Ethnic Differences in Quality of Life in Persons with Heart Failure

Background Chronic illness burdens some groups more than others. In studies of ethnic/racial groups with chronic illness, some investigators have found differences in health-related quality of life (HRQL), whereas others have not. Few such comparisons have been performed in persons with heart failure. The purpose of this study was to compare HRQL in non-Hispanic white, black, and Hispanic adults with heart failure. Methods Data for this longitudinal comparative study were obtained from eight sites in the Southwest, Southeast, Northwest, Northeast, and Midwest United States. Enrollment and 3- and 6-month data on 1212 patients were used in this analysis. Propensity scores were used to adjust for sociodemographic and clinical differences among the ethnic/racial groups. Health-related quality of life was measured using the Minnesota Living with Heart Failure Questionnaire. Results Significant ethnic/racial effects were demonstrated, with more favorable Minnesota Living with Heart Failure Questionnaire total scores post-baseline for Hispanic patients compared with both black and white patients, even after adjusting for baseline scores, age, gender, education, severity of illness, and care setting (acute vs. chronic), and estimating the treatment effect (intervention vs. usual care). The models based on the physical and emotional subscale scores were similar, with post hoc comparisons indicating more positive outcomes for Hispanic patients than non-Hispanic white patients. Conclusion Cultural differences in the interpretation of and response to chronic illness may explain why HRQL improves more over time in Hispanic patients with heart failure compared with white and black patients

Depressive Symptom Trajectory Predicts 1-Year Health-Related Quality of Life in Patients With Heart Failure

One-third of patients with heart failure (HF) experience depressive symptoms that adversely affect health-related quality of life (HRQOL). We aimed to describe depressive symptom trajectory and determine whether a change in depressive symptoms predicts subsequent HRQOL

The integration of social concerns into electricity power planning : a combined delphi and AHP approach

The increasing acceptance of the principle of sustainable development has been a major driving force towards new approaches to energy planning. This is a complex process involving multiple and conflicting objectives, in which many agents were able to influence decisions. The integration of environmental, social and economic issues in decision making, although fundamental, is not an easy task, and tradeoffsmust be made. The increasing importance of social aspects adds additional complexity to the traditional models that must now deal with variables recognizably difficult to measure in a quantitative scale. This study explores the issue of the social impact, as a fundamental aspect of the electricity planning process, aiming to give a measurable interpretation of the expected social impact of future electricity scenarios. A structured methodology, based on a combination of the Analytic Hierarchy Process and Delphi process, is proposed. The methodology is applied for the social evaluation of future electricity scenarios in Portugal, resulting in the elicitation and assignment of average social impact values for these scenarios. The proposed tool offers guidance to decision makers and presents a clear path to explicitl

Smoke-free legislation and child health

In this paper, we aim to present an overview of the scientific literature on the link between smoke-free legislation and early-life health outcomes. Exposure to second-hand smoke is responsible for an estimated 166 ,000 child deaths each year worldwide. To protect people from tobacco smoke, the World Health Organization recommends the implementation of comprehensive smoke-free legislation that prohibits smoking in all public indoor spaces, including workplaces, bars and restaurants. The implementation of such legislation has been found to reduce tobacco smoke exposure, encourage people to quit smoking and improve adult health outcomes. There is an increasing body of evidence that shows that children also experience health benefits after implementation of smoke-free legislation. In addition to protecting children from tobacco smoke in public, the link between smoke-free legislation and improved child health is likely to be mediated via a decline in smoking during pregnancy and reduced exposure in the home environment. Recent studies have found that the implementation of smoke-free legislation is associated with a substantial decrease in the number of perinatal deaths, preterm births and hospital attendance for respiratory tract infections and asthma in children, although such benefits are not found in each study. With over 80% of the world’s population currently unprotected by comprehensive smoke-free laws, protecting (unborn) children from the adverse impact of tobacco smoking and SHS exposure holds great potential to benefit public health and should therefore be a key priority for policymakers and health workers alike

Kiss and Tell: What Do We Know About Pre- and Early Adolescent Females Who Report Dating? A Pilot Study

Study Objective: To evaluate the implications of dating in pre- and early adolescent females. Design: Cross-sectional survey. Setting: Child psychiatry clinic; pediatric clinic; family clinic. Participants: Pre- and early adolescent females (n = 80) aged 11–14 and their parents. Intervention: Pre- and early adolescent females aged 11–14 and a parent were recruited during a regular clinic visit. Pre- and early adolescent females completed a survey that included measures of dating; sensation seeking; lifetime individual and peer drug use; Attention Deficit Hyperactive Disorder, Oppositional Defiant Disorder and Conduct Disorder symptoms; and onset of menses. Parents were asked similar questions about their child\u27s dating behaviors and peer relationships. Main Outcome Measure: Association of early dating with individual and peer drug use, sensation seeking, aggressive behavior, and onset of menses. Results: In pre- and early adolescent females, dating regularly is associated with nicotine and alcohol use, sensation seeking, and aggressive behavior. Dating regularly is also associated with onset of menses and a younger age of onset of menses in those who had started menstruating. Parents under-report their child\u27s dating practices and associated high-risk behaviors. Conclusion: Early dating is associated with nicotine and alcohol use, sensation seeking, aggressive behavior, and early onset of menses in adolescent females. Questions about early dating are a simple and efficient way to open inquiry of both parents and children about high-risk behaviors in the clinic setting

Reduction in asthma-related emergency department visits after implementation of a smoke-free law.

Background Secondhand tobacco smoke increases the risk for the development and increasing severity of asthma among adults and children. Reducing exposure to secondhand smoke decreases symptomatic exacerbations among patients with asthma. Emergency department (ED) visits for asthma were assessed before and after the implementation of smoke-free legislation in Lexington-Fayette County, Ky. Objective To evaluate the effects of a smoke-free law on the rate of ED visits for asthma. Methods The study included ED visits for asthma from 4 hospitals in Lexington-Fayette County, Ky. Age-adjusted rates of asthma ED visits were determined. Poisson regression analysis of ED visits from January 1, 2001, to December 31, 2006 compared the ED visit rates between prelaw and postlaw, adjusting for seasonality, secular trends over time, and differences among demographic subgroups. The actual rates were graphed with the Poisson curve showing the rates predicted by the model. A second prediction curve was generated to show the projected rates in the postlaw period if the law had not been implemented. Results Adjusting for seasonality, secular trends, and demographic characteristics, ED visits for asthma declined 22% from prelaw to postlaw (P \u3c .0001; 95% CI, 14% to 29%). The rate of decline was 24% in adults age 20 years and older (P \u3c .0001), whereas the decrease among children 19 years or younger was 18% (P = .01). Conclusion Although this study did not establish causation, the smoke-free law was associated with fewer asthma ED visits among both children and adults, with a more significant decline among adults