A brief guide to the selection of quality of life instrument

There are numerous quality of life (QOL) scales. Because QOL experts are often partial to their own scales, researchers need to be able to select scales for themselves. Scales best suited for longitudinal purposes (clinical trials and audit) have different properties to those suited for cross-sectional studies (population and correlational studies and clinical use). The reason and logic of these differences is explained. For longitudinal use, researchers need to consider the relationship between item set, population and treatment; scales can be short, floor and ceiling effects must be avoided, and there should be extended response options. For cross-sectional use scales should have a wide range of items, should be longer, and there are no adverse floor and ceiling effects, and response options can be simpler to allow a larger set of items

Improvements in exercise capacity during a 4-weeks pulmonary rehabilitation program for COPD patients do not correspond with improvements in self-reported health status or quality of life

Ninety-two patients with moderate or severe chronic obstructive pulmonary disease (COPD) were assessed for walking tolerance, lung function, perceived health status (HS), perceived quality of life (QoL) and anxiety before and after a four weeks inpatient pulmonary rehabilitation (PR) program. There were significant improvements on all outcomes except anxiety, although the effect sizes were small or moderate. The largest improvement was observed on the walking test, but patients also improved on perceived health status (HS) and perceived quality of life (QoL). Relations between outcome indicators were analyzed cross-sectionally and longitudinally. Cross-sectional correlations were in line with earlier studies. However, improvements on the walking test were generally unrelated to changes in lung function, HS and QoL. Different patients improve on different outcome measures following PR, and this could have implications for the planning and designs of PR programs

Posttraumatic stress disorder and psychiatric co-morbidity following stroke: The role of alexithymia

More research is needed to further our understanding of posttraumatic stress disorder symptoms (PTSD) and psychiatric co-morbidity following stroke, especially the trajectories of such symptoms over time. Previous studies suggest that exposure to a traumatic experience such as stroke is not sufficient to explain the etiology of PTSD. Alexithymia may be involved, but its relationships with PTSD and psychiatric co-morbidity following stroke remains unclear. This study aims to address these knowledge gaps. While in hospital, stroke patients (n = 90) completed questionnaires assessing PTSD symptoms, psychiatric co-morbidity, alexithymia and physical disability. PTSD symptoms and psychiatric co-morbidity were re-assessed approximately 3. months post-stroke (n = 78). The severity of post-stroke PTSD did not change significantly over time, while psychiatric co-morbidity reduced significantly. Alexithymia, in particular difficulty in identifying feelings, was associated with severity of post-stroke PTSD and psychiatric co-morbidity at baseline, but after adjusting for these, there was no significance 3. months post-stroke. We suggest that patients\u27 difficulty in identifying feelings had a role to play in influencing relatively short-term rather than long-term PTSD and co-morbid psychiatric symptoms. Alternatively, PTSD could be interpreted as driving the alexithymic characteristics. © 2010 Elsevier Ltd

Matriptase regulates c-Met mediated proliferation and invasion in inflammatory breast cancer.

The poor prognosis for patients with inflammatory breast cancer (IBC) compared to patients with other types of breast cancers emphasizes the need to better understand the molecular underpinnings of this disease with the goal of developing effective targeted therapeutics. Dysregulation of matriptase expression, an epithelial-specific member of the type II transmembrane serine protease family, has been demonstrated in many different cancer types. To date, no studies have assessed the expression and potential pro-oncogenic role of matriptase in IBC. We examined the functional relationship between matriptase and the HGF/c-MET signaling pathway in the IBC cell lines SUM149 and SUM190, and in IBC patient samples. Matriptase and c-Met proteins are localized on the surface membrane of IBC cells and their expression is strongly correlated in infiltrating cancer cells and in the cancer cells of lymphatic emboli in patient samples. Abrogation of matriptase expression by silencing with RNAi or inhibition of matriptase proteolytic activity with a synthetic inhibitor impairs the conversion of inactive pro-HGF to active HGF and subsequent c-Met-mediated signaling, leading to efficient impairment of proliferation and invasion of IBC cells. These data show the potential of matriptase inhibitors as a novel targeted therapy for IBC, and lay the groundwork for the development and testing of such drugs

Common Factor Mechanisms in Clinical Practice and Their Relationship with Outcome

This study investigates three common factor mechanisms that could affect outcome in clinical practice: response expectancy, the affective expectation model and motivational concordance. Clients attending a gestalt therapy clinic (30 clients), a sophrology (therapeutic technique) clinic (33 clients) and a homeopathy clinic (31 clients) completed measures of expectancy and the Positive Affect and Negative Affect Schedule (PANAS) before their first session. After 1 month, they completed PANAS and measures of intrinsic motivation, perceived effort and empowerment. Expectancy was not associated with better outcome and was no different between treatments. Although some of the 54 clients who endorsed highest expectations showed substantial improvement, others did not: 19 had no change or deteriorated in positive affect, and 18 had the same result for negative affect. Intrinsic motivation independently predicted changes in negative affect (β = −0.23). Intrinsic motivation (β = 0.24), effort (β = 0.23) and empowerment (β = 0.20) independently predicted positive affect change. Expectancy (β = −0.17) negatively affected changes in positive affect. Clients found gestalt and sophrology to be more intrinsically motivating, empowering and effortful compared with homeopathy. Greater improvement in mood was found for sophrology and gestalt than for homeopathy clients. These findings are inconsistent with response expectancy as a common factor mechanism in clinical practice. The results support motivational concordance (outcome influenced by the intrinsic enjoyment of the therapy) and the affective expectation model (high expectations can lead for some clients to worse outcome). When expectancy correlates with outcome in some other studies, this may be due to confound between expectancy and intrinsic enjoyment. Key Practitioner Message Common factors play an important role in outcome. Intrinsic enjoyment of a therapeutic treatment is associated with better outcome. Active engagement with a therapeutic treatment improves outcome. Unrealistic expectations about a therapeutic treatment can have a negative impact on outcome

Evidence for similarity in symptoms and mechanism: The extra‐pulmonary symptoms of severe asthma and the polysymptomatic presentation of fibromyalgia

Background Asthma is a disease of the lung and a systemic disease. Functional disorders are associated with multiple systemic abnormalities that have been explained by complexity models. The aim was to test the similarity in type and aetiology between the extra‐pulmonary symptoms of severe asthma and the symptoms of fibromyalgia. Methods One Hundred patients recruited from a specialist severe asthma clinic and 1751 people reporting different functional disorder diagnoses recruited via the internet completed the same 60‐item questionnaire. Symptom patterns were compared between groups using a new measure, the symptom pattern similarity index where 0 = no relationship, 1 = identical patterns between groups. Results Severe asthma patients report numerous extra‐pulmonary symptoms. The similarity index between the symptom pattern of the asthma patients with other groups was irritable bowel syndrome = 0.54, chronic fatigue syndrome = 0.69, and fibromyalgia = 0.75. The index between fibromyalgia and asthma patients with the most and least frequent extra‐pulmonary symptoms was 0.81 and 0.55 respectively. Conclusions Patients with severe asthma have numerous extra‐pulmonary symptoms similar in type and pattern to the symptoms of fibromyalgia. The similarity of the symptom pattern between asthma and fibromyalgia increases as the number of extra‐pulmonary symptoms increases as predicted by network theory and previously shown to be the case with other functional disorders. These findings support the hypothesis that functional disorders and extra‐pulmonary asthma symptoms have a common complexity or network aetiology. Evidence based behavioural interventions for fibromyalgia may be helpful for patients with severe asthma reporting extra‐pulmonary symptoms

Normative Minor Childhood Stress and Risk of Later Adult Psychopathology in Saudi Arabia

Chronic minor childhood stress in the form of corporal punishment predicts adult psychopathology in the United States but has not been demonstrated in a country where corporal punishment is normative. We tested whether adult psychopathology was predicted by recalled frequency of childhood corporal punishment and recalled controllability of punishment in Saudi Arabia. Two hundred and fifty nine Saudi men with substance addictions (who for cultural reasons were at risk for depression) completed a survey measuring: demographic variables, frequency of beating and controllability of punishment as a child, depression and borderline personality disorder symptoms (BPD). Beating frequency and punishment control were uncorrelated and unrelated to patients’ or parents’ education. 92 men (36%) had major depression (PHQ-9 ≥15). Compared to those never beaten, those experiencing infrequent beating (once or twice a year) were significantly more likely to have major depression and higher BPD symptoms, after controlling for demographic variables. Those experiencing frequent beating (monthly or more frequent) were more likely to have major depression and higher BDP symptoms compared to those never beaten, but only when perceived control was low. Perceived punishment control was not significantly related to outcome for those who never had or had infrequent corporal punishment. These results provide evidence in a culture where corporal punishment is normative that corporal punishment, even when infrequent, predisposes to adult psychopathology and that uncontrollability increases the pathogenic effect of frequent corporal punishment. These results support the hypothesis that frequent minor stressors in childhood act as kindling factor for later depression

A qualitative study of the impact of severe asthma and its treatment showing that treatment burden is neglected in existing asthma assessment scales

Background People with severe asthma experience significant respiratory symptoms and suffer adverse effects of oral corticosteroids (OCS), including disturbed mood and physical symptoms. OCS impacts on health-related quality of life (HRQoL) have not been quantified. Asthma HRQoL scales are valid as outcome measures for patients requiring OCS only if they assess the deficits imposed by OCS. Aims The aim of this study was to compare the burden of disease and treatment in patients with severe asthma with items in eight asthma-specific HRQoL scales. Methods Twenty-three patients with severe asthma recruited from a severe asthma clinic were interviewed about the impact of their respiratory symptoms and the burden of their treatment. The domains from a thematic analysis of these interviews were compared with the items of eight asthma-specific HRQoL scales. Results In addition to the burden caused by symptoms, ten domains of OCS impact on HRQoL were identified: depression, irritability, sleep, hunger, weight, skin, gastric, pain, disease anxiety, and medication anxiety. Some patients experienced substantial HRQoL deficits attributed to OCS. Although all HRQoL scales include some OCS-relevant items, all eight scales fail to adequately assess the several types of burden experienced by some patients while on OCS. Conclusion The burden of OCS in severe asthma is neglected in policy and practice because it is not assessed in outcome studies. Existing asthma HRQoL scales provide an overly positive estimation of HRQoL in patients with frequent exposure to OCS and underestimate the benefit of interventions that reduce OCS exposure. Changes to existing measurement procedures are needed

P196 A new questionnaire to measure quality of life in severe asthma (saq): preliminary validation

Introduction and Objectives Existing HRQoL scales have poor content validity for severe asthma as they fail to measure the qualitatively different burdens experienced by the severe asthma population compared to those with mild or moderate asthma, in particular, the side effects of oral corticosteroids (OCS). A new severe asthma quality of life questionnaire (SAQ) has been designed using extensive patient input in qualitative studies as per FDA guidelines. The questionnaire has 16 questions rated on a 1–7 Likert scale and a 100 point global quality of life scale (GQoL) similar to the EQ-5Ds 100 point visual analogue scale (VAS) (SAQ.org.uk). Methods Consecutive consenting patients attending the severe asthma clinic in Plymouth with severe asthma were invited to participate in a cross sectional survey. Patients completed four questionnaires the SAQ, mini Asthma Quality of Life Questionnaire (miniAQLQ), Asthma Control Test (ACT) and the EQ-5D. Prednisolone dose and frequency of severe exacerbations were obtained from clinic records. Results 102 participants (64 female, mean age=51 years range 18–79 years), of whom 38 were on maintenance OCS consented to take part, mean FEV1% of 69%. Correlations between the four questionnaires were all above 0.65. Correlations with frequency of severe exacerbations were SAQ 0.31, miniAQLQ 0.31, ACT 0.34. The SAQ’s GQoL correlated with the EQ-5D’s VAS at 0.73. The SAQ was significantly better than the miniAQLQ at predicting the quality of life of patients taking ≥10 mg OCS a day (p<0.05 vs p=0.88). These questionnaires had parallel Results for doses up to 10 mg but above that only SAQ provided differentiation between patients

U.S. adult perceptions of the harmfulness of tobacco products: descriptive T findings from the 2013–14 baseline wave 1 of the path study

Introduction: This study is the first nationally representative survey of U.S. adults (18+) to examine perceptions of the relative harms of eight non-cigarette tobacco products. Methods: Data are from Wave 1 of the Population Assessment of Tobacco and Health (PATH) Study Adult Questionnaire, a nationally representative study of 32,320 adults in the United States conducted from September 2013 to December 2014. Results: 40.7% of adults believed that electronic cigarettes were less harmful than cigarettes, and 17.8% of adults believed that hookah was less harmful than cigarettes. Those less knowledgeable about the health risks of smoking were more likely to believe that the non-cigarette products were less harmful than cigarettes. Current non-cigarette tobacco product users were more likely to perceive that product to be less harmful than cigarettes (except filtered cigars). There was a significant positive correlation between beliefs that cigarettes were harmful and the likelihood of using hookah; perceptions of the harmfulness of cigarettes was not associated with the likelihood of using any other product. Conclusions: Perceptions of harmfulness varied widely across non-cigarette tobacco products. E-cigarettes and hookah in particular are seen as less harmful compared to cigarettes