Jakość życia zależna od stanu zdrowia u chorych na astmę oskrzelową

A patient is not, or at least should not be, a passive subject, but the active participant of the process of asthma treatment. This naturally imposes covering patients with bronchial asthma with a holistic model of care. Assessment of health-related quality of life (HRQoL) is one component of this model. HRQoL of asthma patients can be determined with an array of generic instruments, e.g. Medical Outcomes Survey Short Form 36 (SF-36), EuroQoL questionnaire (EQ-5D) or World Health Organization Quality of Life Questionnaire (WHOQOL), as well as with the specific tools, among which Saint George’s Respiratory Questionnaire (SGRO) and Asthma Quality of Life Questionnaire (AQLQ) belong to the most widely used. HRQoL is significantly associated with the degree of asthma control. However, literature data suggest that a determination of HRQoL alone, with either specific or generic instrument, can be insufficient, as the level of health-related quality of life turned out to be modulated by three groups of factors: 1) demographic characteristics of patients, 2) clinical parameters, and 3) personality traits of respondents. Due to particularly strong effect of psychological characteristics on the quality of life of patients with bronchial asthma, also the level of depressiveness should be examined along with the HRQoL determination. Furthermore, complex assessment of the quality of life and its determinants should be conducted longitudinally, either in individual patients or in epidemiological studies.W procesie terapii astmy pacjent nie jest — a przynajmniej nie powinien być — biernym podmiotem, lecz aktywnym uczestnikiem. W sposób naturalny narzuca to objęcie chorych na astmę oskrzelową holistycznym modelem opieki. Jednym z jego elementów jest ocena jakości życia związanej ze stanem zdrowia (HRQoL). Do oceny HRQoL u chorych na astmę oskrzelową można wykorzystać wiele instrumentów generycznych, na przykład Medical Outcomes Survey Short Form 36 (SF-36), kwestionariusz EuroQoL (EQ-5D) czy World Health Organization Quality of Life Questionnaire (WHOQOL), a także specyficzne narzędzia, spośród których najczęściej stosuje się Kwestionariusz Szpitala Św. Jerzego (SGRO) oraz Asthma Quality of Life Questionnaire (AQLQ). HRQoL jest czynnikiem związanym istotnie ze stopniem kontroli astmy. W świetle danych literaturowych wydaje się jednak, że samo określenie HRQoL za pomocą specyficznego lub generycznego instrumentu nie jest wystarczające. Wykazano bowiem, że na poziom jakości życia związanej ze stanem zdrowia wpływają trzy grupy czynników: 1) charakterystyki demograficzne chorych, 2) parametry kliniczne, oraz 3) cechy osobowości badanych. Z uwagi na szczególnie istotny wpływ charakterystyk psychologicznych na jakość życia pacjentów z astmą oskrzelową, równolegle z oceną HRQoL należy określić także poziom depresyjności. Co więcej, kompleksowa ocena jakości życia i jej determinant psychologicznych powinna być prowadzona w sposób ciągły — zarówno u indywidualnych pacjentów, jak i w badaniach epidemiologicznych

Self-Reported Medication Adherence Measured With Morisky Medication Adherence Scales and Its Determinants in Hypertensive Patients Aged ≥60 Years: A Systematic Review and Meta-Analysis

Background: The aim of this systematic review and meta-analysis was to estimate medication adherence in hypertensive patients aged ≥60 years and to explore potential determinants of adherence with antihypertensive treatment in this age group.Methods: A systematic search of the PubMed, Scopus, and Google Scholar using the Cochrane guidelines was performed. The analysis included articles published between 1 January 2000 and 30 June 2018. The patients were considered adherent if they scored ≥6 pts. on the Morisky Medication Adherence Scale (MMAS-8) or ≥3 pts. on the Morisky Green Levine Medication Adherence Scale (MGL). If available, also odds ratios (OR) with 95% confidence intervals (95% CI) for determinants of medication adherence were recorded.Results: Thirteen studies including a total of 5,247 patients were available for the meta-analysis. The pooled percentage of adherence was 68.86% (95% CI: 57.80–79.92%). Subgroup analysis did not demonstrate a significant difference in the adherence measured with the MMAS-8 and the MGL (68.31 vs. 70.39%, P = 0.773). The adherence of patients from Western countries (Europe, United States) turned out to be significantly higher than in other patients (83.87 vs. 54.30%, P = 0.004). The significant determinants of better adherence identified in more than one study were older age, retirement/unemployment, duration of hypertension >10 years, and a lower number of prescribed drugs.Conclusion: Medication adherence in the oldest old hypertensive patients seems to be higher than in younger persons. Adherence in older persons was associated with age, socioeconomic status, and therapy-related factors

Związek akceptacji choroby oraz lęku i depresji z oceną jakości życia pacjentek z chorobą nowotworową gruczołu piersiowego

Introduction. Cancer disease is often synonymous with a lengthy and cumbersome treatment process for the patient and a reduction in quality of life (QoL). The attitude to the disease affects the treatment process and the level of acceptance of the illness determines the well-being of the patient, the level of trust in the medical staff and methods of treatment. It is also associated with the success of the therapy. Material and methods. The study included 112 women diagnosed with breast cancer treated at Lower Silesian Oncology Center. The study used a standardized questionnaire tools: AIS-scale acceptance of the illness, QoL WHOQOL-BREF questionnaire, HADS-M questionnaire. Results. Correlation analysis showed a statistically significant relationship between the level of acceptance of the illness and all the domains of QoL WHOQOL-BREF questionnaire: somatic domain (r = 0.47; p < 0.001), psychological domain (r = 0.40; p < 0.001), social domain (r = 0.39; p < 0.001), environmental domain (r = 0.46; p < 0.001). Analysis of correlation between anxiety and depression with the assessment of acceptance of the illness showed a negative influence of all components of the questionnaire HADS-M level AIS, as appropriate: anxiety (r = -0.51; p < 0.001), depression (r = -0.57; p < 0.001), irritability (r = -0.32; p = 0.001). A similar relationship was observed in the analysis of the correlation of anxiety and depression, quality of life in all domains of the questionnaire WHOQOL-BREF. Conclusions. Patients with breast cancer presented a medium level of acceptance of the illness and limiting level of anxiety and depression. There is a positive relationship between acceptance of the illness with the assessment of QoL, while anxiety and depression negatively affects the assessment of QoL.Wstęp. Choroba nowotworowa często jest równoznaczna z długotrwałym i uciążliwym dla pacjenta procesem leczenia oraz pogorszeniem jakości życia (QoL). Postawa wobec choroby wpływa na proces leczenia, a poziom akceptacji choroby determinuje samopoczucie chorego, zaufanie do personelu medycznego i stosowanych metod leczenia, a co z tym związane — również na powodzenie terapii. Materiał i metody. Badaniami objęto 112 kobiet z rozpoznanym rakiem gruczołu piersiowego leczonych w Dolnośląskim Centrum Onkologii we Wrocławiu. W badaniu wykorzystano standaryzowane narzędzia kwestionariuszowe: skalę akceptacji choroby AIS, kwestionariusz oceny QoL WHOQOL-BREF, kwestionariusz oceny lęku i depresji HADS-M. Wyniki. Analiza korelacji wykazała istotną statystycznie zależność pomiędzy poziomem akceptacji choroby a wszystkimi obszarami QoL WHOQOL-BREF: obszarem somatycznym (r = 0,47; p < 0,001), psychologicznym (r = 0,40; p < 0,001), socjalnym (r = 0,39; p < 0,001) i środowiskowym (r = 0,46; p < 0,001). Analiza korelacji związku lęku i depresji z oceną akceptacji choroby wykazała negatywny wpływ wszystkich składowych kwestionariusza HADS-M na poziom AIS, odpowiednio: lęk (r = -0,51; p < 0,001), depresja (r = -0,57; p < 0,001), rozdrażnienie (r = -0,32; p = 0,001). Podobną zależność zaobserwowano podczas analizy korelacji lęku i depresji z jakością życia we wszystkich obszarach kwestionariusza WHOQOL-BREF. Wnioski. Pacjentki z rakiem piersi wykazują średni poziom akceptacji choroby oraz graniczny poziom lęku i depresji. Akceptacja choroby pozytywnie wpływa na QoL, natomiast lęk i depresja negatywnie wpływają na ocenę QoL

Digital health and modern technologies applied in patients with heart failure: Can we support patients' psychosocial well-being?

Despite advances in the treatment of heart failure (HF), the physical symptoms and stress of the disease continue to negatively impact patients' health outcomes. Technology now offers promising ways to integrate personalized support from health care professionals via a variety of platforms. Digital health technology solutions using mobile devices or those that allow remote patient monitoring are potentially more cost effective and may replace in-person interaction. Notably, digital health methods may not only improve clinical outcomes but may also improve the psycho-social status of HF patients. Using digital health to address biopsychosocial variables, including elements of the person and their context is valuable when considering chronic illness and HF in particular, given the multiple, cross-level factors affecting chronic illness clinical management needed for HF self-care

Adherence problems in elderly patients with hypertension

Introduction: Adherence to treatment recommendations for chronically ill patients is still a complex problem, especially among the older population. Chronic diseases, including hypertension, negatively affect patients’ quality of life (QOL). A satisfactory level of the patients’ QOL and good adherence to medication regimens can prevent complications and deterioration of daily functioning.Objectives: This cross-sectional study aimed to analyse selected sociodemographic and clinical factors affecting adherence to antihypertensive treatment in elderly patients.Material and methods: A total of 100 patients (61 females, 39 males) with hypertension who were treated in a university hospital participated in the study. Medical records were analysed to include required sociodemographic and clinical factors. Data were collected from standardized instruments: World Health Organization Quality of Life-Age (WHOQOL-AGE), the Geriatric Depression Scale (GDS), and the Adherence in Chronic Diseases Scale (ACDS). Results: The median duration of illness was 10 years (Q1 = 4.75, Q3 = 14.0). The median total QOL score was 61.06 points (Q1 = 50, Q3 = 69.23). Symptoms of depressive disorder were found in 32% of patients. There was a high level of adherence in 63% of respondents, 34% presented a moderate level, and 3% of patients adhered to a low level. Significant differences (p < 0.05) were found in the adherence levels in groups varying in depressive symptoms (rs = –0.289) and QOL results (rs = 0.33). Adherence was also significantly higher in patients with a college/university education and a good financial situation (p < 0.05). Conclusions: Education and financial standing affect adherence to antihypertensive treatment in elderly patients and should be considered in everyday clinical practice. Also, the level of QOL and depressive symptoms are significant

Dairy product consumption, eating habits, sedentary behaviour and physical activity association with bone mineral density among adolescent boys: a cross-sectional observational study

Background: During childhood and adolescence, skeletal microarchitecture and bone mineral density (BMD) undergo significant changes. Peak bone mass is built and its level significantly affects the condition of bones in later years of life. Understanding the modifiable factors that improve bone parameters at an early age is necessary to early prevent osteoporosis. To identify these modifiable factors we analysed the relationship between dairy product consumption, eating habits, sedentary behaviour, and level of physical activity with BMD in 115 young boys (14–17 years). Methods: Bone parameters were measured by dual energy x-ray absorptiometry using paediatric specific software to compile the data. Dairy product consumption and eating habits were assessed by means of a dietary interview. Sedentary behaviour and physical activity was assessed in a face-to-face interview conducted using the International Physical Activity Questionnaire. Data collection on total physical activity level was performed by collecting information on the number of days and the duration of vigorous and moderate intensity (MVPA) and average daily time spent in sitting (SIT time). Results: The strongest relationships with BMD in distal part of forearm were found for moderate plus vigorous activity, sit time, and intake of dairy products, intake of calcium, protein, vitamin D, phosphorus from diet. Relationships between BMD, bone mineral content (BMC) in the distal and proximal part of the forearm and PA, sit time and eating parameters were evaluated using the multiple forward stepwise regression. The presented model explained 48–67% (adjusted R2 = 0.48–0.67; p < 0.001) of the variance in bone parameters. The predictor of interactions of three variables: protein intake (g/person/day), vitamin D intake (µg/day) and phosphorus intake (mg/day) was significant for BMD dis (adjusted R2 = 0.59; p < 0.001). The predictor of interactions of two variables: SIT time (h/day) and dairy products (n/day) was significant for BMD prox (adjusted R2 = 0.48; p < 0.001). Furthermore, the predictor of interactions dairy products (n/day), protein intake (g/person/day) and phosphorus intake (mg/day) was significant for BMC prox and dis (adjusted R2 = 0.63–0.67; p < 0.001). Conclusions: High physical activity and optimal eating habits especially adequate intake of important dietary components for bone health such as calcium, protein, vitamin D and phosphorus affect the mineralization of forearm bones

Sex-related differences in the impact of nutritional status on length of hospital stay in atrial fibrillation: a retrospective cohort study

BackgroundNutritional status is related to the length of hospitalization of patients with atrial fibrillation (AF). The aim of this study is to assess the prognostic impact of nutritional status and body mass index on length of hospital stay (LOHS) among patients with AF relative to their sex.MethodsA retrospective analysis of the medical records of 1,342 patients admitted urgently with a diagnosis of AF (ICD10: I48) to the Cardiology Department (University Hospital in Wroclaw, Poland) between January 2017 and June 2021.ResultsIn the study group, women were significantly older than men (72.94 ± 9.56 vs. 65.11 ± 12.68, p &lt; 0.001). In an unadjusted linear regression model, malnutrition risk was a significant independent predictor of prolonged hospitalization in men (B = 1.95, p = 0.003) but not in women. In the age-adjusted linear regression model, malnutrition risk was a significant independent predictor of prolonged hospitalization in men (B = 1.843, p = 0.005) but not in women. In the model adjusted for age and comorbidities, malnutrition risk was a significant independent predictor of prolonged hospitalization in men only (B = 1.285, p = 0.043). In none of the models was BMI score a predictor of LOHS in either sex.ConclusionThe risk of malnutrition directly predicts the length of hospital stays in men but not women. The study did not find a relationship between body mass index and length of hospital stay in both women and men

How May Coexisting Frailty Influence Adherence to Treatment in Elderly Hypertensive Patients?

Background. Hypertension is considered to be the most common condition in the general population. It is the most important risk factor for premature deaths in the world. Treatment compliance at every stage is a condition for successful antihypertensive therapy, and improving the effectiveness of treatment is a major goal in preventing cardiovascular incidents. Treatment noncompliance and lack of cooperation stem from numerous problems of older age, including frailty syndrome. Objective. To evaluate the effect of frailty syndrome on treatment compliance in older patients with hypertension. Methods. The study sample consisted of 160 patients (91 women, 69 men) with hypertension aged 65 to 78 (mean = 72.09, SD = 7.98 years), hospitalized at the University Clinical Hospital due to exacerbation of disease symptoms. Standardised research tools were used: the Tilburg Frailty Indicator questionnaire and the questionnaire for the assessment of treatment compliance in patients with hypertension, the Hill-Bone Compliance to High Blood Pressure Therapy Scale. Results. Frailty syndrome was diagnosed in 65.62% of patients: 35.62% with mild, 29.38% with moderate, and 0.62% with severe frailty. The treatment compliance was 36.14%. The prevalence of the FS and its three components (physical, psychological, social) significantly affected (p <0.05) the global score of the Hill-Bone Compliance to High Blood Pressure Therapy Scale and all subscales: “reduced sodium intake”, “appointment keeping”, and “antihypertensive medication taking”. Conclusions. The coexistence of frailty syndrome has a negative impact on the compliance of older patients with hypertension. Diagnosis of frailty and of the associated difficulties in adhering to treatment may allow for targeting the older patients with a poorer prognosis and at risk of complications from untreated or undertreated hypertension and for planning interventions to improve hypertension control