Predictive factors of quality of life in acquired brain injury

Background/ObjectiveThe sequelae and the disability and dependence that follow an acquired brain injury (ABI) may result in a significant reduction in the quality of life (QoL) of those affected. The objective was to assess the QoL of a sample of Spanish patients with an ABI and analyze the influence of certain sociodemographic and injury-related variables on their QoL. Method: The sample comprised 421 adults (60% male; M_age = 53.12; SD = 14.87). Professionals and relatives assessed the patients’ QoL through the CAVIDACE scale, an ABI-specific tool based on the eight-domain QoL model. Results: Univariate analyses showed statistically significant differences in the QoL scores in several sociodemographic (age, civil status, education level, prior employment status, type of home, level of supports, loss of legal capacity, recognized dependence, and degree of dependence) and injury-related (time since the injury, location of the injury, and presence of post-traumatic amnesia) variables. The multiple linear regression showed that loss of legal capacity, time since the injury, prior employment status, location of the injury, and degree of dependence were significant QoL predictors. Conclusions: These findings provide knowledge for the development of programs aimed at reducing the negative impact of ABI on QoL.     

Sense of coherence,resilience, and habitual optimism in cancer patients

Background/ObjectiveThe aim of this study was to investigate whether the three resource variables sense of coherence, resilience, and dispositional optimism become impaired when people are ill with cancer, whether there are sex and age differences in these variables, and how these variables are associated with quality of life (QoL).MethodA sample of 1108 patients with mixed cancer diagnoses were examined using the Sense of Coherence Scale-3 (SOC-3), the Brief Resilience Scale (BRS), the Life Orientation Test (LOT-R), and the QoL questionnaire EORTC QLQ-C30.ResultsThe three resource variables showed somewhat lower levels in the patients’ sample in comparison with general population controls, with effect sizes between ?0.10 and ?0.23. While there were only small sex differences in the resource variables, significant age differences were found in these variables, with stronger detriments in younger patients. The correlations among the resource variables ranged between .53 and .61. Sense of coherence was more strongly correlated with QoL than resilience and optimism.ConclusionsCancer patients with low levels of personal resources adapt to their disease more poorly than patients with high levels. In addition to limitations in QoL, health care professionals should also consider patients’ resources for coping with the disease. Special attention should be given to young cancer patients.     

Parenting and the dysregulation profile predict executive functioning in children with acquired brain injury

Background: Children with acquired brain injury (ABI) present with high rates of psychological disorders commonly accompanied by deficits in hot and cold executive functions (EFs). Impairments in EFs have been reported to precede mental health problems. Moreover, children who are vulnerable to developing mental health problems in adulthood frequently present with a dysregulation profile in childhood, characterized by impairments in cognitive, behavioral and emotional regulation. Objective: To identify profiles of behaviors associated with impairment in hot and cold EFs and compare injury factors, environmental stressors and dysregulation profile between them. Methods: A latent profile analysis was conducted with 77 children with ABI aged between 6 and 12. Injury factors, child IQ, environmental stressors and the dysregulation profile were compared between these behavioral profiles. Logistic regressions were conducted to predict profile membership. Results: Two profiles were identified: Profile M, with mild deficits (1–2 SD above the mean) in working memory and social skills, and profile C, presenting clinically significant deficits (2–3 SD above the mean) in shift, initiate, working memory, planning and social skills and mild deficits in inhibit, emotional control and task monitor. Proximal environmental stressors (dysfunctional parenting practices, parental stress, parent’s executive dysfunction, anxiety-trait, and depressive symptoms) and dysregulation symptoms predicted profile membership, whereas injury factors, child IQ and distal environmental stressors did not. Conclusion: Following ABI, children with profile C are at risk of mental health problems and present with more proximal stressors. The dysregulation profile may be useful as a proxy for risk for later mental health problems in children with ABI.     

Effects of guided imagery with relaxation training on anxiety and quality of life among patients with inflammatory bowel disease

Background: Inflammatory Bowel Disease (IBD) impacts quality of life (QoL). Psychological factors influence the course of the disease and should be targeted for intervention.

Methods: Our study was a prospective, randomised control trial. Fifty-six outpatients were randomly chosen and allocated to a treatment group or a waiting-list control group. Treatment group patients attended three relaxation-training sessions and received an audio disc for home practice. Evaluations performed pre and post-treatment: state anxiety was assessed with the State-Trait Anxiety Inventory, QoL with the IBD Questionnaire. The Visual Analogue Scale assessed pain, depression, stress and mood. Patients completed a symptom monitoring diary. The control group's symptoms were monitored without study-related treatment.

Results: Thirty-nine subjects completed the study and were included in the data analysis. Following the relaxation-training intervention, the treatment group's (n?=?18) measured results showed a statistically significant improvement as compared to the control group (n?=?21) (time by treatment interaction): anxiety levels decreased (p?<?0.01), QoL and mood improved (p?<?0.05), while levels of pain and stress decreased (p?<?0.01).

Conclusions: Findings indicate IBD patients may benefit from relaxation training in their holistic care. New studies as well as further investigation of the subject are warranted.     

Changing unbalanced coping profiles-A prospective controlled intervention trial in worksite health promotion

Abstract

Effective coping is based upon a broad variety of available strategies and a good balance between instrumental and palliative coping efforts. Thus, stress management training (SMT) should focus on broadening and balancing individual coping-profiles. This study investigated changes in coping profiles after participation in SMT at the worksite. The sample consisted of 82 healthy working persons who participated in a 12-week-SMT and 55 matched controls without intervention. The SMT consisted of six training elements: three of them (assertiveness, cognitive restructuring and time management) addressed instrumental coping and the other three (relaxation, physical activity and scheduling of pleasant activities) focussed on palliative coping. All subjects filled in standardized questionaires on coping, well-being and strain before and after the training. Cluster analyses performed on initial coping scores resulted in a 3-cluster solution: (1) “active flexible coping” (n = 53), (2) “problem-focused coping” (n = 40) and (3) “resignative avoidant coping” (n = 44). Analyses of covariance revealed that SMT-participants of Cluster 2 showed significant improvements regarding emotion-focused coping and those of Cluster 3 regarding problem-focused coping compared to controls of the same cluster. There were also significant associations between these clusterspecific changes of coping and improvements of well-being. In consequence, the SMT improved coping by supplementing one-sided initial coping-profiles.     

A randomized controlled trial of expressive writing in breast cancer survivors with lymphedema

Objective: Breast cancer survivors who develop lymphedema report poorer quality of life (QoL) than those without lymphedema. Expressive writing is a potential intervention to address QoL.

Design: Adult women (N = 107) with breast cancer and chronic Stage II lymphedema were randomised to writing about thoughts and feelings specific to lymphedema and its treatment (intervention) or about daily activities (control) for four, 20-min sessions.

Main Outcome Measures: Outcome measures were several indicators of QoL assessed at baseline, one, three, and six months post-intervention (total scores and subscales of Upper Limb Lymphedema 27 and Functional Assessment of Cancer Therapy–Breast). Hypothesised moderators of change in QoL were dispositional optimism, avoidant behaviours, and time since lymphedema diagnosis.

Results: There was no statistically significant intent-to-treat main effects of expressive writing on QoL. Statistically significant moderating effects on change in different indicators of QoL were observed for all three moderators. Expressive writing was more effective for improving QoL in women who were higher on optimism, lower on avoidance and had less time since a lymphedema diagnosis.

Conclusion: These results provide further evidence that there are subsets of individuals for whom expressive writing is more effective. Future research may investigate targeting expressive writing based on identified moderators.     

Hostility and quality of life among Hispanics/Latinos in the HCHS/SOL Sociocultural Ancillary Study

Objective: The purpose of this study was to determine if hostility is associated with physical and mental health-related quality of life (QoL) in US. Hispanics/Latinos after accounting for depression and anxiety.

Methods: Analyses included 5313 adults (62% women, 18–75 years) who completed the ancillary sociocultural assessment of the Hispanic Community Health Study/Study of Latinos. Participants completed the Center for Epidemiological Studies Depression Scale, Spielberger Trait Anxiety Scale, Spielberger Trait Anger Scale, Cook–Medley Hostility cynicism subscale and Short Form Health Survey. In a structural regression model, associations of hostility with mental and physical QoL were examined.

Results: In a model adjusting for age, sex, disease burden, income, education and years in the US., hostility was related to worse mental QoL, and was marginally associated with worse physical QoL. However, when adjusting for the influence of depression and anxiety, greater hostility was associated with better mental QoL, and was not associated with physical QoL.

Conclusions: Results indicate observed associations between hostility and QoL are confounded by symptoms of anxiety and depression, and suggest hostility is independently associated with better mental QoL in this population. Findings also highlight the importance of differentiating shared and unique associations of specific emotions with health outcomes.     

The Perception of Persons with Anorexia Nervosa on Quality of Life: an Initial Investigation

Anorexia nervosa (AN) is an illness with a large impact on an individual’s quality of life, affecting relationships with friends and family, social inclusion, employment, personal development, and physical health, among other domains. However, most QoL studies primarily focus on health-related QoL without paying attention to the psychosocial and subjective aspects of QoL. In this study, QoL in persons with AN is investigated from a broad perspective. More specifically, this study aims at (1) gaining insight into the personal meaning of QoL of persons recovering from AN, (2) specifying the indicators of the QoL model of Schalock (J Intellect Disabil Res 48(3):203–216, 2004) for persons with AN, and (3) exploring the relationship between a specific treatment program and the perception on QoL of persons with AN. Therefore, in-depth interviews were conducted with 17 persons recovering from AN, who are supported by Empathie, a therapeutic center in Flanders, using solution-focused therapy and client-centered therapy, combined with a systemic orientation. The participants spontaneously mentioned the following themes when asked which elements are important to have a good QoL: interpersonal relationships, personal development, being able to relax, self-determination, and having a healthy lifestyle. Each domain of the QoL model of Schalock was operationalized into specific indicators for persons with AN. These indicators can help service providers to tailor their support strategies to the needs of each patient. The participants reported that being in therapy had positively influenced the following domains: interpersonal relationships, emotional well-being, self-determination, and social inclusion.     

Impact d’une prise en charge par hypnose sur le vécu et l’observances des recommandations hydriques en hémodialyse : résultats d’un protocole à cas unique chez deux patients

IntroductionHemodialysis is associated with dietary and fluid restrictions, which can be a source of frustration, suffering and non-compliance in many patients. Hypnosis, a booming therapeutic tool in the health field, could improve patients’ feelings. The objective of this study is to assess the effect of hypnosis on fluid restrictions experience.MethodThe effectiveness of the hypnotic intervention was evaluated using a single-case protocol (ABA type) with two patients. A protocol in 3 phases of 3 weeks was used with three sessions of hypnosis. Several measurement tools have been used: the KDQoL-36 for quality of life, the Health-Specific Self-Efficacy Scales (adapted for dialysis patients) for self-efficacy, and numeric scales for therapeutic compliance and thirst.ResultsSome significant changes were observed with maintenance of the effects after hypnosis: improvement in the global quality of life for patient 1, improvement of self-efficacy (barrier) for patient 2. The visual analysis showed improvements but without significant effect as alleviation of thirst and discomfort, improvement of perceived compliance.ConclusionThese preliminary results concerning the effects of hypnosis on the experience of fluid restrictions are mixed reflecting variability between patients. However, these results are encouraging and show the need to continue this evaluation with more patients thanks to the advantages of the single-case protocol method.     

The feasibility,reliability and validity of the EORTC QLQ-C30 in assessing the quality of life of patients with a symptomatic HIV infection or AIDS (CDC IV)

Abstract

The objective of this study was to evaluate the feasibility, reliability and validity of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (the QLQ-C30) in a longitudinal study of the quality of life (QoL) of patients with a symptomatic HIV infection or AIDS. The OLQ-C30 is a 30-item questionnaire composed of five functional subscales. 3 symptom subscales, an overall QoL subscale, and a number of additional single item symptom measures. The questionnaire was administered serially to a sample of 156 Dutch patients. The average time to complete the questionnaire was less than 11 minutes, with most patients requiring no assistance. With one exception (role functioning subscale), the data supported the hypothesized scale structure of the questionnaire. Eight of the 9 subscales met or approached the minimal criterion for reliability (Cronbach's alpha ≤ .70) at baseline and/or follow-up. The validity of the QLQ-C30 was supported by 3 findings: (1) the correlations observed among the subscales. while statistically significant, were of only a moderate magnitude, indicating that distinct components of QoL are being assessed; (2) a number of the subscales could discriminate clearly between patients differing in stage of disease and in Karnofsky Performance Status; and (3) significant changes in QLQ-C30 scores in the expected direction, were observed over time. These results lend support to the QLQ-C30 as a reasonably reliable and valid instrument for assessing the QoL of patients with HIV infection. Additional research is needed to improve the role functioning subscale. to evaluate the QLQ-C30's concurrent validity by comparing it with other available QoL instruments, and to examine more thoroughly its responsiveness to clinically important changes in patients' health status over the entire disease and treatment trajectory.     

Quality of Life and Bladder Management post Spinal Cord Injury: A Systematic Review

To explore the relationship between neurogenic bladder management techniques and quality of life (QoL) among individuals with spinal cord injury (SCI). A key terms literature search was conducted in multiple electronic databases (i.e., MEDLINE, CINAHL, EMBASE, and PsycINFO). Studies published up to and including May 2013 were reviewed and evaluated based on the following criteria: (1) full-length journal article published in the English language; (ii) human subjects ≥18 years; (iii) ≥?50 % of subjects had a SCI; (iv) results on QoL, as it related to bladder management method, were reported for at least three subjects. A total of 422 articles were extracted and upon review of titles and abstracts, 7 studies met the inclusion criteria. There were two level 2 cohort studies and five level 5 observational studies. Sample sizes ranged from 37 to 282 with an average of 117.1 individuals per study. All participants were at least six months post injury. Bladder management methods used included intermittent (patient/attendant), indwelling (suprapubic/transurethral), and condom catheterization, micturition assistive maneuvers, and electrical stimulation. Normal voiders scored better in all QoL measure domains compared to other management methods. Those using attendant intermittent and indwelling catheterization scored the poorest on the domains Personal Relationships, Emotions, and Mental Health. There is insufficient evidence to provide a definite conclusion as to the relationship between bladder management methods and QoL post SCI. However, individuals relying on others to aid in voiding may experience lower QoL compared to those who are independent.     

A Framework for Summative Evaluation in Informal Science Education

ABSTRACT

Summative evaluation plays a critical role in documenting the impacts of informal science education (ISE), potentially contributing to the ISE knowledge base and informing ongoing improvements in practice and decision-making. In response to the growing demand for capacity-building in ISE evaluation, this article presents a framework for summative evaluation based on an extensive review of literature and research-based refinements. The framework synthesizes key elements of high-quality summative evaluation into three dimensions: (a) Intervention Rationale, (b) Methodological Rigor and Appropriateness, and (c) Evaluation Uses. Judgment of the value of the intervention (e.g., program, exhibition) should draw upon all three dimensions.     

A Comparison of Posttraumatic Growth After Acquired Brain Injury or Myocardial Infarction

Posttraumatic growth (PTG) is known to occur following acquired brain injury (ABI). It is not yet known to what extent PTG experiences following ABI are unique to the neurological nature of the injury. We investigated PTG in survivors of ABI or myocardial infarction (MI); MI is comparable to ABI but does not have a primary neurological element. Thirty-three ABI survivors (age M = 51.6, SD = 12.4; 52% male; years since injury M = 5.5, SD = 5.3) and 47 MI survivors (age M = 66.4, SD = 9.9; 79% male, years since injury M = 9.9, SD = 8.6) completed a survey including the Posttraumatic Growth Inventory (PTGI). Unadjusted analyses showed no significant group differences on PTGI total score (ABI M = 54.0, SD = 19.6; MI M = 54.6, SD = 23.6; d = .03, p = .902) or on any of the five subscales, but analyses adjusted for covariates showed that scores on “Relating to others” were higher in participants with ABI (unstandardized coefficient = 5.43; 95% CI .27, 10.60; p = .039). Open-ended comments revealed aspects of growth in both samples that were not directly captured by the five PTGI factors.     

Exercise training and health-related quality of life in generalized anxiety disorder

ObjectiveTo quantify the effects of six-weeks of resistance (RET) and aerobic exercise training (AET) on quality of life (QoL) among sedentary women with Generalized Anxiety Disorder (GAD).DesignData from our published randomized controlled trial of the effects of six-weeks of either RET or AET among GAD patients were analyzed.MethodThirty women with GAD were randomized to either six weeks of twice-weekly lower-body weightlifting or cycling, or wait-list control (WL). SF-36 subscales assessed dimensions of QoL. Hedges’ d effect sizes (95%CIs) quantified the magnitude of change in response to exercise training compared to WL.ResultsRET significantly improved role-physical (d = 1.04; 95%CI: [0.11–1.97]), role-emotional (d = 0.96; [0.04–1.89]), and mental health (d = 1.05; [0.11–1.98]). AET resulted in significant improvements in physical function (d = 1.31; [0.34–2.27]) and vitality (d = 0.93; [0.01–1.85]).ConclusionsExercise training improves dimensions of QoL among GAD patients. The largest effects were observed for role impairments, physical function, vitality, and mental health.     

The effect of acute exercise on cognitive and motor inhibition – Does fitness moderate this effect?

BackgroundGiven the extensive evidence on improvements in cognitive inhibition immediately following exercise, and the literature indicating that cognitive and motor inhibitory functions are mediated by overlapping brain networks, the aim of this study was to assess, for the first time, the effect of moderate intensity acute aerobic exercise on multi-limb motor inhibition, as compared to cognitive inhibition.MethodParticipants were 36 healthy adults aged 40–60 years old (mean age 46.8 ± 5.7), who were randomly assigned to experimental or control groups. One-to-two weeks following baseline assessment, participants were asked to perform a three-limb (3-Limb) inhibition task and a vocal version of the Stroop before and after either acute moderate-intense aerobic exercise (experimental group) or rest (control).ResultsSimilar rates of improvement were observed among both groups from baseline to the pre-test. Conversely, a meaningful, yet non-significant trend was seen among the experimental group in their pretest to posttest improvement in both cognitive and motor tasks. In addition, exploratory analysis revealed significant group differences in favor of the experimental group among highly fit participants on the 3-Limb task. A significant correlation was indicated between the inhibition conditions, i.e., choice in the motor inhibition and color/word (incongruent) in the cognitive inhibition, especially in the improvement observed following the exercise.DiscussionModerate-intensity acute aerobic exercise is a potential stimulator of both multi-limb motor inhibition and cognitive inhibition. It appears that high-fit participants benefit from exercise more than low-fit people. Additionally, performance on behavioral tasks that represent motor and cognitive inhibition is related. This observation suggests that fitness levels and acute exercise contribute to the coupling between cognitive and motor inhibition. Neuroimaging methods would allow examining brain-behavior associations of exercise-induced changes in the brain.     

Psychological Factors Associated with a Better Quality of Life Following Head-Up Tilt Testing

Quality of life (QoL) is reduced in patients with recurrent vasovagal (VVS) or unexplained syncope (US). Little is known concerning the natural evolution of QoL following diagnosis. Psychological factors contributing to QoL improvement, such as psychological distress and self-efficacy remain to be explored. The objective of this study is to examine whether QoL changes 2 months and 6 months following head-up tilt (HUT) testing as well as to determine whether psychological factors are predictive of changes in QoL. Seventy-three patients undergoing HUT for recurrent syncope were interviewed 1 month before as well as 2 months and 6 months following HUT, using semi-structured interviews and questionnaires. Pre-HUT QoL was significantly worse than at the 2-month (p = 0.000) and 6-month follow-ups (p = 0.000). Psychological distress at baseline was associated with worse QoL 2 months post-HUT (Beta = .280; p = .024), independently of socio-demographic and clinical factors. Improved self-efficacy at follow-up predicted improvements in QoL (Beta = −.186; p = .023). Two and 6 months post-HUT, QoL is mproved in patients with recurrent syncope. Better QoL is predicted by low psychological distress and a heightened sense of self-efficacy following HUT. Strategies for enhancing self-efficacy and reducing psychological distress could be an efficient way to promote QoL in patients suffering from recurrent syncope.     

Family Measurement Techniques

Abstract

This study examined the extent to which a brief, structured couples therapy program based on Imago Relationship Therapy was associated with improvements on the COMPASS scales of individual psychological functioning as well as on a measure of relationship satisfaction, the Marital Satisfaction Inventory. An examination of pre- to post-treatment differences revealed statistically significant differences on three of the four COMPASS scales and all three MSI scales. The rate of improvement in individual distress per couples therapy session was approximately equal to the improvement, found in previous studies, yielded by individual therapy. The results support previous findings that couples therapy may be an effective modality for the treatment of intrapersonal difficulties, and suggest that both relationship and individual distress indices should be utilized in the evaluation of the efficacy of marital therapies.     

An Evaluation of Two Types of Cognitive Intervention in the Management of Chronic Tinnitus

Abstract

Fifty-four subjects with chronic distressing tinnitus were randomly allocated to one of four experimental treatment conditions: (1) attention control and imagery training (AC1); (2) cognitive restructuring (CR); (3) combined attention control and imagery training plus cognitive restructuring (ACI + CR); and (4) a waiting list control (WLC). Significant overall improvements were found on measures of distress associated with tinnitus, and on a number of other measures of cognition and coping strategies. These improvements were maintained at the six-month follow-up. Relative to the WLC, the three treatment conditions (combined) were associated with improvements in tinnitus-related distress, reductions in tinnitus-related dysfunctional cognitions and an increase in the frequency of use of coping strategies. There was a significant effect in favour of the ACI group compared to the CR group on the measure of irrational beliefs. The analyses also revealed that the combined treatment condition (ACI + CR) showed significantly greater improvement on a measure of psychological distress and achieved a higher clinical response rate compared to the two single treatments. There were significant improvements from pretreatment to follow-up on some measures, although the mean scores revealed that some of the gains had been lost at this stage on the main measure of tinnitus-related distress. There were no significant group X time effects for any of the dependent variables at the six-month follow-up. The results were interpreted as supporting the practice of combining the two cognitive approaches.     

Neuropsychological profiles of six children with anoxic brain injury

Anoxic brain injury (ABI) often results in severe memory impairment and other cognitive and behavioral deficits, although limited information is available regarding pediatric cases. This study reported the neuropsychological outcomes in six children and adolescents who sustained ABI. Profiles were compared by mechanism of injury (ischemic vs. hypoxemic) and three cases were evaluated more than once. Severe intellectual, attention, memory, and behavioral impairments were observed in all six cases although academic achievement, internalizing behavioral problems, and visuospatial deficits were in general less severe than other cognitive and behavioral deficits. The longitudinal case studies varied but showed steady increases in memory and intellectual performance in the younger children with strongest improvement in nonverbal abilities and little change in parent-reported behavior. This study raises several possible hypotheses about specific cognitive and behavioral outcomes observed in pediatric ABI.