Psychometric properties of the EUROHIS-QOL 8-item index (WHOQOL-8) in a Brazilian sample

The Additive Psychosocial Effects of Binge Eating and Food Insecurity Among Midlife and Older Women

Background/Objectives: Evidence suggests that food insecurity (FI) is a risk factor for eating disorder (ED) symptoms, especially binge eating (BE), yet research focusing on the psychosocial effects among midlife/older women is lacking. Midlife/older women living with FI experience intersectional disadvantage, thus highlighting the need for an independent investigation of the cultural and contextual factors of this population. The current study examined the difference in psychological health and quality of life (QOL) among women living with BE and FI (BE + FI) versus FI without BE. Method: Female clients of a food bank, aged 50+ (N = 295; M age = 62.1 years, SD = 8.2) living with FI completed measures of BE and psychosocial comorbidities. The measures were provided in English and Spanish. Results: A multivariate analysis of covariance compared women living with BE and FI (BE + FI) versus FI without BE on outcomes related to mental health and wellbeing. Covarying for age, FI severity, and ethnicity, the results indicated that women living with BE + FI reported worsened anxiety, depression, ED-related psychosocial impairment, internalized weight stigma, and QOL versus women living with FI without BE (all ps < 0.001). Effect sizes ranged from small to medium to large. Conclusions: Midlife/older women living with BE + FI report poorer psychological health and QOL than those living with FI without BE, demonstrating a critical need for mental healthcare in this population. Innovative solutions-and likely a portfolio of interventional approaches with various entry points and delivery modalities-are warranted, if we are to make significant strides in addressing ED symptoms in this population.

Psychometric evaluation of the WHOQOL-BREF and its shorter versions for general Thai population: confirmatory factor analysis and Rasch analysis

PURPOSE

Rasch analysis was employed to validate the World Health Organization Quality of Life-BREF (WHOQOL-BREF) and its existing shorter versions in the general Thai population.

METHODS

1200 respondents were randomly selected to complete the questionnaire. Confirmatory factor analysis (CFA) was employed to test the structure of the WHOQOL-BREF and its shorter versions with the random sub-sample of 900 respondents, while Rasch analysis was performed with a random sub-sample of 300 respondents.

RESULTS

The CFA confirmed the factor structure of WHOQOL-BREF and its shorter versions. The Rasch analysis revealed that the WHOQOL-BREF, when a four-domain structure was tested using a subtest approach, achieved acceptable model fit to the Rasch model and met the expectations of unidimensionality with high reliability (PSI = 0.87). Individual domain models were also unidimensional, but reliability of the 3-item social domain was inadequate. While the 8-item EUROHIS-QOL-8 and 5-item WHOQOL-5 achieved an overall acceptable fit and met the expectations of unidimensionality, the reliability of the WHOQOL-5 was below the acceptable threshold (PSI = 0.66). Reliability of the EUROHIS-QOL-8 was satisfactory (PSI = 0.79).

CONCLUSIONS

The WHOQOL-BREF is a valid instrument for use in the Thai general population, both as a total score as well as individual subscales. Rasch analysis also supports the use of EUROHIS-QOL-8, but the WHOQOL-5 lacks good reliability. While the reliability of the EUROHIS-QOL-8 is sufficiently high for between-group analysis, the Thai WHOQOL-BREF total score can also be used for within-participant analyses. Rasch investigation with a more varied health conditions of general Thai samples or patient groups is encouraged for future studies.

Lifestyle and quality of life in children and adolescents during the covid-19 social distancing period

OBJECTIVE

To evaluate the lifestyle and quality of life in Brazilian children and adolescents during the COVID-19 social distancing period in 2020.

METHODS

This cross-sectional study evaluated children and adolescents (2-18 years of age) and their parents, who voluntarily participated in an online survey. Snowball sampling was used to recruit participants during the first 6 months of the pandemic. A questionnaire was used to characterize the study population. The PedsQL 4.0 and the EUROHIS-QOL 8-item index were used to assess the quality of life (QoL) in children/adolescents and parents, respectively. Data were analyzed using SPSS 18.0 statistical program through the ANOVA with post hoc Bonferroni analysis, student's t test, and the generalized estimating equation.

RESULTS

Mean screen time increased from 2h pre-pandemic to 5h during the pandemic (p < 0.001), which was associated with a decline in PedSQL4.0 scores (from 75.7 ± 2.6 to 71.3 ± 13.7, p < 0.001). Unhealthy eating habits increased from 11% to 34% and were associated with worse QoL scores compared with improved or unchanged eating habits during the pandemic (69.7 ± 13.3 vs 72.80 ± 13.4 vs 76.4 ± 12.6; p < 0.001). Poor sleep quality increased from 9% to 31.7% and was associated with worse QoL scores compared to improved or unchanged sleep quality during the pandemic (67.3 ± 13.1 vs 74.5 ± 13.1 vs 76.8 ± 12.2; p < 0.05). Physical exercise was associated with better PedSQL4.0 scores (77.5 ± 12.3 vs 72.5 ± 14.4; p < 0.001). Children aged 2-4y old had the best QoLscores.

CONCLUSIONS

Pandemic-related social distancing promoted significant lifestyle changes in children and adolescents, increasing screen time, reducing physical activity, and worsening food and sleep quality, which resulted in worse QoL scores.

Internalized Weight Stigma and Weight Discrimination: Associations with Quality of Life and Psychosocial Impairment in a Sample Living with Food Insecurity

Research suggests that experiencing weight discrimination is associated with a lower quality of life and poor psychological and physical health. However, much of the existing weight discrimination literature has neglected under-represented groups. Little is known about how the experience of weight discrimination affects quality of life and eating/weight-related psychosocial impairment in those living with food insecurity. The present study investigated the associations of weight discrimination and eating/weight-related psychosocial impairment and quality of life. We examined internalized weight stigma and several psychological indicators as potential mediators. Participants (N = 1085) who were recruited from a local food bank completed a questionnaire assessing food insecurity, weight discrimination, internalized weight stigma, eating disorder pathology, anxiety, depression, eating/weight-related psychosocial impairment, and quality of life. Overall, almost one in four participants reported experiencing weight discrimination. Our serial mediation models indicated that increased experiences of weight discrimination were associated with greater internalized weight stigma and psychopathology, which were in turn associated with lower quality of life and greater eating/weight-related psychosocial impairment. Thus, experiencing weight discrimination may negatively impact quality of life and eating/weight-related psychosocial impairment through its effect on mental health. It is imperative to address the negative effects of the widespread discrimination of people based on their weight.

Cardiometabolic, functional, and psychosocial effects of a remotely supervised home-based exercise program in individuals with type 2 diabetes (RED study): study protocol for a randomized clinical trial

BACKGROUND

Type 2 diabetes mellitus (T2D) is a serious global health problem, and exercise is considered an essential non-pharmacological tool in T2D prevention and treatment. During periods of social isolation experienced by the COVID-19 pandemic, home-based exercise programs were strongly recommended as a strategy to facilitate exercise practice and reduce the negative impacts of social isolation. Remotely supervised exercise stands out as an easily accessible strategy after the pandemic, as it is a tool that aims to facilitate access to exercise by this population. The purpose of the RED study is to verify the effects of a remotely supervised home-based exercise program compared to a control group on cardiometabolic, functional, and psychosocial outcomes in patients with T2D.

METHODS

Participants are randomized into the control group (CG) and the intervention group (IG). Participants allocated to the CG receive recommendations for the practice of physical activity based on information from chapters of the Physical Activity Guide for the Brazilian Population, while the IG will perform a 12-week home-based exercise program supervised remotely by video call. The intervention has a weekly frequency of two sessions per week on non-consecutive days during the first 6 weeks and three sessions per week on non-consecutive days for the remaining 6 weeks. The RED study has HbA1c as the primary outcome, and the participants' cardiometabolic, functional, and psychosocial parameters are assessed at baseline (week 0) and post-intervention (week 13).

DISCUSSION

Expected results of the proposed study will provide the knowledge base of health professionals and deliver more evidence for a growing area, i.e., home-based exercise and T2D. Additionally, this protocol aims to verify and demonstrate whether this program can be accessible and effective for different health outcomes in patients with T2D.

TRIAL REGISTRATION

The RED study protocol was prospectively registered at ClinicalTrials.gov (NCT05362071). Date registered April 6, 2022. https://clinicaltrials.gov/ct2/show/NCT05362071 .

Fear of childbirth and its determinants in pregnant women in the third trimester: a cross-sectional study

BACKGROUND

Fear of childbirth (FOC) is a prevalent issue among pregnant women and significantly relates to adverse outcomes for the mother and child. However, it is not clear the prevalence and risk factors of FOC among pregnant women in a region with a moderate level of economic development in China. The aim of this study was to investigate the prevalence and risk factors of FOC among pregnant women in the third trimester of pregnancy in Lianyungang city, Eastern China.

METHODS

A cross-sectional survey was conducted from December 2022 to February 2023 among pregnant women in the third trimester who met the inclusion criteria and visited Lianyungang Maternal and Child Health Hospital in Jiangsu Province, Eastern China. A structured questionnaire including sociodemographic characteristics, clinical characteristics, FOC, family function, doctor-patient communication, social support, general self-efficacy, anxiety, depression, insomnia symptoms, and quality of life was used to collect data. A multiple linear regression model was used to identify predictors of FOC.

RESULTS

This study included 535 pregnant women in the third trimester. The mean score of FOC was 30.67 ± 10.18, and the median score was 29.00. The prevalence of FOC was 56.64%. Multiple linear regression analysis revealed that pregnant women with electronic screen exposure time more than 5 h per day (β = 2.02, 95%CI: 0.50-3.53, P < 0.05), no history of cesarean section (β = 2.66, 95%CI: 0.61-4.71, P < 0.05), likes sour food or hates greasy food (β = 1.75, 95%CI: 0.00-3.50, P < 0.05), anxiety (β = 0.50, 95%CI: 0.21-0.80, P < 0.05) and depression (β = 0.30, 95%CI: 0.04-0.57, P < 0.05) were more likely to have a greater level of FOC than their counterparts. However, a significantly lower level of FOC was observed in pregnant women who were multipara (β=-1.64, 95%CI: -3.27-0.01, P < 0.05), not worrying about delivery without family members (β=-3.75, 95%CI: -5.26-2.25, P < 0.001), had good family function (β=-0.32, 95%CI: -0.64-0.00, P < 0.05) and doctor-patient communication (β=-0.33, 95%CI: -0.64-0.02, P < 0.05).

CONCLUSIONS

The prevalence of FOC was high in Lianyungang city, Eastern China. FOC is influenced by multiple factors. There is an urgent need to develop interventions to reduce the prevalence of FOC in the third trimester of pregnancy, and to pay attention to pregnant women with risk factors for FOC.

Brazilian headache registry: methods and preliminary data of the pilot study

BACKGROUND

Evaluation and treatment of primary and secondary headaches is a global public health challenge. Recognizing the epidemiological impact of headaches, a group of researchers linked to the Brazilian Headache Society proposed the Brazilian Headache Registry and drew up its initial protocol.

OBJECTIVE

Here we describe the methods and preliminary data obtained from the pilot study.

METHODS

This was a multicenter longitudinal observational study conducted between September 2020 and August 2021. Prospective data were collected in three specialist centers for headache care in states in southern and southeastern Brazil. Patients aged 18 years or older who sought care for headache in tertiary centers and who agreed to participate in the study, were considered eligible.

RESULTS

Sixty-six patients were included in the pilot study: 43 (65%) from Rio Grande do Sul state and 23 (35%) from Minas Gerais state. Overall, 90% were female, and the subjects' mean age was 38.2 ± 11.2 years. Primary headaches accounted for 85.3% of the diagnoses made. Among secondary headaches, medication overuse headache was the most frequent type (7.1%).

CONCLUSIONS

The pilot study showed the feasibility of the research protocol developed for tertiary centers. The Brazilian Headache Registry will form a source of longitudinal data with the aim of contributing to better characterization of the various phenotypes of patients with primary and secondary headaches, and to detailing the use of health resources and identifying predictors of better clinical outcomes.

The effect of volunteer-led activities on the quality of life of volunteers, residents, and employees of a long-term care institution: a cohort study

BACKGROUND

The COVID-19 pandemic primarily impacted long-term care facilities by restricting visiting and circulation of visitors, affecting the quality of life (QoL) of older adults living in these institutions. Volunteer activities, essential for older adults' daily life, were also interrupted and potentially negatively impacted the QoL of older adults, volunteers themselves, and also employees in these institutions. In this context, this study aims to evaluate the impact of the return of volunteer-led activities in a long-term care institution on the QoL of older adult residents, employees, and volunteers.

METHODS

This study used a pre-test and post-test design within the same group. The first round of data collection was conducted before volunteer-led activities returned and the second round after 1 month of return. The instrument used to assess QoL was the EUROHIS-QoL-8 scale. This study was conducted within a nursing home in São Paulo, Brazil, created in 1937 by members of the Israeli community living in Brazil. Volunteer-led activities were part of residents' daily life before the COVID-19 pandemic, when these activities were interrupted for about 20 months. A total of 79 individuals participated in both rounds (pre and post), of which: 29 residents, 27 volunteers, and 23 employees of the long-term care institution.

RESULTS

Using a Wilcoxon signed-rank test, the analyses indicated improvements after the 1 month return in different QoL aspects for the three groups. Volunteers improved their personal relationships (Z - 2.332, p < .05), residents their overall health (Z - 2.409, p < .05) and employees in their overall QoL perception (Z - 2.714, p < .05). Influencing factors for residents were the number of activities (3 or more), gender (male), and education (undergraduate/graduate). For employees, those who assumed additional activities due to the volunteer-led activities interruption had a significant impact on their overall QoL.

CONCLUSIONS

Evidence from this study suggests that volunteers' return positively impacted different QoL aspects for volunteers, residents, and employees.

[Validity and reliability of the 8-item EUROHIS-QOL to assess Brazilian adults' quality of life]

The study evaluated the psychometric properties of the EUROHIS-QOL 8-item scale in Brazilian adults. The EUROHIS-QOL is a measurement of quality of life developed based on the generic instruments of WHOQOL-100 and WHOQOL-BREF. Based on data from a prospective cohort of 1,100 adults, participants in the baseline in 2006 and 2007, exploratory factor analysis, internal consistency, reliability, and discriminant validity were performed via multitrait-multimethod analysis, with the calculation of the average variance extracted (AVE). Confirmatory factor analysis was conducted with 573 of these participants in 2013 to 2018. Solutions were tested with one and with two factors named functional capacity and socioeconomic conditions. Both solutions presented good internal consistency and reliability. The correlation between the items was 0.535, and the AVE was 0.397 for solution with one factor, and 0.528 and 0.341 for factors one and two, respectively, indicating good discriminant validity in the bifactorial solution. Both factors had eigenvalues greater than one and factor loadings ranging from 0.398 to 0.915. The adjustment of the unifactorial solution presented: χ2 = 186 (g.l. = 18), p < 0.001, RMSEA = 0.128 (90%CI: 0.111-0.145), CFI = 0.960, TLI = 0.938, and SMRM = 0.042; while in the bifactorial presented: χ2 = 135 (g.l. = 17), p < 0.001, RMSEA = 0.110 (90%CI: 0.093-0.128), CFI = 0.972, TLI = 0.954, and SMRM = 0.035. Overall, the results provide reasonable evidence for the construct validity and reliability of the EUROHIS-QOL 8-item. Instruments with fewer items, as in our case, provide greater practicality and are ideal for use in population-based studies with extensive samples.

Quality of Life: Updated Psychometric Properties and New Norm Values in a Representative German Sample Focusing Socioeconomics and Mental Health

Objectives: Quality of life (QOL) is increasingly used as indicator in health research. The aim of this paper was an updated psychometric validation and a new standardization of the German version of the EUROHIS-QOL using a sample of the German general population assessed in 2021. The study focused on socio-economic characteristics and on anxiety and depressiveness as major indicators of mental health.

Methods: With 8 items, the EUROHIS-QOL is an economical instrument for self-assessment.

Results: Statistical tests revealed good psychometric properties. Gender- and age-group-specific norm values were calculated. The EUROHIS-QOL showed good discriminant validity for anxiety and depression symptoms. Participants without clinically relevant scores for depressiveness and anxiety reported significantly higher QOL. Multiple regression analysis showed that unemployment, younger age, not living with a partner, and an immigrant background were important predictors of lower QOL, whereas higher income, living in one’s own home, and a high level of education predicted higher QOL.

Conclusion: The EUROHIS-QOL was confirmed as an economical and reliable instrument for assessing QOL in the German general population.

Post-treatment Outcomes and Changes in Health Literacy of People Discharged from Specialist Substance Use Disorder Treatment Services

Health literacy comprises an individual’s ability to adequately access, understand and utilise health information, enabling effective navigation of the healthcare system. Low health literacy is a problem for people living with substance use disorders (SUDs). This study aims to examine whether health literacy changes for people discharged from specialist SUD treatment services. Two hundred thirty-one people recruited from residential SUD treatment services across New South Wales, Australia, completed a questionnaire upon entry into the service and again at 6 months post-treatment. Treatment outcomes were also measured. Three health literacy profiles were identified: lowest (n = 52, 22.5%), moderate (n = 111, 48.1%) and highest health literacy (n = 68, 29.4%). Lowest and moderate profiles showed improved health literacy at 6 months. However, the lowest profile still had significantly lower health literacy, quality of life and higher levels of psychological distress compared with participants in the highest profile at 6 months. People within the lowest health literacy profile improved, although they continued to experience lower health literacy and some poorer treatment outcomes. Health literacy interventions tailored for people within lowest health literacy profiles should be implemented and assessed for effectiveness within specialist SUD treatment services.

Protective factors against depressive symptoms among Brazilian healthcare workers during the initial stages of the COVID-19 pandemic: a cross-sectional study

OBJECTIVES

This study aims to assess the prevalence of depressive symptoms among healthcare workers and possible factors associated with this outcome (resilience, spirituality, social support, quality of life, among other individual variables). Our hypothesis is that some of these factors can have a protective effect on depressive symptoms.

DESIGN

Web-based cross-sectional survey.

SETTING

Participants were recruited online from 16 April to 23 April 2020.

PARTICIPANTS

1043 healthcare workers, predominantly Brazilians, aged 18 years or older.

PRIMARY AND SECONDARY OUTCOME MEASURES

Depression was the primary outcome, measured using the Patient Health Questionnaire-9 (PHQ-9). Possible protective factors were measured in the following ways: social support was assessed by the modified Medical Outcomes Study Social Support Survey (mMOS-SS); spirituality, religiousness and personal beliefs (SRPB) were evaluated using the 9-item SRPB module of the brief WHO Quality of Life instrument (WHOQoL-SRPB-bref); quality of life was assessed using the brief EUROHIS instrument for Quality of Life (EUROHIS-QoL 8-item); resilience was assessed using the 10-item Connor-Davidson Resilience Scale (CD-RISC 10).

RESULTS

23% met the criteria for depression according to the PHQ-9 scale. Quality of life (B=-3.87 (-4.30 to -3.43), β=-0.37, p<0.001), social support (B=-0.32 (-0.59 to -0.05), β=-0.04, p=0.022), resilience (B=-0.19 (-0.23 to -0.15), β=-0.20, p<0.001), SRPB (B=-0.03 (-0.05 to -0.02), β=-0.01, p<0.001) and physical exercise (B=-0.95 (-1.40 to -0.51), β=-0.08, p<0.001) demonstrated protective effects against depression.

CONCLUSION

Healthcare workers have a high risk of developing depressive symptoms during the COVID-19 pandemic, especially those working in the front line. However, there are factors that seem to work as protective mechanisms against depression, notably perceived quality of life.

A Short Form of the Child/Youth Health Care Questionnaire on Satisfaction, Utilization, and Needs in Children and Adolescents with a Chronic Condition (CHC-SUN-SF/YHC-SUN-SF)

We decided to develop a short-form of the CHC-SUN/YHC-SUN, a questionnaire aiming at assessing health care satisfaction of children and adolescents with chronic health conditions. Data analysis was based on samples from three different studies. Item selection involved statistical analysis and expert consensus. For independent validation purposes, we calculated descriptive statistics on single-item and composite-scale levels and applied classic test theory, confirmatory factor analyses, and correlation analysis to investigate the psychometric properties of the final short-form by different types of reliability and validity. Internal consistency (Cronbach’s Alpha) reached values of a = 0.89 (self-report) and a = 0.92 (parents report), split-half reliability values reached 0.85 (self-report) and 0.91 (parents report). Confirmatory factor analysis indicated no sufficient fit for the single factor solution, whereas the solution with three factors and one higher order factor indicated the best overall fit amongst three competing models. Validity of the short-form measure can be assumed, e.g., as indicated by its association with a single-item measure on general health care satisfaction. The short-form measures of the CHC-SUN for parents (CHC-SUN-SF) and the YHC-SUN self-report version for adolescents (YHC-SUN-SF) feature excellent psychometric performances, provide economical assessments, and are easy-to-administer questionnaires. They should be used whenever brief measures are needed for economic reasons.

Quality of life and its predictors among aging people in urban and rural Nepal

PURPOSE

We studied the quality of life (QoL) of the elderly in Nepal and their special needs. Nepal is a low- and middle-income country where the elderly population is growing significantly.

METHODS

A random selection of informants from the Kavre district was carried out in this cross-sectional, population-based, door-to-door survey. The district has a mixture of urban and rural communities. In Nepal, families generally take care of their elderly. Hardly any placement is made in institutions. A validated Nepali version of World Health Organization Quality of Life 8-question scale (WHOQoL-8) estimated QoL among the elderly (≥ 60 years; N = 439). Other variables of interest were socio-demographics, substance use, physical and psychological health, and family support. Depression was measured by Geriatric Depression Scale short form [GDS-15]. Due to a high illiteracy rate, a structured and culturally adapted questionnaire was presented in an interview format. The relationships between the variables and QoL were analyzed using independent sample t tests, linear regression and Pearson's correlations.

RESULTS

The mean QoL score was 25.7 (± 4.2); 49.2% rated their QoL as good. Positive predictors of QoL were: urban residence (p = 0.03); employment (p = 0.02); absence of chronic physical health problems (p = 0.02); absence of depression (p < 0.001); adequate time given by family (p = 0.001), and reports of non-abusive family relationships (p < 0.001). A negative correlation was found between geriatric depression and the QoL score (r = - 0.697; p < 0.001).

CONCLUSION

QoL of the elderly in Nepal may potentially improve by care directed towards their physical and psychological health, by strengthening family relations, and by financial independence.

Quality of life after stroke rehabilitation discharge: a 12-month longitudinal study

PURPOSE

To analyse trends in quality of life (QoL) development among older stroke patients within the first year after rehabilitation discharge, and to investigate the impact of including proxy interviews in research and practice.

METHODS

A prospective cohort study with follow-up at 3, 6, and 12 months with 411 patients and proxy respondents was conducted. The EUROHIS-QOL 8-item index was used to assess QoL. By performing descriptive analyses, QoL development over time was compared among subgroups. Linear mixed models were calculated to estimate mean changes from baseline to 12-month follow-up. The effects of patient characteristics and time on QoL were investigated using comprehensive mixed models.

RESULTS

One year after rehabilitation discharge, the majority of patients had neither maintained nor regained their initial QoL. Proxy respondents reported significantly lower QoL (22.6-29.5 points, p < 0.001). Characteristics associated with lower QoL were stroke severity, depression, and pain. Having a small social network was negatively associated with QoL (-1.66 points, 95%CI: -2.84/-0.48, p = 0.006).

CONCLUSIONS

Quality of life scores reported at the time of rehabilitation discharge are often not lasting. Including severely impaired patients via proxies reduces the risk of overestimating QoL outcomes. Outpatient's characteristics should be taken into account when planning therapy strategies to maintain previously achieved health goals. Regular re-assessments are required.Implications for rehabilitationThere should be an awareness that improvements in quality of life (QoL) achieved during rehabilitation are not sustainable.Regularly re-assessing pain status, psychological burden, and social network size could help clinicians to determine treatment strategies for maintaining and improving rehabilitation achievements.Conducting proxy interviews is required to assess disease burden of patients with severe stroke (e.g., non-linguistic patients).

Psychosocial aspects and self-reporting of cardiovascular diseases in Brazilian adults

The study aimed to evaluate the effect of psychosocial aspects on self-reporting of cardiovascular diseases (CVDs). The hypotheses were that psychosocial aspects have a direct or indirect effect on health behaviors, cardiovascular disease risk factors (CVDRFs) and CVDs. A cross-sectional population-based study was conducted with a representative sample of 1100 adults from the urban area of a medium-sized municipality in southern Brazil. Structured interviews were conducted using a standardized and pre-tested questionnaire. The psychosocial aspects included scales of resilience, quality of life, sense of coherence and social support. The outcomes were CVDs and CVDRFs measured by single items asking participants whether a physician had stated that they had heart disease, high blood pressure or high cholesterol/triglycerides or were overweight (BMI≥25 kg/m²). Data analysis was based on structural equation models. The final model exhibited good fit : (χ²[57] = 155, p < 0.001, root-mean-square error of approximation [RMSEA] = 0.042, confirmatory fit index [CFI] = 0.902 and standardized root-mean-square residual [SRMR] = 0.042). Consistent with our direct effect hypothesis, favorable psychosocial aspects were inversely associated with CVDRFS (β = -0.15, p = 0.011) and with CVDs (β = -0.10, p = 0.048). The indirect effect through health behaviors was not confirmed. The findings suggest that psychosocial aspects may influence the presence of self-reported CVDs or CVDRFS.

What are the prevalence and factors associated with sexual dysfunction in breastfeeding women? A Brazilian cross-sectional analytical study

OBJECTIVE

This study determined the prevalence and factors associated with sexual dysfunction in breastfeeding women.

DESIGN

Cross-sectional analytical study.

SETTING

Population-based study of individuals living in the northeast region of São Paulo state, Brazil.

PARTICIPANTS

From May to August 2017, 372 women aged ≥18 years were selected who gave exclusive, predominant or complementary breast feeding up to 23 months postpartum, and who did not have contraindications for the resumption of intercourse. Pregnant women, those diagnosed with mental health problems, users of medications that affect sexual function (antihypertensives, antidepressants or antipsychotics) and women unable to read or understand the instructions for the study were excluded.

PRIMARY AND SECONDARY OUTCOME MEASURES

The breastfeeding women completed the Female Sexual Function Index, the EUROHIS-QOL 8-item index and a questionnaire to collect participants' sociodemographic, clinical and interpersonal data. A bivariate analysis was performed, and variables with p values<0.20 were analysed by multivariate logistic regression.

RESULTS

Sexual dysfunction was present in 58.3% of the study population. Factors significantly associated with female sexual dysfunction (FSD) included placing a low importance on sexual intercourse (adjusted OR [AOR]=2.49, 95% CI=1.22 to 5.09), limited communication with the partner (AOR=2.64, 95% CI=1.43 to 4.86), decreased frequency of sexual intercourse (AOR=2.17, 95% CI=1.30 to 3.61) and low quality of life (AOR=2.23, 95% CI=1.33 to 3.74).

CONCLUSIONS

The prevalence of FSD appears with a great magnitude in breastfeeding women. The risk factors for sexual dysfunction are biopsychosocial and these findings may lead to improved counselling for prenatal and postnatal care.

Determinants of Female Sexual Function in Breastfeeding Women

Knowledge about the determinants of female sexual function in breastfeeding women is limited. A total of 355 breastfeeding women completed the Female Sexual Function Index (FSFI) and the Qol-8 quality of life questionnaire. FSFI scores decreased in the first six months of breast feeding. There was a positive relationship between FSFI scores and the importance of sex, level of communication, income, quality of life, and receiving brief sexual counseling.

Complete withdrawal is the most effective approach to reduce disability in patients with medication-overuse headache: A randomized controlled open-label trial

Background

Medication-overuse headache leads to high disability and decreased quality of life, and the best approach for withdrawal has been debated.

Aim

To compare change in disability and quality of life between two withdrawal programs.

Methods

We randomized medication-overuse headache patients to program A (two months without acute analgesics or migraine medications) or program B (two months with acute medications restricted to two days/week) in a prospective, outpatient study. At 6 and 12 months, we measured disability and headache burden by the Headache Under-Response to Treatment index (HURT). We estimated quality of life by EUROHIS-QOL 8-item at 2-, 6-, and 12-month follow-up. Primary endpoint was disability change at 12 months.

Results

We included 72 medication-overuse headache patients with primary migraine and/or tension-type headache. Fifty nine completed withdrawal and 54 completed 12-month follow-up. At 12-month follow-up, 41 patients completed HURT and 38 completed EUROHIS-QOL 8-item. Disability reduction was 25% in program-A and 7% in program-B ( p = 0.027). Headache-burden reduction was 33% in program-A and 3% in program-B ( p = 0.005). Quality of life was increased by 8% in both programs without significant difference between the programs ( p = 0.30). At 2-month follow-up, quality of life increased significantly more in program-A than program-B ( p = 0.006).

Conclusion

Both withdrawal programs reduced disability and increased quality of life. Withdrawal without acute medication was the most effective in reducing disability in medication-overuse headache patients.

Trial registration

Clinicaltrials.gov (NCT02903329).

The effect of the Contemporary Pilates method on physical fitness, cognition and promotion of quality of life among the elderly

Abstract Objective: to evaluate the effects of the Contemporary Pilates method on the physical fitness, cognition and quality of life of the elderly. Method: the Senior Fitness Test battery, the Vienna Test System and the EUROHIS QOL-8 quality of life questionnaire were used. The study group consisted of 16 elderly people and 27 classes of the Solo Contemporary Pilates method, held twice a week. To verify the normality of the data the Shapiro-Wilk test was used while the physical fitness and cognition variables were tested using the t-test for paired samples. Percentage analysis was performed for the quality of life variable and its dimensions. A significance level of 5% was adopted. Results: a significant difference (p <0.05) was observed in the variables: lower and upper extremity flexibility test (p=0.007), agility (p=0.001) and dynamic balance (p=0.001), aerobic endurance test (p=0.001) and Attention and Concentration test time (p=0.047). Conclusion: the Contemporary Pilates Method can improve the quality of life, physical fitness and reaction time of the elderly. It can be concluded that the Contemporary Pilates Method improves the health of the elderly, thereby helping to promote quality of life.