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Purpose: This trial assessed the ability to enhance health-related quality of life (HRQL) and patient-reported outcome (PRO) evaluation in trials and patient management using computer assistance with a handheld device, called a personal digital assistant. The study assessed ease of use and psychometric properties of this approach, comparing the Lung Cancer Symptom Scale (LCSS) paper form with the electronic (eLCSS-QL). Objectives were to: (1) measure completion times; (2) evaluate acceptability by patients, nurses, and physicians; (3) determine the correlation of the eLCSS-QL with the paper version; and (4) determine the feasibility of using a shorter visual analogue scale (VAS) in the electronic version., Patients and Methods: Patients were entered at 12 COMET clinics. All had: (a) stage III or IV non-small cell lung cancer, (b) Karnofsky performance status (KPS)  ≥  60, (c) no prior chemotherapy, and (d) received initial courses of docetaxel + platinum. Of the 148 patients enrolled, characteristics were: men, 57 %; median, KPS 80 %; and median age, 67 years. Of these, 131 patients completed the evaluation form., Results: The eLCSS-QL had excellent acceptance by patients, nurses, and physicians. Patients required 2.2 min (mean) to complete the eLCSS-QL. Reliability coefficients using Cronbach's alpha were high for the paper (0.84) and electronic (0.88) versions. The correlation coefficient between forms was high (0.92). The length of the VAS on the handheld pc (53 mm versus 100 mm on the paper format) resulted in nearly identical scores., Conclusions: The high acceptance rate by patients and professionals, the rapid completion time, ease of use, and strong psychometric properties confirm that the electronic LCSS (eLCSS-QL) is practical for use in trials and patient management. This study indicates that computer assistance helps overcome barriers associated with evaluating HRQL and PROs.

Objective: Breast cancer is the most common cancer among women world-wide. In North America survival rates are >80%, resulting in a large population of survivors. The goal of this review was to systematically explore the literature to identify the status of body image and factors that can impact the body image of older breast cancer survivors., Methods: A systematic review of the literature was conducted and registered with PROSPERO (CRD42019133617). EMBASE and PubMed were searched for articles including terms related to "body image" and "breast cancer." Duplicates were removed and the remaining 322 abstracts were screened. Articles published before 2000, were off-topic, or those that were non-primary research articles were excluded. Sixty-nine remaining full-length articles were screened for language, gender and location. Seven articles underwent quality assessment of which five passed and were reviewed in depth. The remaining two articles were briefly discussed., Results: The literature review suggests that body image is considered important in older BCS and that body image may impact or be impacted by several factors including age, menopausal status, mental health, treatment modality and exercise. Additionally, themes of dealing with physical changes and the length of time women are impacted following treatment were explored., Conclusion: Our findings highlight that older women may be at an advantage in terms of being post-menopausal, however concerns surrounding physical and emotional changes affecting body image are indeed present. Future studies on breast cancer survivorship should consider the inclusion of body image as an outcome measure in addition to including individuals representing a wide range of ages., (© 2020 John Wiley & Sons, Ltd.)

In this paper we focus our attention on an examination of the four-step process adopted by the World Health Organization (WHO) in its systematic campaign to promote physically active lifestyles by older adults across the 193 WHO member states. The four steps adopted by the WHO include (1) Building Consensus Among Professionals; (2) Educating the Public and Building Consumer Demand; (3) Developing an Active Aging Public Policy Framework; and (4) Refining, Expanding, and Evolving the Model. For each of these steps we describe the processes by which the WHO sought input from a wide variety of sources in each of the six WHO regions (Africa, Americas, South-East Asia, Europe, Eastern Mediterranean, Western Pacific). Using this approach they helped to systematically build a transnational consensus with regard to the importance of regular physical activity as a critical component of the prevention of chronic disease and the promotion of high quality of life in the older adult population. The focus of WHO activity has gradually shifted away from advocating for increased physical activity interventions, per se, to a more nuanced approach focusing on articulating the policy requirements for the promotion of active aging across multiple determinants and risk factors. The realization that effective health promotion strategies cannot exist in isolation but rather must be consistent with and reflective of the economic, political, and cultural realities of the societies in which they are to be implemented marks an important advance in the WHO strategy in the area of physical activity promotion. The paper concludes with a brief description of recent WHO efforts to promote Global Age-Friendly Cities and to develop multisectoral strategies to reduce falls in older adult populations. Both of these initiatives underscore the important role that kinesiologists and other health professionals have in the development of, and implementation of, active aging strategies and polices. The goal of this paper is to examine the process by which research findings and other evidence gathered from a variety of sources, countries, and cultures gradually coalesce into a broad transnational consensus with respect to accepted policies and procedures in international public health. To illustrate the complex steps involved in the evolution of transnational consensus with regard to best practices and effective public policy, we will examine the role played by the WHO in building awareness and understanding with respect to the importance of regular physical activity for the promotion of health and quality of life of adults over the age of 50 years. (Contains 3 figures.)

Ginseng is a very commonly used natural product in the world, and its two main species are Asian ginseng and American ginseng. Ginseng is an adaptogenic botanical that reportedly protects the body against stress, stabilizes physiological processes, and restores homeostasis. Previously, different animal models and contemporary research methodologies have been used to reveal ginseng's biomedical activities in different body systems and the linked mechanisms of actions. However, human clinical observation data on ginseng effects have attracted more attention from the general public and medical community. In this paper, after an introduction of the phytochemistry of ginseng species, we review positive ginseng clinical studies, mainly conducted in developed countries, performed over the past 20 years. The reported effects of ginseng are presented in several sections, and conditions impacted by ginseng include diabetes; cardiovascular disorders; cognition, memory, and mood; the common cold and flu; cancer fatigue and well-being; quality of life and social functioning, etc. Administration of ginseng demonstrated a good safety record in humans. Although encouraging beneficial effects obtained from clinical data, using the study treatment regimen, the reported ginseng effects in general only ranged from mild to moderate. Nonetheless, these beneficial effects of ginseng could be a valuable add-on therapy for patients receiving standard drug treatments. Additionally, as a dietary supplement, ginseng possesses an important role in maintaining and promoting human health. We believe that the quality of future ginseng trials should be improved, particularly by providing detailed herbal phytochemistry and quality control information. With solid effectiveness data obtained from a well-designed, carefully executed ginseng clinical trial, this meritoriously herbal medicine will be widely used by consumers and patients. [ABSTRACT FROM AUTHOR]

Aims and objectives: To examine the effectiveness of cognitive interventions after general anaesthesia to improve cognitive functioning. Background: The number of surgical procedures performed worldwide is large and growing. Postoperative cognitive dysfunction is a common complication associated with poor postoperative outcomes. A variety of cognitive interventions have been developed to maintain or improve cognitive function in one or more cognitive domains. Cognitive interventions have shown to be effective in healthy older populations, those with mild cognitive impairment, and those with heart failure. The impact of cognitive interventions in surgical patients after general anaesthesia is a relatively new focus of research and is therefore less well established. Methods: Seven bibliographic databases were searched in relation to 'surgery' and 'cognitive interventions'; no date or language limits were imposed. Studies including adult patients who were scheduled for, or who had undergone surgery under general anaesthesia, had a baseline cognitive assessment using a validated measurement, and had engaged with any cognition‐based intervention were included. Full‐text review for inclusion, quality assessment and data extraction were undertaken independently by two authors. This study is reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta‐Analyses guidelines. Results: A total of 550 papers were identified for possible inclusion, of which nine met the inclusion criteria and were included in the review. The majority were randomised controlled trials (RCTs) (n = 6 [66.7%]). Four studies used computerised cognitive interventions, while five used traditional cognitive interventions. Most of the studies used multi‐domain cognitive training focusing on two or more domains (n = 7 [77.8%]) while two studies used single‐domain cognitive training. Memory (n = 7 [77.8%]) and attention (n = 5 [55.6%]) were the cognitive domains most often targeted during the intervention. Conclusions: The use of cognitive interventions demonstrated some efficacy in improving cognitive function after general anaesthesia, particularly those targeting memory. Relevance for clinical practice The findings of this review suggest that cognitive interventions show promise at improving cognitive performance in patients with POCD and could be usefully implemented in clinical practice to improve patient outcomes. [ABSTRACT FROM AUTHOR]

Purpose: There are gaps in our knowledge to provide quality cancer care to the growing numbers of survivors. Leveraging existing data to answer survivorship research questions is one approach to address these gaps. Therefore, the purpose of this paper is to replicate and expand a previous report of existing cancer survivorship survey data.Methods: We conducted a trifold search strategy for relevant surveys and data sets to (1) determine the extent to which cancer survivors are being surveyed, (2) determine the topics being covered in these surveys, and (3) create a compendium of information about these surveys and data sets, so researchers can conduct additional analyses.Results: Thirty-five surveys were identified and included in this report; most were longitudinal studies (71%) in adult cancer survivors (91%). The domains addressed in these surveys were general medical characteristics, medical conditions, costs, employment, symptoms and/or side effects, psychosocial factors and coping, perceived quality of care, and health behaviors.Conclusions: Existing data are available for researchers to explore new knowledge to enhance cancer survivorship quality care. This is an opportunity to fully utilize existing data to answer survivorship questions in a cost effective manner.Implications For Cancer Survivors: Survivors should be encouraged to participate in research studies as these data can close the gap in our knowledge and care of this growing population. [ABSTRACT FROM AUTHOR]

Objective: Minimally Invasive Ponto Surgery (MIPS) was recently described to facilitate the placement of percutaneous bone anchored hearing devices. As early adopters of this new procedure, we sought to perform a quality assurance project using our own small prospective cohort to justify this change in practice. We chose to examine device stability and to gauge our patients' perspective of the surgery and their overall satisfaction with the process., Methods: A total of 12 adult patients who underwent MIPS between 2016 and 2017 with a minimum post-operative follow-up of 12 months were included in this study. A prospective MIPS research clinic was used to follow patients, assess the implant site soft tissue status and gather qualitative information through patient interviews and surveys., Results: The mean (SD) soft tissue status score averages using the IPS Scale were low for inflammation 0.1 (0.1), pain 0.1 (0.1), skin height 0.2 (0.1) and total IPS score 0.4 (0.3) indicating minimal soft tissue changes. Patient experiences with MIPS were overwhelmingly positive in reports through the MIPS modified SSQ-8. All patients reported speedy recoveries and no long-term complications. There were zero device losses., Conclusion: The series presented in this paper represents the first MIPS cohort with long term follow-up to be published to date in North America. Our findings conclude both device stability and patient satisfaction with no loss of fixtures. Consequently, we have adopted MIPS as our procedure of choice for the placement of all percutaneous BAHDs.

Background: This is the largest study in North America investigating olfactory outcomes after pituitary surgery to date. Objective: Characterize factors associated with subjective olfactory dysfunction (OD) and worsened sinonasal quality-of-life (QOL) after endoscopic TSA. Methods: Patients undergoing primary TSA for secreting and non-secreting pituitary adenomas between 2017 and 2021 with pre- and post-operative SNOT-22 scores were included. Subjective OD was determined by the smell/taste dysfunction question on the SNOT-22 (smell-SNOT). Results: 159 patients with pre- and post-operative SNOT-22 scores were included. Average total SNOT-22 scores worsened from pre-operative (16.91 ± 16.91) to POM1 (25.15 ± 20.83, P <.001), with no difference from pre-operative (16.40 ± 15.88) to POM6 (16.27 ± 17.92, P =.936) or pre-operative (13.63 ± 13.54) to POM12 (12.60 ± 16.45, P =.651). Average smell-SNOT scores worsened from pre-operative (0.40 ± 1.27) to POM1 (2.09 ± 2.01, P <.001), and pre-operative (0.46 ± 1.29) to POM6 (1.13 ± 2.45, P =.002), with no difference from pre-operative (0.40 ± 1.07) to POM12 (0.71 ± 1.32, P =.100). Female gender had a 0.9-point (95% CI 0.1 to 1.6) P =.021, increase in smell-SNOT at POM1, resolving by POM6 (0.1 [−0.9 to 1.1], P =.800) and POM12 (0.0 [−1.0 to 0.9], P =.942). Septoplasty with tunnel approach had a 1.1 [0.2 to 2.0] out of 5-point (P =.023) increase in smell-SNOT at POM1, resolving by POM6 (0.2 [−1.1 to 1.6], P =.764) and POM12 (0.4 [−0.9 to 1.6], P =.567). Female gender had a 9.5 (4.0 to 15.1)-point (P =.001) increase in SNOT-22 scores at POM1, resolving by POM6 (3.4 [−3.0 to 9.8], P =.292) and POM12 (6.4 [−5.4 to 18.2], P =.276). Intra-operative CSF leak had an 8.6 [2.1 to 15.1]-point (P =.009) increase in SNOT-22 scores at POM1, resolving by POM6 (5.4 [−1.7 to 12.5], P =.135), and POM12 (1.1 [−12.9 to 15.1], P =.873). Conclusion: Changes in subjective olfaction and sinonasal QOL after TSA may be associated with gender, operative approach, and intra-operative CSF leak, resolving 6-12 months post-operatively. [ABSTRACT FROM AUTHOR]

Background: Nutrition care can positively affect multiple aspects of patient's health; outcomes are commonly evaluated on the basis of their impact on a patient's (i) illness-specific conditions and (ii) health-related quality of life (HRQoL). Our systematic review examined how HRQoL was measured in studies of nutritional interventions. To help future researchers select appropriate Quality of Life Questionnaires (QoLQ), we identified commonly-used instruments and their uses across populations in different regions, of different ages, and with different diseases. Methods: We searched EMCare, EMBASE, and Medline databases for studies that had HRQoL and nutrition intervention terms in the title, the abstract, or the MeSH term classifications "quality of life" and any of "nutrition therapy", "diet therapy", or "dietary supplements" and identified 1,113 studies for possible inclusion.We then reviewed titles, abstracts, and full texts to identify studies for final inclusion. Results: Our review of titles, abstracts, and full texts resulted in the inclusion of 116 relevant studies in our final analysis. Our review identified 14 general and 25 disease-specific QoLQ. The most-used general QoLQ were the Short-Form 36-Item Health Survey (SF-36) in 27 studies and EuroQol 5-Dimension, (EQ-5D) in 26 studies. The European Organization for Research and Treatment of Cancer Quality of life Questionnaire (EORTC-QLQ), a cancer-specific QoLQ, was the most frequently used disease-specific QoLQ (28 studies). Disease-specific QoLQ were also identified for nutrition-related diseases such as diabetes, obesity, and dysphagia. Sixteen studies used multiple QoLQ, of which eight studies included both general and disease-specific measures of HRQoL. The most studied diseases were cancer (36 studies) and malnutrition (24 studies). There were few studies focused on specific age-group populations, with only 38 studies (33%) focused on adults 65 years and older and only 4 studies focused on pediatric patients. Regional variation in QoLQ use was observed, with EQ-5D used more frequently in Europe and SF-36 more commonly used in North America. Conclusions: Use of QoLQ to measure HRQoL is well established in the literature; both general and disease-specific instruments are now available for use. We advise further studies to examine potential benefits of using both general and disease-specific QoLQ to better understand the impact of nutritional interventions on HRQoL. [ABSTRACT FROM AUTHOR]

Objective : This study evaluated the effectiveness of academic screening measures in relation to parent-reported diagnoses. Design : Multicenter, retrospective cohort study including structured interviews, questionnaires, and chart reviews. Setting : Six North American cleft centers. Participants : Children (n = 391) with cleft lip and/or palate, ages 8 to 10 years of age (192 male) and their guardians were recruited during regular clinic visits. Main Outcome Measures : Parent and child ratings on the Pediatric Quality of Life Inventory (PedsQL) School Scale, child report on CleftQ School Scale, parent report on the Adaptive Behavior Assessment System-Third Edition Functional Academics (ABAS-FA) Scale and Child Behavior Checklist (CBCL) School Competency Scale, parent interview, and medical chart review. Results : Risk for concerns ranged from 12% to 41%, with higher risk reflected on the CBCL-SC compared to other measures. Males with cleft palate were consistently at the highest risk. Only 9% of the sample had a parent-reported diagnosis of a learning or language disability. Ratings from the ABAS-FA and CBCL-SC had the highest utility in identifying those with language and/or learning concerns. Conclusions : As cleft teams work to develop standardized batteries for screening and monitoring of patients, it is important to evaluate the effectiveness of measures in identifying those at highest risk. When screening for language and learning disorders, questions related to potential academic struggles, such as increased school effort or increased school distress, are most useful. Referrals for follow-up evaluation are recommended for those identified at high risk. [ABSTRACT FROM AUTHOR]

The International Psycho-oncology Society (IPOS) has just celebrated its 30th anniversary. The growth of psychosocial oncology has been exponential, and this relatively new field is becoming a core service that focuses on prevention, reducing the burden of cancer, and enhancing the quality of life from time of diagnosis, through treatment, survivorship, and palliative care. Looking back over the past 30 years, we see that cancer care globally has evolved to a new and higher standard. Today, 'cancer care for the whole patient' is being accomplished with an evidence-based model that addresses psychosocial needs and integrates psycho-oncology into the treatment and care of patients. The President's Plenary Session in Lisbon, Portugal, highlighted the IPOS Mission of promoting global excellence in psychosocial care of people affected by cancer through our research, public policy, advocacy, and education. The internationally endorsed IPOS Standard of Quality Cancer Care, for example, clearly states the necessity of integrating the psychosocial domain into routine care, and that distress should be measured as the sixth vital sign after temperature, blood pressure, pulse, respiratory rate, and pain. The plenary paper also discussed the global progress being made in Europe, North America, and Australia in providing quality cancer care for the whole patient. Collaborative partnerships between IPOS and organizations such as the European Partnership Action Against Cancer and the World Health Organization are essential in building capacity for the delivery of high-quality psycho-oncology services in the future. [ABSTRACT FROM AUTHOR]

Background: Life expectancy (LE) and healthy life expectancy (HALE) are indicators measuring the national health level. GAP is the difference between them. This study systematically analyzed and projected LE, HALE, and GAP across global regions from 1995 to 2025.Methods: We obtained the data of 195 countries/regions on their LE, HALE, and influencing factors from 1995 to 2017. We compared the overall changes of LE, HALE, and GAP. Multiple linear regression analysis examined relationships among LE, HALE, GAP, and the associated factors. Using the Autoregressive Integrated Moving Average (ARIMA) model, we projected trends in LE, HALE, and GAP for 2017-2025.Results: During 1995-2017, LE, HALE, and their GAP in 195 countries/regions in the world showed overall increasing trends. Global average LE increased from 66.20 to 72.98 years, HALE from 57.59 to 63.25 years, and GAP from 8.62 to 9.72 years. LE and HALE in North America, Europe, and Australia were generally higher, while Africa had the lowest rates. Females' LE, HALE, and GAP were all higher than males', but females' growth rates of LE and HALE were lower. Different factors were included to project LE, HALE, and GAP, respectively, and prediction results showed that approximately 18% of the 195 countries/regions might achieve improved LE and HALE and lower GAP.Conclusions: LE, HALE will likely continue to increase in most of countries and regions worldwide in the future and GAP will further expand. While striving to improve LE and HALE, more attention needs be made to reduce GAP and improve quality of life. [ABSTRACT FROM AUTHOR]

Background: Sexual dysfunction is a prevalent symptom in multiple sclerosis (MS) that may affect patients' health-related quality of life (HrQoL)., Objective: The objective of this paper is to examine the impact of sexual dysfunction on HrQoL in a large national sample using The Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ-19)., Methods: Participants were recruited from a large MS registry, the North American Research Committee on Multiple Sclerosis (NARCOMS) Registry. Participants self-reported demographic information and completed the Patient Determined Disease Steps (PDDS), MSISQ-19, and the Short Form-12 (SF-12)., Results: The study population included 6183 persons (mean age: 50.6, SD = 9.6; 74.7% female, 42.3% currently employed). Using multivariate hierarchical regression analyses, all variables excluding gender predicted both the physical component summary (PCS-12) and the mental component summary (MCS-12) of the SF-12. Scores on the MSISQ-19 uniquely accounted for 3% of the variance in PCS-12 scores while disability level, as measured by PDDS, accounted for 31% of the variance. Conversely, MSISQ-19 scores uniquely accounted for 13% of the variance in MCS-12 scores, whereas disability level accounted for less than 1% of the variance., Conclusion: In patients with MS, sexual dysfunction has a much larger detrimental impact on the mental health aspects of HrQoL than severity of physical disability.

Background: While evidence shows that occupational therapists can play a key role in the care of people with palliative care needs, more knowledge about effective occupational therapy interventions for this group is needed. Aim: To identify, organise and prioritise intervention components considered to be effective within occupational therapy for people with palliative care needs from the perspective of occupational therapy clinicians, managers and researchers. Design: Group Concept Mapping utilising a mixed methods participatory approach. Using a focus prompt, participants brainstormed, sorted, labelled and rated generated statements about effective occupational therapy intervention components. Multidimensional scaling analysis and cluster analysis were conducted. Setting/Participants: Snowball recruitment was used to recruit participants. Participants included occupational therapists worldwide who were able to read and write in English and were working as clinicians, managers and/or researchers with occupational therapy interventions for people with palliative care needs. Results: Seventy-two occupational therapists from 15 countries participated in the study representing Asia (n = 3, 20%), Europe (n = 8, 53%), Oceania (n = 2, 13%) and North America (n = 2, 13%). A total of 117 statements were identified and organised into five clusters: (1) being client-centred, (2) promoting occupational engagement to optimise quality of life, (3) involving the social and relational environment, (4) enabling occupations and (5) facilitating occupational adaptation. Conclusions: Five clusters of core occupational therapy intervention components were considered to be effective when supporting people with palliative care needs. Research should use this knowledge to inform future occupational therapy interventions for this group of people. [ABSTRACT FROM AUTHOR]

Objective: To describe differences in the age of onset of menopause and in the prevalence of climacteric symptoms in different geographical areas., Design: Systematic review of published data on onset of menopause and symptoms in Europe, North America, Latin America and Asia., Methods: We identified publications by searching electronic databases, including MEDLINE (1966-October 2009) and EMBASE (1975-October 2009). Primary search criteria were age of menopause and climacteric symptoms. A sensitive analysis that excluded papers without full data was performed., Results: The median age at menopause in Europe ranges from 50.1 to 52.8 years, in North America from 50.5 to 51.4 years, in Latin America from 43.8 to 53 years, and in Asia from 42.1 to 49.5 years. The frequency of vasomotor symptoms varies widely depending on the geographical region, selection of criteria, and method of symptom identification. The prevalence of such symptoms ranges from 74% of women in Europe, 36-50% in North America, 45-69% in Latin America and 22-63% in Asia, as reported in different, large, epidemiological studies., Conclusion: There are wide geographical differences in the prevalence of menopausal symptomatology and some differences in the age of onset of menopause. Both in Asia and Latin America, women of poorer socioeconomic status have significantly earlier onset of menopause. Within a geographical region, there are ethnic differences in menopause symptoms. Given differences in study methodologies, firm conclusions are not possible. However, regional differences in age at menopause and in climacteric symptoms are important to acknowledge and lay the foundation for an informed approach to the management of menopause and an understanding of its impact on women's health in the different regions of the world.

Introduction: Erectile dysfunction (ED) is associated with psychological impairment, and further research is required to understand their relationship., Aim: We present descriptive baseline results from a longitudinal observational study of North American men seeking treatment for ED., Methods: Patients completed clinical and health-related quality-of-life information at baseline and three follow-up points over 12 months; 162 patients had usable baseline data, including clinical history and current status, sociodemographic information, and standard paper-and-pencil scales of psychosocial characteristics. Scores on the International Index of Erectile Functioning erectile functioning subscale were collapsed into mild (N = 27), moderate (N = 41), or severe (N = 94) categories. Using chi-square, anova, and logistic regression, we identified baseline characteristics associated with ED severity., Main Outcome Measure: The main outcome measure was the degree of psychosocial impairment associated with mild, moderate, and severe ED., Results: Severe ED was significantly associated with not having a regular sex partner; a history of prostate cancer; and worse scores on measures of positive affect, belonging/loneliness, sexual self-efficacy-strength, psychological adjustment, marital happiness, anxiety at last intercourse, and depression. In a multivariate logistic regression model, poorer sexual self-efficacy was most closely associated with severe ED. The model rescaled R(2) was 0.63 (area-under-the-curve, 0.91)., Conclusions: Severe ED is related to impairment across a broad range of psychosocial domains, and clinicians should consider offering patients assistance in dealing with its psychosocial impact.

Background: This paper compiles data from different sources to get a first comprehensive picture of psychometric and other methodological characteristics of the Menopause Rating Scale (MRS) scale. The scale was designed and standardized as a self-administered scale to (a) to assess symptoms/complaints of aging women under different conditions, (b) to evaluate the severity of symptoms over time, and (c) to measure changes pre- and postmenopause replacement therapy. The scale became widespread used (available in 10 languages)., Method: A large multinational survey (9 countries in 4 continents) from 2001/ 2002 is the basis for in depth analyses on reliability and validity of the MRS. Additional small convenience samples were used to get first impressions about test-retest reliability. The data were centrally analyzed. Data from a postmarketing HRT study were used to estimate discriminative validity., Results: Reliability measures (consistency and test-retest stability) were found to be good across countries, although the sample size for test-retest reliability was small., Validity: The internal structure of the MRS across countries was astonishingly similar to conclude that the scale really measures the same phenomenon in symptomatic women. The sub-scores and total score correlations were high (0.7-0.9) but lower among the sub-scales (0.5-0.7). This however suggests that the subscales are not fully independent. Norm values from different populations were presented showing that a direct comparison between Europe and North America is possible, but caution recommended with comparisons of data from Latin America and Indonesia. But this will not affect intra-individual comparisons within clinical trials. The comparison with the Kupperman Index showed sufficiently good correlations, illustrating an adept criterion-oriented validity. The same is true for the comparison with the generic quality-of-life scale SF-36 where also a sufficiently close association has been shown., Conclusion: The currently available methodological evidence points towards a high quality of the MRS scale to measure and to compare HRQoL of aging women in different regions and over time, it suggests a high reliability and high validity as far as the process of construct validation could be completed yet.

Summary: The quality of life during the first 4 months after fracture was estimated in 2,808 fractured patients from 11 countries. Analysis showed that there were significant differences in the quality of life (QoL) loss between countries. Other factors such as QoL prior fracture and hospitalisation also had a significant impact on the QoL loss. Introduction: The International Costs and Utilities Related to Osteoporotic Fractures Study (ICUROS) was initiated in 2007 with the objective of estimating costs and quality of life related to fractures in several countries worldwide. The ICUROS is ongoing and enrols patients in 11 countries (Australia, Austria, Estonia, France, Italy, Lithuania, Mexico, Russia, Spain, UK and the USA). The objective of this paper is to outline the study design of ICUROS and present results regarding the QoL (measured using the EQ-5D) during the first 4 months after fracture based on the patients that have been thus far enrolled ICUROS. Methods: ICUROS uses a prospective study design where data (costs and quality of life) are collected in four phases over 18 months after fracture. All countries use the same core case report forms. Quality of life was collected using the EQ-5D instrument and a time trade-off questionnaire. Results: The total sample for the analysis was 2,808 patients (1,273 hip, 987 distal forearm and 548 vertebral fracture). For all fracture types and countries, the QoL was reduced significantly after fracture compared to pre-fracture QoL. A regression analysis showed that there were significant differences in the QoL loss between countries. Also, a higher level of QoL prior to the fracture significantly increased the QoL loss and patients who were hospitalised for their fracture also had a significantly higher loss compared to those who were not. Conclusions: The findings in this study indicate that there appear to be important variations in the QoL decrements related to fracture between countries. [ABSTRACT FROM AUTHOR]

Neglect of the mouth can lead to impairment, disability, and discomfort; as a result, it can have a negative impact on quality of life in old age. Some minority groups in North America shoulder a disproportionate burden of dental impairment compared to people of European origins, possibly because of different cultural beliefs and a distrust of Western oral healthcare. This paper explores these factors in elderly Chinese immigrants through a meta-synthesis of selected literature that reveals a dynamic interplay of traditional Chinese beliefs about oral health, immigration, and structural factors mediating access to Western dentistry. It also identifies several conceptual issues and gaps in knowledge, offers avenues of research including the cross-cultural application of two recent models of oral health, and discusses various strategies for improving access to dental services for minority populations. [ABSTRACT FROM AUTHOR]

Background: research in care home settings is often negatively focused, portraying life as sterile and devoid of meaningful experiences. Care homes have the potential to influence people's lives socially, physically and psychologically. It is important to understand what factors contribute to this.Objective: to conduct a systematic qualitative review of care home life and provide practical recommendations to enhance residents' quality of life.Methods: the following databases were searched: PsycINFO, Medline, Web of Science, EMBASE, Allied and Complementary Medicine Database and Cumulative Index to Nursing and Allied Health Literature. References from appropriate journals and individual articles were checked. Papers that fitted our selection criteria were selected. Two independent reviewers assessed methodological study quality. Thematic analysis and meta-ethnographic methods were adapted to synthesise findings.Results: thirty-one studies were identified. People in care homes voiced concerns about lack of autonomy and difficulty in forming appropriate relationships with others. Four key themes were identified: (i) acceptance and adaptation, (ii) connectedness with others, (iii) a homelike environment, (iv) caring practices.Conclusion: positive experiences in care homes can occur and are important for residents' quality of life. The review supports literature highlighting the need for relationship-centred approaches to care and emphasises the importance of understanding the resident's attitude towards living in care homes. [ABSTRACT FROM AUTHOR]

This paper systematically reviews published randomised controlled trials, to determine the educational focus and effectiveness of type 2 diabetes multi-component self-management interventions. PubMed, PsycINFO, Web of Science and reference lists of included studies were searched for English-language articles published 2000–2010. Descriptive information was summarised; when possible, effect sizes were calculated. Fourteen studies, described in 19 articles, were reviewed: six one-on-one interventions; six group interventions; two interventions comprising both intervention types. Four studies used learning as an intervention method; seven used learning and planning; three used learning, planning and practising. Self-management interventions seemed effective for diet, self-monitoring of blood glucose, knowledge and diabetes specific quality of life (QoL) there were mixed results for exercise and clinical outcomes. Findings showed that dietary behaviour seemed relatively easy to change with self-management interventions. Group interventions with a practise component had the greatest potential to improve metabolic control. Self-management interventions had positive effects on diabetes-specific QoL, and interventions using a collaborative learning approach improved knowledge. Multi-component self-management interventions potentially lead to clinically relevant improvements in behaviour and some clinical parameters. Further research is needed to explain the mixed effects on exercise and to identify processes underlying behaviour change. Copyright © 2010 FEND [ABSTRACT FROM AUTHOR]

"This paper utilizes 1980-89 data on Florida's metropolitan areas to test the hypothesis that fiscal variables have differing influences on the in-migration of the aged as compared to the general population. The model, which is based on the Tiebout hypothesis, tests the role of variables which represent public school-related finances and public assistance.... Consistent with the Teibout theory, the general population is found to prefer high public school-related spending and low taxes. The elderly, in contrast, choose locations where school spending and taxes are low. Nonschool-related taxes positively impact the migration of both groups. Contrary to previous studies, there is evidence of a role, albeit a mostly negative one, for the economic determinants of elderly migration. The possible importance of quality of life influences is also suggested by the findings.", (excerpt)

"The objective of this paper is to evaluate the extent to which racial variation in children's economic well-being resides in divergent parental work patterns and/or family living arrangements. This is accomplished using recently-released data from the 1 percent sample of the Public Use Microdata Sample of the 1990 [U.S.] decennial census. The results indicate that racial differences in family structure undermine efforts to eliminate racial inequality among American children. Among blacks, for example, the high proportions of children living in female-headed families account for 60 percent of the difference from white children in poverty rates. Similarly, racial differences in parental work patterns contribute to (but cannot explain completely) racial variation in child poverty. Among black children in married-couple families, poverty rates are roughly twice those of their white counterparts, even though black children are more likely to have both parents working." (SUMMARY IN ENG AND SPA), (excerpt)

Purpose: Opioid use rates have dropped as North American patients gain access to medical cannabis, indicating a harm reduction role, yet health outcomes remain mostly unexplored. This study presents self-reported medical cannabis use, perceptions of health functioning, and changes in opioid pain medication use in Florida medical cannabis patients. Methods: Patients (n = 2,183) recruited from medical dispensaries across Florida completed a 66-item cross-sectional survey that included demographic, health, and medication usage items, along with items from the Medical Outcomes Survey (SF-36) to assess health functioning before and after cannabis initiation. Results: Most participants were between the ages of 20 and 70 years of age (95%), over 54% were female, 47% were employed, and most (85%) were white. Commonly reported ailment groups were Pain and Mental Health combined (47.92%), Mental Health (28.86%) or Pain (9.07%). Health domains of bodily pain, physical functioning, and social functioning improved while limitations due to physical and emotional problems were unchanged. Most patients rated medical cannabis as being important to their quality of life. Many (60.98%) reported using pain medications prior to medical cannabis, 93.36% of these reported a change in pain medication after medical cannabis. The majority of participants (79%) reported either cessation or reduction in pain medication use following initiation of medical cannabis and 11.47% described improved functioning. Conclusions: The findings suggest that some medical cannabis patients decreased opioid use without harming quality of life or health functioning, soon after the legalization of medical cannabis. The public health implications of medical cannabis as an alternative pain medication are discussed. [ABSTRACT FROM AUTHOR]

Hence, the Virtual Village can be a space to bring OPLH together to discuss shared interests beyond HIV. Lessons learned in co-creating a Virtual Village for people ageing with HIV Keywords: community; key and vulnerable populations; North America; public health; quality of life; structural interventions EN community key and vulnerable populations North America public health quality of life structural interventions 1 3 3 05/31/23 20230501 NES 230501 The COVID-19 pandemic emerged as a global threat in early 2020, resulting in new psychosocial stressors and widespread lifestyle changes. [Extracted from the article]

The article offers information on the role and contributions of geographer Denis Cosgrove in the cultural geography. He wrote a paper on new directions in cultural geography, which outlined an agenda for a new cultural geography that would be contemporary as well as historical. He has been accused of conspiring to desecrate the memory of an earlier generation of North American cultural geographers. He has a wonderful passage on his reply to the geographers attack, including a withering remark about the kind of backpack entry ticket to the ranks of genuine cultural geography. He was forthright in views, irrepressibly convivial, and deeply engaged to be around.

The PROgress study assessed the value and feasibility of implementing web-based patient-reported outcomes assessments (PROs) within routine HIV care at two North American outpatient clinics. People with HIV (PWH) completed PROs on a tablet computer in clinic before their routine care visit. Data collection included PROs from 1632 unique PWH, 596 chart reviews, 200 patient questionnaires, and 16 provider/staff questionnaires. During an initial setup phase involving 200 patients, PRO results were not delivered to providers; for all subsequent patients, providers received PRO results before the consultation. Chart review demonstrated that delivery of PRO results to providers improved patient-provider communication and increased the number of complex health and behavioral issues identified, recorded, and acted on, including suicidal ideation (88% with vs 38% without PRO feedback) and anxiety (54% with vs 24% without PRO feedback). In post-visit questionnaires, PWH (82%) and providers (82%) indicated that the PRO added value to the visit. [ABSTRACT FROM AUTHOR]

Background: Parkinson's disease is a complex neurodegenerative condition with significant impact on quality of life (QoL), wellbeing and function. The objective of this review is to evaluate the clinical effectiveness of self-management interventions for people with Parkinson's disease, taking a broad view of self-management and considering effects on QoL, wellbeing and function.Methods: Systematic searches of four databases (MEDLINE, Embase, PsycINFO, Web of Science) were conducted for studies evaluating self-management interventions for people with Parkinson's disease published up to 16th November 2020. Original quantitative studies of adults with idiopathic Parkinson's disease were included, whilst studies of atypical Parkinsonism were excluded. Full-text articles were independently assessed by two reviewers, with data extracted by one reviewer and reliability checked by a second reviewer, then synthesised through a narrative approach and, for sufficiently similar studies, a meta-analysis of effect size was conducted (using a random-effects meta-analysis with restricted maximum likelihood method pooled estimate). Interventions were subdivided into self-management components according to PRISMS Taxonomy. Risk of bias was examined with the Cochrane Risk of Bias 2 (RoB2) tool or ROBIN-I tool as appropriate.Results: Thirty-six studies were included, evaluating a diverse array of interventions and encompassing a range of study designs (RCT n = 19; non-randomised CT n = five; within subject pre- and post-intervention comparisons n = 12). A total of 2884 participants were assessed in studies across ten countries, with greatest output from North America (14 studies) and UK (six studies). Risk of bias was moderate to high for the majority of studies, mostly due to lack of participant blinding, which is not often practical for interventions of this nature. Only four studies reported statistically significant improvements in QoL, wellbeing or functional outcomes for the intervention compared to controls. These interventions were group-based self-management education and training programmes, either alone, combined with multi-disciplinary rehabilitation, or combined with Cognitive Behaviour Therapy; and a self-guided community-based exercise programme. Four of the RCTs evaluated sufficiently similar interventions and outcomes for meta-analysis: these were studies of self-management education and training programmes evaluating QoL (n = 478). Meta-analysis demonstrated no significant difference between the self-management and the control groups with a standardised mean difference (Hedges g) of - 0.17 (- 0.56, 0.21) p = 0.38. By the GRADE approach, the quality of this evidence was deemed "very low" and the effect of the intervention is therefore uncertain. Components more frequently observed in effective interventions, as per PRISMS taxonomy analysis, were: information about resources; training or rehearsing psychological strategies; social support; and lifestyle advice and support. The applicability of these findings is weakened by the ambiguous and at times overlapping nature of self-management components.Conclusion: Approaches and outcomes to self-management interventions in Parkinson's disease are heterogenous. There are insufficient high quality RCTs in this field to show effectiveness of self-management interventions in Parkinson's disease. Whilst it is not possible to draw conclusions on specific intervention components that convey effectiveness, there are promising findings from some studies, which could be targeted in future evaluations. [ABSTRACT FROM AUTHOR]

Although many regional multiple sclerosis (MS) databases existed in the United States and Canada, there was no single clinician-derived registry that examined this disease as a group across the North American continent. This distinction is important because information that results from such database can potentially give perspectives about MS that cannot be derived from any single regional registry. A partnership was forged between the pharmaceutical industry and the Consortium of Multiple Sclerosis Centers (CMSC) to create a registry of patients with MS from Canada and the United States, including Puerto Rico. Case report forms were created to collect physician-derived information, and the Patient-Reported Outcomes Measurement Information System (PROMIS) was selected to capture patient-reported outcomes. As of November 2021, 754 of 1000 patients have been enrolled. Completion of recruitment is expected by the end of 2021. Twenty-five centers are participating, with an expected total of 30, including five centers from Canada. Clinical status, health economic outcomes, magnetic resonance images, and, soon, biomarkers relevant to understanding relapses and progression are collected. The short-term goal is to understand and better treat MS disease progression, and the long-term goal is its prevention. The North American Registry for Care and Research in Multiple Sclerosis (NARCRMS) is one of few clinician/patient-generated registries that examines MS across North America, including Puerto Rico. Information derived from the natural history studies should help physicians, the pharmaceutical industry, and regulatory bodies understand MS better and improve quality of life for patients with MS worldwide. [ABSTRACT FROM AUTHOR]

The authors examine nine indicators of quality of life in the 277 U.S. Standard Metropolitan Statistical Areas (SMSAs) in terms of their impact on the decision to migrate. The factors considered were utilized in the 1985 publication "Places Rated Almanac" and include climate, housing, health care, crime, transportation, education, recreation, arts, and economics. "The purpose of this paper is both to analyze several alternative methods by which the nine 'Places Rated' indicators have been combined in previous studies, and to estimate a new system of weights for combining such indicators from a multivariate model of metropolitan out-migration." In this article, the authors examine out-migration of metropolitan households during the years 1975-1980. "Coefficient estimates from a multivariate model of out-migration form the basis for a ranking of metropolitan areas in the third section. Also included are comparisons among this and other studies of both the implicit weights employed against the 'Places Rated' scores...to derive both overall measures of urban life quality, and how such quality varies by city size.", (excerpt)

The authors attempt to determine the net effect of city size on quality of life by developing a welfare measure of urbanization. "The estimation procedure suggested in the theoretical part of the paper (section II) is implemented in the empirical part (section III) using 1980 census data from the [U.S.] PUMS (Public Use Micro Data Sample). The results indicate there is no single optimal city size, but rather a worst city size, and about 90 percent of the U.S. population reside in cities smaller than worst city size. If quality of life is related to the degree of urbanization, then long-term trends in the locational distribution of the population should be accounted for in any welfare-oriented measure of national income. One application of our results is, as indicated, the derivation of a GNP welfare deflator reflecting changes in the degree of urbanization (section IV). The findings suggest an urban deflator on the order of six to seven percentage points, which is steadily increasing at a rate of about half a percentage point per decade.", (excerpt)

"In the literature on population migration, increasing attention has been devoted to quality-of-life factors. Measures of temperature (as proxies for climate) have frequently been employed in empirical work regarding the determinants of population migration decisions. A wide range of such specifications have been used, most of which imply restrictions on the preferences of migrants. In this paper, a variety of temperature variable specifications are analyzed and interpreted. Statistical tests for nested and nonnested hypotheses are used to compare and choose among the various specifications." The model is used to analyze interstate migration in the 48 contiguous states of the United States for the period 1975-1980., (excerpt)

To evaluate the impact of chronic stone recurrence on an individual's quality of life using the validated Wisconsin Stone Quality of Life (WISQOL) questionnaire. We collected cross-sectional data on patients with kidney stones from 14 institutions in North America. A stone event was defined as renal colic, stone-related procedure or emergency department visit. The regression analyses using general linear models and pairwise comparison determined the impact of the number of stone events on quality of life. The median number of stone events among the 2205 patients who completed the questionnaire was 3 (IQR 1–6). The mean total score was 107.4 ± 28.7 (max 140 points). The number of lifetime stone events was an independent predictor of lower quality of life (p < 0.001), specifically, score declined significantly beyond five events. Compared with patients who experienced a single stone event, there was a 0.4, 2.5, and 6.9 point decline in the adjusted mean WISQOL score after 2–5, 6–10, or > 10 events, respectively. The cumulative number of lifetime stone events was associated with a lower quality of life when more than five stone events were occurred. These findings underscore the importance of efforts to determine the underlying metabolic etiology of urolithiasis in the recurrent stone former, and the institution of a regimen to place their stone disease in remission. [ABSTRACT FROM AUTHOR]

The focus of this paper is on the voices and the life reflections of Punjabi older adults who constitute a segment of the larger South Asian diaspora in North America. These older persons have migrated to North America via England, West Africa, Fiji and from mainly the Punjabi region of India. As a diaspora, these Punjabi older people are now living in Canada and are trying to integrate into its social structure. The author has three goals in mind: (1) to document some cultural themes that have emerged in the life stories of the Punjabi older adults now living in North America; (2) to indicate the significance of the cultural knowledge produced by these persons as a source of "cultural capital" both for service providers and for the young who interact routinely with older adults in multicultural Canadian society, and (3) to emphasize or demonstrate the importance of listening to the narratives of older individuals for intergenerational communication and well-being. Underpinning these goals are two assumptions: (a) that cultural knowledge produced by the elderly through voicing of their experiences is a valuable resource for addressing problems faced by families linked to the South Asian diaspora both in India and North America, and also for today's multicultural communities which are the context in which South Indian youths grow up; and (b) that programs and projects which provide the aged memorist with a sympathetic audience and the opportunity to express themes about the joys and problems of aging, enhance the well-being of the older adults. [ABSTRACT FROM AUTHOR]

Background: Patient Reported Outcome Measures (PROMs) are widely used in Europe and North America in a variety of areas including research, clinical governance, clinical registries and insurance ascertainment. The aim of this study was to assess commonly used knee and hip PROMs among Chinese surgeons and to gain an insight into their impact on evaluation of clinical outcomes.Methods: 1. A systematic literature search of databases Medline, EMBASE, CINAHL and CNKI was performed from the earliest records to 22/07/2020 for knee instruments and 22/08/2020 for hip instruments, to retrieve Chinese Mandarin cross culturally adapted and validated knee and hip PROMs. 2. An 11-item electronic questionnaire was then designed under four domain categories. The survey was distributed via a ubiquitous online social media platform to orthopaedic surgeons. Responses were collected and analyzed. Output from 1. was used to populate parts of the survey questionnaire.Results: The systematic online search yielded a total of 41 evaluation instruments, (10 hip and 31 knee); all of which were incorporated as response options. 234 viable questionnaires were retrieved with the largest group representing attending surgeons. 59.0% were familiar with the concept of PROMs among which 78.4% reported to have used PROMs themselves. In order of frequency of use, PROMs were purposed for clinical assessment (55.6%), research (40.7%), health regulation policies (18.6%) and insurance service requirements (10.6%). Implementation was prompted by both departmental (43.4%) and institutional policy (34.5%). 89.4% of PROMs users reported difficulties in the use of PROMs, with major barriers including license fees, limited access, inadequate training and burden of fill-out time (all > 40%).Conclusion: There is evidence of limited familiarity with knee and hip PROMs among orthopaedic surgeons. Barriers to their use are significant. Development of a Chinese language PROMs database would be helpful. [ABSTRACT FROM AUTHOR]

Background: The number of research articles on health-related quality of life (HRQoL) has been strikingly increasing. This study aimed to explore the general trends and hotspots of HRQoL.Methods: Based on the Web of Science database, research on HRQoL published between 2000 and 2019 were identified. A bibliometric analysis was performed based on the number of articles, citations, published journals, authors' addresses, and keywords. Descriptive analysis, visualization of geographic distribution and keyword clustering analysis were applied to the collected data.Results: The annual number of articles showed growth over the past twenty years, but the annual total citations and annual citations per article were both in decreasing trends. Articles about HRQoL were more likely to be published in journals of multi-subject categories. The HRQoL research was mainly distributed across North America and Europe throughout the twenty years and ushered in a vigorous development worldwide after 2015. Cooperation strength between domestic institutions was much greater than that of international institutions. HRQoL research had six concentrated clusters: HRQoL, Depression, Obesity, Disability, Oncology, Fatigue.Conclusion: This study provided an overall perspective of global research trends and hotspots in HRQoL, and a potential insight for future research. HRQoL research had experienced significant increasing development during 2000-2019, especially the HRQoL measurement instruments, however, there were significant regional disparities in scientific output in HRQoL. [ABSTRACT FROM AUTHOR]

There is an abundance of research on the health consequences of sexual assault during university, but less attention has been paid to how sexual assault also shapes women's everyday lives. To develop an understanding of the everyday aftermath of sexual assault, we used narrative inquiry to analyze how women textually represent everyday living after sexual assault during university within four memoirs. Memoirists discussed their lives as significantly changed and worked to repair their lives after sexual assault by engaging in a range of everyday activities. Although no single behavioral response was described, some memoirists were perceived as deviant if they engaged in behaviors that contradicted prevailing cultural myths and expectations about how one should behave after sexual assault. We need to create room for women to engage in personal, idiosyncratic responses if we are to challenge restrictive standards for doing in the aftermath of sexual assault during university. [ABSTRACT FROM AUTHOR]

Older adults in the twenty-first century are engaging in different activities to promote their healthy aging in place. The purpose of this article is to describe older adults' experiences of forming and living in a seniors' cohousing community, and its impact on their healthy aging in place. The author conducted a secondary data analysis of qualitative data. Seventeen older adults from a seniors' cohousing community participated in the previous study. The findings from the secondary analysis of data showed that living in the building supported the older adults' independence, social interaction, safety, and mental health, as well as provided supportive services. An implication of the study is for policy makers, service providers, researchers, and society as a whole to collaborate with older people to address their needs for healthy aging in place in the community. [ABSTRACT FROM AUTHOR]

Introduction: Verbal autopsy (VA) is a useful tool for evaluating causes of death, especially in places with limited or no vital registration systems. The Population Health Metrics Research Consortium (PHMRC) developed a validated questionnaire and a set of automated methods to determine the cause of death from a VA. However, the application of these methods needs to be tested in a community environment. Objective: To estimate cause-specific mortality fractions (CSMFs) using VAs and compare them against those obtained in the vital statistics of the state of Hidalgo, Mexico. Methods: A random sample of deaths occurred in 2009 was selected from vital statistics in the state of Hidalgo. The full PHMRC validated VA instrument was applied to the relatives of the deceased, and the cause of death was determined using Tariff's automated method. The causes of death were grouped into 34 causes for adults, 21 for children and 6 for newborns. Results were compared with cause of death on death certificates for all deaths. Results: A total of 1,198 VAs were analyzed. The Tariff method was not able to assign a cause of death in only 9% of adults, 2% of children and 7% of neonatal deaths. The CSMFs obtained from the Tariff method were similar in some cases to those of vital statistics (e.g. cirrhosis), but different in others (e.g. sepsis). Conclusion: The application of VAs in a community sample, analyzed with the Tariff method, allowed assigning a cause of death to most of the cases, with results similar to those of vital statistics for most conditions. This tool can be useful to strengthen the quality of vital statistics. [ABSTRACT FROM AUTHOR]

In this article, we offer insights into how individuals with cystic fibrosis (CF) share information about their disease with a romantic partner. Using communication privacy management as a sensitizing theoretical construct, four themes emerged following 13 qualitative interviews with persons with CF. Themes about sharing CF-related information with a romantic partner include weighing the risks and benefits of sharing information, the role of health-related triggered rules, the motivations for disclosures, and the reactions from outsiders. Implications of the research suggest a need for more nuanced understandings of how privacy rules are communicated in relationships, how the mismanagement of co-owned information influences future disclosures, how the public–private nature of rare genetic illnesses is managed, and how people with genetic illnesses make disclosure decisions. [ABSTRACT FROM AUTHOR]

Background: Herpes zoster (HZ) has a significant negative effect on the productive work life of individuals, and has been shown to be responsible for cases of absenteeism, presenteeism and decreased work effectiveness. The aim of this study was to evaluate health utility scores and associated predictors in an actively employed population of Herpes Zoster (HZ) patients with and without work time loss (WTL).Methods: This was a pooled analysis of the prospective, observational MASTER cohort studies, conducted in 8 countries across North America, Latin America and Asia. A total of 428 HZ patients engaged in full or part time work were included. WTL, defined as missing ≥ 1 partial or full work day, and work effectiveness, reported on a scale of 0-100%, were evaluated with the Work and Productivity Questionnaire (WPQ). The Pearson product-moment correlation was used to assess the correlation between work effectiveness and HRQoL. Mixed models with repeated measures assessed the relationship between HZ-related WTL over a 6-month follow-up period, and HRQoL, as evaluated by the EQ-5D. Additional predictors of HRQoL were also identified.Results: Overall, 57.7% of respondents reported WTL. Mean (SD) percent work effectiveness of patients in the WTL group was significantly lower compared to non-WTL (NWTL) patients at baseline [50.3 (31.6) vs. 71.4 (27.8); p < 0.001]. Patients in the WTL group also reported lower health utility scores at baseline and overall than their NWTL counterparts, with WTL identified as an independent negative predictor of both the EQ-5D summary scores and the EQ-5D VAS (p < 0.001). Decrease in work effectiveness was negatively associated with HRQoL overall (p < 0.001). Predictors of lower HRQoL were worst Zoster Brief Pain Inventory (ZBPI) pain score, the presence of HZ complications and country income (predictor of EQ-5D VAS only).Conclusions: HZ adversely impacts the work and productive life of actively employed individuals. In turn, HZ-related reductions in work effectiveness and work time are associated with a negative effect on HRQoL. [ABSTRACT FROM AUTHOR]

Individuals reveal their preferences for alternative locations as they ‘vote with their feet’. Persistent positive net migration indicates that on net, individuals expect their well-being, based on both economic and non-economic factors, to be greater in the destination region compared with the origin. Other measures of well-being are highly subjective either because they rely on surveys or because they aggregate quasi-objective measures using subjective weights. We show key relationships between population change and two key determinants—local natural amenities and per capita incomes, finding that revealed preference measures are likely more reflective of well-being in North America than in Europe. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to expand the understanding of the burden of illness experienced by adults with Attention Deficit-Hyperactivity Disorder (ADHD) living in different countries and treated through different health care systems. Methods: Fourteen focus groups and five telephone interviews were conducted in seven countries in North America and Europe, comprised of adults who had received a diagnosis of ADHD. The countries included Canada, France, Germany, Italy, The Netherlands, United Kingdom, and United States (two focus groups in each country). There were 108 participants. The focus groups were designed to elicit narratives of the experience of ADHD in key domains of symptoms, daily life, and social relationships. Consonant with grounded theory, the transcripts were analyzed using descriptive coding and then themed into larger domains. Results: Participants' statements regarding the presentation of symptoms, childhood experience, impact of ADHD across the life course, addictive and risk-taking behavior, work and productivity, finances, relationships and psychological health impacts were similarly themed across all seven countries. These similarities were expressed through the domains of symptom presentation, childhood experience, medication treatment issues, impacts in adult life and across the life cycle, addictive and risk-taking behavior, work and productivity, finances, psychological and social impacts. Conclusions: These data suggest that symptoms associated with adult ADHD affect individuals similarly in different countries and that the relevance of the diagnostic category for adults is not necessarily limited to certain countries and sociocultural milieus. [ABSTRACT FROM AUTHOR]

Background: The long-term efficacy and safety of aclidinium bromide, a novel, long-acting muscarinic antagonist, were investigated in patients with moderate to severe chronic obstructive pulmonary disease (COPD).Methods: In two double-blind, 52-week studies, ACCLAIM/COPD I (n=843) and II (n=804), patients were randomised to inhaled aclidinium 200 μg or placebo once-daily. Patients were required to have a post-bronchodilator forced expiratory volume in 1 second (FEV1)/forced vital capacity ratio of ≤70% and FEV1<80% of the predicted value. The primary endpoint was trough FEV1 at 12 and 28 weeks. Secondary endpoints were health status measured by St George's Respiratory Questionnaire (SGRQ) and time to first moderate or severe COPD exacerbation.Results: At 12 and 28 weeks, aclidinium improved trough FEV1 versus placebo in ACCLAIM/COPD I (by 61 and 67 mL; both p<0.001) and ACCLAIM/COPD II (by 63 and 59 mL; both p<0.001). More patients had a SGRQ improvement≥4 units at 52 weeks with aclidinium versus placebo in ACCLAIM/COPD I (48.1% versus 39.5%; p=0.025) and ACCLAIM/COPD II (39.0% versus 32.8%; p=0.074). The time to first exacerbation was significantly delayed by aclidinium in ACCLAIM/COPD II (hazard ratio [HR] 0.7; 95% confidence interval [CI] 0.55 to 0.92; p=0.01), but not ACCLAIM/COPD I (HR 1.0; 95% CI 0.72 to 1.33; p=0.9). Adverse events were minor in both studies.Conclusion: Aclidinium is effective and well tolerated in patients with moderate to severe COPD.Trial Registration: ClinicalTrials.gov: NCT00363896 (ACCLAIM/COPD I) and NCT00358436 (ACCLAIM/COPD II). [ABSTRACT FROM AUTHOR]

Not much is known about cross-geographic region differences in quality of life (QoL) in women with and without prevalent vertebral fractures (VFX). QoL differed between continents, countries, and ethnicities. The observed differences in QoL mostly appeared larger than the difference in QoL between women with or without mild to moderate VFX. Quality of life (QoL) is an increasingly important outcome measure in randomized controlled trials and cost-utility studies. However, not much is known about cross-geographic region differences in QoL. The objective of this study was to describe the cross-geographic region differences in QoL in women with and without mild to moderate prevalent vertebral fractures (VFX). The study was performed using baseline data of the bazedoxifene study. The study was carried out in 25 countries in six continents ( n = 7117). QoL was assessed using the index and Visual Analogue Scale (VAS) scores of the EQ-5D, Qualeffo-41, and Women's Health Questionnaire (WHQ). VFX were assessed using semi-quantitative and quantitative morphometric methods. In general, all four instruments followed more or less the same pattern. In most analyses, the reported QoL was lowest in Asia and Europe and highest in North America and Oceania. To examine the influence of ethnicity, North and South America were stratified on race. In both continents, a lower QoL was observed in Hispanic people. QoL differed between continents, countries, and ethnicities. The observed differences in QoL appeared larger between most continents and countries than the difference in QoL between women with or without mild to moderate VFX. [ABSTRACT FROM AUTHOR]

In North America almost everyone has assumed that, from the 1860s to the 1960s, suburbs were healthier than cities, but this has not been established as fact by urban or demographic historians. Contemporary evidence is scattered but, especially for the interwar years, significant. The most useful data pertain to infant mortality rates. They indicate that, in terms of population health, suburbs were diverse and so were city neighborhoods. On the average, suburbs were healthier than cities but, partly because of poor sanitation, many unincorporated fringe areas were as unhealthy as the worst city slums. As mortality rates declined, so did the relative advantage of suburbs; in the early postwar period the widespread use of septic tanks caused problems. Future research should utilize neglected, published data and, where possible, supplement these with the analysis of vital records. [ABSTRACT FROM AUTHOR]