Health-related quality of life of primary care patients with depressive disorders

Background: Depressive disorders are known to impair health-related quality of life (HRQoL) both in the short and long term. However, the determinants of long-term HRQoL outcomes in primary care patients with depressive disorders remain unclear. Methods: In a primary care cohort study of patients with depressive disorders, 82% of 137 patients were prospectively followed up for five years. Psychiatric disorders were diagnosed with SCID-I/P and SCID-II interviews; clinical, psychosocial and socio-economic factors were investigated by rating scales and questionnaires plus medical and psychiatric records. HRQoL was measured with the generic 15D instrument at baseline and five years, and compared with an age-standardized general population sample (n = 3707) at five years. Results: Depression affected the 15D total score and almost all dimensions at both time points. At the end of follow-up, HRQoL of patients in major depressive episode (MDE) was particularly low, and the association between severity of depression (Beck Depression Inventory [BDI]) and HRQoL was very strong (r = -0.804). The most significant predictors for change in HRQoL were changes in BDI and Beck Anxiety Inventory (BAI) scores. The mean 15D score of depressive primary care patients at five years was much worse than in the age-standardized general population, reaching normal range only among patients who were in clinical remission and had virtually no symptoms. Conclusions: Among depressive primary care patients, presence of current depressive symptoms markedly reduces HRQoL, with symptoms of concurrent anxiety also having a marked impact. For HRQoL to normalize, current depressive and anxiety symptoms must be virtually absent. (C) 2016 Elsevier Masson SAS. All rights reserved.Peer reviewe

Cross-country cross-survey design in international marketing research: the role of input data in multiple imputation

Purpose – The present paper focuses on the case where – by design – one needs to impute cross-country cross-survey data (situation typical for example among multinational firms who are confronted with the need to carry out comparative marketing surveys with respondents located in several countries). Importantly, while some work demonstrates approaches for single-item direct measures, no prior research has examined the common situation in international marketing where the researcher needs to use multi-item scales of latent constructs. Our paper presents problem areas related to the choices international marketers have to make when doing cross-country / cross-survey research and provides guidance for future research. Design/methodology/approach – Multi-country sample of real data is used as an example of cross-sample imputation (292 New Zealand exporters and 302 Finnish ones) the international entrepreneurial orientation data. Three variations of the input data are tested: A) imputation based on all the data available for the measurement model, B) imputation based on the set of items based on the invariance structure of the joint items shared across the two groups, and C) imputation based both on examination of the invariance structures of the joint items and the performance of the measurement model in the group where the full data was originally available. Findings – Based on distribution comparisons imputation for New Zealand after completing the measurement model with Finnish data (Model C) gave the most promising results. Consequently, using knowledge on between country measurement qualities may improve the imputation results, but this benefit comes with a downside since it simultaneously reduces the amount of data used for imputation. None of the imputation models leads to the same statistical inferences about covariances between latent constructs than as the original full data, however. Research limitations / Implications - The present exploratory study suggests that there are several concerns and issues that should be taken into account when planning cross-country cross-surveys. These concerns arising from current study lead us to question the appropriateness of the cross-country cross-survey approach in general although in general advantages exist. Further research is needed to find the best methods. Originality / value – The combination of cross-country and cross-survey approaches is novel to international marketing, and it is not known how the different procedures utilized in imputation affect the results and their validity and reliability. We demonstrate the consequences of the various imputation strategy choices taken by using a real example of a two-country sample. Our exploration may have significant implications to international marketing researchers and the paper offers stimulus for further research in the area

Long-term quality of life after surgery of head and neck cancer with microvascular reconstruction: a prospective study with 4.9-years follow-up

PurposeThe aim of this study was to evaluate the long-term health-related quality of life (HRQoL) of head and neck cancer patients with microvascular surgery. Surgical treatment causes great changes in patient HRQoL. Studies focusing on long-term HRQoL after microvascular reconstruction for head and neck cancer patients are scarce.MethodsWe conducted a prospective study of 93 patients with head and neck cancer and microvascular reconstruction in Helsinki University Hospital Finland. HRQoL was measured using the 15D instrument at baseline and after a mean 4.9-years follow up. Results were compared with those of an age-standardized general population.ResultsOf the 93 patients, 61 (66%) were alive after follow-up; of these, 42 (69%) answered the follow-up questionnaire. The median time between surgery and HRQoL assessment was 4.9 years (range 3.7–7.8 years). The mean 15D score of all patients (n = 42) at the 4.9-years follow up was statistically significantly (p = 0.010) and clinically importantly lower than at baseline. The dimensions of “speech” and “usual activities” were significantly impaired at the end of follow up. There was a significant difference at the 4.9-years follow-up in the mean 15D score between patients and the general population (p = 0.014). After follow up, patients were significantly (p ConclusionsLong-term HRQoL was significantly reduced in the whole patient cohort. Speech and usual activities were the most affected dimensions in head and neck cancer patients with microvascular reconstruction at the end of the 4.9-years follow up.</p

Effects of risk-based multifactorial fall prevention on health-related quality of life among the community-dwelling aged: a randomized controlled trial

BACKGROUND: This study aimed to assess the effects of a risk-based, multifactorial fall prevention programme on health-related quality of life among the community-dwelling aged who had fallen at least once during the previous 12 months. METHODS: The study is a part of a single-centre, risk-based, multifactorial randomised controlled trial. The intervention lasted for 12 months and consisted of a geriatric assessment, guidance and treatment, individual instruction in fall prevention, group exercise, lectures on themes related to falling, psychosocial group activities and home exercise. Of the total study population (n = 591, 97% of eligible subjects), 513(251 in the intervention group and 262 in the control group) participated in this study. The effect of the intervention on quality of life was measured using the 15D health-related quality of life instrument consisting of 15 dimensions. The data were analysed using the chi-square test or Fisher's exact test, the Mann-Whitney U-test and logistic regression. RESULTS: In men, the results showed significant differences in the changes between the intervention and control groups in depression (p = 0.017) and distress (p = 0.029) and marginally significant differences in usual activities (p = 0.058) and sexual activity (p = 0.051). In women, significant differences in the changes between the groups were found in usual activities (p = 0.005) and discomfort/symptoms (p = 0.047). For the subjects aged 65 to 74 years, significant differences in the changes between the groups were seen in distress (p = 0.037) among men and in usual activities (p = 0.011) among women. All improvements were in favour of the intervention group. CONCLUSION: Fall prevention produced positive effects on some dimensions of health-related quality of life in the community-dwelling aged. Men benefited more than women