Adjunctive Brexpiprazole for Patient Life Engagement in Major Depressive Disorder: A Canadian, Phase 4, Open-Label, Interventional Study: Brexpiprazole d'appoint pour l'engagement dans la vie des patients souffrant de trouble dépressif majeur: une étude interventionnelle canadienne ouverte de phase 4

OBJECTIVES

To characterize the effects of adjunctive brexpiprazole on patient life engagement and depressive symptoms in patients with major depressive disorder (MDD) using patient-reported outcomes.

METHODS

An 8-week, Phase 4, open-label, interventional study was conducted at 15 Canadian trial sites between April 2021 and May 2022. Adult outpatients with MDD (at least moderately severe) and inadequate response to 1-2 antidepressants continued their current antidepressant and received oral adjunctive brexpiprazole 0.5-2 mg/day. Co-primary endpoints were change from baseline to Week 8 in Inventory of Depressive Symptomatology Self-Report (IDS-SR) 10-item Life Engagement subscale score, and IDS-SR 30-item total score. Safety was assessed by standard variables.

RESULTS

Of 122 enrolled patients, 120 (98.4%) were treated (mean [SD] dose: 1.2 [0.4] mg/day) and analyzed, and 111 (91.0%) completed the study. Statistically significant least squares mean improvements to Week 8 were observed on IDS-SR10 Life Engagement subscale score (baseline mean [SD]: 16.1 [4.7]; change [95% confidence interval]: -8.11 [-9.34, -6.88]; p < 0.001) and IDS-SR total score (baseline mean [SD]: 41.3 [9.8]; change [95% confidence interval]: -17.38 [-20.08, -14.68]; p < 0.001). Improvements were observed from Week 2, onwards. Treatment-emergent adverse events with incidence ≥5% were fatigue (n = 13, 10.8%), headache (n = 13, 10.8%), insomnia (n = 12, 10.0%), nausea (n = 9, 7.5%), tremor (n = 8, 6.7%), and weight increase (n = 7, 5.8%). Six patients (5.0%) discontinued due to adverse events. Mean (SD) change in body weight from baseline to last visit was +1.9 (3.4) kg.

CONCLUSIONS

Using an exploratory patient-reported outcome measure, patients with MDD and inadequate response to antidepressants who received open-label adjunctive brexpiprazole showed early and clinically meaningful improvement in patient life engagement, which should be further assessed in a prospective randomized controlled trial. Patient-rated depressive symptoms (on the validated 30-item IDS-SR) also improved. Adjunctive brexpiprazole was well tolerated, and no new safety signals were observed.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT04830215.

[The benefits of physical activity in the workplace for maintaining employee health]

Some jobs, particularly in the service sector, involve little physical activity on the part of employees. To improve their health, several areas or periods could be used to increase the amount of daily physical activity. Active transport to and from work is one such initiative, but physical activity can also be envisaged outside and during working hours. The aim of this article is to provide insights and research perspectives to better measure the importance of physical activity in the workplace.

Open-source Artificial Pancreas Systems Are Safe and Effective When Supported In-clinic: Outcomes in 248 Consecutive Type 1 Diabetes Clients

OBJECTIVE

Our aim in this study was to determine the safety, glycemia, and quality of life (QoL) associated with in-clinic installation and management of supported open-source artificial pancreas systems (SOSAPS) in type 1 diabetes (T1D).

METHODS

This investigation is a retrospective cohort study of consecutive SOSAPS users at a Canadian diabetes centre. SOSAPS were offered to all moderately tech-savvy T1D clients on sensor-augmented multiple daily injection or pump, able to pay for hardware, and willing to sign a consent and waiver document. SOSAPS were installed and maintained by clinic staff at no cost to clients. iPhone users were assigned to either Loop (n=108) or iPhone artificial pancreas systems (iAPS; n=114) and Android users to Android-type APS (n=24). Outcomes included severe hypoglycemia and diabetic ketoacidosis (DKA), time in range (TIR) 4.0 to 10.0 mmol/L, time below range (TBR) <4 mmol/L, glucose management indicator (GMI), mean sensor glucose (MSG), change in glycated hemoglobin (A1C), and QoL.

RESULTS

Two hundred forty-eight subjects (131 males, 117 females), with a mean age of 36 years and diabetes duration of 21 years, experienced 3 episodes of severe hypoglycemia and no DKA over a follow-up of 17 months. TIR rose by 16%, from 64% to 80% (p<0.0001); TBR fell by 1.0%, from 3.5% to 2.5% (p=0.001); MSG fell from 9.0 to 8.1 mmol/L (p<0.001); GMI fell from 7.3% to 6.7% (p<0.001); and A1C fell from 7.2% to 6.7% (p<0.0001). QoL scores were healthy before and improved after SOSAPS.

CONCLUSIONS

Clients with T1D using SOSAPS and supported with no-cost care to the client (software, technology, and physician/physician assistant) safely achieved improved TIR, GMI, A1C, and QoL.

[Improving the experience of racialized immigrant seniors in Quebec]

In Quebec, racialized immigrant seniors (AIRs) are a significant presence in long-term care facilities (CHSLDs) in the Greater Montreal area. To identify interventions that best meet their needs, this study interviewed 12 RIAs, including their families, about their experience in CHSLDs. The results show that RIAs face three challenges: food, clothing and play. Addressing these issues could improve their LTRCC experience.

Understanding Acceptability of Group Leisure Activities Used to Address Loneliness Among People Living With Dementia: An Exploratory Mixed-Methods Study

This mixed-methods complementarity study explored family members', friends', and health care providers' perspectives of acceptability of group leisure activities as an intervention for loneliness experienced by older adults living with dementia. A sample of 25 family members, friends, and health care providers of people living with dementia in ON rated the acceptability of group leisure activities (adapted Treatment Perception and Preference questionnaire) and discussed their ratings in an interview. Quantitative (descriptive statistics) and qualitative (conventional content analysis) results were integrated to understand acceptability. Participants viewed group leisure activities as effective, logical, and suitable for use with people living with dementia. Participants described the need for flexible programs, careful facilitation, and attention to activity selection. Group leisure activities were seen as low risk, but stigmas related to dementia could prevent participation. The findings inform the design of acceptable group leisure activities, promoting their use to address loneliness in people living with dementia.

Older Adults' Quality of Life in Long-Term Care: A Cross-Sectional Comparison Before and During the COVID-19 Pandemic

This study aims to assess changes in long-term care (LTC) residents' quality of life (QoL) before and during the COVID-19 pandemic. A pre-test post-test study of 49 QoL measures, across four dimensions from the interRAI self-reported QoL survey, was conducted. Secondary data from 2019 (n = 116) and 2020 (n = 128) were analysed to assess the change in QoL. A significant decline in 12 measures was observed, indicating a change in QoL of LTC residents during the pandemic. Social life was the dimension mostly affected with residents reporting less opportunities to spend time with like-minded residents, explore new skills and interests, participate in meaningful religious activities, and have enjoyable things to do in the evenings. Several measures of personal control, staff responsiveness and care, and safety also demonstrated a significant change. The results can inform future strategies for pandemic and outbreak preparedness. Balancing the safety of residents with attention to their QoL should be a priority moving forward.

Efficacy and Feasibility of the CO-OP Approach in Parkinson's Disease: RCT Study Protocol

Background. Parkinson's disease (PD) leads to cognitive dysfunction which limits participation and occupational performance. Cognitive Orientation to Daily Occupational Performance (CO-OP) approach is effective in other adult neurological populations and warrants investigation in PD. Purpose. To describe a study protocol evaluating the preliminary efficacy and feasibility of CO-OP approach in PD. Method. A randomised controlled trial (RCT) with adults with PD was assigned to either: CO-OP training-intensive (CO-OP-I, 20 sessions) or waitlist control (WLC) followed by CO-OP-standard (CO-OP-S, 10 sessions). Outcomes. Occupational performance and satisfaction of adults with PD in chosen goals. Measures will be obtained at baseline, post-intervention, and 3-month follow-up. Implications. As the first RCT focused on CO-OP in PD, this trial will provide evidence for the potential of this approach in PD and lay the groundwork for future large-scale trials. Trial Registration. Australian New Zealand Clinical Trials registry, ACTRN12621001483842. Registered November 1, 2021; retrospectively registered 3 months after commencement.

Feasibility of Mindfulness-Based Intervention for Veterans Managing Chronic Pain

Background. Chronic pain impacts people's activity participation, productivity, mental health, and sense of wellbeing. Purpose. This study aimed to (1) evaluate the feasibility of the Mindfulness-Based Chronic Pain Management (MBCPMTM) program on reducing pain perception and enhancing the quality of life, and (2) understand veterans' experience with the program. Method. The pretest-posttest single-group, mixed-methods design was used. Thirty-one veterans were offered the 12-week intervention. The Pain Catastrophizing Scale (PCS) and the Patient-Reported Outcomes Measurement Information System-29 were administered before and after the program. Focus groups and individual interviews were conducted to understand the experience. Findings. Participants' PCS scores improved (Z = -3.116, p = .002), but the pain intensity did not change significantly. Themes from qualitative data include: (1) We are not alone! (2) I have a sense of awareness, choices, and control; and (3) It does work! Implications. The study shows preliminary feasibility of MBCPMTM for veterans. This promising effect supports future rigorous testing of this intervention.

Barriers to Exercise in Adults With Type 1 Diabetes and Insulin Resistance

OBJECTIVE

Our aim in this study was to assess attitudes toward exercise and quality of life (QoL) in adults with type 1 diabetes (T1D) with and without insulin resistance (IR).

METHODS

We pooled baseline pretreatment data from a subset of individuals with T1D from 2 randomized controlled trials. Estimated glucose disposal rate (eGDR), a validated surrogate marker of IR, was calculated using an established formula to classify individuals according to IR status with a cutpoint of <6 mg/kg/min for the determination of IR. Self-reported barriers to exercise were obtained using a validated questionnaire, the Barriers to Physical Activity in T1D (BAPAD-1). In addition, QoL was determined using the 36-item Short Form (SF-36) questionnaire. Differences between dichotomized variables were assessed using the independent t test, Mann-Whitney U test, or Fisher exact test. Linear regression was employed to explore the association of eGDR with BAPAD-1 and QoL scores, with sequential adjustment for potential confounders.

RESULTS

Of the 85 individuals included in our study, 39 were classified as having IR. The mean BAPAD-1 total score was higher for individuals with IR (IR: 3.87±0.61; non-IR: 2.83±0.55; p<0.001). The highest exercise barrier scores for individuals with IR were risk of hypoglycemia (5.67±1.26) and risk of hyperglycemia (5.23±1.20), whereas the highest scoring exercise barrier scores for non-IR individuals were not diabetes-related, with low level of fitness (3.91±1.26) and physical health status, excluding diabetes (3.67±1.48), ranked highest. QoL scores were comparable between groups (p>0.05).

CONCLUSIONS

Risk of hypoglycemia was the greatest barrier to exercise in individuals with T1D with IR, whereas non-diabetes-related barriers to exercise were more salient in individuals with T1D without IR.

Associations of Diabetes-related and Health-related Quality of Life With Glycemic Levels in Adolescents With Type 1 Diabetes Preparing to Transition to Adult Care

OBJECTIVES

As adolescents with type 1 diabetes (T1D) progress to adulthood, they assume responsibility for diabetes self-management while dealing with competing life demands, decreasing parental support, and the transfer to adult care. Lower perceived quality of life (QOL) may hamper diabetes management, which is associated with suboptimal glycemic levels. Our objective was to determine associations of diabetes- and health-related QOL with glycemic management (glycated hemoglobin [A1C]) in adolescents with T1D before their transfer to adult care.

METHODS

We conducted a cross-sectional analysis of baseline data from the Group Education Trial to Improve Transition (GET-IT- T1D) in adolescents with T1D (16 to 17 years of age). Participants completed validated questionnaires measuring diabetes-related QOL (PedsQL 3.2 Diabetes Module) and health-related QOL (PedsQL 4.0 Generic Core Scales). Associations of QOL Total and subscale scores with A1C were assessed using linear regression models adjusted for sex, diabetes duration, socioeconomic status, insulin pump use, and mental health comorbidity.

RESULTS

One hundred fifty-three adolescents with T1D were included (mean age, 16.5 [standard deviation, 0.3] years). Diabetes-related QOL Total scores (adjusted β=-0.04; 95% confidence interval [CI], -0.05 to -0.02) as well as subscale scores for Diabetes Symptoms (adjusted β=-0.02; 95% CI, -0.04 to -0.00) and Diabetes Management (adjusted β=-0.04; 95% CI, -0.05 to -0.02) were inversely associated with A1C. Health-related QOL Total scores were not associated with A1C, but Psychosocial Health subscale scores were (adjusted β=-0.01; 95% CI, -0.03 to -0.00).

CONCLUSION

Our results suggest that strategies focussing on diabetes-related QOL and psychosocial health may help prepare adolescents for the increasing responsibility of diabetes self-care.

[A listening and psychological support line for people with MS]

The French Multiple Sclerosis Association offers a psychological helpline for people with this disease, their families, friends and caregivers. Two clinical psychologists answer this toll-free number, which is accessible seven days a week at set times. They offer callers active listening and adapted support, particularly after the announcement of the medical diagnosis and/or in times of difficulty. The space thus created for discussion allows them to address emotional or personal aspects, material situations, as well as questions and problems associated with the experience of the disease.

[Predictive factors for the level of knowledge, attitudes and quality of life of Tunisian diabetics : 1007 cases]

AIM OF THE STUDY

To study the predictors of knowledge level, attitudes and quality of life of type 1(T1D) and type 2 (T2D) Tunisian diabetics POPULATION AND METHODS: We undertook an analytical cross-sectional study. The questionnaire was administered in Arabic and contained a section collecting socio-demographic, clinical and diabetes-specific data. The following sections contained the Arabic-translated and validated versions of the "Simplified Diabetes Knowledge Scale", the "Diabetes Attitude Scale-3" and the "Diabetes Health Profile-18" to assess level of diabetes knowledge, attitudes towards the disease and diabetics' quality of life.

RESULTS

We collected 186 T1D (18.5%) and 821 T2D (81.5%) completed questionnaires. A good level of knowledge about diabetes was indicated in T1D patients by glycemic self-monitoring and by secondary and university education, urban housing, stable employment, insulin therapy and prior therapeutic education, while regular medical follow-up was of particular importance in T2DM patients. Smoking and diabetes complications were predictors of a negative attitude towards the disease in T1D and T2D respectively. Diabetics' Impaired quality of life was predicted by age < 40 years and a low level of knowledge about diabetes in T1D and by female sex, insulin therapy and a low level of knowledge about diabetes in T2D.

CONCLUSION

Predictors of the level of knowledge, attitudes and quality of life of diabetics may be a basis for establishing a therapeutic education program tailored to the different populations.

Association of health literacy with physical and mental health in people with chronic diseases

OBJECTIVE

to explore the association of health literacy domains with physical and mental quality of life in people with selected chronic diseases.

METHODS

Community-dwelling people with selected chronic diseases planned for immunization against influenza in 2017/2018 were included in the study. All non-vaccinated people and the corresponding number of randomly selected vaccinated people matched on town of residence were included. Data were collected by means of socio-demographic questionnaire, Health Literacy Questionnaire (HLQ) and Short Form-36 (SF-36). The Physical and Mental Composite Scores as well as their domains were observed as the study outcomes.

RESULTS

A total of 295 people were studied. The adjusted logistic regression showed that Physical and Mental composite scores were associated with all HLQ domains except 5) Appraisal of health information. Better Physical Functioning was associated with higher scores on 1) Feeling understood and supported by healthcare providers, 6) Ability to actively engage with healthcare providers, 7) Navigating the healthcare system and 8) Ability to find good health information. Better scores on Vitality, Social Functioning, Role Emotional and Mental Health were associated with higher scores on all HLQ domains except 5) Appraisal of health information.

CONCLUSION

Health literacy is important for physical and mental quality of life among people with chronic diseases. Health care providers and other stakeholders should continuously work to improve health literacy of their patients.

Identifying Primary Care Models of Dementia Care that Improve Quality of Life for People Living with Dementia and their Care Partners: An Environmental Scan

Dementia is a growing concern in Canada, affecting peoples' health and raising the cost of care. Between June and October 2019, we conducted an environmental scan to identify primary care models, strategies, and resources for dementia care from 11 pre-selected countries and assess their impact on quality-of-life measures. Search strategies included a rapid scoping review, grey literature search, and discussions with stakeholders. Eighteen primary care-based models of dementia care were identified. Common factors include team-based care, centralized care/case coordination, individual treatment plans, a stepped-care approach, and support for care partners. Five provinces had released a dementia strategy. Evidence of positive outcomes supported primary care-based models for dementia care, although only one model demonstrated evidence of impact on quality of life. Although these findings are encouraging, further research is needed to identify primary care-based models of dementia care that demonstrably improve quality of life for people living with dementia and their care partners.

[Depression in the elderly and the environment]

Depression in the elderly is difficult to identify because it is often masked by other pathological features. It is therefore important for everyone involved to be vigilant and to be able to ask for help from a qualified professional. The individual interacts with his or her human and material environment. The environment can be depressogenic. The quality of life of the person intervenes in the course of the depression.

[Évaluation de la qualité de vie et description des facteurs associés, chez les patients en insuffisance cardiaque chronique vivant dans un pays d'Afrique de l'Ouest à faible revenu]

OBJECTIVE

To assess the quality of life (QOL) and describe associated factors in patients with chronic heart failure (HF) living in a low-income population in West Africa.

METHODS

This is was a cross-sectional study conducted from January 2017 to June 2018, in the department of cardiology of the University Teaching Hospital (CHU-Campus) in Lomé (Togo). Enrolled patients had stable chronic HF and have been hospitalized in the past 6 months; QOL was assessed using the Minnesota Living with Heart Failure questionnaire (MLHFQ).

RESULTS

171 patients were included (women = 40.9%, 33% unschooled, 75% without health insurance; 46.8% in NYHA class II). The prevalence of depression was 62%. The mean total score of MLHFQ was 37.2 ± 22.3. In univariate analysis, there was a positive correlation between the total score and the following factors: age (r= 0.33, p ˂0.0001), NYHA classes (r= 0.67, p ˂0.0001), number of rehospitalizations (r= 0.61, p ˂0.0001), number of comorbidities (r= 0.43, p ˂0.0001), and the depression score (r= 0.67, p ˂0.0001). After adjustments, positive correlation persisted with NYHA classes (p ˂0.0001), number of rehospitalizations (p= 0.02), and depression (p ˂0.0001).

CONCLUSION

The QOL of HF patients was moderately impaired and was comparable to values reported among high-income populations. Factors associated with poor quality of life were advanced NYHA classes, number of rehospitalizations, and depression.

[Chronic obstructive pulmonary disease: somato-psychological dimensions]

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide and is a poorly understood lung disease. It is accompanied by significant psychological co-morbidities (anxiety, depression, identity and body image disorders) which are under-diagnosed and have an impact on quality of life and the frequency of  re-hospitalization. The management of COPD is multidisciplinary and its role is to prevent complications, relieve symptoms and slow the progression of the disease. Therapeutic education of the patient brings a real added value in this multidisciplinary management.

Prevalence and associated factors of lower digestive symptoms in type 2 diabetics in Tunisia

AIMS

To estimate the prevalence of lower digestive symptoms according to the Rome III criteria among diabetic patients of type 2, and second to identify the factors associated with the digestive symptoms among these subjects.

METHODS

A cross-sectional study was carried out among recruited diabetes mellitus type 2 patients from basic health centers at Sousse and Monastir (Tunisia). Diagnosis of digestive symptoms was based on Rome III criteria. We studied the influence of socio-demographic characteristics, life style, diabetes mellitus characteristics, somatization, psychological state (HAD scale) and quality of life (SF-12 scale) on the prevalence of digestive symptoms.

RESULTS

Four hundred and seventeen patients were enrolled in our study. The average age was 61.3±10.4 years with a female predominance (68.8%). The overall prevalence of digestive symptoms was 44.8%. The main digestive symptoms found were abdominal bloating (23%), diarrhea (11.7%), constipation (8.6%), irritable bowel syndrome (8.6%) and fecal incontinence (8.1%). Logistic regression showed that digestive intolerance (OR=2.28; 95%CI[2-5.31]), request care for a digestive problem (OR=2.95; 95%CI [1.49-5.83]), anti-acid treatment (OR=4.22; 95%CI [1.13-15.69]), diabetic retinopathy (OR=2.66; 95%CI [1.52-4.7]), somatization (OR=1.75; 95%CI [1.06-2.88]), and a deteriorated mental health state (OR=2.8; [1.66- 4.72]) were the independent factors associated with digestive symptoms.

CONCLUSION

Digestive symptoms cause an important request for care and have a negative impact on quality of life of diabetics. Thus digestive symptoms should be systematically diagnosed in patients with type 2 diabete.

[The expectations of families in Ehpad]

Taking into account the needs and expectations of families in residential care facilities for the dependent elderly (Ehpad) leads to their satisfaction with the care given to their institutionalized relative. A relational charter participate to prevent conflicts and misunderstandings between the various formal (caregivers) and informal (families) care providers at the bedside of residents. Families must feel invited to the Ehpad and recognized in their place in their role of care, at least relational. Some families, however, remain firmly anchored in an irrefragable hostility. Solidarity in the teams and the robustness of the care project are essential here.

[The right of elderly people in old people's homes to have a fulfilling emotional and sexual life]

The sexual life of elderly people living in residential institutions for the dependent elderly (Ehpad) is a sensitive subject that is rarely discussed. Particular difficulties sometimes arise when they have cognitive problems. Affectivity and sexuality in old people's homes must be approached with tact and maturity by the carers. Sexuality belongs to private life, but its excesses are difficult to reconcile with collective life. Some proposals can be made on ethical issues and on the relationship with residents and their families.

[Psycho-social experiences and quality of life of pacemaker patients in Cotonou]

PURPOSE OF THE STUDY

The aim was to study the psycho-social experiences and quality of life (QOL) of pacemaker patients at the National Teaching Hospital Hubert Koutoukou Maga in Cotonou.

PATIENTS AND METHOD

A descriptive cross-sectional observational study was performed in 2017 and included over a three-month period all pacemaker patients admitted on an ambulatory basis. The psychological impact of wearing a pacemaker was studied, as well as the limits and constraints of daily life and the quality of life appreciated by the SF-36 score.

RESULTS

Fifty-five (55) patients were included with an average age of 67 ± 11.3 years. In terms of psychological impact, 98.2% (n=54) had a good overall perception of their health status. However, 60.6% (n=33) perceived pacemaker use as a handicap and 52.5% (n=29) wanted psychological support in post-implantation. Limitations and constraints mainly concerned lateral decubitus on the side of the pacemaker (54.5%, n=30), travel (27.3%, n=15) and sexual relations (21.8%, n=12). The average quality of life was rated good in 6 out of 8 dimensions. The level of quality of life was independent of gender.

CONCLUSION

This study has highlighted misperceptions of daily life that may hinder the expected improvement in post-implantation patient performance. Psychological support and enhanced communication with these patients are needed.

[The management of cancer and its chronicisation, a major challenge for our health system]

The successive cancer plans mobilize health professionals by emphasizing personalized medicine that is accessible to all. This individualization of therapeutic care, along with major innovations in therapeutic tools, leads to the chronicization of certain cancers. A new situation that requires support for people affected by the disease during their treatment and also after in order to preserve autonomy, continuity and quality of life.

Prognostic value of Quality of life (QoL) assessment among Tunisian lung cancer patients

OBJECTIF

Etudier la valeur pronostique de l'évaluation de la qualité de vie (QDV) pour la survie chez les patients Tunisiens atteints du CDP. Méthodes: Une étude prospective de cohorte a été réalisée entre Janvier 2018 et Juin 2019. Le Performance status (PS), QoL questionnairecore30 (QLQ-C30), QoL questionnaire-Lung Cancer 13 (QLQ-LC13) et European QoL-5 dimensions-3level version questionnaire (EQ-5D-3L) ont été utilisés pour l'évaluation de la QDV. Les patients ont été divisés en 2 groupes selon le score global QLQ-C30, un Déficit Cliniquement Significatif (DCS) a été considéré si le score était ≤50. Les modèles de régression de Cox et Stepwise ont été réalisée pour évaluer la signification pronostique de la QDV. La survie globale (SG) a été calculée à l'aide de la méthode de Kaplan-Meier. Le test du log-rank a été utilisé pour comparer les courbes de survie. Le seuil de valeur de p pour la signification statistique était de 0,05. Résultats: Cent patients ont été inclus. La médiane de SG des patients avec DCS en qualité de vie était significativement inférieure à celle des patients sans déficit : respectivement 365 jours versus 467 jours, (test du log-rank, p = 0,036). De même pour la médiane de survie sans progression : 122 jours versus 326 jours pour ceux qui n'ont pas signalé de différence significative en QDV (test du log-rank, p = 0,05). L'analyse de régression multivariée stepwise a montré que le score global de QDV (QLQ-C30) était un facteur prédictif significatif de SG (coefficient estimate (CE)= 0.336, p=0.005), ainsi que le stade IV (CE=-0.193, p=0.033) et la progression tumorale (CE =-0.238, p=0.047).

CONCLUSION

La QDV était un facteur prédictif de survie dans notre cohorte de patients atteints de CDP. Cela devrait recommander une intervention active en soins palliatifs précoces pour les patients présentant un déficit significatif en QDV.

[Clinical research in the home as a tool for improving practice]

The quality of life in hospital at home has been very little described. In the "Feel'HAD" study, 488 patients completed an EQ-5D-3L questionnaire during a nursing visit. Neurological and geriatric pathologies were found to be the most degraded, even if there were strong disparities within the different types of conditions. This work has shown that beyond technical care, some people need more support, psychological care, comfort or social support. It led to concrete improvements in our practices and demonstrated that large-scale research is possible in the home.

Deficiency, incapacity and social disadvantage of patients with chronic hepatitis B: a case-control study

INTRODUCTION

Studies examining impairment, disability and social disadvantage of patients with chronic viral hepatitis B (CHB) are scarce and present conflicting conclusions.

AIM

To assess the deficiency, incapacity, and social disadvantage of patients with CHB.

METHODS

This is a project of a case-control study with two age-matched groups. Cases (n=27) will be untreated patients with a CHB. Controls (n=27) will be healthy participants. The following data will be collected: deficiency [anthropometric, biochemical (renal and hepatic functions, lipid balance, and inflammatory markers), haematological, virological, handgrip-strength, and spirometric data], incapacity [6-min walk distance, number of stops, oxy-haemoglobin saturation, dyspnoea (visual analogue scale), heart-rate, and blood-pressure] and social disadvantage ["chronic liver disease" and physical-activity questionnaires]. Each spirometric data < lower-limit-of-normal will be considered abnormal. A handgrip-strength <26 kg (male) or <16 kg (female) will be considered low. The signs of walking intolerance will be: stop during the walk, 6-min walk distance ≤ lower-limit-of-normal, dyspnoea at the end of the walk> 5/10, drop in oxy-haemoglobin saturation >5 points, heart-rate at the end of the walk ≤60%. A total physical-activity score <9.42 will classify the participant as sedentary.

EXPECTED RESULTS

Compared with controls, cases will have a marked alteration of submaximal aerobic data. These alterations will worsen quality-of-life and may be related to muscle and/or spirometric abnormalities, and supported by systemic inflammation and high viral load.

[Implementation of a support system for isolated elderly people to limit the consequences of the Covid-19 epidemic in Buenos Aires]

The Covid-19 pandemic with its associated quarantine and isolation has had a dramatic impact on the elderly. In order to mitigate this, the National University of La Plata and the Agence Universitaire de la Francophonie set up a health surveillance and early warning project for the elderly in Buenos Aires, Argentina. This interventional study, has included 1,964 people. A general health and quality of life questionnaire was completed by all participants at the beginning of the isolation, and another time a year later.

[Care pathway for the sickle cell child]

The management of sickle cell disease, the leading genetic disease in France, has made immense progress in recent years thanks to the creation of reference centres and multidisciplinary expertise. Pediatric mortality has almost disappeared, but the disease is still burdened with significant morbidity. The challenge for the coming years is to reduce this morbidity in order to improve quality of life and prevent chronic diseases, which occur mainly in adults.

[The place of therapeutic education in the care of the sickle cell patient]

Therapeutic education is an integral part of the management of sickle cell patients. It includes the medical aspects but also the psychological, family and social repercussions of their chronic disease. It allows, at every stage of the patient's life, a care practice centred on the patient as a subject by offering him tools to become an effective actor of the management of complications, in the search for an acceptable quality of life.

[Enjoying Sports and Movement in Mental Illness]

Enjoying Sports and Movement in Mental Illness Abstract. Sports and exercise therapy is an effective complemant in the treatment of major depression. The recommendations of at least 150 minutes of moderate or 75 minutes of intensive physical activity per week should be met to achieve positive effects of physical activity. In addition, individual needs and the physical health conditions must be considered in the planning and implementation, so that exercise will be enjoyed in the long term.

[Physical activity and quality of life with chronic disease]

After the diagnosis of a genetic disease, Fabrice Huré underwent dialysis and a kidney transplant, followed by graft rejection. Thanks to regular physical activity and night-time care, his living conditions, physical and mental capacities improved. Passionate about mountains and wide open spaces, he participated in the Grand Raid, on the island of Reunion. Testimonial.

[Evaluation of the quality-of-life of patients with pacemakers : experience of Burkina Faso about 120 patients paired with the collaboration of doctors from AUVERGNE (France)]

INTRODUCTION

In Burkina Faso, cardiac stimulation was introduced in October 2000 has grown over time.In orderto evaluate the effectiveness of stimulation on life, we proposed to evaluate the quality of life of patients with a pacemaker. GENERAL OBJECTIVE: to study the effect of the pacemaker on the quality of life of patients PATIENTS AND METHODS: This was a cross-sectional study aimed at describingthe wearers of a pacemaker for at least six months at the Yalgado OUEDRAOGO University Hospital and the Schiphramedical center.The AQUAREL questionnaire has been adapted to our context to establish a quality-of-life score.

RESULTS

The mean age of the study population was 68 years with a female predominance (53.3%). Complete atrioventricular block was the main indication of stimulation in 55%. The average duration of implantation was 41.6 months with extremes of 8 and 128 months. The primo implantation was found in 79.1 % of patients against 18.3 % for a first change of case and2.5 % for a second change of housing. Double chamber stimulation was performed in 65% of cases. DDD mode was the most used followed by VVIR. The average quality of life score was 90.12. Negative predictors of quality of life were age and female.A correlation between quality-of-life score and age, hypertension and dyslipidemia was found (p< 0.05). On the other hand, no correlation between the number of implantation, the duration of implantation and the mode of stimulation was found (p> 0.05).

CONCLUSION

patients with a pacemaker have a good quality of life. However, quality-of-life is not correlated with the number of pacemakers, nor the duration and mode of stimulation.

[Practice changes in the management of major paediatric haemophilia]

Recent therapeutic innovations are significantly changing the management of young children with severe haemophilia. A team from the University Hospital of Nice (06) introduced emicizumab, the first subcutaneous non-replacement therapy. Integrated into the multi-professional management of children and their families, this innovative therapeutic option has shown encouraging initial results. Experience sharing.

[Preventing elderly abuse]

While violence permeates society in many ways, it does not spare any age group. The elderly are particularly exposed to violence and abuse, especially in the current pandemic context, which they suffer without being able or daring to defend themselves. Within "Les Petits Frères des Pauvres" association, the support and advice unit for the fight against abuse is designed to support and assist, at their request, teams of volunteers and/or employees who are faced with the questionare wondering about the best choices to make in complex support situations when there is a suspicion of abuse.

Liens entre les besoins non satisfaits, la qualité de vie et les caractéristiques des survivantes de cancers gynécologiques en Indonésie

Les survivantes de cancers gynécologiques ont des besoins complexes très souvent négligés. La présente étude indonésienne vise à établir les liens entre les besoins non satisfaits, la qualité de vie et certaines caractéristiques particulières de ces survivantes. Au total, 298 participantes ont rempli le questionnaire sur les besoins non satisfaits des survivants au cancer (Cancer Survivor Unmet Needs ou CaSUN), le questionnaire sur la qualité de vie EORTC QLQ-C30 ainsi que les questionnaires démographiques et cliniques. L'étude, réalisée suivant un devis corrélationnel transversal, a établi un lien entre les besoins non satisfaits et la dégradation de la qualité de vie perçue. Plusieurs facteurs sont associés à l'augmentation des besoins insatisfaits: patients jeunes, revenu moindre, niveau d'éducation moyen, diagnostic récent, stade avancé de la maladie, et polythérapie (p < .05). Chez les survivantes indonésiennes d'un cancer gynécologique, le soutien financier (70,5 %) constitue le besoin le plus souvent insatisfait. À la fin des traitements primaires, elles ont besoin de soins globaux et continus pour gérer les problèmes, nouveaux comme anciens, causés par le cancer et le traitement.

The Role of Volunteers in Enhancing Resident Quality of Life in Long-Term Care: Analyzing Policies that May Enable or Limit this Role

Research has shown that long-term care (LTC) volunteers play important roles in enhancing the quality of life (QoL) of older LTC residents, often through providing unique forms of relational care. Guided by Kane's QoL domains, we used a modified objective hermeneutics method to analyze how unique volunteer roles are represented and supported in provincial policies in Alberta, British Columbia, Ontario, and Nova Scotia. We found that policies define volunteer roles narrowly, which may limit residents' QoL. This happens through (1) omitting volunteers from most regulatory policy, (2) likening volunteers to supplementary staff rather than to caregivers with unique roles, and (3) overemphasizing residents' safety, security, and order. We offer insights into promising provincial policy directions for LTC volunteers, yet we argue that further regulating volunteers may be an inadequate or ill-suited approach to addressing the cultural, social, and structural changes required for volunteers to enhance LTC residents' QoL effectively.

Validation Study and Outcomes of the Diabetes Quality of Life in Youth Instrument in Haitian Youth With Type 1 Diabetes Residing in Haiti

OBJECTIVES

Health-related quality of life (HRQL) in type 1 diabetes is a critical health outcome but has not been studied in many low-income countries. In this study we evaluated the validity of 2 HRQL instruments, measured the HRQL and explored the association between HRQL and glycemic control.

METHODS

This was a cross-sectional study of Haitian youth with diabetes between 0 and 25 years of age and living in Haiti. We administered the 51-item Diabetes Quality of Life in Youth (DQOLY) questionnaire and the EuroQol Visual Analogue Scale (EQ-VAS). Psychometric analyses evaluated internal consistency and construct validity of the DQOLY and its 21-item short form, the DQOLY-SF. Linear regression was used to identify predictors of HRQL and glycated hemoglobin (A1C).

RESULTS

In 85 youth (59% female; mean age, 17.5 years; mean diabetes duration, 3.7 years; mean A1C, 11.3%), DQOLY and DQOLY-SF had adequate internal consistency with Cronbach's alpha values of 0.86 and 0.84, respectively. Confirmatory factor analysis revealed adequate validity for the DQOLY-SF and DQOLY Satisfaction subscale. HRQL, as measured using the DQOLY-SF, was 62±16 (mean ± standard deviation) out of 100. Mean EQ-VAS score was 78±24 out of 100. Older age (p=0.004), female sex (p=0.02) and lower socioeconomic status (SES) (p=0.03) were risk factors for lower DQOLY score, and older age (p=0.02) and marginally female sex (p=0.06) for lower DQOLY-SF score. No predictors of EQ-VAS were identified. HRQL measures were not associated with glycemic control.

CONCLUSIONS

The DQOLY-SF and DQOLY Satisfaction subscale are valid measures of HRQL in Haitian youth with diabetes. HRQL is low and was worse in older, female and low-SES youth, but was not associated with glycemic control.

[Nursing management of patients with intrathecal pumps in oncology]

Some pains, especially in oncology, are refractory to standard analgesics. Epidural analgesia is an efficient way to manage them. It allows the patient to be relieved, to improve his quality of life and the conditions of his return home or in an institution. The nurse has a very important role in the therapeutic education of the patient, the follow-up of the management, the accompaniment of the family and the anticipation of these needs.

Return to Work and Quality of Life in Disease-Free Adult Patients with Soft-Tissue and Bone Sarcoma of the Extremity

Treatment of extremital sarcoma patients may be associated with significant functional disabilities and psychosocial distress affecting return to work (RtW) and quality of life (QoL). In this exploratory study we prospectively investigated the RtW rate, explored biomedical and psychosocial predictors of RtW, and compared generic QoL with Swiss population norms. Forty people (89 %) returned to work. Full-time employment before sarcoma diagnosis, high educational level, and low tumor grade showed an increased probability of RtW. The median age was lower in patients who returned to work, and they reported less fear of progression. Generic QoL (SF-36) was reduced in almost all dimensions when compared to a normative Swiss population. Physical functioning and fear of progression have to be addressed in the rehabilitation process.

Insulin Pump Therapy Improves Quality of Life of Young Patients With Type 1 Diabetes Enrolled in a Government-Funded Insulin Pump Program: A Qualitative Study

BACKGROUND

The Nova Scotia Insulin Pump Program (NSIPP) subsidizes the cost of insulin pump therapy for young patients (≤25 years) with type 1 diabetes. The first NSIPP evaluation focused on clinical outcomes rather than quality of life. Existing research on insulin pumps and quality of life is mostly survey based, with limited first-voice experiences. In this qualitative study, we examined patient and parent perspectives on how insulin pumps affect quality of life in the context of a government-funded program.

METHODS

In this investigation, we used a phenomenological approach, guided by a conceptual model. In-depth semistructured telephone interviews (median, 37 minutes) were completed with NSIPP enrollees and/or their parents. Saturation was reached after 23 interviews. Verbatim transcripts were coded independently by 2 researchers. Coding discrepancies were discussed and resolved using concept mapping to clarify relationships between codes and to identify main themes.

RESULTS

There were 2 main themes: 1) NSIPP financial support was necessary for those without private insurance and 2) control over life and diabetes with subthemes of social experiences and worry. Participants expressed this theme differently depending on their stage of life. For example, some children experienced shame and even hid their pump, whereas teens were more self-confident with the discreetness of pumps and young adults wore their pump with pride.

CONCLUSIONS

Insulin pump therapy, subsidized through the NSIPP, led to improved quality of life, which was experienced differently depending on stage of life.

Peer Support Added to Diabetes Education Improves Metabolic Control and Quality of Life in Mayan Adults Living With Type 2 Diabetes: A Randomized Controlled Trial

BACKGROUND

Yucatán, located in the southern region of Mexico, is the state with the country's highest prevalence of uncontrolled diabetes. Because of its particular cultural and socioeconomic characteristics, the residents of Yucatán face unique health-care challenges. The objective of our study was to evaluate the effect of peer support added to a diabetes education program on glycemic control and diabetes-related quality of life when compared with a conventional diabetes education program in patients with type 2 diabetes in a Mayan community in Mexico.

METHODS

In March 2015, a total of 58 participants with a previous diagnosis of type 2 diabetes who were recruited from community health centres in Komchén were randomly assigned in equal numbers to 1 of 2 groups: 1) a peer support and diabetes self-management education group (PSEG) or 2) a conventional diabetes self-management education-only group. The primary outcomes of interest were glycated hemoglobin (A1C) values and diabetes-related quality of life. The majority of subjects were bilingual (Mayan and Spanish speakers), female and middle aged, and had a low level of formal education and high baseline A1C (mean, 8.7%).

RESULTS

Whereas both groups showed significant improvements from baseline to study end in absolute levels of A1C, the PSEG group had a more pronounced clinical improvement, but no statistical improvement, in A1C compared with the conventional diabetes self-management education-only group. PSEG participants exhibited statistically significant improvement in diabetes-related quality of life at 8 months.

CONCLUSIONS

Our study demonstrates the benefits of peer-support education above and beyond the impact of diabetes self-management education on diabetes-related quality of life in an underserved Mayan community in Mexico.

[Normal sensory aging]

Normal aging can be defined as the result of the effects of genetic and environmental factors to which subjects are exposed throughout their lives. This process is slow and progressive and must be distinguished from disease. All organs are subject to aging in a physiological way.

[Vision pathologies]

The prevalence of visual impairment increases very significantly with age. The most common visual pathologies with aging are: Age-related Macular Degeneration, Cataracts, Glaucoma, Diabetic Retinopathy. Given their consequences on autonomy and quality of life, it is important to have regular ophthalmological monitoring, to identify and at best prevent these pathologies which can be disabling.

Influence of Frailty Status on Pain, Disability, and Quality of Life in Older Adults with Acute Low Back Pain: Results from the Back Complaints in the Elders (BACE-Brazil) Study

A cross-sectional analysis was conducted using data from a prospective cohort study to investigate whether frailty is associated with pain intensity, disability caused by low back pain (LBP), and quality of life in an older population with acute non-specific LBP. Six hundred and two individuals with a mean age of 67.6 (standard deviation [SD] 7.0) years were included in the analysis. In relation to frailty status, 21.3 per cent of the sample were classified as robust, 59.2 per cent were classified as pre-frail, and 19.5 per cent were classified as frail. In the unadjusted analysis, pre-frail and frail groups showed significantly higher pain and disability scores than the robust group. Moreover, the same two groups exhibited lower scores in both physical and mental domains of quality of life than the robust group. After adjusting for socio-demographic and clinical variables, disability scores and the physical component of quality of life were significantly associated with frailty. In older adults with acute LBP, frailty is associated with more disability and worse scores in the physical component of quality of life.

Subclinical Inflammation Is Associated With Reductions in Muscle Oxygenation, Exercise Capacity and Quality of Life in Adults With Type 2 Diabetes

OBJECTIVES

Exercise capacity is related to both morbidity and mortality in patients with type 2 diabetes (T2DM). The aim of this study was to investigate the relationship between subclinical inflammation level, exercise capacity, muscle oxygenation and quality of life in T2DM.

METHODS

This study includes 28 patients with T2DM (mean age, 51.5±5.0 years; male-to-female ratio, 6:22). Exercise capacity was evaluated using an incremental symptom-limited maximal exercise test on a bicycle ergometer. Muscle oxygenation was investigated using a wearable lactate-measuring device. Diabetes-specific quality of life was assessed using the Diabetes Quality of Life Questionnaire (DQOL). Subclinical inflammation was assessed using C-reactive protein (CRP) levels.

RESULTS

CRP level was negatively correlated with peak workload during the test (r=-0.588, p=0.002), muscle oxygenation (r=-0.465, p=0.019) and the psychological impact of treatment subscale of the DQOL (r=-0.540, p=0.017), and positively correlated with body mass index (r=0.519, p=0.008), waist circumference (r=0.426, p=0.038) and fat percentage (r=0.573, p=0.004). There was no correlation between CRP and fasting blood glucose or glycated hemoglobin level (p>0.05). Peak workload was inversely related to fat percentage (r=-0.467, p=0.016) and the DQOL worry about the future impact of diabetes subscale (r=-0.501, p=0.021).

CONCLUSIONS

In our study, subclinical inflammation negatively affected muscle oxygenation, exercise capacity and quality of life independently of glycemic indicators. Our findings suggest that the degree of glycemic control is insufficient to explain lower exercise capacity. Further studies are needed to investigate subclinical inflammation-reducing interventions in T2DM.

[Elderly heart failure patient, quality or quantity of life?]

Heart failure is a serious and common disease in the elderly. It causes repeated hospitalizations with a progressive overall decline. It is often difficult at an advanced stage of the disease to "choose" between quality and quantity of life for both patients and their families and caregivers. A reflection conducted at the Centre for Clinical Ethics of the Assistance publique-Hôpitaux de Paris can help to make progress on these difficult choices.

Cardiac rehabilitation is associated with greater improvements in psychological health following coronary artery bypass graft surgery when compared with percutaneous coronary intervention

Following coronary revascularization, patients treated with coronary artery bypass graft surgery (CABG) have lower risk of major adverse cardiovascular events when compared with those treated with percutaneous coronary intervention (PCI). We compared changes in cardiovascular risk factors, such as psychological and cardiometabolic health indicators, among patients who completed cardiac rehabilitation (CR) following CABG and PCI. Longitudinal records of 278 patients who completed an outpatient CR program following CABG or PCI were analyzed. We compared changes in anxiety and depression assessed by the Hospital Anxiety and Depression Scale (HADS); health-related quality of life (HR-QoL) measured by the Medical Outcomes Study Short Form-36 (SF-36); and indicators of cardiometabolic health (i.e., body mass, blood pressure, glucose, and lipid profiles) between CABG and PCI groups using analysis of covariance (ANCOVA). At baseline, patients treated with PCI (n = 191) had superior physical function (i.e., physical functioning: 62.5 ± 22.1 vs. 54.3 ± 23.0 points, p = 0.006; and role limitations due to physical health: 31.2 ± 36.8 vs. 20.6 ± 31.8 points, p = 0.024) when compared with those treated with CABG (n = 87). Following CR, patients treated with PCI showed significantly smaller improvements in depression (-0.4 ± 3.1 vs. -1.3 ± 2.7 points, p = 0.036) and mental HR-QoL (mental component summary: 2.4 ± 10.8 vs. 5.7 ± 10.7 points, p = 0.020) when compared with those treated with CABG. Novelty Patients with coronary artery disease treated with PCI have smaller functional limitations but similar psychological health when compared with those treated with CABG at CR enrollment. Patients participating in CR following PCI appear to achieve smaller psychological health benefits from CR when compared with those recovering from CABG.

[Ethical décision making and septic shock]

Nurses can contribute to the decision-making process in emergency situations in cases of septic shock, particularly if the patient has not drawn up advance directives and/or nominated a health care proxy. They can undertake or facilitate the collective decision making on the legal and ethical level. The team's habitus in terms of ethical analysis and the gathering of initial data can help to ensure the patients wishes are respected.

[Cystic fibrosis, growing and living better through sport]

For more than twenty years, the association "Étoiles des neiges" has placed sport at the heart of its actions and promotes its practice adapted for all: children, teenagers, adults and transplant patients. If in 1999, when it launched its projects, young people suffering from cystic fibrosis were rather exempt from sport, since then it has been recognized as one of the pillars of its care. The association deploys its Sport projects to all the CRCMs in France.

[Psychological impact of Wii-empowerment in hospitalized elderly patients who fall: pilot study]

Falls have serious psychological consequences in senior citizens. The practice of Wii, «Wii-habilitation», among senior fallers hospitalized in follow-up care and rehabilitation, improves their quality of life, but without impacting their fear of falling and self-esteem.

Interactive Effects of Quality of Life and Related Factors on Alcohol Use Outcomes

This investigation derives its impetus from public health concerns around detecting, mitigating, and preventing the deleterious effects that alcohol use can cause particularly in advanced age. We aim to complement gerontological research by exploring the interactive effects of quality of life and related factors on alcohol use outcomes assessed by the Drinking Problem Index. The study is based on cross-sectional data collected from questionnaires mailed to a randomly drawn sample of 6,000 Norwegian adults aged 62 and older (participation rate: 32%). According to the Chi-square Automatic Interaction Detection (CHAID) analysis, constellations of interactive factors emerged differently for women and men, and, between non-problem and problem drinkers. For women, drinking outcomes were related to intra-psychic functioning, and for men, to physical health and social situation. An ongoing quality-of-life assessment may be very important in the comprehensive assistance provided to those older people who are vulnerable to undergoing alcohol-related harms.