Health-related quality of life in chronic fatigue syndrome: predictors of physical functioning and psychological distress

This study investigated health-related quality of life (HRQoL; physical functioning and psychological distress) in an Australian chronic fatigue syndrome (CFS) population. The aims of the study were to compare HRQoL in those with CFS to the normal population, and to investigate the extent to which sociodemographic (age, gender, partner status, education), illness-related (illness duration, symptom frequency), and fatigue severity (physical, mental) variables predicted HRQoL. A total of 139 people meeting CFS criteria completed questionnaires. HRQoL was assessed using standardised measures of distress and physical functioning. Compared with norms, those with CFS obtained significantly lower scores on all physical functioning areas, whereas 63% of participants reported clinically significant psychological distress. Hierarchical regression analyses indicated that physical fatigue severity and symptom frequency were the strongest predictors of deficits in physical domain HRQoL. Physical HRQoL outcomes were also predicted by mental fatigue severity, older age, and female gender. All predictors were unrelated to psychological distress apart from weak positive associations with physical fatigue and symptom frequency. Results identify a potent set of predictors of HRQoL and show that CFS has a pervasive negative impact on quality of life, particularly physical and psychological functioning.     

Does Posttraumatic Growth Buffer the Association Between Death Anxiety and Quality of Life Among People living with HIV/AIDS?

People living with HIV (PLWH) may experience death anxiety (DA), which can be detrimental to quality of life. Posttraumatic growth (PTG), however, is antithetical to DA, with its positive attributes at odds with negative psychosocial outcomes. Previous research has not examined the buffering effect of PTG on the association between DA and quality of life. Therefore, in addition to the direct effects of DA and PTG on health-related quality of life (HRQoL), we investigated the moderating role of PTG on the relationship between DA and HRQoL among people living with HIV/AIDS (PLWH) in Nigeria. Using cross-sectional design and availability sampling method, we selected 201 outpatients (men, n?=?63, 31.3%, women, n?=?138, 68.7%, mean age?=?40.1, SD?=?10.5) managed for HIV/AIDS in a Nigerian tertiary healthcare institution. Death Anxiety Inventory-Revised, Posttraumatic Growth Inventory-Short Form, and Patient-Reported Outcome Quality of Life-HIV were used to access DA, PTG and HRQoL, respectively. Results showed that while adjusting for socio-demographic factors (age, gender, time since diagnosis and educational status), DA was associated with physical health, mental health and social relationships domains of HRQoL as well as overall HRQoL. In contrast, PTG did not evidence significant association with HRQoL dimensions and overall HRQoL. The moderation effect of PTG on the association between DA and HRQoL was not supported. Independent of PTG, alleviating DA may be an important target in terms of therapeutic intervention towards improving quality life of PLWH.

     

Coping and social support and health related quality of life in women with breast cancer in Turkey

This study aims to investigate the role of social support and coping in explaining health related quality of life (HRQoL) among Turkish breast cancer patients. A cross-sectional sample of 188 women from three hospitals in Turkey completed the Multidimensional Scale of Perceived Social Support, the Ways of Coping Inventory, and the Short Form 36 Health Survey. Socio-demographic and medical information was also collected. Results indicated high HRQoL levels, with 7 of the 10 SF-36 scores being within 1 SD of population mean. Correlations showed that helplessness coping was inversely associated with HRQoL whereas social support, religious coping, optimistic coping and problem focused coping were positively associated with HRQoL. Multiple regressions indicated that time since diagnosis, time since operation, stage of cancer, post-operative treatment, social support and problem solving coping were significant predictors of HRQoL accounting for 54.7% to 46.4% of the variance in physical and emotional HRQoL. Coping and social support have an independent effect on HRQoL over and above sociodemographic and medical variables and should be targeted by appropriate interventions.     

Predictors of Health-Related Quality of Life over Time Among Adolescents and Young Adults with Sickle Cell Disease

Little is known about what factors affect the health-related quality of life (HRQoL) of adolescents and young adults (AYAs) with sickle cell disease (SCD), and how their HRQoL changes over time. This retrospective study included 87 AYAs attending a SCD Adolescent Clinic who completed a measure of HRQoL at each visit over the course of approximately 1.3 years. Results suggested that the following were associated with poorer physical HRQoL: being female, more healthcare utilization events, and presence of internalizing symptoms. Internalizing and externalizing symptoms were the only factors correlated with poorer psychosocial HRQoL. Generalized linear mixed models indicated that physical and psychosocial HRQoL improved among all participants during the assessment period, and those with externalizing behaviors reported faster improvement in physical HRQoL over time. AYAs with SCD may benefit from early mental health screening and intervention to optimize clinical care.     

Analysing the Simultaneous Relationship Between Life Satisfaction and Health-Related Quality of Life

This paper aims to examine whether life satisfaction and health-related quality of life (HRQoL) are simultaneously related, as well as to quantify the bias that occurs if simultaneity is not accounted for. The study sample consisted of 870 respondents, representative of the Spanish adult general population. Using a simultaneous equations system —with the satisfaction with life scale (SWLS) and the SF-6D index as outcome variables—, we found a simultaneous association between life satisfaction and HRQoL, although this relationship is heterogeneous in individual characteristics such as age and sex. More important, the fact of estimating the relationship between life satisfaction and HRQoL under a unidirectional approach severely underestimates the effect of life satisfaction on HRQoL and, to a lesser degree, the reverse direction effect. In consequence, policy decisions intended to improve satisfaction with life or HRQoL can be wrong if they rely on unidirectional estimates. Another relevant implication of this research is that, as a result of the simultaneous relationship between life satisfaction and HRQoL, not only health interventions may increase satisfaction with life, but also policies that improve life satisfaction can lead to positive side effects on HRQoL.     

Emotions and physical health in the second half of life: interindividual differences in age-related trajectories and dynamic associations according to socioeconomic status

The importance of socioeconomic status (SES) for psychological functioning over the life span is increasingly acknowledged in psychological research. The Reserve Capacity Model by Gallo and Matthews (2003) suggests that SES is not only linked to physical health but also to the experience of positive and negative emotions. Moreover, due to differential amounts of psychosocial resources, cross-domain associations between emotions and health might differ according to SES. The present study examined age-related developments in positive affect (PA), negative affect (NA), and physical health, as well as dynamic associations between health and emotions in the second half of life. We looked at differences in these trajectories and their interrelationships according to education as one aspect of SES. We used data of up to three waves spanning 12 years from the nationally representative German Ageing Survey (N = 3,847, AgeT1 = 40-85 years). Applying multiple-group dual change score models, we found differential age-related change in PA and physical health, but not in NA, in two groups differing in level of education. NA did only predict change in physical health in low-educated individuals, whereas physical health was equally strongly related to change in PA in both education groups. These results indicate that SES not only affects changes in physical health and emotional functioning but also their interrelationships.     

Ambulatory assessment for physical activity research: State of the science,best practices and future directions

Technological and digital progress benefits physical activity (PA) research. Here we compiled expert knowledge on how Ambulatory Assessment (AA) is utilized to advance PA research, i.e., we present results of the 2nd International CAPA Workshop 2019 “Physical Activity Assessment – State of the Science, Best Practices, Future Directions” where invited researchers with experience in PA assessment, evaluation, technology and application participated. First, we provide readers with the state of the AA science, then we give best practice recommendations on how to measure PA via AA and shed light on methodological frontiers, and we furthermore discuss future directions. AA encompasses a class of methods that allows the study of PA and its behavioral, biological and physiological correlates as they unfold in everyday life. AA includes monitoring of movement (e.g., via accelerometry), physiological function (e.g., via mobile electrocardiogram), contextual information (e.g., via geolocation-tracking), and ecological momentary assessment (EMA; e.g., electronic diaries) to capture self-reported information. The strengths of AA are data assessments near real-time, which minimize retrospective biases in real-world settings, consequentially enabling ecological valid findings. Importantly, AA enables multiple assessments across time within subjects resulting in intensive longitudinal data (ILD), which allows unraveling within-person determinants of PA in everyday life. In this paper, we show how AA methods such as triggered e-diaries and geolocation-tracking can be used to measure PA and its correlates, and furthermore how these findings may translate into real-life interventions. In sum, AA provides numerous possibilities for PA research, especially the opportunity to tackle within-subject antecedents, concomitants, and consequences of PA as they unfold in everyday life. In-depth insights on determinants of PA could help us design and deliver impactful interventions in real-world contexts, thus enabling us to solve critical health issues in the 21st century such as insufficient PA and high levels of sedentary behavior.     

Using national survey data incorporating the theory of planned behavior: Implications for social marketing strategies in physical activity

Abstract

This paper illustratesthe potential use of the Theory of Planned Behavior (TPB) as a guiding fiamework for the conduct of population based survey research to develop strategies to promote physical activity involvement in various market segments. The Campbell's Survey of Well-Being (1988), a nation-Wide representative study of the Canadian population incorporated a modified operationali- zation of the TPB Pertainingto intended involvement in regularphysical activity. The theory was found to be generally effitive in munting for intentions in the general population (Rz= .32)as well as in various age and gender subgroups. Whereas, neither the model's direct predictors of intentions (e.g., attitudes, sub jective normdsocial support, perceived behavioral control) nor the indirect predictors (e.g., the beliefs underlying these predictors) varied consistently across gender, a number of age-related differenceswere observed. These differencesare used to exemplify how population-based data utilizing the TPB can be utilized to develop promotional and programming implications for fostering greater physical activity involvement in various ag-ender market segments.     

Sociodemographic and Lifestyle Correlates of Health-Related Quality of Life in Croatian University Students

The purpose of this study was to assess the health-related quality of life (HRQoL) in a sample of Croatian university students and to determine its association with sociodemographic and lifestyle characteristics. The study was conducted on a random sample of 1750 students in Zagreb, Croatia. We used the 12-item Short-Form Health Survey (SF-12v2) and separate questions on sex, age, body mass index (BMI), settlement size, disposable income, cigarette consumption, alcohol consumption, and exercise frequency. The HRQoL scale on which Croatian students scored the highest was Physical Functioning. High mean scores were also found for other physical health measures, while the scores in mental health scales were somewhat lower. Male students scored significantly higher than females on all SF-12 scales (p?<?0.05). The regression analysis showed that Physical Component Summary score (PCS) is negatively related to BMI (partial r?=??0.09) and cigarette consumption (partial r?=??0.06), and positively related to alcohol consumption and exercise frequency (partial r?=?0.08, for both), while Mental Component Summary score (MSC) is positively related to BMI (partial r?=?0.07) and exercise frequency (partial r?=?0.10). Although HRQoL-scores for the Croatian students were higher than in the general population of Croatia and student populations in several other countries, there is still room for improvement, especially in the mental health aspect. In general, HRQoL was found to be significantly lower among females and smokers, but positively related with exercise frequency. In order to improve students’ HRQoL, university authorities should consider initiating health-promotion programs with emphasis on females, smokers and non-exercisers.     

Speech and Language Difficulties Along with Other Child and Family Factors Associated with Health Related Quality of Life of Australian Children

Speech and/or language difficulties (SaLD) can potentially compromise a child’s health-related quality-of-life (HRQoL). Very few studies have examined associations between SaLD, other child and family factors and HRQoL and none have been undertaken in Australia. We explore these associations using data from a nationally representative Australian sample of 4–5 year old children, extracted from the Longitudinal Study of Australian Children (LSAC) (n?=?4386). The Disability-Stress-Coping Model informed variable selection. Three domains of HRQoL were examined, and assessed on physical, emotional and social functioning subscales of the Pediatric Quality of Life Inventory (PedsQL). SaLD measures included parent concern about speech/language (Parents’ Evaluation of Developmental Status) and receptive vocabulary ability (adapted Peabody Picture Vocabulary Test-III). Multiple regression analyses revealed that various child and family factors representing all constructs from the Disability-Stress-Coping Model were significantly associated with HRQoL. Specifically, HRQoL was positively associated with parental warmth and child’s general health and negatively associated with parent speech/language concerns and maternal depression across all domains. Parents with concerns about their pre-school child’s speech and language rate the quality of their child’s health more poorly across physical, emotional and social domains. Associations between parent speech/language concerns and HRQoL were notable for being apparent in a (non-clinical) population sample and for persisting independent of factors such as maternal depression, parenting style and the child’s general health.     

Longitudinal Associations Between Parental SES and Adolescent Health-Related Quality of Life Using Growth Curve Modeling

We evaluate how two aspects of socioeconomic status, parental objective and subjective social status, are associated with health-related quality of life in three racial/ethnic groups during pre- to mid-adolescent development, using growth curve modeling. In a longitudinal cohort study, 4,048 Black, Latinx, or White adolescents were assessed in 5th, 7th and 10th grade. Objective social status (OSS) was based on parent-reported highest household educational attainment and total household income, and subjective social status (SSS) was measured with the MacArthur Scale, through which parents indicated their social standing in reference to community and national norms. Adolescents completed the Pediatric Quality of Life Inventory to measure their physical and psychosocial health-related quality of life. Based on growth curve modeling of the intercept, adolescents whose parents have higher OSS levels reported better health-related quality of life, whereas parental SSS was not associated with adolescent health-related quality of life in 5^th grade. These findings were largely consistent across racial/ethnic groups. Based on growth curve modeling of the developmental slopes (or growth curves), higher objective social status was associated with a slower positive growth of health-related quality of life from 5^th to 10^th grade, which was largely consistent across racial/ethnic groups. The opposite appeared for parental SSS and physical health-related quality of life, and only for Latinx, where higher parental perceived social status was associated with an acceleration of positive change. Family income and education may influence health-related quality of life at the start of adolescence, but its effect appears to diminish as youth mature. However, in Latinx youth, parents’ perceived social status may continue to influence improvement in their physical health-related quality of life as they mature.

     

Effects of lifestyles and the Mediterranean diet on elderly people’s quality of life according to gender / Efectos de los estilos de vida y la dieta mediterránea en la calidad de vida en personas mayores en función del género

Abstract

Health-related quality of life (HRQoL) has been associated with certain eating habits, such as the Mediterranean diet (MD) and lifestyles. However, the specific role of gender in this association is not yet known. The objective of this study was to analyse the relationship between the consumption of the MD essential foods and lifestyle (tobacco and alcohol consumption and exercise) with the HRQoL of 340 elderly people aged over 60 living in the Spanish Mediterranean area. The results show a better HRQoL in males. Compared to females, the lifestyles of males include a moderate consumption of alcohol and tobacco in addition to a greater frequency of physical activity. The predictive models of HRQoL were also different between males and females, as the influence of lifestyles and MD were greater in males. These results are clinically useful for the designing of programmes that promote successful ageing as they can be specified for sex.     

The Relationship Between Religious Beliefs and Quality of Life Among Patients With Multiple Sclerosis

Patients with chronic diseases, such as multiple sclerosis (MS), are prone to emotional distresses and reduction in life quality more than others. This study aimed to assess the relationship between religious beliefs and quality of life among patients with MS. In this study, 145 MS patients completed 36-Item Short-Form Health Survey (SF-36) and the Duke University Religion Index (DUREL) questionnaires. The results indicated that unorganized religious activities were significantly associated with marital status and education level. Besides, internal religion was positively correlated to mental health. However, religious variables were not effective prognostic factors in physical and mental quality of life. Overall, further studies have to be conducted to determine the role of religion in quality of life of MS patients with different religious backgrounds.

     

Perceived positive and negative consequences after surviving cancer and their relation to quality of life

Surviving childhood cancer has multiple implications on both physical and psychological domains of the individual. However, its study and possible effects on health‐related quality of life (HRQoL) outcomes of adolescent survivors has been understudied. The objective of this study was twofold; to assess positive and negative cancer‐related consequences (psychosocial and physical) in a sample of adolescent cancer survivors and to explore their relationship with HRQoL outcomes. Forty‐one participants answered two questions about positive and negative consequences in the aftermath of cancer and filled in the KIDSCREEN‐52 self‐reported version. Data were analysed using mixed methods approach. Overall, 87.8% of the studied sample identified positive consequences and 63.4% negative consequences in survivorship. Four positive categories and five negative categories with regard to cancer‐related consequences were found. Changed perspectives in life narratives seem to be the positive consequence more related to HRQoL (physical well‐being, mood & emotions, autonomy, social support & peers), followed by useful life experience (physical well‐being, autonomy, social support & peers). Psychological impact was the most referred negative consequence with a significant detrimental effect on social support and peers HRQoL dimension. Even if the majority of survivors reported benefit finding in the aftermath of cancer, concomitant positive and negative consequences have been found. However, findings only reveal a significant relationship between positive narratives and HRQoL, and negative consequences do not seem to have a significant influence on overall HRQoL in survivorship.     

Within-person association of volitional factors and physical activity: Insights from an ecological momentary assessment study

ObjectiveCurrent health behavior models of physical activity (PA) suggest that not all PA intentions are translated into actual PA behavior, resulting in a significant intention-behavior gap (IBG) of almost 50%. These models further suggest that higher self-efficacy and specific planning can aid in decreasing this gap. However, as most evidence stems from between-person (trait level), questionnaire-based research, it is unclear how large short-term IBGs are, how self-efficacy and planning covary within-persons across time and whether they similarly predict smaller IBGs. It is likely that day-to-day changes in circumstances and barriers affect these variables thus the applicability of theoretical models is uncertain. Here, within-person prospective analyses of ecological momentary assessment (EMA) data can provide insights.Methods35 healthy participants (aged 23–67) completed four EMA-based questionnaires every day for three weeks. Each prompt assessed PA (retrospectively, “since the last EMA prompt”); PA intentions, planning specificity, self-efficacy, and intrinsic motivation (prospectively, “until the next EMA prompt”) and momentary affect. Generalized logistic mixed-effect modeling was used to test predictors of PA.ResultsAcross the 2341 answered EMA prompts, PA intentions were not enacted in 25% of the episodes (IBG). In episodes with given intentions, PA likelihood increased with higher levels of self-efficacy, planning specificity, and intrinsic motivation. The latter two also positively predicted PA duration and intensity.ConclusionsShort-term intention behavior gaps seem to be smaller than what is known from more long-term studies, most likely as individuals can anticipate the actual circumstances of PA. Further, current health behavior models show validity in explaining within-person dynamics in IBGs across time. Knowing the relevance of planning specificity, self-efficacy and intrinsic motivation for day-to-day variations in PA enactment can inform respective real-time mHealth interventions for facilitating PA.     

Estimating the Religious Composition of All Nations: An Empirical Assessment of the World Christian Database

The international religious data in the World Christian Database (WCD), and its print predecessor, the World Christian Encyclopedia (WCE) have been used frequently in academic studies and the popular press. Scholars have raised questions about the WCD's estimates categories, and potential bias, but the data have not yet been systematically assessed. We test the reliability of the WCD by comparing its religious composition estimates to four other data sources (World Values Survey, Pew Global Assessment Project,CIA World Factbook, and the U.S. Department of State), finding that estimates are highly correlated. In comparing the WCD estimates for Islamic countries and American Christian adherents with local data sources, we identify specific groups for which estimates differ. In addition, we discuss countries where the data sets provide inconsistent religious estimates. Religious composition estimates in the WCD are generally plausible and consistent with other data sets. The WCD also includes comprehensive nonreligious data. Recommendations regarding the use of the WCD are given.     

Apathy is associated with lower mental and physical quality of life in persons infected with HIV

HIV infection is associated with lower health-related quality of life (HRQoL), which is influenced by immunovirological factors, negative affect, neurocognitive impairment, and functional dependence. Although apathy is a common neuropsychiatric sequela of HIV infection, emerging findings regarding its unique role in lower HRQoL have been mixed. The present study was guided by Wilson and Cleary's (1995), model in examining the association between apathy and physical and mental HRQoL in 80 HIV+ individuals who completed a neuromedical examination, neuropsychological assessment, structured psychiatric interview, and a series of questionnaires including the SF-36. Apathy was measured using a composite of the apathy subscale of the Frontal Systems Behavioral Scale and the vigor-activation subscale of the Profile of Mood States. Independent of major depressive disorder, neurocognitive impairment, functional status, and current CD4 count, apathy was strongly associated with HRQoL. Specifically, apathy and CD4 count were significant predictors of physical HRQoL, whereas apathy and depression were the only predictors of mental HRQoL. All told, these findings suggest that apathy plays a unique role in HRQoL and support the importance of assessing and managing apathy in an effort to maximize health outcomes among individuals with HIV disease.     

Health-Related Quality of Life in a National Sample of Caregivers: Findings from the Behavioral Risk Factor Surveillance System

Purpose Recent national public health agendas, such as Healthy People 2010, call for improved public health surveillance and health promotion programs for people with disabilities and their caregivers. The goal of this study was to understand the public health impact of caregiving on health-related quality of life (HRQoL) using population-level data. Design & Methods A cross-sectional study design was used. 184,450 adults surveyed during the 2000 national Behavioral Risk Factor Surveillance System survey formed the sample. Binary logistic regression models ascertained differences between caregivers and non-caregivers in reporting reduced (“fair” or “poor”) health. Ordinary least squares regression (OLS) and multinomial logistic regression models examined the influence of caregiving status on HRQoL, measured as categories of healthy days reported in the last 30 days and the number of days reported as physical and mental health not good in the last 30 days. Results Sixteen percent (16%) of the survey respondents were caregivers. There was an interaction effect between caregiving status and age of the caregiver. In the fully adjusted models, caregivers <55 years old had a 35% increased risk of having fair or poor health (odds ratio [OR] = 1.35, 95% confidence interval [CI] 1.28, 1.43) as compared to non-caregivers in that age group, while caregivers 55 years and older had a 3% decreased risk in having fair or poor health (OR = 0.97, 95% confidence interval [CI] 0.92, 1.03) compared to non-caregivers of the same age. In the adjusted models that examined the association of caregiving and healthy days, younger caregivers similarly showed larger deficits in both mental and physical HRQoL compared to older caregivers. For example combining mental and physical days, caregivers <55 had 1.44 fewer healthy days (β = −1.44, standard error (SE) = 0.07), while caregivers 55+ had 0.55 fewer days *β = −0.55, standard error (SE) = 0.13 (compared to non-caregivers in their respective age groups). Implications With increasing population age and the projected increase in caregivers, it is important that we understand the social and public health burden of caregiving and begin to identify interventions to sustain the HRQoL of caregivers. We found that caregivers have a slight to modest decline in HRQoL compared to non-caregivers, and that caregiving affects the HRQoL of younger adults more than older adults. Further research at the population level as to the type and level of burden of caregiving is needed.     

Comparing Quality of Life Instruments in a Population of Abused Women

The SF-36 Health Survey and the WHO Quality of Life Index—BREF (WHOQOL-BREF) were used to study quality of life among women who had experienced intimate partner violence (IPV). The aim was to determine how these instruments correlated with each other and with physical and psychological IPV, in order to find the best instrument to use. IPV was measured using the Severity of Violence against Women Scale (SVAWS) and the Psychological Maltreatment of Women Index (PMWI). A self-administrated questionnaire was given to women able to understand Norwegian who were staying at a women’s shelter in Norway for more than 1 week. 87 of 212 women asked to participate completed the questionnaire. The physical acts of violence in SVAWS correlated significantly (P<0.001) with both the general health and bodily pain dimensions in SF-36 and global overall health (OH) in WHOQOL-BREF. Most correlations between WHOQOL-BREF and SF-36 were moderate. The WHOQOL-BREF domains explained 46% of the variance in OH and 40% of the variance in the global overall quality of life (OQOL). The SF-36 domains explained 66% of the variance in OH and 27% of OQOL. The mean WHOQOL-BREF and SF-36 scores were all low. The SF-36 correlated better with physical and psychological IPV in this population than the WHOQOL-BREF. The significant correlations between the OH, general health and bodily pain domains and acts of violence show the importance of including questions concerning bodily symptoms in determining the quality of life in a population of abused women.     

Religiosity and Social Support: Implications for the Health-Related Quality of Life of African American Hemodialysis Patients

The purpose of this study was to determine whether sociocultural differences have any effect on the health-related quality of life among African American hemodialysis patients. This study examined relationships between religiosity, social support, and the health-related quality of life of African American hemodialysis patients. Four hemodialysis units were selected for the study. The study population consisted of 176 African American hemodialysis patients who had been receiving hemodialysis treatments for at least 1 month. The religiosity variable was measured by the Measure of Religious Involvement. Social Support was measured by the Medical Outcomes Study Social Support Survey, and health-related quality of life was measured by the Medical Outcomes Study 36 Short Form Health Survey (SF-36v2). The investigators found that social support contributed to the emotional and physical health of African American hemodialysis patients in the sample, whereas religiosity was inversely related to the physical health of these patients.