Performance of the WHOQOL-BREF among Norwegian substance use disorder patients

Implications of Switching from Conventional to Electronic Cigarettes on Quality of Life and Smoking Behaviour: Results from the EQualLife Trial

INTRODUCTION

Electronic cigarettes and "vaping" have become popular since their appearance in Europe and the USA in approximately 2006. They are often perceived as having fewer health risks than conventional cigarettes, which makes them of interest as a support tool in smoking cessation. However, its efficacy regarding cessation or reduction of smoking under real-life conditions remains controversial. Our objective was to clarify this question in an observational study of smoking habits after initiating vaping without targeted intervention, as compared to a validated cessation programme.

METHODS

From October 2015 to April 2018, 80 subjects (60 in the e-cigarette group and 20 in the supervised smoking cessation group) were included in two trial visits, one at the start of the trial and the second after 3 months, plus 4 questionnaire surveys: at the start of the trial and after a 1, 2, and 3 month period. The questionnaire included a nicotine use inventory, a modified Fagerström test for nicotine dependence, and the WHO-QOL-BREF survey.

RESULTS

E-cigarettes were effective, leading to a significant (p < 0.03) reduction (p < 0.03) in tobacco consumption and nicotine dependence, with an abstinence rate of 43% after 3 months. Compared to participants in the smoking cessation programme, their use was not associated with an improvement in quality of life during the quitting attempt, and there were no significant differences in clinical symptoms between groups. The reduction in nicotine dependence was more pronounced (p < 0.012) for the smoking cessation programme, with higher abstinence rates (p = 0.011 after 12 weeks) and lower (p < 0.003) remaining tobacco consumption compared to electronic cigarettes.

DISCUSSION/CONCLUSIONS

The use of electronic cigarettes reduced nicotine dependence and tobacco consumption, but a supervised smoking cessation programme was superior in terms of achieved cessation in both regards. Electronic cigarettes did not improve the quality of life. Since e-cigarettes could be associated with long-term health risks, their usefulness in smoking cessation remains questionable, and a professionally guided and validated smoking cessation programme still appears to be superior and preferable, in terms of achieved cessation. Although this trial is limited regarding the number of participants and follow-up time, it highlights the need for additional, large clinical trials evaluating the efficacy of e-cigarettes for smoking cessation in comparison to a professionally guided smoking cessation programme.

Evaluation of the executive functions and quality of life in a sample of Egyptian male adolescents with substance use disorder: A case-control study

BACKGROUND

Adolescent substance use is a major problem that has serious medical, psychological, and legal consequences later in life. Substance use disorder is closely linked to deficits in executive functions. Impaired executive functions (EFs) have been linked to all stages of the substance use disorder (SUD) life cycle, increasing the likelihood of commencing use, escalating use more quickly, and increasing the likelihood of relapsing following treatment. The current study aimed at evaluating of the executive functions and quality of life in a sample of adolescent Egyptian males with substance use disorder.

RESULTS

A significantly higher mean Trail Making Test-A, B (TMT-A and TMT-B) scores among studied cases than the control group (equals lower executive functions) with a mean score of TMT-A is 74.38 versus 63.2 among controls and for TMT-B; the mean score for control is 97.22 versus 142.04 among cases. A statistically significant difference between the case and control groups on all quality of life scores measuring the following domains: general health and well-being, physical health, psychological health, social interactions, and the environment, also there has been a negative correlation between TMT-A and the environmental domain (r = - 0.279) and TMT-B with the same variable (r = - 0.414).

CONCLUSIONS

Substance use disorders are a major health problem among youth. Deficits in executive functions are strongly associated with adolescent substance use. The more affected executive functions are associated with more affected quality of life of these patients.

Associations between excessive screen time and school and out-of-school injuries among adolescents: A population-based study

Most adolescents spend excessive screen time (with television viewing, computer/console gaming, discussion forums/chatting online, internet surfing, doing homework, and electronic mails) which may impact the occurring of various types of school and out-of-school injuries. We assessed their associations and potential confounding factors among 1559 middle-school students from north-eastern France (mean age=13.5 ± 1.3). Participants completed a questionnaire including socioeconomic features, daily screen time for various screen-based activities (coded 1=<2, 2 = 2-4, 3=≥5 h; daily-total-screen time level (TDST) was defined as their sum, categorized into <7/7-11/≥12), various injury types during the school-year, behavior and health difficulties (BHDs; alcohol/tobacco/cannabis/other illicit drugs use, suffered physical/verbal violence, sexual abuse, poor family-peer support, sleep difficulty, depressive symptoms, suicide attempt, and time at onset). Most subjects had TDST≥7 (82.3 %). There were dose-effect associations of TDST with school-physical/sports training, school-free-time, out-of-school-sports, and single/repeated injuries (sex-age-adjusted odds ratio reaching 4.45). BHDs explained up to 39 % of these associations. The frequency of subjects without various BHDs decreased with age since age 10 more quickly among the participants with both TDST≥7 and injury than among the others. Our findings may inform health care providers, parents, schools, and public policy that reducing elevated screen time is efficient to prevent injuries and BHDs among adolescents.

Evaluating the Aspects of Quality of Life in Individuals with Substance Use Disorder: A Systematic Review Based on the WHOQOL Questionnaire

Substance Use Disorder (SUD) has become a significant public health concern and it profoundly impacts an individual's quality of life (QOL). This systematic review aimed to assess the QOL among patients with SUD, and to understand the differential impact of SUD on physical, mental, social, and environmental QOL domains, considering a variety of substances and identifying key factors that influence these outcomes. A comprehensive search was conducted in PubMed, Web of Science, Cochrane, and Scopus in January 2023, covering literature published until December 2022. The QOL was assessed using the World Health Organization Quality of Life (WHOQOL) instrument and the brief version of the WHOQOL, identifying the same four domains of QOL (physical, mental, social, and environmental). A total of 19 studies were selected for inclusion in the systematic review, based on individuals' polysubstance use, and excluding those using only nicotine or alcohol. The analysis included 6079 patients, with only 40.3% women, and a mean age of 36.6 years. The substances most commonly involved in SUD were cocaine (47.1%), alcohol (46.3%), and amphetamine (43.6%), considering most individuals being polysubstance users. The highest variability in QOL scores was observed in the physical domain. Mental disorders were reported in 68.3% of the patients, while long-term use of drugs, criminal history, unemployment, and low levels of education were identified as significant predictors for lower QOL by some of the studies. Similarly, sleep problems and teeth decay were also identified as significant worsening factors for QOL. This systematic review highlights that the WHOQOL survey is widely accepted and applicable for individuals with SUD worldwide. The results suggest a substantial negative impact of SUD on the QOL of affected individuals. The findings underscore the need for comprehensive interventions to address the physical, psychological, social, and environmental dimensions of QOL among individuals with SUD.

Quality of life and associated factors of heroin-dependent patients receiving methadone and buprenorphine maintenance treatment

AIM

Although studies in Western countries have investigated the quality of life (QoL) of heroin users, limited research on this topic has been conducted in Asia. The present study assessed QoL in patients with heroin dependence receiving medications to treat opioid use disorder.

METHODS

We performed a cross-sectional study of patients with heroin dependence receiving methadone and buprenorphine treatment. The demographic and substance use variables of patients receiving methadone and buprenorphine were compared. The Chinese Health Questionnaire (CHQ-12), Obsessive Compulsive Drug Use Scale (OCDUS), and World Health Organization Quality of Life Short Form Taiwan version (WHOQOL-BREF-T) were administered to measure patient mental health problems, addiction severity, and QoL, respectively. Multivariate regression was used to identify the factors associated with QoL.

RESULTS

A total of 149 patients receiving methadone and 31 receiving buprenorphine completed the questionnaires. Individuals in the buprenorphine group were more likely to be married (p = 0.024) or employed (p = 0.024), have a higher educational level (p = 0.013), have lower drug craving (OCDUS: p = 0.035), or have higher QoL (WHOQOL-BREF-T: p = 0.004) than those in the methadone group. After adjustment for other variables, employment was positively associated with the physical, psychological, and environmental domains of QoL. Receiving buprenorphine treatment (p = 0.032) and longer treatment duration (p = 0.016) were associated with higher psychological QoL.

CONCLUSION

Several factors were associated with QoL in patients with heroin dependence. Some measures may improve their QoL, such as reducing employment barriers, improving treatment adherence, or increasing accessibility to buprenorphine treatment.

Visual Impairment in Hemodialyzed Patients-An IVIS Study

Background and Objectives: The growing and aging population of hemodialysis patients has become increasingly disabled, with more complex comorbidities, and are older upon initiating dialysis. Visual impairment can adversely affect their quality of life and life satisfaction. Treatment evaluation should not only consider remission of the disease, but also the improvement of quality of life and life satisfaction. This is a single-center cross-sectional study. It was designed to evaluate visual impairment in hemodialyzed patients, its correlation with quality of life and life satisfaction, and its relationship to clinical outcomes in hemodialyzed patients. Materials and Methods: Seventy patients with chronic kidney disease undergoing hemodialysis and aged 18 years or older were recruited from a single Dialysis Unit. The Impact of Visual Impairment Scale (IVIS), WHOQOL-BREF, and Cantril Ladder questionnaires were utilized to assess both sociodemographic and clinical variables. Results: It was found that, among all assessed variables (i.e., sex, marital status, level of education, months on hemodialysis, history of kidney transplantation, Kt/V, URR, and UF), only age and central venous catheter placement were positively correlated with IVIS scores, while arteriovenous fistula and willingness to become a kidney transplant recipient were negatively correlated. Furthermore, a comparison between patients with moderate and severe visual impairment yielded supplemental data indicating that individuals whose dialysis access was through a dialysis catheter and those ineligible or unwilling to undergo transplantation suffered more often from severe visual impairment. This finding may be attributed to age. Conclusions: Older patients were predominantly observed to experience visual impairment. Patients intending to receive a kidney transplant and whose dialysis access was through an arteriovenous fistula were less prone to visual impairment, compared to those who may be ineligible or unwilling to receive transplantation and those with hemodialysis catheters. This phenomenon can be attributed to age-related distinctions in patients' suitability for specific dialysis access and transplantation. Those reporting visual impairment gave lower ratings in all four domains of their quality of life (comprising physical health, psychological health, social relationships, and environment) and in both present and anticipated five-year life satisfaction. More severe visual impairment was related to an additional reduction in physical health, social relationship, and environment domains, and in life satisfaction.

Administration and patient-incurred costs associated with opioid agonist treatment in Norway

OBJECTIVES

Opioid use disorder is associated with high rates of mortality and has become an escalating global health issue. Opioid agonist treatment (OAT) with oral methadone or daily sublingual buprenorphine hydrochloride, either administered separately or in combination with naloxone hydrochloride (SL-BPN, SL-BPN/NX), is supervised by a healthcare professional experienced in treating opioid use disorder to ensure proper dosing and prevent misuse. For that reason, there may be substantial direct and indirect costs associated with OAT. Recently, weekly and monthly subcutaneous depot formulations of buprenorphine (SC-BPN) have been approved. This study aimed to estimate management and patient-incurred costs associated with the most commonly used OATs compared to the cost of weekly and monthly SC-BPN.

METHODS

We conducted a cost-minimisation analysis comparing the monthly costs of OAT treatment with oral formulations, i.e. oral methadone, SL-BPN, SL-BPN/NX and SC-BPN. The analysis assessed treatment acquisition costs and costs associated with management, supervision and administration of therapy, patients' transportation costs and the indirect costs associated with patients' time-use. The model was set up to reflect the Norwegian medically assisted rehabilitation system and considered the costs of a stable maintenance OAT regimen given continuously to patients already initiated and titrated on the therapy.

RESULTS

OAT management with monthly formulation of SC-BPN was associated with a reduction in monthly costs of €605, €586, and €411 per month compared to SL-BPN, SL-BPN/NX and oral methadone, respectively. Similar results were estimated when comparing to the weekly formulation of SC-BPN.

CONCLUSION

The analysis showed that the monthly formulation of SC-BPN was the cost-minimising alternative, followed by the weekly formulation, when considering all cost components.

Health-related quality of life measured by EQ-5D-3L for the spouses of breast cancer patients

To explore factors influencing the health-related quality of life of spouses of breast cancer patients and the suitable questionnaires for this purpose. A cross-sectional study was conducted in the Third Affiliated Hospital of Kunming Medical University. The spouses of breast cancer patients were included and evaluated via face-to-face interviews. Self-designed demographic characteristics and disease-related questionnaires, the 12-item health survey questionnaire (SF-12), the three-level European five-dimensional health status scale (EQ-5D-3L), and the Social Support Rate Scale (SSRS) were used. The internal consistency reliability measure Cronbach’s coefficient, criterion-related validity, construct validity, and sensitivity were used to evaluate the applicability of the EQ-5D-3L. Univariate and multivariate analyses were performed to analyze the factors associated with the health-related quality of life of spouses of breast cancer patients. We investigated a total of 100 spouses of breast cancer patients. Cronbach’s α, the internal consistency reliability coefficient, was 0.502. The EQ-5D-3L health utility score was moderately correlated with PCS-12 (r=0.46, p=0.0001) and weakly correlated with MCS-12 (r=0.35, p=0.0001). The EQ-5D-3L health utility score for the spouses of breast cancer patients was 0.870, and the EQ-VAS was 78.3. In multivariate analysis, social support and cognition of the treatment effect were factors that influenced the EQ-5D-3L health utility score. The EQ-5D-3L has good reliability, validity, and sensitivity for measuring the physiological aspects of the health-related quality of life of spouses of BC patients. EQ-5D-3L was considered suitable for this study.

Cannabis and cocaine use, drinking outcomes, and quality of life in general hospital inpatients with alcohol use disorder

Background: While associations between cannabis and cocaine use, and heavy drinking and quality of life (QOL), are well-established in the general population, it is unclear whether they are present in hospital inpatients with alcohol use disorder (AUD). The aim of the study was to assess associations between cannabis and cocaine use and two outcomes [heavy drinking days (HDDs) and QOL] among hospital inpatients with AUD. Methods: Hospitalized patients with AUD and at least one past-month HDD participated in this cross-sectional study. Cannabis and cocaine use were assessed using the Alcohol, Smoking, and Substance Involvement Screening Test. HDDs were assessed using the Timeline Followback. QOL was assessed by the WHOQOL-BREF instrument. Multivariable regression models assessed associations. Results: Of 248 participants, 225 (91%) had severe AUD. There were no statistically significant associations between: recent cannabis use and HDDs [Incidence Rate Ratio (IRR) = 0.95; 95% Confidence Interval (95% CI): 0.80, 1.14], cocaine use and HDDs [IRR = 0.88; 95% CI: 0.66, 1.18], or both cannabis and cocaine use and HDDs [IRR = 0.87; 95%CI: 0.70, 1.09], as compared to use of neither cannabis nor cocaine. Use of cannabis, cocaine, and both, were not associated with QOL [(odds ratio (OR) = 0.98; 95% CI:0.55, 1.74), (OR = 0.76; 95% CI:0.30, 1.93), (OR = 1.00; 95%CI: 0.49, 2.03), respectively]. Conclusions: Among hospital inpatients with AUD, there were no significant associations between cannabis and cocaine use, heavy drinking, or QOL. Our findings raise questions regarding how drug use affects AUD and whether similar results would be found among those with milder AUD and in prospective studies.

Former inpatients’ narratives of substance use four years after substance use disorder treatment: A qualitative follow-up study

Aim: The aim of this study was to explore the narratives of former substance use disorder (SUD) inpatients about substance use after their discharge from long-term SUD treatment in 2017. Method: We conducted semi-structured in-depth interviews with 11 former inpatients of SUD treatment. The data were analysed using a qualitative, thematic analysis model. Findings: During the analysis, two main themes emerged pertaining to participant reflections on substance use – their experience of non-problematic substance use (that is, substance use without declining into pre-treatment levels of misuse behaviours) and problematic substance use (that is, substance use associated with destructive patterns). All participants except one had engaged in substance use after their discharge three to four years ago. The commonly used substance was alcohol, which also appeared to be the most common substance for which there was consensus among the informants regarding non-problematic use. Conclusions: Most of the participants continued to use substances in some way, and some reported that such use did not affect them negatively. Healthcare providers and therapists in SUD treatment should avoid defining a relapse or failed treatment outcome in concrete terms. What is perceived as an actual relapse or a failed treatment outcome is highly subjective. Furthermore, complete sobriety might not necessarily be the best or the only way to measure the SUD treatment stay. An improvement in the quality of life and well-being, even when core symptoms are still present, may be considered a successful treatment outcome.

Quality of life among people who use drugs living in poor urban communities in the Philippines

BACKGROUND

The quality of life (QOL) and mental health of people who use drugs (PWUD) in the Philippines, especially those living in poor urban communities, are highly concerning due to the situations surrounding drug use and the ongoing hard-line antidrug policy. This study aimed to investigate the QOL and mental health status of PWUD, compare them with a comparison group with no history of drug use, and identify factors associated with QOL among Filipino PWUD.

METHODS

A cross-sectional study was conducted with recruitment from a community-based rehabilitation programme and poor urban communities in Muntinlupa in 2018. QOL was measured using the WHOQOL-BREF, while psychological distress and posttraumatic stress disorder (PTSD) were measured using the Kessler Psychological Distress Scale (K-6) and the Primary Care PTSD Screen for DSM-5 (PC-PTSD-5), respectively. Multivariable linear regressions with each WHOQOL-BREF domain as a dependent factor were conducted to establish three predictions: age- and gender-adjusted QOL means, factors associated with QOL among PWUD, and interaction of lifetime drug use with each covariate.

RESULTS

In total, 272 PWUD and 402 comparison participants were recruited. Most PWUD were current drug users (53%), primarily of methamphetamine (70%). Among PWUD, the prevalence of moderate to severe psychological distress was 70%, and probable PTSD was 28%-both rates higher than those among the comparison group. All four QOL domain scores (physical, psychological, social, and environmental) of PWUD were lower than those of the comparison group. Multivariable regressions showed that psychological distress, current drug use, selling drugs, experiencing discrimination, and being never-married were associated with lower QOL. Higher individual income, household resources, social activity participation, and service use for drug use problems were associated with higher QOL among PWUD. Stratified and interaction analyses revealed that the QOL of PWUD was more sensitive to changes in individual income relative to the QOL of comparison group.

CONCLUSION

A comprehensive intervention addressing psychological distress reduction, economic empowerment, and social inclusion-complementary to abstinence-oriented programmes-may improve the well-being of Filipino PWUD.

Perceived Caregiver Stress, Coping, and Quality of Life of Older Ugandan Grandparent-Caregivers

With the continued loss of lives due to HIV/AIDS in sub-Saharan Africa, grandparents bear the stress of caring for children affected by the epidemic, often with very limited resources. Yet, despite the acknowledgement that these older adults serve as the backbone and safety net of the African family in this HIV/AIDS era, very limited research has focused on investigating the specific health outcomes of caregivers in this region and how these changes in health status impact the overall quality of life of caregivers. This study highlights the stress perceived by Ugandan grandparent-caregivers, its impact on their overall quality of life, and the coping strategies they use to manage their stress. Thirty-two grandparent-caregivers (age 50 years and older) were recruited from urban and rural areas in Uganda and individually interviewed in 2016. Using constructivist grounded theory as the qualitative methodology, the narratives generated from the semi-structured, one-on-one interviews were audio-recorded, transcribed, and analyzed using both open and axial coding as well as reflexive and analytic memoing. Descriptions of caregiver stress (physical, emotional, financial, and social) were reported. Additionally, study findings uniquely explore the impact of the perceived stress on the grandparents' overall quality of life. Study findings provide a foundation upon which clinicians, researchers, and policy-makers can design and implement effective interventions to improve the health and quality of life of grandparent-caregivers in sub-Saharan Africa.

Tobacco use disorder: Prevalence, associated factors and its influence on quality of life among patients on methadone assisted treatment

Background and Objectives: Smoking is the primary cause of preventable death and is highly prevalent among patients on methadone assisted treatment (MAT). This study aims to assess the prevalence of tobacco use disorder (TUD) among patients on MAT, the factors associated with TUD, and to examine the association between TUD and quality of life.Methods: A total of 171 male patients receiving MAT in two Malaysian government hospitals were assessed for TUD, levels of nicotine dependence, relevant associated factors and quality of life using DSM-5 criteria, Fagerström Test for Nicotine Dependence (FTND), Opiate Treatment Index (OTI), Mini-International Neuropsychiatric Interview (M.I.N.I.) and World Health Organization Quality of Life (WHOQOL)-BREF.Results: The prevalence of TUD was 81.3%. Being employed was significantly associated with having a TUD. Among the patients with TUD, the mean FTND score was 3.8 (SD ± 2.0). Being younger, having poorer social function, and presence of current opioid dependence were significantly correlated with higher FTND scores. There was no significant difference in the quality of life between patients with and without TUD. Following multiple linear regression analysis, being unmarried and poor health status were the two factors that significantly predicted a lower quality of life in all four domains of WHOQOL-BREF.Conclusions: Given the high prevalence of TUD among methadone-assisted patients, smoking cessation treatment should be integrated into the MAT program in Malaysia. Also, addressing patients' marital and health issues during MAT can be instrumental in improving their quality of life.

Quality of Life in Patients With Methamphetamine Use Disorder: Relationship to Impulsivity and Drug Use Characteristics

BACKGROUND

The quality of life (QOL) of patients with methamphetamine use disorder (MAUD) is increasingly recognized as an important outcome. Previous studies have found that impulsivity is negatively associated with QOL in mental disorders, but this relationship is rarely confirmed in patients with MAUD. We hypothesized that impulsivity is negatively correlated with QOL in patients with MAUD based on previous findings. In addition, a variety of drug use characteristics of patients that may potentially affect their QOL need to be further explored. Therefore, the purpose of this study was to explore the relationship between impulsivity, multiple drug use characteristics, and QOL in patients with MAUD.

METHODS

A total of 379 patients with MAUD were recruited, and the majority of them were male (85.5%), with an average age of 33.93 ± 7.08 years. Two psychiatrists conducted semi-structured interviews with methamphetamine (MA) users in two compulsory drug rehabilitation centers to obtain their demographics and drug use characteristics. The Barratt Impulsiveness Scale-11 (BIS-11) and Brief WHO Quality of Life Assessment (WHOQOL-BREF) were used to assess patients' impulsivity and QOL, respectively. Correlation and univariate regression analysis were used to explore the relationships between impulsivity, a series of drug use characteristics and patients' QOL in different domains. Further multiple linear regression analysis was used to identify what extent the above clinical variables explained the variations in patients' QOL.

RESULTS

Age, marital status, employment, and various drug use characteristics were significantly associated with at least one QOL domain. Among them, married and full-time job were positively correlated with QOL, while others were negatively correlated with QOL. The total score of BIS-11 was significantly negatively correlated with all four domains of QOL. Impulsivity, a range of drug use characteristics and certain demographic characteristics collectively explained varying degrees of variation in different domains of QOL.

CONCLUSIONS

Impulsivity and various drug use characteristics can significantly predict QOL in all fields of MAUD patients. In addition, we have also found differences in the predictors of QOL in different domains. Overall, this study provides clinical guidance for the treatment of MAUD patients, that is, management of impulsivity in patients with MAUD may help improve their QOL and even sustain their drug rehabilitation.