Quality of life in diabetic foot ulcer, grade 3: associated demographic factors

Abstract Introduction: Patients with diabetic foot ulcer grade 3 experience some limitations that adversely affect their quality of life (QoL). Aim: The aim of the study was to explore demographic characteristics associated with the quality of life of diabetic foot ulcer patients, grade 3. Materials and methods: The present study recruited 120 diabetic foot ulcer patients. Data collected by completion of SF-36 Health Survey (SF-36). Results: Of the 120 participants, 65.8% were men and 73% were more than 60 years of age. Patients showed moderate to high levels of quality of life in social functionality, energy/fatigue, emotional well-being, and physical pain (medians: 50, 60, 72, and 67.5, respectively) and poor levels in physical functioning, role physical, and role emotional (medians: 22, 0 and 0, respectively). In addition, patients had moderate levels of quality of life in general health (median: 48.5). It was observed that physical functioning was significantly associated with place of residence (p=0.005). Moreover, physical role was significantly associated with age (p=0.020) and occupation (p=0.018), while emotional role was significantly associated with age (p=0.012), marital status (p=0.016), and occupation (p=0.012). Energy/fatigue was significantly associated with age (p=0.026), marital status (p=0.018), and occupation (p=0.009). Emotional well-being was significantly associated with gender (p=0.009), level of education (p=0.001), and occupation (p=0.007). Social functionality was significantly associated with marital status (p=0.001) while pain was significantly associated with education level (p=0.010). General health was significantly associated with marital status (p=0.037), and place of residence (p=0.024). Conclusions: The findings of the present study may adequately inform stakeholders in the field of diabetic foot ulcer grade 3 when planning effective care

Factors Affecting Health Related Quality of Life in Hospitalized Patients with Heart Failure

This study identified factors affecting health related quality of life (HRQOL) in 300 hospitalized patients with heart failure (HF). Data were collected by the completion of a questionnaire which included patients’ characteristics and the Minnesota Living with Heart Failure Questionnaire (MLHFQ). Analysis of data showed that the median of the total score of MLHFQ was 46 and the median of the physical and mental state was 22 and 6, respectively. Also, participants who were householders or had “other” professions had lower score of 17 points and therefore better quality of life compared to patients who were civil/private employees (p<0.001 and p<0.001, resp.). Patients not receiving anxiolytics and antidepressants had lower quality of life scores of 6 and 15.5 points, respectively, compared to patients who received (p=0.003 and p<0.001, resp.). Patients with no prior hospitalization had lower score of 7 points compared to those with prior hospitalization (p=0.002), whereas patients not retired due to the disease had higher score of 7 points (p=0.034). Similar results were observed for the physical and mental state. Improvement of HF patients’ quality of life should come to the forefront of clinical practice

Anxiety and Depression in Patients with Permanent Atrial Fibrillation: Prevalence and Associated Factors

Atrial fibrillation (AF) is an important public health problem that is increasing at an alarming rate, worldwide. The most common type is permanent AF followed by the paroxysmal and persistent AF. Purpose. This study was aimed at exploring anxiety and depression and the associated factors in patients with permanent AF. Materials and Methods. The sample of the study included 170 AF patients. Data collection was performed by the method of interview using the “Hospital Anxiety and Depression Scale” (HADS) to assess anxiety and depression and a questionnaire including patients’ characteristics. Results. 70% of the participants were men, and 32.4% were above 70 years old. Furthermore, 34.9% of the patients had high levels of anxiety, and 20.2% had high levels of depression. Anxiety levels were statistically significantly associated with gender p=0.022, age p=0.022, educational level p=0.025, years having the disease p=0.005, and relations with nursing staff p=0.040. Depression levels were statistically significantly associated with age p=0.037, degree of information of the state of health p<0.001, years having the disease p<0.001, and relations with medical staff p=0.041. Conclusions. Patients’ characteristics are associated with anxiety and depression and need to be evaluated when treating this frequently encountered arrhythmia

Quality of life of patients with cardiac pacemaker: levels, associated characteristics, and the impact of anxiety and depression

Introduction: Implantation of a permanent cardiac pacemaker (PPM) improves recipients’ quality of life (QoL). However, psychiatric disturbance may adversely affect QoL and undermine clinical outcomes. Aim: To explore impact of anxiety and depression on QoL of PPM recipients. Materials and methods: A hundred and fifty PPM recipients were enrolled. Data collection was performed by completing the Hospital Anxiety and Depression Scale (HADS) and the SF-36 Health Survey (SF-36). Demographic characteristics were also included. The statistical significance level was p<0.05. Results: Almost a quarter of the patients experienced anxiety (25.3%) and depression (26.0%). In terms of QoL, patients showed moderate to high levels in social functionality, energy/fatigue, emotional well-being and pain (median: 50, 60, 72, and 67.5, respectively) and poor levels in physical functioning, physical role and emotional role (medians: 22, 0, and 0 respectively). In addition, patients had moderate levels of general health (median 48.5). All QoL subscales were negatively associated with anxiety and depression of patients on a univariate level (p<0.05). Regarding demographic variables affecting QoL, age was statistically significantly associated with physical role (p=0.025), emotional role (p=0.005), social functioning (p=0.033), and pain (p=0.018). Furthermore, physical role was statistically significantly associated with number of children (p=0.024), emotional role with education level (p=0.011), social functioning with family status (p=0.018), and general health with residency (p=0.006). Conclusions: Demographic characteristics and anxiety/depression are related with QoL. A better understanding of these associations may help clinicians in planning rational and cost-effective interventions

Quality of life in diabetic foot ulcer, grade 3: associated demographic factors

Abstract Introduction: Patients with diabetic foot ulcer grade 3 experience some limitations that adversely affect their quality of life (QoL). Aim: The aim of the study was to explore demographic characteristics associated with the quality of life of diabetic foot ulcer patients, grade 3. Materials and methods: The present study recruited 120 diabetic foot ulcer patients. Data collected by completion of SF-36 Health Survey (SF-36). Results: Of the 120 participants, 65.8% were men and 73% were more than 60 years of age. Patients showed moderate to high levels of quality of life in social functionality, energy/fatigue, emotional well-being, and physical pain (medians: 50, 60, 72, and 67.5, respectively) and poor levels in physical functioning, role physical, and role emotional (medians: 22, 0 and 0, respectively). In addition, patients had moderate levels of quality of life in general health (median: 48.5). It was observed that physical functioning was significantly associated with place of residence (p=0.005). Moreover, physical role was significantly associated with age (p=0.020) and occupation (p=0.018), while emotional role was significantly associated with age (p=0.012), marital status (p=0.016), and occupation (p=0.012). Energy/fatigue was significantly associated with age (p=0.026), marital status (p=0.018), and occupation (p=0.009). Emotional well-being was significantly associated with gender (p=0.009), level of education (p=0.001), and occupation (p=0.007). Social functionality was significantly associated with marital status (p=0.001) while pain was significantly associated with education level (p=0.010). General health was significantly associated with marital status (p=0.037), and place of residence (p=0.024). Conclusions: The findings of the present study may adequately inform stakeholders in the field of diabetic foot ulcer grade 3 when planning effective care

Διερεύνηση της επίπτωσης του άγχους και της κατάθλιψης στις ανάγκες νοσηλευομένων ασθενών με στεφανιαία νόσο

Introduction: Metabolic Syndrome (M.S.) is a chronic and a complex condition that can cause physical, emotional and psycho-social issues, characterized by multiple interrelated disorders which increase the risk of cardiovascular disease.Aim: The aim of the present study is to explore the quality of life in patients with M.S. compared to the control group. Moreover, this study examined the prevalence of personality type D in patients with M.S. compared to the control group and whether this relation is independent from the existence of stress or symptoms of depression.Methods: During a 2 year period (2007 to 2009), 749 consecutive patients referred to the outpatient lipid clinic of our hospital for evaluation of possible M.S., from whom 359 were eligible for the study. M.S. was defined according to the International Diabetes Federation (IDF) diagnostic criteria. A questionnaire of SF-36 was used for the evaluation of M.S. patients’ quality of life. The Greek certified HADS-scale was used for the evaluation of stress and depression. Finally, Type D personality was assessed using the DS-14 scale.Results: Three hundred and fifty-nine persons were screened of whom 206 (57.4%) met the diagnostic criteria of M.S. ("cases") while 153 persons (42.6%) did not ("control group"). M.S. was associated with lower scores of all subscales of the SF-36 except of bodily pain. The Physical component summary score of SF-36 was independently associated with gender (β=2.41, P=.01), married or living together (β=3.20, P=.003) and satisfactory household income (β=5.77, P<.0001). The Mental component summary score of SF-36 was independently associated with gender (β=3.94, P=.02). A predominance of anxiety and depressive symptoms was observed among subjects with M.S.. The prevalence of type D personality was significantly higher in M.S. patients when compared with the control group (44% versus 15% respectively, p<0.001). In multivariate logistic regression analysis the presence of type D personality was significantly associated with MS independently of other clinical factors, anxiety and depression symptoms (odds ratio 3.47;95% CI: 1.90 - 6.33).Conclusions: Our study demonstrated that subjects with M.S. have significantly worse quality of life (HRQoL) than those without M.S.. These findings suggest that HRQoL should be considered in the management of subjects with MS. Type D personality was independently associated with the M.S. in this cross-sectional study. The potential implications of these findings, especially from a clinical or preventive perspective, should be examined in future research.ΣΚΟΠΟΣ H διερεύνηση της επίπτωσης του άγχους και της κατάθλιψης στις ανάγκες νοσηλευομένων ασθενών με στεφανιαία νόσο. ΥΛΙΚΟ ΚΑΙ ΜΕΘΟΔΟΣ Τον πληθυσμό της παρούσης μελέτης αποτέλεσαν 702 νοσηλευόμενοι ασθενείς με στεφανιαία νόσο σε τέσσερα δημόσια νοσοκομεία του νομού Αττικής και σε δυο νοσοκομεία της επαρχίας. Η συλλογή των στοιχείων έγινε με τη συμπλήρωση ειδικού ερωτηματολογίου, το οποίο εκτός από τα δημογραφικά και κλινικά χαρακτηριστικά περιελάμβανε την κλίμακα «The Hospital Anxiety And Depression Scale (HADS)» και ένα ειδικά διαμορφωμένο ερωτηματολόγιο που αφορούσε στην εκτίμηση των αναγκών των ασθενών. Η στατιστική ανάλυση έγινε με το στατιστικό πακέτο SPSS 17. ΑΠΟΤΕΛΕΣΜΑΤΑ Από τους συμμετέχοντες το 78,3% ήταν ηλικίας 50-80 χρόνων, το 71,4% ήταν παντρεμένοι, το 48,1% ήταν συνταξιούχοι, το 48,4% ήταν βασικής εκπαίδευσης και το 48,3% είχε 2 παιδιά. Ως προς τη διάγνωση, το 32,2% των συμμετεχόντων είχε έμφραγμα του μυοκαρδίου με ανάσπαση του ST (STEMI) και το 27,1% καρδιακή ανεπάρκεια. Το 63,4% το πληθυσμού της μελέτης ελάμβανε φαρμακευτική θεραπεία, το 49,7% είχε ιστορικό καρδιαγγειακής νόσου και στο 43,8% συνυπήρχε άλλη νόσος. Το 25,5% των συμμετεχόντων βίωνε μέτρια επίπεδα άγχους και το 32,7% υψηλά επίπεδα άγχους, ενώ το 19,1% βίωνε μέτρια επίπεδα κατάθλιψης και το 20,0% υψηλά επίπεδα. Όσον αφορά στις ανάγκες νοσηλευομένων ασθενών σχετικά με τη ψυχική τους υγεία, βρέθηκε, ότι κανένα είδος από τις ανάγκες δεν σχετίζονταν στατιστικά σημαντικά με το άγχος των ασθενών. Αντιθέτως, : α) η ανάγκη για στήριξη και καθοδήγηση, β) η ανάγκη για πληροφόρηση από το ιατρο-νοσηλευτικό προσωπικό, γ) η ανάγκη για επικοινωνία με άλλες ομάδες ασθενών και εξασφάλιση συνθηκών για επικοινωνία με τους συγγενείς, δ) η ανάγκη για εξατομίκευση της φροντίδας και συμμετοχή του ιδίου του ασθενή στη φροντίδα, ε) η ανάγκη για κάλυψη των συναισθηματικών αναγκών (π.χ. άγχος, φόβος, μοναξιά) και φυσικών αναγκών (όπως ξεκούραση, ύπνος, καλύτερες συνθήκες νοσηλείας), στ) η ανάγκη εμπιστοσύνης από το ιατρο-νοσηλευτικό προσωπικό συσχετίζονταν στατιστικά σημαντικά με τα επίπεδα κατάθλιψης, p<0,001. Επιπρόσθετα, η πολυπαραγοντική γραμμική παλινδρόμηση έδειξε ότι η κατάθλιψη συσχετίζονταν με τις ανάγκες των ασθενών ακόμα και μετά από τη διόρθωση για την ηλικία των ασθενών, το φύλο τους, την οικογενειακή τους κατάσταση, τον τόπο διαμονής τους, τον τύπο του καρδιολογικού προβλήματος, το βαθμό ενημέρωσής τους για το καρδιολογικό τους πρόβλημα και τα έτη που πάσχουν από το συγκεκριμένο πρόβλημα. ΣΥΜΠΕΡΑΣΜΑ Η εκτίμηση των αναγκών των ασθενών με στεφανιαία νόσο και η συστηματική προσέγγιση του άγχους και της κατάθλιψης πρέπει να αποτελούν αναπόσπαστο τμήμα της θεραπείας αφού επιτρέπουν την αποτελεσματική βιο-ψυχοκοινωνική προσέγγιση των ασθενών και την καλύτερη έκβαση της νόσου

Effectiveness and Safety of Complete Decongestive Therapy of Phase I: A Lymphedema Treatment Study in the Greek Population

Background Lymphedema is a chronic condition caused by a failure in the lymphatic system that most commonly occurs in the limbs. Complete decongestive therapy (CDT) is the gold standard for lymphedema management. Objective To evaluate the effectiveness and safety of complete decongestive therapy (CDT) of phase I in the Greek population with lymphedema. Methods The patients’ demographic and clinical characteristics were recorded. CDT was implemented in all patients for 20 sessions in a four-week treatment period. The edema’s (excess volume (EV) and percent of excess volume (PEV)) measurements were carried out four times in the treatment period, whereas the percent reduction of excess volume (PREV) was calculated at the end of phase I. Moreover, we recorded every infection, trauma of skin, and pain of limb during the treatment. Results One-hundred five patients with lymphedema were enrolled in the present study, of whom 31.4% had upper limb lymphedema and 68.6% had lower limb lymphedema. All patients with upper limb lymphedema had a secondary type while the corresponding proportion of patients with lower limb lymphedema was 58.3%. A significant reduction (p&lt;0.001) between the pretreatment and post-treatment values of EV and PEV was found for both upper and lower limb lymphedema. For patients with upper limb lymphedema, the average PREV was 66.5% (interquartile range, 57.3%-80.6%), whereas for patients with lower limb lymphedema, a 71.5% (interquartile range, 64.5%-80.7%) median value was measured. No side effects from the treatment were recorded during CDT. Conclusion The proper treatment of the CDT phase I ensures safety and a great reduction in edema in patients with lymphedema that predispose the success of phase II of CDT

Comparison of Radial Extracorporeal Shockwave Therapy versus Ultrasound Therapy in the Treatment of Rotator Cuff Tendinopathy

Introduction: People suffering from rotator cuff tendinopathy exhibit reduced mobility due to pain. The pain and the limited functionality affect negatively the overall quality of life.Aim: The present study aimed to investigate the intensity of pain, the functionality of the upper limbs and the quality of life of patients with rotator cuff tendinopathy by using two different therapeutic modalities, shockwave and ultrasound, whose outcomes were assessed pre-treatment and post-treatment as well as after a 4-week follow-up.Materials and methods: Out of the total sample of 115 patients with rotator cuff tendinopathy, 56 patients constituted the shockwave intervention group, 47 patients constituted the therapeutic ultrasound group and 12 patients made up the control group. The self-administered questionnaire “The University of Peloponnese Pain, Functionality and Quality of Life Questionnaire, UoP – PFQ” was used where the intensity of pain, functionality and quality of life of the upper limbs were evaluated on a five-point Likert scale, pre-treatment, post-treatment and at a 4-week follow-up.Results: The pain intensity was reduced and both the functionality and quality of life were improved after shockwave therapy post-treatment (p<0.001) and at a 4-week follow-up (p<0.001) compared with those found after the treatment. Similar improvements in all three parameters were also observed after ultrasound treatment but the outcomes were not as pronounced as in the shockwave group. Conclusion: Both radial shockwave and ultrasound therapies were found to be effective in the treatment of rotator cuff tendinopathy, the statistical analysis showing that radial shockwave therapy was superior to the ultrasound therapy post-treatment and at the 4-week follow-up