Serum folate concentration and health-related quality of life among the elderly in South Korea

Background The purpose of this study was to investigate the association between serum folate concentration and health-related quality of life (HRQOL) among the elderly in South Korea. Materials and methods The data used in this study were drawn from 1,021 participants over 65 years old in the Korea National Health and Nutrition Examination Survey from 2016–2018. HRQOL was measured by the EQ-5D questionnaire. Participants were divided into tertiles of folate concentration (ranges 1.7–5.6, 5.7–9.4, and 9.5–31.9 ng/mL). We performed multivariable linear regression to examine the relationship between folate and HRQOL, and multivariable logistic regression to examine the relationship between folate and the dimensional problem of HRQOL. Results Higher folate concentrations were significantly associated with higher HRQOL in the elderly. The average HRQOL score of the elderly in the highest tertile of the folate level was 0.0289 higher than that of the lowest tertile (coefficient: 0.0289; 95% CI 0.0016, 0.0563). The HRQOL score increased by 0.0174 points when the folate concentration increased by 100%. When analyzing specific dimensions, a significant association with folate concentration was found only for the self-care dimension of HRQOL (odds ratio for self-care problems: 0.63; 95% CI 0.41, 0.99). Conclusions The elderly with higher serum folate concentration tended to have higher HRQOL. Among HRQOL dimensions, self-care was only significantly associated with folate concentration.

The relationship between health literacy and health-related quality of life among school-aged children in regional China

Objectives To examine the association between health literacy (HL) and health-related quality of life (HRQoL) among primary and high school students in Nanjing, China. Methods A cross-sectional study was conducted among randomly selected primary (graders 4–6), junior (graders 7–9) and senior (graders 10–12) high school students in 2018 in Nanjing Municipality of China. HRQoL, the outcome variable, was assessed with the validated Chinese version of Child Health Utility 9D (CHU9D) and used as continuous variable, while HL, our independent variable, was measured with the validated Chinese Students’ Health literacy Assessment Scale and treated as categorical variable (“adequate” or “inadequate”) in the analysis. Mixed-effects linear regression models were introduced to calculate mean difference and 95% confidence interval (CI) for examining the association between HL and HRQoL. Results Totally, 4388 of 4498 students completed the survey. Among these responders, the mean score of CHU9D was 0.78 ± 0.17, and the proportion of participants with adequate HL was 85.8% (95% CI = 84.7%, 86.8%). After adjustment for potential confounders and class-level clustering effects, participants who had adequate HL were observed having, on average, an elevated HRQoL score of 0.08 (95% CI = 0.06, 0.11) units compared to their counterparts with inadequate HL. Such a positive HL-HRQoL association was also identified among each stratum of participants’ age, gender and residence. Conclusions HL was positively associated with HRQoL score among primary and high school students in China. It has public health implications that HRQoL may be improved through school-based health literacy intervention among children and adolescents in China.

Viability of a MSQOL-54 general health-related quality of life score using bifactor model

Background MSQOL-54 is a multidimensional, widely-used, health-related quality of life (HRQOL) instrument specific for multiple sclerosis (MS). Findings from the validation study suggested that the two MSQOL-54 composite scores are correlated. Given this correlation, it could be assumed that a unique total score of HRQOL may be calculated, with the advantage to provide key stakeholders with a single overall HRQOL score. We aimed to assess how well the bifactor model could account for the MSQOL-54 structure, in order to verify whether a total HRQOL score can be calculated. Methods A large international database (3669 MS patients) was used. By means of confirmatory factor analysis, we estimated a bifactor model in which every item loads onto both a general factor and a group factor. Fit of the bifactor model was compared to that of single and two second-order factor models by means of Akaike information and Bayesian information criteria reduction. Reliability of the total and subscale scores was evaluated with Mc Donald’s coefficients (omega, and omega hierarchical). Results The bifactor model outperformed the two second-order factor models in all the statistics. All items loaded satisfactorily (≥ 0.40) on the general HRQOL factor, except the sexual function items. Omega coefficients for total score were very satisfactory (0.98 and 0.87). Omega hierarchical for subscales ranged between 0.22 to 0.57, except for the sexual function (0.70). Conclusions The bifactor model is particularly useful when it is intended to acknowledge multidimensionality and at the same time take account of a single general construct, as the HRQOL related to MS. The total raw score can be used as an estimate of the general HRQOL latent score.

Examining the association between menstrual symptoms and health-related quality of life among working women in Japan using the EQ-5D

Background Menstrual symptoms have been identified as a substantial burden among women of reproductive age, affecting their health status and quality of life globally. A range of menstrual symptoms have been studied as they affect the health-related quality of life (HRQoL), showing variations across specific menstrual symptoms and study settings. A major concern is demonstrated due to menstrual symptoms in women’s professional and social life, and consequently societal and economic loss for women and the society at large. Yet evidence is scarce that estimates the index form HRQoL score related to menstrual symptoms that is needed for health economic evaluations. Methods This study aims to investigate the association between menstrual symptoms and the HRQoL among working women in Japan in an index form, using a self-reporting questionnaire (n = 6048). The EQ-5D-3L (EuroQoL 5-dimension 3-level) is used that is a widely used tool to measure health outcomes for health economic evaluations globally. Multivariate regression analysis is conducted to assess the association between the HRQoL score and specific nineteen physical and mental conditions related to menstruation (e.g., pain, heavy bleeding, concentration, negative affect). Results The index form HRQoL score for menstrual symptoms is estimated as 0.682 in the study population (where a score one suggests perfect health). The association of the HRQoL score varies substantially across the menstrual symptoms. Several of the physical conditions and disorders show a substantial negative association with the HRQoL score. Also, most of the mental and psychological issues are significantly and negatively related to the HRQoL score. Conclusions This study suggests that HRQoL is substantially and negatively affected by menstruation among working women in Japan. Distinct variations of negative influences across menstrual symptoms underscore the multi-dimensional nature of menstruation and consequently the need of collective interventions to address these difficulties. The evidence of HRQoL continues to be an important area for future research on women’s health and health economic evaluations to inform effective and efficient resource allocations for relevant health policies and financing strategies.

Is Age-adjusted Sagittal Parameter Important for Patients Receiving Short Anterior and Oblique Anterolateral Lumbar Surgery? A Single Center Retrospective Review

Background Recent studies have suggested the sagittal profiles: SVA, PT, and PI-LL may be age dependent. However, the clinical applications of the age-adjusted parameters remain inconclusive. This study aims to investigate whether age-adjusted sagittal parameter is important for patients receiving short anterolateral lumbar surgery since the recently increased adoption of this surgery.MethodsPatients receiving ALIF and OLIF were prospectively collected. The severity of symptoms was measured via the Health-related Quality of Life (HRQOL) score. After the operation, patients were divided into either the “Sufficient group” or “Under group” in accordance with whether they achieved the three age-adjusted parameters. Postoperative clinical outcomes were measured and compared to the pre-OP baselines between the groups at one-year follow-up. Additionally, patients were stratified through the severity cut-off value of each HRQOL score prior to surgery for subgroup analysis.ResultsAll age-adjusted parameters and HRQOLs showed significant improvement after receiving ALIF or OLIF. The sufficient correction rate was 78%, 74%, and 70% in age-adjusted SVA, PT, and PI-LL, respectively. EQ-5D and ODI demonstrated significant improvements at one-year follow-up upon all patients. Sufficient correction of age-adjusted SVA, PT, and PI-LL revealed better performance in EQ-5D, ODI, and VAS of pain amongst patients with worse pre-OP disability. However, no difference in HRQOLs was observed despite SVA, PT, and PI-LL being sufficiently corrected among the patients with moderate disability. ALIF offered better improvement in EQ-5D compared to OLIF. ConclusionsBoth ALIF and OLIF can achieve satisfactory clinical results when targeting age-adjusted thresholds. Patients with a worse disability status prior to surgery require sufficient rigorous correction in accordance with age-adjusted targets to achieve better HRQOL.

Health related quality of life of Icelandic patients six months after coronary heart disease incidence

Funding Acknowledgements Regional Development Institute, Landspitali, Akureyri Hospital; University of Akureyri, Icelandic Nursing Association, KEA, Akureyri Heart Association OnBehalf KRANS-Study research group Background Patients with coronary heart disease (CHD) are likely to have impaired health-related quality of life (HRQoL) due to functional and emotional effects of the disease. Research suggests that HRQoL is an indicator of CHD patient’s health and it has been associated with self-care and risk factor management. Purpose The aim of this study was to assess HRQoL of Icelandic patients with CHD, six months after coronary heart disease incidence and to identify associated factors. Methods Cross-sectional study design was used. Participants were admitted to two main hospitals in Iceland. Data was collected with questionnaires and from patient records in the years 2018 to 2019. HRQoL was assessed with The HeartQoL questionnaire, which comprises 14-items with 10-item physical and 4-item emotional subscales which are scored from 0 (poor) to 3 (better) HRQoL and a global score. Data was analyzed with descriptive and inferential statistics. Results Data from 366 patients with CHD will be presented. Preliminary data analysis shows that patients, (mean age 64 years (SD 8.8), 81% male), had mean global HRQoL score of 2.3 (SD = 0.6). The physical score measured 2.2 (SD = 0.7) and the emotional score 2.4 (SD = 0.7). The mean global HRQoL score were lower in women (t(364) =3.7, p < 0.001) and so were the physical score (t(364) =3.8, p < 0.001). However, the emotional score did not differ between the genders (t(363) =1.9, p = 0.061). Low income patients had lower HRQoL (p < 0.001). While physical HRQoL decreased with age (β= -0.12, p = 0.006), emotional HRQoL increased (β=0.14, p = 0.001). Better HRQoL was associated with more physical activity on global (β=0.28, p < 0.001), emotional (β=0.16, p = 0.001) and physical (β=0.36, p < 0.001) scales. Association between HRQoL and other risk factor profiles will be presented. Conclusion Our findings suggest that among patients with CHD physical activity is associated with better HRQoL. This emphasizes the importance of cardiac rehabilitation and physical activity after discharge from hospital. Special attention should be given to follow up of women and low-income groups.

Health-related quality of life of female sex workers living with HIV in South Africa

Background: Health-related quality of life (HRQoL) is an important HIV outcome beyond viral suppression. However, there are limited data characterizing HRQoL of key populations including female sex workers (FSW) living with HIV. Methods: We used baseline data (2018-2020) of FSW who were diagnosed with HIV and enrolled into a randomized trial in Durban, South Africa. HRQoL information was collected by a generic preference-based tool with five domains (EQ-5D), and summarized into a single score (range 0-1) which represents health utility. We employed multivariable beta regression models to identify determinants of HRQoL and to estimate subgroup-specific HRQoL score. Findings: Of 1363 individuals (mean age: 32.4 years; mean HRQoL score: 0.857) in our analysis, 62.6% used drugs, 61.3% experienced physical or sexual violence, and 64.6% self-reported taking antiretroviral treatment (ART). The following were associated with a reduction in the average marginal HRQoL score: older age (per decade: 0.018 [95% confidence interval (CI): 0.008, 0.027]), drug use (0.022 [0.007, 0.036]), experience of violence (0.024 [0.010, 0.038]), and moderate (vs. no) level of internalized stigma (0.023 [0.004, 0.041]). Current ART use was associated with a 0.015-point (-0.001, 0.031) increase in the HRQoL score. The estimated mean (95%CI) HRQoL scores ranged from 0.838 (0.816, 0.860) for FSW who used drugs, experienced violence, and were not on ART; to 0.899 (0.883, 0.916) for FSW who did not use drugs nor experience violence and were on ART. Interpretation: These results demonstrate the association of ART with higher HRQoL among FSW and the need to further address structural risks including drug use, violence, and stigma. Population-specific estimates of HRQoL score can be further used to calculate quality-adjusted life years in economic evaluations of individual and structural interventions addressing the needs of FSW living with HIV. Funding: National Institutes of Health (R01NR016650)

Relationship between both cardiorespiratory and muscular fitness and health-related quality of life in children and adolescents: a systematic review and meta-analysis of observational studies

Background No review to date has evaluated the association between physical fitness and health-related quality of life (HRQoL) in healthy children and adolescents. The aims of this systematic review and meta-analysis were to examine the relationship between both cardiorespiratory fitness (CRF) and muscular fitness (MF) and HRQoL in healthy subjects under 18 years of age and to describe the dimensions of HRQoL in which these relationships are more robust. Methods The Medline, Embase, Cochrane Library, SCIELO, SPORTDiscus and PEDro databases were systematically searched to collect observational studies that examined the relationship between CRF and HRQoL and between MF and HRQoL in participants under 18 years of age without any diagnosed medical condition. Pooled effect sizes (ES) were estimated for the associations between both CRF and MF and the various HRQoL dimensions. Results The pooled ES (95% CI) estimates for the relationship between CRF and HRQoL were as follows: 0.19 (0.10 to 0.27) for physical well-being, 0.19 (0.07 to 0.32) for psychological well-being, 0.20 (− 0.14 to 0.55) for perceived health status, 0.10 (0.00 to 0.20) for self-perception/self-esteem, 0.07 (− 0.05 to 0.19) for quality of family relationship, 0.14 (0.04 to 0.25) for quality of peer relationship, 0.17 (0.04 to 0.29) for everyday functioning at school and 0.20 (0.12 to 0.28) for total HRQoL score. The pooled ES (95% CI) estimates for the relationship between MF and HRQoL were: 0.25 (0.12 to 0.37) for physical well-being, 0.11 (0.04 to 0.17) for psychological well-being, 0.08 (0.01 to 0.15) for quality of family relationship, 0.14 (0.03 to 0.25) for quality of peer relationship, and 0.09 (0.03 to 0.14) for total HRQoL score. Conclusions Our data suggest that both CRF and MF are positively associated with HRQoL, mainly in physical, psychological and peer relationships. Moreover, CRF is positively associated with school dimensions and MF is positively associated with family relationships. Trail registration Protocol PROSPERO registration number: CRD42015025823.

Long-Term Health-Related Quality of Life (HRQoL) After Redo-Fundoplication

Background We aim to shed light on long-term subjective outcomes after re-operations for failed fundoplication. Methods 1809 patients were operated on for hiatal hernia and/or gastroesophageal reflux disease (GERD) at the Helsinki University Hospital between 2000 and 2017. 111 (6%) of these had undergone a re-operation for a failed antireflux operation. Overall, HRQoL was assessed in 89 patients at the latest follow-up using the generic 15D© instrument. The results were compared to a sample of the general population, weighted to reflect the age and gender distribution of patients. Disease-specific HRQoL was assessed using the GERD-HRQoL questionnaire. We studied variation in the overall HRQoL with respect to disease-specific HRQoL and known patients' parameters using univariate and multivariable linear regression models. Results The median postoperative follow-up period was 9.3 years. All patients were operated on laparoscopically (6% conversion rate), and 87% were satisfied with the re-operation. Postoperative complications were minimal (5%). Twelve patients (11%) underwent a second re-operation. The median GERD-HRQoL score was nine. In multivariable analysis, four variables were independently associated with the 15D score, suggesting a decrease in the 15D score with increasing GERD-HRQoL score, increasing Charlson Comorbidity Index (CCI) and the presence of chronic pain syndrome (CPS) and depression. Conclusion Re-do LF is a safe procedure in experienced hands and may offer acceptable long-term alleviation in patients with recurring symptoms after antireflux surgery. Decreased HRQoL in the long run is related to recurring GERD and co-morbidities.