Psychometric properties of the thyroid-specific quality of life questionnaire ThyPRO in Singaporean patients with Graves' disease.

BACKGROUND: Graves' disease is the most common cause of hyperthyroidism. It results in accelerated tissue metabolism with multi-organ involvement ranging from cardiovascular to neuropsychological function. This results in a negative impact on the quality of life (QOL) of the individual patient. We aim to evaluate the psychometric properties of ThyPRO, a Thyroid-related Patient Reported Outcome questionnaire, and validate its use in our multi-ethnic Asian patients with Graves' hyperthyroidism. METHODS: Forty-seven consecutive Graves' hyperthyroidism patients answered the ThyPRO questionnaire at baseline and at 4 months after treatment initiation. Data were recorded for thyroid related symptoms and signs, thyroid function tests and thyroid volume. We analyzed the internal consistency using Cronbach's alpha, construct validity by evaluating relationship between clinical variables and ThyPRO scales, ceiling and floor effects, and responsiveness of ThyPRO to treatment based on Cohen's effect size. RESULTS: Correlations between individual scale scores and free thyroxine concentrations were moderate and statistically significant: 0.21-0.64 (p <  0.05). There was high internal consistency between the items in this instrument, Cronbach's alpha > 0.7 for all scales. ThyPRO was responsive to the changes in QOL after treatment (Effect Size: 0.20-0.77) in 9 of the 14 scales including the hyperthyroid symptoms and psychosocial scales (Tiredness, Cognitive complaints, Anxiety, Emotional susceptibility, Impact on Social, Daily and Sex life). CONCLUSION: This study provides evidence that ThyPRO has satisfactory measurement properties in hyperthyroid Graves' disease patients in Singapore population with the potential to complement clinical care.

Testing measurement properties of two EQ-5D youth versions and KIDSCREEN-10 in China.

OBJECTIVE: To assess measurement properties of the two youth versions of EQ-5D (i.e., 5-level EQ-5D-Y [Y-5L] and 3-level EQ-5D-Y [Y-3L]) and KIDSCREEN-10 in China. METHODS: Children and adolescents attending schools in Shanghai, China were recruited to self-complete the Y-5L, KIDSCREEN-10, and Y-3L questionnaires. Their feasibility was assessed according to missing responses. Convergent validity of the EQ-5D-Y dimensions, a summated dimension score [SDS], and Visual Analogue Scale (VAS) were assessed by examining their correlations with the KIDSCREEN-10 index score and dimensions. Known-groups validity of SDS, VAS, and KIDSCREEN-10 index score were tested by comparing the scores of pupils with and without two conditions (i.e., overweight and shortsightedness), and the relative efficiency (RE) between them was also evaluated. RESULTS: A total of 262 pupils (girl: 58.4%; mean age: 12.7 years) were enrolled. Missing responses were low for both the Y-5L (0.3%) and Y-3L (2.4%), and KIDSCREEN-10 (0.3%). The overall ceiling effects were 40.3% for the Y-5L, 44.1% for the Y-3L and 1.1% for the KIDSCREEN-10. The SDSY-5L, SDSY-3L and VAS were moderately correlated with the KIDSCREEN-10 index score (|r|= 0.425 for SDSY-5L, 0.323 for SDSY-3L, and 0.435 for VAS; p < 0.01 for all). Similar EQ-5D-Y and KIDSCREEN-10 dimensions showed moderate to strong correlations (|r|> 0.3). Both the SDSY-5L and SDSY-3L had lower values, and VAS and KIDSCREEN-10 index score had higher values for pupils without shortsightedness compared with those for their counterparts. The difference was statistical significance for the SDSY-5L and VAS (P < 0.05 for both), which also had higher RE in the condition. CONCLUSIONS: The Y-5L, Y-3L, and KIDSCREEN-10 questionnaires are feasible and valid for measuring HRQoL among children/adolescents in China. It also appears that the advantages of Y-5L over Y-3L were modest.

Healthcare utilization and cost trajectories post-stroke: role of caregiver and stroke factors.

BACKGROUND: It is essential to study post-stroke healthcare utilization trajectories from a stroke patient caregiver dyadic perspective to improve healthcare delivery, practices and eventually improve long-term outcomes for stroke patients. However, literature addressing this area is currently limited. Addressing this gap, our study described the trajectory of healthcare service utilization by stroke patients and associated costs over 1-year post-stroke and examined the association with caregiver identity and clinical stroke factors. METHODS: Patient and caregiver variables were obtained from a prospective cohort, while healthcare data was obtained from the national claims database. Generalized estimating equation approach was used to get the population average estimates of healthcare utilization and cost trend across 4 quarters post-stroke. RESULTS: Five hundred ninety-two stroke patient and caregiver dyads were available for current analysis. The highest utilization occurred in the first quarter post-stroke across all service types and decreased with time. The incidence rate ratio (IRR) of hospitalization decreased by 51, 40, 11 and 1% for patients having spouse, sibling, child and others as caregivers respectively when compared with not having a caregiver (p = 0.017). Disability level modified the specialist outpatient clinic usage trajectory with increasing difference between mildly and severely disabled sub-groups across quarters. Stroke type and severity modified the primary care cost trajectory with expected cost estimates differing across second to fourth quarters for moderately-severe ischemic (IRR: 1.67, 1.74, 1.64; p = 0.003), moderately-severe non-ischemic (IRR: 1.61, 3.15, 2.44; p = 0.001) and severe non-ischemic (IRR: 2.18, 4.92, 4.77; p = 0.032) subgroups respectively, compared to first quarter. CONCLUSION: Highlighting the quarterly variations, we reported distinct utilization trajectories across subgroups based on clinical characteristics. Caregiver availability reducing hospitalization supports revisiting caregiver's role as potential hidden workforce, incentivizing their efforts by designing socially inclusive bundled payment models for post-acute stroke care and adopting family-centered clinical care practices.

Impact of psychiatric disorders and chronic physical conditions on health-related quality of life: Singapore Mental Health Study.

BACKGROUND: Few studies have established Quality Adjusted Life Years (QALY) losses associated with mental and chronic physical conditions in the community. The aim of the current study was to establish and compare the QALY losses associated with select mental and chronic physical conditions in Singapore. METHODS: The Singapore Mental Health Study was a cross-sectional epidemiological survey of a nationally representative sample. The diagnosis of psychiatric disorders was established using the Composite International Diagnostic Interview (CIDI 3.0) and health related quality of life (HRQoL) was measured using the Euro-Qol-5D (EQ-5D). RESULTS: Pain conditions, hypertension and MDD were associated with the highest loss of QALYs in Singapore at a population level. The marginal effect on HRQoL by - Major Depressive Disorder (MDD), Obsessive Compulsive Disorder (OCD) and Bipolar Disorder was higher than the effect of any physical condition. LIMITATIONS: The presence of chronic physical diseases was established using a check-list rather than with more objective measures and UK tariffs were used as local tariffs are not available and this might introduce some cultural bias. CONCLUSIONS: QALY losses associated with psychiatric disorders were high, emphasizing the need for recognizing them as major public health concerns and the need for appropriate resource allocation.

Prevalence and impact of mental and physical comorbidity in the adult Singapore population.

INTRODUCTION: This study aims to assess the prevalence rates of mental disorders and chronic medical conditions in the Singapore resident population, and examine their association and respective impact on the quality of life. MATERIALS AND METHODS: A household survey was carried out on a nationally representative sample of the adult (18 years and above) resident population. The main instrument used to establish the diagnosis of mental disorders is the World Mental Health Composite International Diagnostic Interview (WMH-CIDI). The mental disorders included in study were major depressive disorder, bipolar disorder, generalised anxiety disorder, obsessive compulsive disorder, alcohol abuse and alcohol dependence. Respondents were asked if they had any of the chronic medical conditions from a list of 15 conditions. Health-related quality of life was assessed with the EQ-5D. RESULTS: Of the 6616 respondents, the lifetime prevalence of mental disorders was 12.0%, and that of chronic medical disorders were 42.6% and those with comorbid mental and medical disorders was 6.1%. The prevalence of any physical disorder in this population was high (42.6%). Among those with chronic physical disorders, 14.3% also had a mental disorder, and among those with mental disorders, more than half (50.6%) had a medical disorder. Most of the mental disorders were not treated. Males, Indians, older people, and those who were separated or divorced were more likely to have comorbidity. The health-related quality of life was significant worse in those with both mental and medical disorders compared to those with either mental or medical disorder. CONCLUSION: Our study re-emphasised the common occurrence of mental and medical disorders and the importance for an integrated care system with the capability to screen and treat both types of disorders. It also identified certain subpopulations which are more likely to have comorbidity for which a more targeted intervention could be planned.

Health-related quality of life in thyroid cancer survivors.

OBJECTIVE: The study objective was to study the impact of the diagnosis, treatment, and follow-up of differentiated thyroid cancer (DTC) on the quality of life and related issues in an urban multi-ethnic Asian population. DESIGN: A self-administered questionnaire containing the Short Form 36 Health Survey (SF-36) and assessing sociodemographic, disease, and treatment-related status was mailed to patients with DTC. MAIN OUTCOMES: One hundred fifty-two (52.4%) of 290 patients answered the questionnaire. There was a statistically significant decrease in SF-36 scores between thyroid cancer survivors and the general population in all domains except for social functioning (SF). Physical functioning (PF) was worse in those survivors who were aged 50 years or older. Mental health (MH) scores were better in those who had more than 12 years of formal education. Being employed had a positive influence on role physical (RP) and role emotional (RE) scores. Being of Malay/Indian ethnicity strongly correlated with lower scores in bodily pain (BP), SF, RE and MH domains. CONCLUSION: Although most patients with well-differentiated thyroid cancer have near normal life expectancy, our study has shown that there is a significant decrease in their quality of life, especially in the elderly and poorer educated. Returning to work should be encouraged to improve the quality of life in DTC survivors.

Serum citrulline is a simple quantitative marker for small intestinal enterocytes mass and absorption function in short bowel patients.

BACKGROUND: To investigate the clinical significance of serum citrulline in evaluating the remnant small bowel enterocytes mass and absorptive function in short bowel (SB) patients. MATERIALS AND METHODS: Serum citrulline concentrations were determined using high-performance liquid chromatography (HPLC) in 22 SBS patients and 33 healthy controls. Five-hour urine D-xylose excretion and digestive protein absorption were measured using HPLC and micro-Kjeldahl method, respectively. Small bowel length and surface area were assessed on X-ray radiograph. Correlations between serum citrulline levels and small bowel length, small bowel surface, and nutritional substrate digestive absorption percentage were analyzed. For six patients receiving bowel rehabilitation therapy, serum citrulline, D-xylose excretion, and intestinal protein absorption were measured pre- and immediately postmanagement, and their correlations were analyzed. RESULTS: Serum citrulline levels were significantly lower in SB patients compared with healthy controls. In SB patients, they correlated well with remnant small bowel length (r = 0.82, P < 0.001), surface area (r = 0.86, P < 0.001), 5-h urine D-xylose excretion (r = 0.56, P = 0.007), and digestive protein absorption (r = 0.48, P = 0.046). The increased percentage of serum citrulline level in six patients receiving rehabilitation therapy followed a trend of correlating with that of intestinal protein absorption (r = 0.79, P = 0.063) and urine D-xylose excretion (r = 0.81, P = 0.053). CONCLUSIONS: In patients with short bowel syndrome, serum citrulline is a simple and accurate biomarker for the severity of intestinal failure and may be a candidate marker for the gut-trophic effects of bowel rehabilitation therapies.