ObjectiveIn recent years, quality of life (QoL) in multiple sclerosis (MS) has been gaining considerable importance in clinical research and practice. Against this backdrop, this systematic review ...aimed to provide a broad overview of clinical, sociodemographic and psychosocial risk and protective factors for QoL in adults with MS and analyse psychological interventions for improving QoL.MethodThe literature search was conducted in the Scopus, Web of Science and ProQuest electronic databases. Document type was limited to articles written in English, published from January 1, 2014, to January 31, 2019. Information from the selected articles was extracted using a coding sheet and then qualitatively synthesised.ResultsThe search identified 4886 records. After duplicate removal and screening, 106 articles met the inclusion and exclusion criteria for qualitative synthesis and were assessed for study quality. Disability, fatigue, depression, cognitive impairment and unemployment were consistently identified as QoL risk factors, whereas higher self-esteem, self-efficacy, resilience and social support proved to be protective. The review analysed a wide spectrum of approaches for QoL psychological intervention, such as mindfulness, cognitive behavioural therapy, self-help groups and self-management. The majority of interventions were successful in improving various aspects of QoL.ConclusionAdequate biopsychosocial assessment is of vital importance to treat risk and promote protective factors to improve QoL in patients with MS in general care practice.
Multiple sclerosis (MS) symptoms and unpredictability can damage patient well-being. This study is aimed to investigate the relation between sociodemographic and clinical characteristics and the use ...of coping strategies as well as social support on health-related quality of life (HRQOL). We evaluated 314 MS outpatients of Virgen Macarena University Hospital in Sevilla/Spain (mean age 45 years, 67.8% women) twice over an 18-months period by Brief COPE Questionnaire (COPE-28), Multidimensional Scale of Perceived Social Support (MSPSS) and 12-Item Short Form Health Survey (SF-12). Female gender was significantly related to religion (r= 0.175, p< 0.001), self-distraction (r= 0.160, p< 0.001) and self-blame (r= 0.131, p< 0.05). Age correlated positively with religion (r= 0.240, p< 0.001), and self-blame (r= 0.123, p< 0.05). Progressive MS as well as functional impairment (EDSS) showed a positive relation with denial (r= 0.125, p< 0.05; r= 0.150, p< 0.001). Longer duration since diagnosis was related to lower perceived support from family (r= −0.123, p< 0.05). EDSS (β= −0.452, p< 0.001) was the strongest negative predictor of physical HRQOL followed by age (β= −0.123, p< 0.001), whereas family support was a protective factor (β= 0.096, p< 0.001). Denial (β= −0.132, p< 0.05), self-blame (β= −0.156, p< 0.05), female gender (β= −0.115, p< 0.05) and EDSS (β= −0.108, p< 0.05) negatively impacted on mental HRQOL 18 months later, whereas positive reframing (β= 0.142, p< 0.05) was a protective factor. Our study could identify sociodemographic and clinical variables associated with dysfunctional coping strategies, such as self-blame and denial, which specifically predict worse mental HRQOL as opposed to positive reframing. Diminishing dysfunctional coping and supporting cognitive reframing may contribute to improve HRQOL in MS.
For multinational clinical trials in multiple sclerosis (MS), identifying cross-country differences on quality of life (QoL) is important for understanding patients' response variability. No study ...has compared QoL between Spanish and American MS samples. This study aims to: 1) compare QoL and depressive symptomatology between Spanish and American patients, and against normative data; 2) compare the interrelationship between such constructs between countries; and 3) compare sociodemographic and clinical predictors on these outcomes.
114 participants with MS were included and matched for gender, disability and education. The SF-36 Health Survey and BDI-FastScreen (BDI-FS) were the outcomes. ANCOVA, partial-correlations and multiple regression analyses were compared between countries.
Spaniards reported worse depressive symptomatology and QoL, and clinically significant impairment in all QoL dimensions, while Americans showed clinically significant impairment only in physical domains. Among Spaniards, more Bodily pain was more related to worse Social functioning and Vitality, and worse Vitality was more related to worse Social functioning than among Americans. From the regression models, Physical functioning predicted BDI-FS greater among Americans. Conversely, disability and Role-emotional predicted BDI-FS and Mental health, respectively, significantly stronger in Spain.
Spaniards show worse QoL and depressive symptomatology and greater clinically significant impairment than the Americans.
The valid assessment of the impact of transplantation on psychological well-being is highly relevant to optimize treatment. However, to date there is no standardized instrument available in Spain. ...The Transplant Effects Questionnaire (TxEQ) evaluates the specific problems associated with organ transplantation, such as worry about transplant, guilt regarding the donor, disclosure of having undergone transplantation, adherence to medical treatment and responsibility toward the donor, family, friends, or medical staff. Against this backdrop the English original version of the TxEQ was translated into Spanish and validated in a sample of 240 liver transplant recipients. Participants also filled in the Posttraumatic Growth Inventory (PTGI), and the 12-Item Short Form Health Survey (SF-12v.2). Confirmatory factor analysis of the TxEQ-Spanish revealed a five-factor structure equivalent to the English original version, and satisfactory internal consistency (Cronbach's alpha: worry α = 0.82, guilt α = 0.77, disclosure α = 0.91, adherence α = 0.82, responsibility α = 0.83). Results showed that better mental quality of life was associated with higher adherence and disclosure, as well as less worry and guilt. Higher posttraumatic growth was significantly associated with worry, guilt, and responsibility. Interestingly, the most powerful predictor of posttraumatic growth was worry. Analysis of variance showed an interaction effect of PTG and mental quality of life on adherence, with medium PTG being associated with significantly stronger adherence in participants with better mental quality of life. In conclusion our study could successfully adapt and validate the Spanish version of the TxEQ in a large sample of liver transplant recipients. Our findings show a complex relationship between emotional reactions to transplantation, mental quality of life, and posttraumatic growth, which give further insight into inner processes supporting psychological well-being and adherence after liver transplantation.
Our aim was to analyze how type 2 diabetes and obesity influence quality of life (QoL) and coping in patients with nonalcoholic fatty liver disease (NAFLD), and which coping strategies predict ...diabetic or obese participants' QoL. QoL (SF-12, CLDQ-NAFLD) and coping strategies (COPE-28) were evaluated in 307 biopsy-proven NAFLD patients with absence or presence of diabetes or obesity. QoL was compared with normality tables for the general Spanish population. Interactive effects were found in physical functioning (
= 0.008), role-physical (
= 0.016) and activity (
= 0.014). Diabetic patients reported worse scores when they were also obese and vice versa, that is, obese patients scored worse when they were also diabetic. Both diabetic and obese patients had lower QoL than those without metabolic pathology or the general population, and obese patients also reported more passive/avoidance coping. Active coping, positive reframing and acceptance predicted better QoL, while denial, self-blame, self-distraction, disengagement and religion predicted lower QoL. In conclusion, diabetes and obesity were associated with lower QoL in patients with NAFLD. Obesity was also associated with more passive/avoidance coping. Furthermore, passive/avoidance coping strategies predicted lower QoL than active, recommending modification of maladaptive coping strategies in future multidisciplinary NAFLD treatments.
Despite the negative repercussions of a chronic disease, multiple sclerosis (MS) might also lead to positive consequences. This longitudinal study explored post-traumatic growth in MS patients and ...attempted to identify possible determinants. Post-traumatic growth of 260 patients and their caregivers was compared. A subset of 209 patients and caregivers were evaluated at baseline. Patients filled in the Posttraumatic Growth Inventory and General Health Questionnaire at three different times over a 36-month follow-up period. Patient post-traumatic growth significantly increased over the follow-up period (
p
< 0.001) with large effect sizes on almost every subscale. Higher score on the Expanded Disability Status Scale, higher pain severity, female gender, and higher anxiety were positive predictors of post-traumatic growth, while more interference of pain, higher level of education, and more social dysfunction were negative predictors. Post-traumatic growth did not differ significantly between patients and caregivers. Our results showed significant positive intrapsychic changes of MS patients over a 36-month follow-up period up to 12 years from diagnosis. The potential influence of clinical, demographic, and mental health variables underlines the need for a personalized approach to be able to understand and sustain these processes. Comparable post-traumatic growth levels in patient-caregiver dyads at baseline suggest interdependently driven cognitive processes stabilizing well-being. Future research is recommended for further insight into the underlying cognitive processes.
(1) Background: Patients' behavioral attempts in dealing with Multiple sclerosis (MS) play an important role in post-traumatic growth (PTG). In a longitudinal study, we aimed to identify coping ...strategies predicting PTG. (2) Methods: 260 MS patients answered the Post-traumatic Growth Inventory and the Brief COPE Questionnaire at three time points during a 36-month follow-up period. (3) Results: an interaction effect between PTG level and assessment time was found for emotional support, positive reframing, active coping, and planning coping strategies. Positive reframing, emotional support, instrumental support, religion, planning, and self-distraction positively predicted PTG. (4) Conclusions: to encourage PTG development, early interventions in MS patients are recommended to promote adaptive coping, particularly positive reframing, social support, active coping, planning, religion, and self-distraction.
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•To our knowledge, the first study of functional effects of apple extracts on THP-1 macrophages.•Apple pulp inhibits IL-1B production in LPS-treated THP-1 macrophages.•Apple extracts ...induce alterations related to lipid, carbohydrate and amino acid metabolism.•Apple extracts seems to counteract the molecular mechanisms triggered by LPS.
Apples represent a significant source of dietary phenolic compounds with evidenced anti-inflammatory and immunomodulatory activities. Nevertheless, the effect of the whole apple matrix on human macrophages is unknown. In this context, our study attempts to evaluate the effect of apple-derived phenolic compounds-rich extracts (pulp, peel and leaf) on IL-1β production in THP-1-differentiated macrophages and derived metabolic alterations through untargeted metabolomics. Our results have showed that apple pulp treatment inhibited the release of the pro-inflammatory cytokine IL-1β induced by LPS in THP-1 macrophages by ELISA analysis. Metabolomics demonstrate that different proportions of phenolic compounds led to differential alterations in the metabolism of THP-1 macrophages. Indeed, apple extracts promoted alterations in lipid, carbohydrate, amino acid and vitamins as well as cofactors metabolism. Specifically, leaf extracts were characterized by alteration of galactose metabolism while the extracts derived from the fruit showed predominant alterations in lipids metabolism. All extracts mimicked the response observed under normal conditions in LPS-stimulated macrophages, inhibiting LPS response. Thus, the phenolic enriched extracts from apples will be a good source of natural compounds with a beneficial effect against inflammation, and they may be applied as a food supplement and/or functional ingredient for the treatment of inflammatory diseases.
Dihydrochalcones, phlorizin (PZ) and its aglycone phloretin (PT), have evidenced immunomodulatory effects through several mechanisms. However, the differential metabolic signatures that lead to these ...properties are largely unknown. Since macrophages play an important role in the immune response, our study aimed to characterise human THP-1 macrophages under PZ and PT exposure. A multiplatform-based untargeted metabolomics approach was used to reveal metabolites associated with the anti-inflammatory mechanisms triggered by the dihydrochalcones in LPS-stimulated macrophages, for the first time. Results showed differential phenotypic response in macrophages for all treatments. Dihydrochalcone treatment in LPS-stimulated macrophages mimics the response under normal conditions, suggesting inhibition of LPS response. Antagonistic effects of dihydrochalcones against LPS was mainly observed in glycerophospholipid and sphingolipid metabolism besides promoting amino acid biosynthesis. Moreover, PT showed greater metabolic activity than PZ. Overall, the findings of this study yielded knowledge about the mechanisms of action PZ and PT at metabolic level in modulating inflammatory response in human cells.
To evaluate the impact of a school-based obesity prevention program that seeks to change food intake among students at schools in Rosario, Argentina.
This was a prospective study involving 405 ...children 9-11 years of age at six schools in the poor areas of Rosario, Argentina, in May-October 2008. After matching for socioeconomic status, schools were selected by simple randomization; participants were assessed at baseline (T1) and again 6 months later, after completion of the intervention (T2). The program focused on increasing the children's knowledge of healthy nutrition and exercise through four workshops; educating the parents/caregivers; and offering healthy options at the school snack bar. The main outcome measures were the children's intake of healthy and unhealthy foods (assessed with a weekly food frequency questionnaire) and their body mass index (BMI).
Of the 387 children assessed at T1, 369 were reassessed at T2 (205 intervention; 164 control). Girls at the schools where the intervention occurred increased their intake of three of the five healthy food items promoted by the program (fruits, vegetables, low-sugar cereals). Statistical significance was reached for skim milk (P = 0.03) and for pure orange juice (P = 0.05). Boys of both the intervention and control groups failed to improve their intake of healthy foods, but those of the intervention arm significantly reduced their intake of hamburgers and hot dogs (P = 0.001).
Girls were more amenable to improving their dietary intake. Overall, the program was more likely to increase consumption of healthy food than to decrease intake of unhealthy foods. Gender differences should be taken into account when designing preventive interventions.
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