Psychosocial Risk Factors for Health-Related Quality of Life in Adult Congenital Heart Disease

Background: There is variability in the impact of adult congenital heart disease (ACHD) on health-related quality of life (HRQoL). A greater insight into the impact of ACHD may be gained from investigating HRQoL in various diagnostic groups and considering the importance of psychosocial risk factors for poor HRQoL. / Objective: We compared the HRQoL of people with ACHD with normative data from the general population and among 4 diagnostic groups and identified risk factors for poor HRQoL in ACHD from a comprehensive set of sociodemographic, clinical, and psychosocial factors. / Methods: We conducted a cross-sectional study with 303 participants from 4 diagnostic groups Simple, Tetralogy of Fallot, Transposition of the Great Arteries, Single Ventricle who completed measures of illness perceptions, coping, social support, mood, and generic and disease-specific HRQoL. Data were analyzed using 1-sample t tests, analysis of variance, and hierarchical multiple regressions. / Results: There was diminished psychosocial HRQoL in the Simple group compared with the general population. Consistently significant risk factors for poor HRQoL included younger age, a perception of more severe symptoms due to ACHD, depression, and anxiety. Clinical factors were poor predictors of HRQoL. / Conclusions: The findings highlight the need to develop intervention studies aiming to improve HRQoL in people with ACHD and the routine assessment of illness perceptions and mood problems during key periods in people's lives. This will help address patient misconceptions that could be tackled by clinicians or specialist nurses during routine outpatient appointments and identify people in need of psychological support

Cognitive dysfunction in Adult Congenital Heart Disease with different structural complexity

We carried out a cross-sectional study to assess cognitive function in a sample of adult CHD patients, within the Functioning in Adult Congenital Heart Disease study London. The association between cognitive functioning and disease complexity was examined. A total of 310 patients participated in this study. Patients were classified into four structural complexity groups – tetralogy of Fallot, transposition of the great arteries, single ventricle, and simple conditions. Each patient underwent neuropsychological assessment to evaluate cognitive function, including memory and executive function, and completed questionnaires to assess depression and anxiety. Among all, 41% of the sample showed impaired performance (>1.5 SD below the normative mean) on at least three tests of cognitive function compared with established normative data. This was higher than the 8% that was expected in a normal population. The sample exhibited significant deficits in divided attention, motor function, and executive functioning. There was a significant group difference in divided attention (F=5.01, p=0.002) and the mean total composite score (F=5.19, p=0.002) between different structural complexity groups, with the simple group displaying better cognitive function. The results indicate that many adult CHD patients display impaired cognitive function relative to a healthy population, which differs in relation to disease complexity. These findings may have implications for clinical decision making in this group of patients during childhood. Possible mechanisms underlying these deficits and how they may be reduced or prevented are discussed; however, further work is needed to draw conclusive judgements

Urban mobility plan environmental impacts assessment: a methodology including socio-economic consequences - The Eval-PDU project

International audienceThe project objective is to develop an optimized methodology to assess the environmental impacts of urban mobility plans (UMP, in French PDU), taking into account their social and economic consequences. The main proposed methodology is based on a systemic approach: multi-factor (air quality, noise, energy consumption, greenhouse gas emission) numerical simulations with a chain of physically-based models, based on alternative and comparative scenarios. The social and economic consequences of these alternative simulations are assessed by means of econometric models. Two alternative approaches are explored: (i) the use of composite environmental indicators to correlate the sources to the impacts, especially health impacts, and (ii) the analysis of sample surveys on what makes inhabitants' quality of life, well-being and territorial satisfaction and on citizens' behavioral changes linked to transport offer changes

Environmental impact assessment of urban mobility plan: a methodology including socio-economic consequences

International audienceThe project objective is to develop an optimized methodology to assess the environmental impacts of urban mobility plans (UMP, in French PDU), taking into account their social and economic consequences. The main proposed methodology is based on a systemic approach: multi factor (air quality, noise, energy consumption, greenhouse gas emission) numerical simulations with a chain of physically-based models, based on alternative and comparative scenarios. The social and economic consequences of these alternative simulations are assessed by means of econometric models. Two alternative approaches are explored: (i) the use of composite environmental indicators to correlate the sources to the impacts, especially health impacts, and (ii) the analysis of sample surveys on what makes inhabitants’ quality of life, well-being and territorial satisfaction and on citizens’ behavioral changes linked to transport offer changes