Consequences of chronic obstructive pulmonary disease and chronic heart failure: The relationship between objective and subjective health

A structural equation model of health-related quality of life among Thai men with chronic obstructive pulmonary disease

AIM AND OBJECTIVES

To identify physiological, psychological and socioenvironmental factors that affect the health-related quality of life of Thai men living with chronic obstructive pulmonary disease. The vast majority of Thai persons living with chronic obstructive pulmonary disease are men.

BACKGROUND

Little is known about the health-related quality of life of Thai people living with chronic obstructive pulmonary disease or about the physiological and psychosocial factors that most affect it. Applying a prevailing theoretical model of health-related quality of life, we explored how physiological, psychological and socioenvironmental factors simultaneously affect the health-related quality of life of Thai men with chronic obstructive pulmonary disease.

DESIGN

A cross-sectional study design was used, together with the STROBE checklist.

METHODS

In this study, 290 Thai male outpatients at a chronic obstructive pulmonary disease specialist clinic near Bangkok were recruited using purposive sampling. The participants completed the Satisfaction With Life Scale, the St. George Respiratory Questionnaire, the Center for Epidemiologic Studies Depression Scale, the Short Form Health Survey Version 2, the chronic obstructive pulmonary disease Self-Efficacy Scale and the Social Support Questionnaire. A structural equation model was used to examine the relationships between the assessed variables.

RESULTS

Biological function (FEV-1, chronic obstructive pulmonary disease exacerbations), symptoms (chronic obstructive pulmonary disease and depression), functional status, general health perceptions and individual characteristics (age and self-efficacy to control dyspnoea) accounted for 56.9% of the variance in health-related quality of life.

CONCLUSIONS

Symptoms of chronic obstructive pulmonary disease and depression were the main factors with statistically significant direct and indirect effects on the health-related quality of life of the Thai men in this study. The effects of both symptoms included an indirect effect on health-related quality of life through functional status and general health perceptions.

RELEVANCE TO CLINICAL PRACTICE

The study findings may help nurses to better understand factors affecting health-related quality of life among men with chronic obstructive pulmonary disease. Preventing or minimising symptom exacerbations could be important in nursing practice. Cognitive-behavioural interventions addressing chronic obstructive pulmonary disease symptom management, depression screening and smoking cessation may improve health-related quality of life among Thai men with chronic obstructive pulmonary disease.

Effectiveness of mindfulness-based stress reduction program on quality of life in cardiovascular disease patients

Introduction

Cardiovascular disease is one of the most fatal physical illnesses that impose many financial losses on societies every year.

Aim

This study was to investigate the effectiveness of a mindfulness-based stress reduction (MBSR) program on self-efficacy and quality of life in patients with cardiovascular disease.

Material and methods

The samples of this clinical trial were 60 patients who were selected by convenience sampling from patients were diagnosed, clinically interviewed by a cardiologist and randomized to two groups; experimental and control, and then completed Sherer et al. General Self-Efficacy Scale and 36-item Short Form Survey three times; pre-test, post-test, and after 3 months of follow-up. MBSR Program includes the methods that patients learn to calm their minds and body to help them cope with disease that was based on self-efficacy and quality of life. Data analysis was performed by the SPSS v22 using t-test and ANOVA.

Results

The results show that the mean pre-test scores of self-efficacy and quality of life of patients were not significantly different between the experimental and control groups (P > 0.05). However, the mean scores of the two variables were found to be significantly different between the experimental group and the control group on the post-test and follow-up as the research hypotheses were examined (P < 0.01). So that the means of self-efficacy were 60.80 ± 5.91 and 60.40 ± 7.03 and quality of life were 103.80 ± 9.35 and 101.10 ± 9.13 at post-test and 3 months later respectively in experimental group.

Conclusion

Self-efficacy and quality of life of cardiovascular patients could be improved by providing an MBSR program.

Comorbidity health pathways in heart failure patients: A sequences-of-regressions analysis using cross-sectional data from 10,575 patients in the Swedish Heart Failure Registry

BACKGROUND

Optimally treated heart failure (HF) patients often have persisting symptoms and poor health-related quality of life. Comorbidities are common, but little is known about their impact on these factors, and guideline-driven HF care remains focused on cardiovascular status. The following hypotheses were tested: (i) comorbidities are associated with more severe symptoms and functional limitations and subsequently worse patient-rated health in HF, and (ii) these patterns of association differ among selected comorbidities.

METHODS AND FINDINGS

The Swedish Heart Failure Registry (SHFR) is a national population-based register of HF patients admitted to >85% of hospitals in Sweden or attending outpatient clinics. This study included 10,575 HF patients with patient-rated health recorded during first registration in the SHFR (1 February 2008 to 1 November 2013). An a priori health model and sequences-of-regressions analysis were used to test associations among comorbidities and patient-reported symptoms, functional limitations, and patient-rated health. Patient-rated health measures included the EuroQol-5 dimension (EQ-5D) questionnaire and the EuroQol visual analogue scale (EQ-VAS). EQ-VAS score ranges from 0 (worst health) to 100 (best health). Patient-rated health declined progressively from patients with no comorbidities (mean EQ-VAS score, 66) to patients with cardiovascular comorbidities (mean EQ-VAS score, 62) to patients with non-cardiovascular comorbidities (mean EQ-VAS score, 59). The relationships among cardiovascular comorbidities and patient-rated health were explained by their associations with anxiety or depression (atrial fibrillation, odds ratio [OR] 1.16, 95% CI 1.06 to 1.27; ischemic heart disease [IHD], OR 1.20, 95% CI 1.09 to 1.32) and with pain (IHD, OR 1.25, 95% CI 1.14 to 1.38). Associations of non-cardiovascular comorbidities with patient-rated health were explained by their associations with shortness of breath (diabetes, OR 1.17, 95% CI 1.03 to 1.32; chronic kidney disease [CKD, OR 1.23, 95% CI 1.10 to 1.38; chronic obstructive pulmonary disease [COPD], OR 95% CI 1.84, 1.62 to 2.10) and with fatigue (diabetes, OR 1.27, 95% CI 1.13 to 1.42; CKD, OR 1.24, 95% CI 1.12 to 1.38; COPD, OR 1.69, 95% CI 1.50 to 1.91). There were direct associations between all symptoms and patient-rated health, and indirect associations via functional limitations. Anxiety or depression had the strongest association with functional limitations (OR 10.03, 95% CI 5.16 to 19.50) and patient-rated health (mean difference in EQ-VAS score, -18.68, 95% CI -23.22 to -14.14). HF optimizing therapies did not influence these associations. Key limitations of the study include the cross-sectional design and unclear generalisability to other populations. Further prospective HF studies are required to test the consistency of the relationships and their implications for health.

CONCLUSIONS

Identification of distinct comorbidity health pathways in HF could provide the evidence for individualised person-centred care that targets specific comorbidities and associated symptoms.

Beyond Disease: Happiness, Goals, and Meanings among Persons with Multiple Sclerosis and Their Caregivers

The experience of persons with multiple sclerosis (MS) and their caregivers is usually investigated in terms of emotional distress and health-related quality of life, while well-being indicators remain largely underexplored. In addition, findings are often interpreted from the clinical perspective, neglecting socio-cultural aspects that may crucially contribute to individuals' functioning. At the methodological level, most studies rely on scaled instruments, not allowing participants to freely express their needs and resources. Based on the bio-psycho-social perspective endorsed by the International Classification of Functioning, well-being indicators were investigated among 62 persons with MS (PwMS), their 62 caregivers and two control groups, matched by age and gender. Participants completed the Positive Affect Negative Affect Schedule (PANAS), the Satisfaction with Life Scale (SWLS), and the Eudaimonic and Hedonic Happiness Investigation instrument (EHHI). EHHI provides information on participants' happiness, goals and meanings through scaled and open-ended questions, contextualized within major life domains. No relevant differences emerged among PwMS and caregivers, compared with the respective control groups, as concerns life domains associated with happiness, goals and meaning. Participants across groups prominently mentioned family, highlighting its intrinsic value and its relevance as a sharing context; health did not represent a major theme for PwMS; community, society and religion/spirituality issues were substantially neglected by all participants. PwMS and caregivers reported lower levels of positive affect than their control groups, while no substantial differences emerged for negative affect, happiness and meaningfulness levels in life and across most domains. Results suggest that the experience of MS is associated with well-being in relevant life domains, such as family and close relationships. Although PwMS and caregivers identified a lower number of goals and meaning-related opportunities compared to control groups, they showed a positive adjustment to disease through the development of personal and family resources. These assets are often undervalued by health professionals and social institutions, while they could be fruitfully exploited through the active involvement of PwMS and their families as expert and exemplary informants in initiatives aimed at promoting the well-being of individuals and communities

A systematic review of the application of Wilson and Cleary health-related quality of life model in chronic diseases

Background

A conceptual model approach to clarify the elements of health-related quality of life (HRQL), their determinants and causal pathways is needed to aid researchers, health practitioners and policy makers in their bid to improve HRQL outcomes in patients. The aim of this systematic review was to appraise empirical evidence on the performance of the Wilson and Cleary Model of HRQL.

Methods

We conducted a search of MEDLINE, Science Direct, PsyARTICLES and CINAHL databases to identify articles that used Wilson and Cleary model to examine HRQL in chronic diseases. A narrative synthesis was employed in the review of the articles.

Results

Evidence supports linkages between adjacent concepts and between non-adjacent concepts of the Wilson and Cleary model indicating that in practice there is a need to examine relationships among constructs - or to consider interventions in terms of - both with and without mediators. Symptoms status has the highest magnitude of relative impact on health-related quality of life.

Conclusion

The Wilson and Cleary model demonstrated good features suitable for evaluating health-related quality of life in chronic diseases.

Effects of stress, health competence, and social support on depressive symptoms after cardiac hospitalization

Little is known about the role of stress on the psychological well-being of patients after cardiac hospitalization or about factors that protect against or exacerbate the effects of stress. We use prospective data from 1542 patients to investigate the relationship between post-discharge stress and changes in depressive symptoms, and whether the level of prior depressive symptoms, health competence, and perceived social support moderate this relationship. Net of depressive symptoms in the 2 weeks prior to hospitalization, higher levels of post-discharge stress significantly increase depressive symptoms 30 days after discharge. The level of prior depressive symptoms moderates the effect of stress. On the other hand, perceived health competence and social support buffer the negative effects of post-discharge stress. Knowing which patients are particularly vulnerable to experiencing stress and a subsequent increase in depressive symptoms can help trigger interventions prior to discharge and possibly ameliorate the prevalence of depression.

A few seconds to have an accident, a long time to recover: consequences for road accident victims from the ESPARR cohort 2 years after the accident

OBJECTIVE

The aim of the present study was to describe the consequences of a road accident in adults, taking account of the type of road user, and to determine predictive factors for consequences at 2 years.

DESIGN

Prospective follow-up study.

METHODS

The cohort was composed of 1168 victims of road traffic accidents, aged ≥16 years. Two years after the accident, 912 victims completed a self-administered questionnaire. Weighted logistic regression models were implemented to compare casualties still reporting impact related to the accident versus those reporting no residual impact. Five outcomes were analysed: unrecovered health status, impact on occupation or studies, on familial or affective life, on leisure or sport activities and but also the financial difficulties related to the accident.

RESULTS

46.1% of respondents were motorised four-wheel users, 29.6% motorised two-wheel (including quad) users, 13.3% pedestrians (including inline skate and push scooter users) and 11.1% cyclists. 53.3% reported unrecovered health status, 32.0% persisting impact on occupation or studies, 25.2% on familial or affective life, 46.9% on leisure or sport activities and 20.2% still had accident-related financial difficulties. Type of user, adjusted on age and gender, was linked to unrecovered health status and to impact on leisure or sport activities. When global severity (as measured by NISS) was integrated in the previous model, type of user was also associated with impact on occupation or studies. Type of user was further associated with impact on occupation or studies and on leisure or sport activities when global severity and the sociodemographic data obtained at inclusion were taken into account. It was not, however, related to any of the outcomes studied here, when the models focused on the injured body region. Finally, type of road user did not seem, on the various predictive models, to be related to financial difficulties due to the accident or to impact on familial or affective life.

CONCLUSIONS

Overall, victims were affected by their accident even 2 years after it occurred. The severity of lesions induced by the accident was the main predictive factor. However, considering lesion as intermediary factors between the accident and the recovery status at 2 year post-accident, impact on health status was lower for cyclists than M4W users or M2W users.

Health conditions in regions of Eastern and Western Europe

OBJECTIVES

We report health conditions in the regions of the European Union (EU) from both objective and subjective perspectives and verify whether drawing conclusions regarding the health conditions in different countries without considering the countries' sub-national variability may lead to inaccurate results.

METHODS

To depict health conditions in the EU regions, two classification methods are used: (1) hierarchical clustering with Ward's method and squared Euclidean distance and (2) k-mean clustering. To illustrate the intra-country variability of health conditions, the coefficients of variation are computed.

RESULTS

Health conditions are considerably better in the western regions of the EU. Objective and subjective health measures do not always coincide. Extensive within-country differences in health conditions exist.

CONCLUSIONS

The EU is clearly split into the EU-15 and Central and Eastern European countries; however, this division is observed with respect to objective health conditions only. Inclusion of self-perceived health status in the analysis measures considerably changes this picture.

Prognosis of outcome in adult survivors of road accidents in France: one-year follow-Up in the ESPARR cohort

OBJECTIVE

The consequences of road crashes are various, and few studies have dealt with the multidimensionality of outcomes. The aim of the present study was to assess the multidimensional nature of outcomes one year after a crash and to determine predictive factors that could help in adapting medical and social care to prevent such consequences to improve road crash victims' prognosis.

METHODS

The study population was the 886 respondents to the one-year follow-up from the ESPARR (Etude et Suivi d'une Population d'Accidentés de la Route du Rhône) cohort, aged ≥ 16 years; the analysis was carried out only on the 616 subjects who fully completed a self-report questionnaire on health, social, emotional, and financial status one year after a crash. Multiple correspondence analysis and hierarchical clustering was implemented to produce homogeneous groups according to differences in outcome. Groups were compared using the World Health Organization Quality of Life Assessment (WHOQOL-BREF, a standard instrument of quality of life, assessing physical health, psychological health, social relationships, and environment) and the Injury Impairment Scale (IIS), a tool to predict road crash sequelae. Baseline predictive factors for group attribution were analyzed by weighted multinomial logistic regression models.

RESULTS

Three hundred seventeen of the 616 subjects (60.1%) were men. Mean age was 36.9 years (SD = 16.5). Five victim groups were identified in terms of consequences at one year: one group (206 subjects, 33.4%) with few problems, one with essentially physical sequelae, one with problems that were essentially both physical and social, and 2 groups with a wider range of problems (one including psychological problems but fewer environmental problems; the last one reported negative physical, psychological, social, and environmental impact; notably, all had post-concussion syndrome [PCS]). There were significant differences between groups in terms of family status, injury severity, and certain types of injury (thorax, spine, lower limbs). Comparison on the WHOQOL-BREF confirmed that groups reporting more adverse outcomes had a lower quality of life. Description of the 5 groups by IIS indicators showed that IIS underestimated physical consequences one year after the crash. In addition to the known prognostic factors such as age, initial injury severity, and injury type, socioeconomic fragility and having a relative involved in the accident emerged as predictive of poor outcome at one year.

CONCLUSIONS

One year after the crash, victims may still be experiencing multiple problems in terms of not only physical health but also of mental health, social life, and environment. Poor outcome may be predicted from both accident-related factors and socioeconomic fragility. Our results are useful in catching the attention of both clinicians and the public administration regarding victims at risk of suffering from important consequences after an accident. If those suffering head injuries are recognized, it would be very important to better consider and treat posttraumatic stress disorder (PTSD) or PCS. Furthermore, subjects from lower socioeconomic backgrounds, with or without lower limb injuries, have numerous difficulties after an accident, notably for returning to work. An objective would be to provide them with more specific support. Supplemental materials are available for this article. Go to the publisher's online edition of Traffic Injury Prevention to view the supplemental file.

Pulmonary function tests overestimate chronic pulmonary disease in patients with severe aortic stenosis

BACKGROUND

Pulmonary dysfunction is an important risk factor for postoperative complications after cardiac surgery, and severe chronic obstructive pulmonary disease (COPD) is considered a relative contraindication to aortic valve replacement. Pulmonary function tests may mistakenly diagnose patients as having COPD, when in fact they have pulmonary dysfunction due to heart failure that potentially will improve with valve replacement.

METHODS

Between January 2009 and July 2011, 214 consecutive patients underwent pulmonary function testing as part of their preoperative screening. Based on the testing, 143 patients were identified as having COPD (52 mild, 42 moderate, and 49 severe), according to The Society of Thoracic Surgery definition. A total of 71 patients had follow-up tests performed at 6 to 12 months postprocedure.

RESULTS

A recent smoking history was present in 55 of 214 (25.7%) patients. Aortic valve replacement was performed in 13.6% (29 of 214) of patients by a conventional surgical approach, in 39.3% (84 of 214) by a transfemoral approach, and in 47.2% (101 of 214) by a transapical approach. Mortality was not significantly different in patients with COPD (12 of 71, 16.9%) compared with patients without COPD (37 of 143, 25.9%), p = 0.141. Logistic regression analyses failed to identify preoperative COPD severity category (p = 0.332) as a predictor for mortality. Comparison of pre- and postprocedure tests revealed that 42% (30 of 71) of patients with COPD showed improvement of one COPD severity category or more, including 40% (12 of 30) of patients in the mild group, 43% (9 of 21) of patients in the moderate group, and 45% (9 of 20) of patients in the severe category.

CONCLUSIONS

Abnormal pulmonary function improves in a significant number of patients with severe aortic stenosis after valve replacement.

High nutritional risk is associated with worse health-related quality of life in patients with heart failure beyond sodium intake

BACKGROUND

The most desirable outcome in heart failure (HF) management is to improve health-related quality of life (HRQoL) as a patient-centred health outcome. Nutrition is assumed to be important in HF management, whereas there is little evidence that nutritional risk affects HRQoL, except for sodium.

PURPOSE

We aimed to determine whether nutritional risk is associated with worse HRQoL after controlling for daily sodium intake.

METHODS

A total of 134 consecutive patients with HF [age 63 ± 11 years, 35% female, 45% New York Heart Association (NYHA) class III/IV, ejection fraction (EF) 33 ± 13%] completed the Nutrition Screening Initiative (NSI) to assess nutritional risk and a 24-h urine sodium excretion assessment to estimate daily sodium intake at baseline. The Minnesota Living with HF Questionnaire was used to evaluate HRQoL at baseline and 6 months later. Hierarchical linear regressions were used to determine whether nutritional risk predicted HRQoL at baseline and 6 months later.

RESULTS

Seventy-eight (58.2%) patients had high nutritional risk as indicated by a total NSI score ≥ 6. Increased nutritional risk was independently associated with worse HRQoL at baseline and 6 months later (β = 0.33, p < 0.001; β = 0.35, p < 0.001, respectively), after controlling for age, gender, aetiology, body mass index, NYHA class, EF, total comorbidity score, prescribed medications, and daily sodium intake.

CONCLUSION

These findings show that higher nutritional risk beyond sodium intake affects worse HRQoL in patients with HF. Further work is required to provide specific dietary guidelines to improve health outcomes for patients with HF.

An Interaction Effect of Leisure Self-determination and Leisure Competence on Older Adults’ Self-rated Health

This study examined whether there was an interaction effect of leisure self-determination and leisure competence on older adults’ self-rated health (SRH), controlling for self-efficacy. Three hundred eighty-nine older adults living in Keelung City, Taiwan were systematically selected as participants. Data were collected by a face-to-face questionnaire survey which included measures of self-efficacy, leisure self-determination, leisure competence, and SRH scales. The data were analyzed using multiple regression analysis. The results showed a significant reinforcement interaction effect of leisure self-determination and leisure competence on SRH among the participants after controlling for self-efficacy. Implications of the results are further discussed.

Advanced chronic obstructive pulmonary disease: rethinking models of care

Chronic obstructive pulmonary disease (COPD) is unique among leading causes of death in western society. Prevalence, associated morbidity and attributable mortality continue to rise. The resultant cost in quality of life to patients, families and to the health care system in general, demands improvements in the prevention and treatment of this common and ultimately debilitating condition. Traditional healthcare approaches to COPD, based on the biomedical model, have focused on the underlying pathophysiology of disease within which patients receive episodic care aimed at treating and preventing acute exacerbations. In contrast, patients living with COPD interpret it from an individually experienced illness perspective impacted by unique contextual factors that influence personal meaning. The psychosocial ramifications that follow the inexorable decline in capacity and independence are powerful forces shaping the experience of patients living with advancing COPD. The dominant role and impact of psychosocial effects on quality of life in advancing COPD require us to rethink our approach to care to more effectively address these more elusive yet chronically troublesome issues.

An exploration of the relationship between fatigue and physical functioning in patients with end stage renal disease receiving haemodialysis

AIM

To measure fatigue and physical functioning in patients with end stage renal disease (ESRD) receiving haemodialysis and to investigate the relationships between fatigue and physical functioning.

BACKGROUND

Fatigue and reduced physical functioning are among the most bothersome symptoms experienced by individuals receiving haemodialysis for ESRD. Research has shown that increasing activity levels has resulted in decreased fatigue levels and improved physical functioning in individuals with cancer. Establishing whether or not a relationship exists between both concepts in haemodialysis patients is a preliminary step in identifying potential fatigue reducing strategies necessary for improved wellbeing.

METHOD

A quantitative exploratory correlational design was used with 46 individuals completing the Multi-dimensional Fatigue Inventory, the Medical Outcomes Study Short-Form 36-item questionnaire and a Demographic Questionnaire.

RESULTS

Results indicated fatigue was prevalent with highest scores achieved for physical fatigue; reduced activity and general fatigue. Substantial limitations in physical functioning were found. A significant moderate negative relationship between general fatigue and physical functioning indicated that, as physical functioning levels increased, fatigue levels decreased. A significant difference was also found between general fatigue scores for males and females. Significant relationships were found between overall physical functioning, older age and employment status.

CONCLUSION

The research indicates the prevalence of fatigue and limitations in physical functioning in individuals with ESRD. However, as physical functioning increased fatigue decreased; a finding relevant to clinical nursing.

RELEVANCE TO CLINICAL PRACTICE

Understanding the levels of fatigue and the value of exercise is of relevance to clinical practice thus assessment of fatigue and physical functioning ability in the clinical setting is necessary.

Symptom perception in CHF: (why mind matters)

Symptoms utilized in the clinical care of heart failure as markers of disease severity include, dyspnea, insomnia, low energy, fatigue, poor appetite, and diminished memory. This is despite the fact that physiologic variables such as cardiac ejection fraction and oxygen consumption do not accurately predict functional state in individuals with congestive heart failure (CHF). Distress (anxiety and depression) may amplify symptom complaints without associated physiologic aberration. Personality traits and psychiatric illness, such as mood, anxiety, and psychotic illnesses may also alter perception of somatic symptoms that are associated with this chronic illness. The impact of distress and its treatment on functional performance and CHF symptom reporting deserve additional attention. The need to screen for distress in all with serious symptomatic heart failure is certain.

Testing relationships between clinical and non-clinical variables in xerostomia: A structural equation model of oral health-related quality of life

OBJECTIVES

The aim of the study was to systematically test Wilson and Cleary's [Wilson IB, Cleary PD. JAMA 1995; 273: 59-65] conceptual model of the direct and mediated pathways between clinical and non-clinical variables in relation to the oral health-related quality of life (OHRQoL) of patients with xerostomia.

METHODS

We collected measures of clinical variables, self-reported symptoms, OHRQoL, global oral health perceptions and subjective well-being from 85 patients attending outpatient clinics.

RESULTS

Structural equation modelling indicated support for the dominant direct pathways between the main levels of the model; more severe clinical signs predicted worse patient reported symptoms; worse symptom perception was associated with a lower functional status as measured by OHRQoL; and lower OHRQoL predicted worse global oral health perceptions. There was no relationship between the final two levels of the model; global oral health perceptions and subjective well-being. Subjective well-being was associated instead with earlier non-adjacent levels; biological variables, symptoms and functional status. These pathways were both direct (salivary flow-well-being, functioning-well-being) and indirect (clinical signs-well being, symptom status-well-being). There were also indirect pathways; most notably, the impact of clinical variables on OHRQoL was mediated by patient reported symptom status.

CONCLUSIONS

The results support Wilson and Cleary's conceptual model of patient outcomes as applied to a chronic oral health condition and highlight the complexity of (inter)relationships between key clinical and non-clinical variables. Further conceptual development of the model is discussed, particularly the role of individual difference factors, and theoretical and methodological issues in OHRQoL research are highlighted.