Background: Interventions for managing pediatric obesity can have a positive effect on patient/parent reported outcome measures (PROMs), including health-related quality of life, anxiety, and ...depression. To optimize data presentation and interpretation, the GRADE approach to developing systematic reviews and practice guidelines includes establishing minimal important difference (MID) estimates that represent a small but important difference for PROMs. The purpose of this narrative review was to identify MID estimates for PROMs used in interventions for managing pediatric obesity. Methods: We searched PubMed (1989 to Jan 2023) to identify available MID estimates for the PROMs reported in three systematic reviews on behavioral, pharmacological and surgical interventions to inform the Canadian guidelines for managing pediatric obesity. PROMs included measures of quality of life depression, and anxiety. We searched for both anchor or distribution-based MID estimates using search terms for MID and each of the PROMs reported in our reviews. If no MID estimates were found for PROMs, we calculated the MID using a distribution-based approach (i.e., calculated as onehalf the standard deviation SD from representative or normative sample data). Results: We included 18 PROMs across our three reviews. All MID estimates were distribution-based, using approaches that included standard error of measurement (SEM) and one-half the baseline SD. MIDs were identified for several measures, including the Pediatrics Quality of Life (4.36), Impact of Weight on Quality of Life (4.8), Short Form-36 (11), and State-Trait Anxiety Inventory (10). We also calculated MIDs for other PROMs related to depression (e.g., Children's Depression Inventory: 3.57) and anxiety (e.g., Multidimensional Anxiety Scale for Children: 7.9). Conclusions: MIDs for PROMs will help determine intervention effectiveness for guideline development and improve patients', parents' and clinicians' understanding of PROM data.
Background: In SURMOUNT-1, a phase 3, 72-week, randomized, double-blind clinical trial in participants with obesity or overweight with weight-related comorbidities, tirzepatide (TZP), a novel GIP and ...GLP-1 receptor agonist, resulted in significantly greater weight reduction than placebo. This post-hoc analysis assessed whether weight reduction was associated with patient-reported outcomes (PRO) improvements in participants treated with TZP 5,10,15 mg. Methods: SF-36v2, IWQOL-Lite-CT, and EQ-5D-5L are generic and obesity-specific health-related quality of life questionnaires and were collected at baseline and endpoint of the primary treatment period (week 72 or early discontinuation) from patients treated with TZP in the SURMOUNT-1 trial. Higher scores indicate better outcome. Participants with baseline and at least one post-baseline value were included in the analysis. Mean change in PRO scores from baseline to endpoint were summarized by weight reduction targets (>5%, >10%, >15%, >20%, >25%). Results: At endpoint, participants with weight reduction showed improvements from baseline in all domains of SF-36v2 including Physical Functioning (Norm-Based) (>5%, 4.06; >10%, 4.31; >15%, 4.66; >20%, 4.80; >25%, 4.82) and Mental Health (Norm-Based) (>5%, 0.95; >10%, 0.98; >15%, 1.06; >20%, 1.25; >25%, 1.18) domains. Grouped by weight reduction targets, participants who achieved the most weight reduction showed greater improvements from baseline in IWQOL-Lite-CT total score (>5%, 21.16; >10%, 22.38; >15%, 23.93; >20%, 25.86; >25%, 27.54), and both physical and psychosocial composite scores. Participants meeting greater weight reduction targets showed greater improvements from baseline in EQ-5D-5L VAS score (>5%, 8.13; >10%, 8.79; >15%, 9.62; >20%, 9.86; >25%, 10.66). Conclusions: Weight reduction was associated with improvement in all domains of health-related quality of life, including physical function and mental health. Participants who lost the most weight showed the greatest quality of life improvements.
Background: Experienced weight stigma (EWS) is common in people with obesity and can impact health outcomes, mental health and quality of life. There is a paucity of published data on the prevalence ...of EWS in metabolic and bariatric surgery (MBS) patients compared to patients who have not completed MBS. Methods: This cross-sectional study analyzed survey data on demographics, MBS status, and social/self-perceptions collected from an academic center's obesity medicine program. The Stigmatizing Situations Inventory (SSI-B, range 0-90; 0 = never, 1-40 = mild-moderate; >40 = severe) categorized EWS. Chi-square tests explored the distribution of EWS by MBS status and logistic regression assessed the association of EWS and MBS status adjusting for key demographics. Results: The analysis included 811 participants with mean age 56.2 (SD 12.5) years, 90.5% female, 52.3% non-Hispanic White, 28.0% non-Hispanic Black, 14.2% Hispanic, 5.5% other race, and 36.3% completed MBS. MBS completers had a higher mean BMI versus NS (nonsurgery) participants (35.9 SD 9.9 33.8 SD 9.4, respectively p = 0.003). NS participants had lower median SSI-B scores vs. MBS completers (5.0 IQR 1.0-15.0 vs. 18 IQR 5.0-34.0, respectively, p < 0.001) and 24.0% of NS vs 15.0% of MBS participants reported no history of EWS (p = 0.002). Mild-moderate EWS was reported by 71.4% of NS versus 66.3% of MBS participants. Severe EWS was reported by 4.64% of NS versus 18.71% of MBS participants (p < 0.001). MBS patients were almost twice (aOR: 1.93; 95% Cl: 1.30-2.86; p = 0.001) as likely to report EWS compared to NS patients, adjusted for BMI, age, sex, and education level. Conclusions: Patients who completed MBS were almost twice as likely to report EWS compared with non-MBS patients. Obesity care programs should consider screening for EWS in patients being evaluated for MBS or those who have completed MBS. This can identify patients who may benefit from additional interventions and support that address EWS and to optimize health outcomes and quality of life.
Purpose
To examine (1) racial/ethnic disparities in health-related quality of life (HRQOL) and overall health status among Black, Latino, and White youth during adolescence; (2) whether socioeconomic ...status (SES) and family contextual variables influence disparities; and (3) whether disparities are consistent from pre- to early- to mid-adolescence.
Methods
A population sample of 4823 Black (1755), Latino (1812), and White (1256) youth in three US metropolitan areas was prospectively assessed in a longitudinal survey conducted on three occasions, in 5th, 7th, and 10th grades, when youth reported their HRQOL using the PedsQL™ short-form Total, Physical and Psychosocial scales and youth and parents separately reported on youth’s overall health status. Parents reported their education and household income to index SES, family structure, and use of English at home.
Results
Based on analysis conducted separately at each grade, marked racial/ethnic disparities were observed across all measures of HRQOL and health status, favoring White and disfavoring Black, and especially Latino youth. More strongly present in 5th and 7th grade, HRQOL disparities decreased by 10th grade. Most disparities between White and Black youth disappeared when adjusting for SES. However, even after adjusting for SES, family structure, and English use, overall health status disparities disfavoring Latino youth remained across all three assessments.
Conclusions
Racial/ethnic disparities in adolescent HRQOL and health are substantial. These disparities appear consistent from pre- to early-adolescence but diminish for HRQOL by mid-adolescence. As disparities appear influenced by SES and other family contextual variables differently in different racial/ethnic groups, efforts to reduce health disparities in youth should address culturally specific conditions impinging on health.
To evaluate the quality of life in patients treated for locally advanced laryngeal cancer with surgery, radiation therapy or both
A retrospective study conducted at the radiation therapy department ...of Mohamed 6 University Hospital of Tangier. This study included patients treated for non-metastatic laryngeal cancer between April 2017 and April 2023, who received radiation therapy during their course of treatment. Treatment modalities included either surgery followed by radiotherapy or laryngeal preservation (LP) strategy by concomitant chemoradiotherapy (CRT) or induction chemotherapy (IC) followed by CRT. Clinical data, treatment and follow-up results were gathered using the digitalized hospital network. All patients answered the EORTC QLQ H&N 35 questionnaire for quality of life in its approved Arabic version.
40 patients were included in the study. Mean age was 62 +/- 12 years old. 50% of the patients had a stage IVA disease and 30% had a stage III cancer. Radiation therapy was administered in adjuvant setting for 75% of the patients. Amongst patients treated with surgery + radiotherapy, 50% had a stage IV disease.
Regarding dysphonia, 80% of patients considered they had a poor quality of voice. 45% of the patients found difficulties communicating with others. 66.7% of them described these difficulties as severe. In the LP group, 3 patients reported severe difficulties and they were all treated for a stage IVA disease: the choice of treatment modality was due to patients’ refusal of surgery for 2 of them. Voice restoration surgery was performed for 3 patients.
Pain issues were reported by 3 patients and nearly half of patients (45%) had dysphagia: 13 of them had surgery and 5 were treated following a LP strategy. A feeling of an abnormal rate of mucus secretion was found in 11.5% of the patients. Regarding sensory disorders (taste and odor), there was 1 case of dysgueusia reported: the patient was treated with IC + CRT.
Sexual life was worsened in 12.5% of patients (4 men and a woman), all of whom had a definitive tracheostomy. Issues reported were dyserection, lack of libido and a poorer quality of physical relations.
Quality of life is an important factor to consider in the choice of treatment setting, which has to be done according to the stage and international guidelines. Our study found that quality of voice is the main altered function after treatment according to patients, even when they have recovered their voice. Same results were found in the literature. Despite the mutilating treatment and the toxicity of irradiation, and as shown in the study, a decent quality of life can still be obtained for our patients, thus avoiding a poorer outcome of the cancer. Research in laryngeal cancer these days tends towards the improvement of quality of life without compromising survival results.
Purpose
Health-related quality of life outcomes are increasingly used to monitor population health and health inequalities and to assess the (cost-) effectiveness of health interventions. The ...EQ-5D-5L has been included in the Belgian Health Interview Survey, providing a new source of population-based self-perceived health status information. This study aims to estimate Belgian population norms for the EQ-5D-5L by sex, age, and region and to analyze its association with educational attainment.
Methods
The BHIS 2018 provided EQ-5D-5L data for a nationally representative sample of the Belgian population. The dimension scores and index values were analyzed using logistic and linear regressions, respectively, accounting for the survey design.
Results
More than half of respondents reported problems of pain/discomfort, while over a quarter reported problems of anxiety/depression. The average index value was 0.84. Women reported more problems on all dimensions, but particularly on anxiety/depression and pain/discomfort, resulting in significantly lower index values. Problems with mobility, self-care, and usual activities showed a sharp increase after the age of 80 years. Consequently, index values decreased significantly by age. Lower education was associated with a higher prevalence of problems for all dimensions except anxiety/depression and with a significantly lower index value.
Conclusion
This paper presents the first nationally representative Belgian population norms using the EQ-5D-5L. Inclusion of the EQ-5D in future surveys will allow monitoring over time of self-reported health, disease burden, and health inequalities.
Aims and objectives
To test whether the revised Wilson and Cleary model could identify which factors contribute to health‐related quality of life in chronic kidney disease.
Background
Chronic kidney ...disease affects a person's health‐related quality of life detrimentally although nursing practice informed by theory is only beginning to emerge.
Design
A cross‐sectional study reported using the STROBE guidelines.
Methods
About 886 participants with chronic kidney disease (varying grades) completed validated measures of symptoms (renal version of the Integrated Palliative care Outcome Scale), and general health perceptions and health‐related quality of life (European Quality of Life five‐dimension three‐level). Socio‐demographic and renal characteristics were also collected. Data were analysed using descriptive statistics and structural equation modelling.
Results
Biological function (decreased kidney function and haemoglobin and greater number of comorbidities), directly contributed to increased symptom burden. Symptoms demonstrated strong negative relationships with both general health perceptions and health‐related quality of life. General health perceptions had a direct positive relationship with health‐related quality of life. As age increased, health‐related quality of life decreased. The only environmental characteristic of significance was the distance between home and hospital although it was not directly associated with health‐related quality of life. Overall, the model explained approximately half of the deterioration in health‐related quality of life.
Conclusions
The model demonstrated how various factors influence alteration of health‐related quality of life in people with chronic kidney disease. Early identification of these factors could assist nurses to introduce effective management strategies into patient care plans proactively.
Relevance to clinical practice
Comprehensive symptom assessment needs to occur not only in kidney failure but in earlier chronic kidney disease grades to enable timely interventions targeted at improving people's wellbeing.
Patient or public contribution
Validated interviewer administered questionnaires were completed by participants with chronic kidney disease in this study.
Background
It is important to understand the interaction of various predictors with oral health‐related quality of life (OHRQoL) to better design effective interventions to improve OHRQoL.
Aim
The ...aim of this study was to develop and validate a conceptual model evaluating the factors affecting the OHRQoL in children.
Design
The study group consisted of 754 parent‐child dyads. The data collection tools were a socio‐demographic data form, the Early Childhood Oral Health Impact Scale (ECOHIS), Corah Dental Anxiety Scale (C‐DAS), Children's Fear Survey Schedule‐Dental Subscale (CFSS‐DS), and an oral and dental health examination form. A conceptual model was developed to examine the factors affecting OHRQoL in children consisting of four endogenous and four exogenous variables. Path analysis was used to test the compatibility of the conceptual model.
Results
OHRQoL was associated with parental socio‐economic status (β = −0.12; P < .001), dental anxiety (β = −0.15; P < .001), and oral health behaviours (β = −0.13; P < .001). Although parental dental anxiety had the strongest direct effect on OHRQoL, children's oral health behaviours had the strongest indirect effect.
Conclusions
This study revealed a valid demonstrable path of association between parental socio‐economic status, dental anxiety, childhood dental anxiety, oral health behaviours, and OHRQoL.
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