urban HEART-2), concepts and framework

BACKGROUND

Current evidence consistently confirm inequalities in health status among socioeconomic none, gender,ethnicity, geographical area and other social determinants of health (SDH), which adversely influence health ofthe population. SDH refer to a wide range of factors not limited to social component, but also involve economic, cultural,educational, political or environmental problems. Measuring inequalities, improving daily living conditions, andtackling inequitable distribution of resources are highly recommended by international SDH commissioners in recentyears to 'close the gaps within a generation'. To measure inequalities in socio-economic determinants and core healthindicators in Tehran, the second round of Urban Health Equity Assessment and Response Tool (Urban HEART-2)was conducted in November 2011, within the main framework of WHO Centre for Health Development (Kobe Centre).

METHOD

For 'assessment' part of the project, 65 indicators in six policy domains namely 'physical and infrastructure','human and social', 'economic', 'governance', 'health and nutrition', and also 'cultural' domain were targetedeither through a population based survey or using routine system. Survey was conducted in a multistage random sampling,disaggregated to 22 districts and 368 neighborhoods of Tehran, where data of almost 35000 households(118000 individuals) were collected. For 'response' part of the project, widespread community based development(CBD) projects were organized in all 368 neighborhoods, which are being undertaken throughout 2013.

CONCLUSION

Following the first round of Urban HEART project in 2008, the second round was conducted to trackchanges over time, to institutionalize inequality assessment within the local government, to build up community participationin 'assessment' and 'response' parts of the project, and to implement appropriate and evidence-based actionsto reduce health inequalities within all neighborhoods of Tehran.

Influence of sociodemographic features and general health on social capital: findings from a large population-based survey in Tehran, Iran (Urban-HEART)

OBJECTIVES

Social capital is associated with a number of sociodemographic characteristics and health outcomes. This study aimed to assess the components of social capital, and determine its association with different demographic features and general health in Tehran.

STUDY DESIGN

A large population-based cross-sectional survey was conducted using the Urban Health Equity Assessment and Response Tool (Urban-HEART).

METHOD

A comprehensive questionnaire containing 13 sections, including a specific tool to measure social capital, was administered to 22,300 randomly selected clustered sample households within all 22 districts in Tehran between June and September 2008. The social capital questionnaire consists of two main components - structural and cognitive - which measure collective activities, voluntary help, social cohesion, social network, reciprocity and trust. The first question of Short Form-12 was used to evaluate self-rated health. Descriptive statistics, contingency tables, independent sample t-test, analysis of variance, post-hoc test (least squares difference) and multiple linear regression were used to detect differences. A P-value <0.01 was considered to indicate significance.

RESULTS

The social capital questionnaire and health-related quality-of-life tool were completed by 21,704 individuals (response rate 97%) in all 22 districts of Tehran. All social capital components apart from participation varied by age group and gender (P < 0.01). An improvement was seen in several social capital components with increased level of education (P < 0.01). All social capital elements apart from volunteering were associated with marital status (P < 0.01). Family size, family assets and length of residence in neighbourhood were considered to be determinants of social capital (P < 0.01), and respondents with better health showed higher levels of social capital (P < 0.0001).

CONCLUSION

Various individual and household characteristics influence social capital. General health and social capital are mutually and independently correlated with other determinants, so improvements in either may lead to higher levels of social capital and well-being.