Can the concepts of depression and quality of life be integrated using a time perspective?

BACKGROUND: Little is understood about the conceptual relationship of depression and quality of life (QoL). Judgments concerning both, implicitly or explicitly, involve a time perspective. The aim of this study was to test de Leval's theoretical model linking depression and QoL with a time perspective. The model predicts that changes in cognitions about one's past, present and future QoL, will be associated with changes in depressive symptomatology. METHODS: Eighteen psychiatric in-patients with a clinically confirmed diagnosis of depression were assessed on commencing treatment and 12 weeks later. QoL was assessed by the Schedule for Evaluation of Individual Quality of Life (SEIQoL), depression by the Beck Depression Inventory (BDI-II) and hopelessness by the Beck Hopelessness Scale (BHS). Time perspective was incorporated by asking QoL questions about the past, present and future. RESULTS: Depression and hopelessness were associated with a poorer present QoL. Depression lowered present QoL but did not alter future QoL, as these remained consistently high whether participants were depressed or recovering. However, depressed individuals had a larger gap between their actual present QoL and future (aspired to) QoL. Changes in QoL were influenced by depression and hopelessness. Contrary to the model, perception of "past" QoL was not affected by depression or hopelessness. CONCLUSIONS: de Leval's model was largely confirmed. Thus depression and hopelessness influence a person's present and future QoL. The analysis of a temporal horizon was helpful in understanding the link between depression and QoL

The MacNew Heart Disease health-related quality of life instrument: A summary

BACKGROUND: The measurement of health, the effects of disease, and the impact of health care include not only an indication of changes in disease frequency and severity but also an estimate of patients' perception of health status before and after treatment. One of the more important developments in health care in the past decade may be the recognition that the patient's perspective is as legitimate and valid as the clinician's in monitoring health care outcomes. This has lead to the development of instruments to quantify the patients' perception of their health status before and after treatment. METHODS: We review evidence supporting the measurement properties of the MacNew Heart Disease Health-related Quality of Life [MacNew] Questionnaire which was designed to evaluate how daily activities and physical, emotional, and social functioning are affected by coronary heart disease and its treatment. RESULTS: Reliability was demonstrated by using internal consistency and the intraclass correlation coefficients for the three domains in the Dutch, English, Farsi, German, and Spanish versions of the MacNew. With internal consistency and intraclass correlation coefficients =>0.73, reliability is high. Validity of the MacNew was examined with factor analysis and three core underlying factors, physical, emotional, and social, were identified, explaining 63.0 – 66.5% of the observed variance and replicated in the translations with psychometric data. Construct validity of the MacNew was further demonstrated by extensive substantiation of the logical relationships, defined a priori, between items and other comparison tools. The MacNew is responsive and sensitive to changes in HRQL following various interventions for patients with heart disease with 11 of 13 effect size statistics >0.80. Taking an average of 10 minutes or less to complete, the respondent-burden for the MacNew is low and its acceptability is demonstrated by response rates of over 90%. Normative data are available for patients with myocardial infarction, angina, and heart failure in the English version. CONCLUSION: The MacNew may be a valuable tool for assessing and evaluating health related quality of life in patients with heart disease

The Polish MacNew heart disease heath-related quality of life questionnaire: A validation study

Background: The MacNew health-related quality of life questionnaire was designed to assess feelings about how heart disease affects their daily physical, emotional and social functioning in patients with 1 of the 3 major coronary artery diagnoses, stable coronary artery disease (CAD) with angina, ST-elevation myocardial infarction (STEMI), and ischemic heart failure (HF). The aim of this study was to determine the reliability and validity of the Polish version of the MacNew in patients with CAD. Methods: Patients with CAD completed a self-report sociodemographic and clinical ques­tionnaire: the MacNew, the Short-Form 36 Health Survey, and HADS at baseline; 10% of the patients completed each questionnaire 2 weeks later. Results: We studied patients with stable CAD with angina (n = 115), with STEMI (n = 112), and with ischemic HF (n = 105). Internal consistency reliability was demonstrated with Cronbach’s a from 0.86 to 0.95 for the MacNew global scale and subscales. The original 3-factor structure was confirmed for the Polish version of the MacNew explaining 53.5% of the variance. Convergent validity of similar MacNew and SF-36 subscales was confirmed in the total group and in each diagnosis. Discriminant validity with the SF-36 health transition was fully confirmed in the total group and in patients with HF and partially confirmed in patients with stable CAD with angina or myocardial infarction. Conclusions: The Polish MacNew health-related quality of life questionnaire can be recommended in patients with stable CAD with angina, myocardial infarction and HF

Drohnenschlag auf Hubschrauberscheiben

Zunehmend werden Drohnen in der Nähe von Hubschraubern gesichtet. Darüber hinaus stellt für Hubschrauber im Einsatz auch die absichtlich herbeigeführte Kollision mit einer Drohne eine mögliche Gefahr dar. Ziel der Forschung ist es, die Gefährdung von Insassen durch Drohnenschlag auf die Cockpitverglasung im Vergleich zum Vogelschlag zu bewerten. Dazu werden durch geeignete Tests überprüfte Computermodelle sowohl der Struktur als auch der Drohne und des Vogels eingesetzt. Increasingly there are drone sightings close to helicopters. An accidental or deliberate collision of drones and rotorcrafts is a possible hazard to safe operation. Objective of the research is to determine the threat of drone strike on the cockpit glazing in comparison to bird strike. Computer models of the helicopter structure as well as the drone and bird impactors are applied here. Suitable tests are carried out to validate this numerical approach

How do medical students value health on the EQ-5D? Evaluation of hypothetical health states compared to the general population

<p>Abstract</p> <p>Background</p> <p>Medical students gain a particular perspective on health problems during their medical education. This article describes how medical students value 10 hypothetical health states using the EQ-5D compared to the general population.</p> <p>Methods</p> <p>Based on a sample of 161 medical students (male: 41%) we compared valuations of 10 hypothetical EQ-5D health states collected in face to face interviews with the valuations of the general population. Self-reported health on the EQ-5D was also collected.</p> <p>Results</p> <p>Every third health state was valuated higher by the medical students compared to data of the general population. The differences were independent of the severity of the hypothetical health state. Concerning the self-reported health, the majority of the students (66%) reported no problems in the five EQ-5D domains (EQ-5D VAS M = 87.3 ± 9.6 SD). However, when compared to an age-matched sample the medical students show significantly more problems in the area of pain/discomfort and anxiety/depression.</p> <p>Conclusion</p> <p>Medical students have a tendency to value health states higher than the general public. Medical professionals should be continuously aware that their assessment of the patients health state can differ from the valuations of the general population.</p

Response shift masks the treatment impact on patient reported outcomes (PROs): the example of individual quality of life in edentulous patients

BACKGROUND: Quality of life (QoL) is now established as an important outcome for evaluating the impact of disease, and for assessing the efficacy of treatments. However, individuals change with time and the basis on which they make a QoL judgement may also change, a phenomenon increasingly referred to as response shift. Here, the individual may change his or her internal standards, values, and/or conceptualization on the target construct as a result of external factors such as a treatment or a change in health status. This has important implications for assessing the effects of treatments as a change in QoL may reflect a response shift, a treatment effect, or a complex combination of both. In this study, we used an individualised quality of life (IQoL) measure, the SEIQoL, together with a then-test to determine whether response shift would influence the measurement of treatment efficacy in edentulous patients. METHODS: Data are reported here for the first phase of a randomised controlled clinical trial designed to assess the impact, on IQoL, of implant supported dentures compared with high quality conventional dentures. IQoL was measured using the SEIQoL-DW in 117 patients (mean age 64.8; 32% male) at baseline (T(1)) and 3 months (T(2)) after receiving high quality conventional dentures. The work was carried out in dental teaching hospitals in Dublin and Belfast. RESULTS: Unadjusted SEIQoL index scores revealed no significant impact of treatment at three months (baseline: 75.0; 3 months: 73.2, p = .33, n.s.). However, the then-test at 3 months revealed that patients retrospectively rated their baseline IQoL as significantly lower (P < .001) than they had rated it at the time (then-test baseline: 69.2). Comparison of the 3 month scores with this readjusted baseline indicated a significant treatment effect (then-test baseline: 69.2; 3 months: 73.2, p = 0.016). 81% of patients nominated at least one different IQoL domain at 3 months. CONCLUSION: The positive impact of denture treatment for edentulous patients on IQoL was seen only when response shifts were taken into consideration. The nature of the response shifts was highly complex but the data indicated a degree of re-conceptualisation and reprioritisation. Assessment of the impact of treatments using patient-generated reports must take account of the adaptive nature of patients

Do Mutual Fund Ratings Provide Valuable Information for Retail Investors? Empirical Evidence on Ratings Non-Persistence and the Risk of Mutual Fund Closure

Retail investors use information provided by mutual fund rating agencies to make investment decisions. Using hand-collected data on Morningstar’s mutual fund ratings we examine the rating migration and closure risk of mutual funds from 2005 to 2012. We differentiate between buy-and-hold investment strategies and dynamic investment strategies. To assess the information content of mutual fund ratings for buy-and-hold investment strategies, we determine the rating migration based on the first and the last mutual fund rating during two-, four-, six-, and eight-year horizons. With respect to dynamic investment strategies, we calculate the number of rating changes per fund during these time horizons on a monthly basis. We find that mutual fund rating persistence is low or even inexistent in particular during longer time periods. Only for lower-rated funds the rating appears to indicate higher risk of fund closure. In addition, mutual funds face a large number of up to 38 monthly rating changes in the eight-year window. Overall, due to the extensive rating migration and the high number of monthly rating changes, we conclude that retail investors barely benefit from using mutual fund ratings

Reality Meets Belief: A Mixed Methods Study on Character Strengths and Well-Being of Hospital Physicians

Positive psychology deals with factors that make life most worth living and focuses on enhancing individual potentials. Particularly, character strengths can positively contribute to well-being and work-related health, bearing a promising potential for professions, such as physicians, who are at risk for burnout or mental illnesses. This study aims to identify beneficial character strengths by examining the quantitative and qualitative data. In a cross-sectional multi-method study, 218 hospital physicians completed an online survey assessing their character strengths and their general and work-related well-being, comprising thriving, work engagement, and burnout dimensions (outcome variables). Quantitative data were analyzed for the total sample and by tertiary split. Additionally, interview-gathered opinions of four resident physicians and four medical specialist educators were collected to expand the perspective on which character strengths might be beneficial for the well-being of the resident physicians. The highest significant correlations between character strengths and outcome variables were found for hope and thriving (r = 0.67), zest, and work engagement (r = 0.67) as well as emotional exhaustion (r = −0.47), perseverance/leadership and depersonalization (r = −0.27), bravery, and reduced personal accomplishment (r = −0.39). Tertiary splits revealed that some correlations were not consistent across the entire scale continuum, for example, creativity was only significantly correlated with comparatively high levels of thriving (r = 0.28) or forgiveness with comparatively high levels of depersonalization (r = −0.34). Humility, social intelligence, and teamwork showed predominantly low correlations with all outcome variables (r = −0.17 − 0.34), although humility was stated by all interviewed medical specialist educators to be the most relevant for the well-being at work, and the latter two by three resident physicians, respectively. Different perspectives resulting from quantitative and qualitative data in terms of beneficial character strengths for work-related well-being may be driven by different work experiences, professional understandings, generational beliefs, or social expectations. Some significant correlations between character strengths and well-being outcomes varied depending on low, medium, or high outcomes. This raises questions about suitable work-related well-being interventions, as simple single intervention approaches (one intervention fits all) may not work for the respective outcome levels. These new findings warrant further research on how to foster the well-being of resident physicians at work

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Background  Patient health-related quality of life (HRQL) is an important health outcome with lower HRQL associated with adverse events in patients with ischaemic heart disease (IHD).Design Baseline health-related quality of life was investigated as a predictor of 5-year all-cause mortality and cardiac readmissions in Danish patients with IHD. Methods  The international HeartQoL Project survey was designed to develop a core HRQL questionnaire for patients with IHD. Baseline scores on each of the 14 items ultimately included in the HeartQoL questionnaire were linked to Danish national health registries and hazard ratios for mortality and readmissions were estimated using Cox regression models.Results Among 938 eligible Danish patients with IHD, 662 (70.6%) participated in the international HeartQoL Project. During the 5-year follow-up, 83 patients died and 196 patients were readmitted. Adjusted analyses showed a significant linear association between all-cause mortality and both lower global HRQL (HR = 1.67, 95% CI: 1.26–2.23; p < 0.001) and physical scores (HR = 1.71, 1.33–2.21; p < 0.001) and between readmission and both lower global (HR = 1.73, 1.41–2.12; p < 0.001) and physical scores (HR = 1.63, 1.35–1.96; p < 0.001). A significant, but non-linear, effect was found for emotional HRQL score on outcomes. Conclusion  This study shows a significant and linear relationship between lower global and physical HRQL scores in patients with IHD and 5-year all-cause mortality and cardiac readmission