Anxiety, depression and quality of life in patients with head and neck cancer undergoing laryngectomy: A long-term prospective evaluation.

BACKGROUND: This study aimed to assess anxiety, depression and quality of life (QoL) in patients with head and neck cancer undergoing laryngectomy using comprehensive self-reported questionnaires for a period of up to 5 years. METHODS: This prospective observational study enrolled 150 consecutive patients with locally advanced head and neck cancer who underwent laryngectomy at Nagoya University Hospital between 2007 and 2020. Anxiety, depression and QoL were assessed at baseline (preoperative) and at 3, 6, 12, 24, 36, 48 and 60 months after surgery using two brief self-reported questionnaires, such as the eight-item Short Form Health Survey (SF-8) and the Hospital Anxiety and Depression Scale (HADS). RESULTS: The surgical procedures were total laryngectomy, pharyngo-laryngectomy and pharyngo-laryngo-oesophagectomy in 97 (65%), 41 (27%) and 12 (8%) patients, respectively. All eight items of the SF-8 were significantly worse than those of the normal population at baseline and at 3 months after surgery. However, general health, vitality, mental health and bodily pain improved to normal levels within 1 year after surgery and were maintained for 5 years. In this study, 35% of patients were categorised as potential cases of depression, and 35% were potential cases of anxiety. During the follow-up period, the proportion of patients with anxiety gradually decreased after surgery. Further analysis revealed that the SF-8 and HADS scores and trends in 89 patients without tumour recurrence were similar to those in the total enrolled 150 patients. CONCLUSION: Anxiety, depression and QoL in laryngectomised patients improved at 1 year after surgery and were maintained for up to 5 years. WHAT THIS PAPER ADDS: What is already known on the subject Laryngectomy is associated with prolonged functional and psychological effects and has a major impact on patient quality of life (QoL). Several prospective studies evaluating the QoL in laryngectomised patients have been reported, in which significant deterioration in social functioning was found even 1 year after surgery. What this paper adds to existing knowledge One year is not a sufficient period for laryngectomised patients to return to normal life and spend their time in a social community. A recent review showed that most studies on QoL in laryngectomised patients were conducted under 1 year after the procedure, and there were not enough studies of sufficient quality. This is the first long-term prospective observational study of Japanese patients with head and neck cancer who underwent laryngectomy up to 5 years after surgery. What are the potential or actual clinical implications of this work? Our long-term observational study showed that the scores for anxiety, depression and QoL in laryngectomised patients improved at 1 year after surgery and were maintained for up to 5 years. Clinicians should recognize the importance of psychosocial risk factors in their QoL and multidisciplinary management, including social and psychological support, is essential for long-term laryngectomised survivors.

Effect Estimate of Time-varying Social Support and Trust on the Physical and Mental Health of Mothers at 2.5 Years Postpartum: The Japan Environment and Children's Study (JECS).

BACKGROUND: Many epidemiological studies have reported the association between various social factors and health status in mothers during and after pregnancy. However, little is known about their joint and longitudinal impact. We examined the association of lack of social support and trust during pregnancy and at 2.5 years postpartum with health status in mothers. METHODS: To adequately address time-varying exposure, marginal structural models were fitted to a pseudopopulation constructed using inverse probability weighting. The model included records of 90,071 mothers participating in the Japan Environment and Children's Study. Social support and trust were measured using a 9-item questionnaire (Q1-9). Mental and physical health were measured using Mental and Physical Component Summary scores from the 8-item Short-Form Health Survey. RESULTS: For the Mental Component Summary, the magnitude of the effect estimate was largest when participants lacked close friends/neighbors (Q4) at only 2.5 years postpartum (effect estimate, -6.23), followed by a lack in emotional support (Q2) at the same time point (effect estimate, -4.94). For the Physical Component Summary, effect estimates were negligible. The magnitude of the effect estimates of lack of social support and trust tended to be larger when there was a lack at only 2.5 years postpartum than at both time points. CONCLUSION: These findings suggest that, after childbirth, a loss in social support, particularly in an emotional aspect, carries high risk, especially for mental health. Our results highlight the importance of supporting mothers for more than a few years after pregnancy.

Confirmatory and bi-factor analysis of the Short Form Health Survey 8 (SF-8) scale structure in a German general population sample.

BACKGROUND: The SF-8 is a short form of the SF-36 Health Survey, which is used for generic assessment of physical and mental aspects of health-related quality of life (HRQoL). Each of the 8 dimensions of the SF-36 is covered by a single item in the SF-8. The aim of the study was to examine the latent model structure of the SF-8. METHOD: One-, two- and three dimensional as well as bi-factor structural models were defined and estimated adopting the ML- as well as the WLSMV-algorithm for ordinal data. The data were collected in a German general population sample (N = 2545 persons). RESULTS: A two- (physical and mental health) and a three-dimensional CFA structure (in addition overall health) represent the empirical data information adequately [CFI = .987/.995; SRMR = .024/.014]. If a general factor is added, the resulting bi-factor models provide a further improvement in data fit [CFI = .999/.998; SRMR = .001]. The individual items are much more highly associated with the general HRQoL factor (loadings: .698 to .908) than with the factors physical, mental, and overall health (loadings: -.206 to .566). CONCLUSIONS: In the SF-8, each item reflects mainly general HRQoL (general factor) as well as one of the three components physical, mental, and overall health. The findings suggest in particular that the evaluation of the information of the SF-8 items can be validly supplemented by a general value HRQoL.

Health-related quality of life in patients with chronic hepatitis C treated with sofosbuvir-based treatment at 1-year post-sustained virological response.

PURPOSE: Long-term effects on patient health-related quality of life (HRQoL) after direct-acting antiviral (DAA) treatment for hepatitis C virus (HCV) are unknown. We assessed the impact of DAA-mediated HCV clearance on HRQoL from DAA initiation to 1 year after confirmed sustained virological response at 24 weeks post-treatment (SVR24). METHODS: HRQoL was evaluated using the eight-item Short Form Health Survey (SF-8). Chronic HCV-infected patients were treated for 12 weeks with sofosbuvir-based DAAs. SF-8 was administered at baseline, treatment cessation, SVR24, and 1-year post-SVR24. RESULTS: A total of 109 chronic HCV-infected patients were enrolled. The average SF-8 scores were higher than the Japanese national standard values for bodily pain (BP) and mental health at baseline and for general health at 1-year post-SVR24. None of the SF-8 scores differed significantly between baseline and 1-year post-SVR24. Regarding age, sex, liver status, and treatment regimen, the SF-8 scores at 1-year post-SVR24 were affected by only age; individuals aged < 65 years had significantly higher physical component score (PCS), physical functioning, role physical, and BP scores than older individuals. In the multivariable analysis, only age of ≥ 65 years was significantly associated with influencing PCS at 1-year post-SVR24. However, no significant factors were identified for mental component score. CONCLUSION: Upon long-term assessment, although more factors trended higher than national standard values at 1-year post-SVR24 than at baseline, there were no significant changes within factors. As PCS tended to be associated with age, patients aged ≥ 65 years should be carefully monitored for PCS.

Mental component of health-related quality of life is an independent predictor of incident functional disability among community-dwelling older people: a prospective cohort study.

PURPOSE: Previous studies have reported a positive association between poor health-related quality of life (HRQOL) and disability mainly in relation to the physical component of HRQOL. Given the mental component's responsivity to interventions, this study aimed to investigate whether the mental component of HRQOL independently predicted functional disability. METHODS: We targeted all residents aged ≥ 65 years in one municipality and analyzed 3858 men and 4475 women without disability at baseline (November 2016). HRQOL was measured using the physical component summary (PCS) and mental component summary (MCS) of the SF-8 Health Survey. At 3-year follow-up (October 2019), incident functional disability was measured, defined as a new certification according to the Japanese long-term care insurance system. Multivariable Poisson regression models stratified by gender were used to estimate adjusted cumulative incidence ratio (CIR) and 95% confidence interval (CI) for functional disability. RESULTS: Among both genders, there was a significant dose-response relationship between better MCS and lower risk of functional disability, independent of potential confounders including the PCS (P for trend = 0.026 in men and 0.003 in women). Compared with the worst MCS group, the CIRs (95% CIs) for functional disability in the second worst, the middle, the second best, and the best MCS quintile groups were 1.09 (0.80-1.48), 0.58 (0.40-0.85), 0.90 (0.59-1.37), and 0.70 (0.48-1.02) for men, and 0.76 (0.58-1.00), 0.62 (0.46-0.84), 0.73 (0.53-0.99), and 0.63 (0.48-0.85) for women, respectively. CONCLUSION: The MCS is an independent predictor of functional disability among high-functioning older adults. This suggests that strategies focused on mental HRQOL are important for realizing a healthy, long-lived society.

Mental and physical health status among chronic hepatitis B patients.

PURPOSE: Little is known about health-related quality of life (HRQoL) in patients with chronic hepatitis B virus (CHB) infection in the United States. Our goal is to understand factors associated with HRQoL in this population. METHODS: We conducted a survey to assess HRQoL and behavioral risks among patients with CHB infection from four large U.S. health care systems. Primary outcomes were generated from the SF-8 scale to assess HRQoL, as measured by the mental component scores (MCS) and physical component scores (PCS). The survey also measured socio-demographic information, hepatitis-related behavioral risk factors, treatment exposure/history, stress, and social support. We supplemented survey data with electronic health records data on patient income, insurance, disease severity, and comorbidities. Multivariate analysis was used to estimate and compare adjusted least square means of MCS and PCS, and examine which risk factors were associated with lower MCS and PCS. RESULTS: Nine hundred sixty-nine patients (44.6%) responded to the survey. Current life stressors and unemployment were associated with both lower MCS and PCS results in multivariate analyses. Lower MCS was also associated with White race and low social support, while lower PCS was also associated with Medicaid insurance. CONCLUSIONS: Stressful life events and unemployment were related to mental and physical health status of CHB patients. Those who have social support have better mental health; White and Medicaid patients are more likely to have poorer mental and physical health, respectively. Management of CHB patients should include stress management, social support, and financial or employment assistance.

Impact of individual and neighborhood social capital on the physical and mental health of pregnant women: the Japan Environment and Children's Study (JECS).

BACKGROUND: Previous studies revealed positive, negative, and no influence of social capital on the health outcomes of pregnant women. It was considered that such differences were caused by the disparities of outcome measures and sample sizes between studies. Our chief aim was to verify the positive influence of social capital on the health condition of pregnant women using established health outcome measures and large-scale nationwide survey data. METHODS: We employed questionnaire survey data from 79,210 respondents to the Japan Environment and Children's Study, and physical and mental component summary scores from the 8-Item Short-Form Health Survey as outcome measures. We estimated the effect of individual and neighborhood social capitals on physical and mental component summary scores. To consider the property that the richness of social capital would be generally determined by individual characteristics, and to estimate the causal influence of social capital on health without bias caused by said property, we adopted average treatment effect estimation with inverse probability weighting. Generally, average treatment effects are based on the difference of average outcomes between treated and untreated groups in an intervention. In this research, we reckoned individuals' different levels of social capital as a kind of non-randomized treatment for respective individuals, and we applied average treatment effect estimation. The analysis regarded pregnant women with the lowest level of social capital as untreated samples and women with other levels of social capitals as treated samples. RESULTS: For mental component summary score, the maximum average treatment effects in the comparison between the lowest and highest levels of social capital were approximately 4.4 and 1.6 for individual and neighborhood social capital, respectively. The average treatment effects for the physical component summary score were negligible for both social capital types. CONCLUSIONS: Social capital particularly contributes to improving mental component summary score in pregnant women. The likelihood of a mentally healthy pregnancy may be increased by enhancing social capital.

Evaluating the reliability and validity of SF-8 with a large representative sample of urban Chinese.

BACKGROUND: The Short Form-8 (SF-8) is a widely used instrument for measuring health-related quality of life (HRQOL). The purpose of the current study is to evaluate the reliability and validity of the Chinese version SF-8 using a large, representative sample of city residents in mainland China. METHODS: We surveyed residents of 35 major cities in China using random digit dialing of both landlines and cell phones. We adopted a multi-stage stratified sampling scheme and selected a probability sample of 10,885 adults. Internal consistency reliability of the SF-8 was evaluated with item-total correlations and Cronbach's alphas. Construct validity was assessed with factor analysis. Known-groups validity was examined based on known HRQOL differences in age, gender, income, and overall quality of life. RESULTS: We showed that SF-8 has very good internal consistency reliability and known-groups validity. Our results also confirmed that the traditional 2-factor structure of SF-8 (physical and mental health) is reasonable among Chinese city residents. Further, we showed that a 3-factor model (physical, mental, and overall health) fit the data better than the traditional 2-factor model. CONCLUSIONS: This study is the first to confirm the traditional 2-factor structure of SF-8 using a large, representative sample from China. We have shown that the SF-8 Chinese version is feasible, reliable, and valid. Our findings support the use of the SF-8 summary scores for assessing general HRQOL among Chinese. Future studies may further explore the possibility of a 3-factor structure for the SF-8 among the Chinese population.

Relationship between quality of life instruments and phonatory function in tracheoesophageal speech with voice prosthesis.

BACKGROUND: The use of tracheoesophageal speech with voice prosthesis (T-E speech) after total laryngectomy has increased recently as a method of vocalization following laryngeal cancer. Previous research has not investigated the relationship between quality of life (QOL) and phonatory function in those using T-E speech. This study aimed to demonstrate the relationship between phonatory function and both comprehensive health-related QOL and QOL related to speech in people using T-E speech. METHODS: The subjects of the study were 20 male patients using T-E speech after total laryngectomy. At a visit to our clinic, the subjects underwent a phonatory function test and completed three questionnaires: the MOS 8-Item Short-Form Health Survey (SF-8), the Voice Handicap Index-10 (VHI-10), and the Voice-Related Quality of Life (V-RQOL) Measure. RESULTS: A significant correlation was observed between the physical component summary (PCS), a summary score of SF-8, and VHI-10. Additionally, a significant correlation was observed between the SF-8 mental component summary (MCS) and both VHI-10 and VRQOL. Significant correlations were also observed between voice intensity in the phonatory function test and both VHI-10 and V-RQOL. Finally, voice intensity was significantly correlated with the SF-8 PCS. CONCLUSIONS: QOL questionnaires and phonatory function tests showed that, in people using T-E speech after total laryngectomy, voice intensity was correlated with comprehensive QOL, including physical and mental health. This finding suggests that voice intensity can be used as a performance index for speech rehabilitation.

Health-related quality of life in the first year after laparoscopic radical prostatectomy compared with open radical prostatectomy.

OBJECTIVE: To assess health-related quality of life in the first year after laparoscopic radical prostatectomy compared with that after open radical prostatectomy. METHODS: The subjects were 105 consecutive patients with localized prostate cancer treated with laparoscopic radical prostatectomy between January 2011 and June 2012. Health-related quality of life was evaluated using the International Prostate Symptom Score, Medical Outcome Study 8-Items Short Form Health Survey (SF-8) and Expanded Prostate Cancer Index Composite at baseline and 1, 3, 6 and 12 months after surgery. Comparisons were made with data for 107 consecutive patients treated with open radical prostatectomy between October 2005 and July 2007. RESULTS: The International Prostate Symptom Score change was similar in each group. The laparoscopic radical prostatectomy group had a better baseline Medical Outcome Study 8-Items Short Form Health Survey mental component summary score and a better Medical Outcome Study 8-Items Short Form Health Survey physical component summary score at 1 month after surgery. In Expanded Prostate Cancer Index Composite, obstructive/irritative symptoms did not differ between the groups, but urinary incontinence was worse until 12 months after surgery and particularly severe after 1 month in the laparoscopic radical prostatectomy group. The rate of severe urinary incontinence was much higher in the laparoscopic radical prostatectomy group in the early period. Urinary bother was worse in the laparoscopic radical prostatectomy group at 1 and 3 months, but did not differ between the groups thereafter. Urinary function and bother were good after nerve sparing procedures and did not differ between the groups. Bowel and sexual function and bother were similar in the two groups. CONCLUSION: Urinary function in the first year after laparoscopic radical prostatectomy is worse than that after open radical prostatectomy.

Effect of fezolinetant on sleep disturbance and impairment during treatment of vasomotor symptoms due to menopause.

OBJECTIVES: To analyse the effect of fezolinetant on patient-reported sleep disturbance and impairment in individuals with vasomotor symptoms (VMS) using pooled data from the SKYLIGHT 1 and 2 studies. STUDY DESIGN: The SKYLIGHT studies were phase-3, double-blind investigations. Individuals (≥40-≤65 years) who were assigned female at birth and seeking treatment of/relief from moderate-to-severe VMS were enrolled. Participants were randomised to receive placebo, fezolinetant 30 mg, or fezolinetant 45 mg during a 12-week treatment period. MAIN OUTCOME MEASURES: Sleep assessments: Patient-Reported Outcomes Measurement Information System Sleep Disturbance - Short Form 8b (PROMIS SD SF 8b), PROMIS Sleep-Related Impairment - Short Form 8a (PROMIS SRI SF 8a), and Patient Global Impression of Change/Severity in SD (PGI-C SD and PGI-S SD). Assessments were completed at baseline (except PGI-C SD), weeks 4 and 12. RESULTS: Overall, 1022 individuals were randomised and took ≥1 dose of study drug. PROMIS SD SF 8b results showed that improvements in sleep disturbance were observed for fezolinetant 30 and 45 mg versus placebo (week 12, least squares [LS] mean differences: -0.6 [95 % confidence interval [CI]: -1.7, 0.4] for 30 mg and -1.5 [-2.5, -0.5] for 45 mg). Similar improvements in sleep impairment were reported using the PROMIS SRI SF 8a (week 12, LS mean differences: -1.1 [95 % CI: -2.1, -0.1] for 30 mg and -1.3 [-2.3, -0.3] for 45 mg). For PGI-C SD at week 12, 33.6 % (98/292 participants) of the placebo group felt much/moderately better versus 40.1 % (110/274) and 51.0 % (154/302) of the fezolinetant 30 mg and 45 mg groups, respectively. For PGI-S SD at week 12, 44.0 % (129/293) of the placebo group had severe/moderate problems versus 41.1 % (113/275) and 36.6 % (111/303) of the fezolinetant 30 mg and 45 mg groups, respectively. The 12-week timeframe for this analysis was limited by the length of the placebo-controlled period. CONCLUSIONS: Fezolinetant had a beneficial effect on four measures of sleep disturbance and impairment following treatment for VMS.

Association of infants' feeding pattern up to 2 years postpartum with mothers' mental and physical health: the Japan Environment and Children's Study.

BACKGROUND: Exclusive breastfeeding, a longer breastfeeding duration, and interaction with the baby during lactation improve mothers' mental health. However, few studies have targeted women around 2.5 years after childbirth, when women are still considered to have been in a period of mental and physical health vulnerability. This study examined this aspect in a large cohort of mother-child pairs. METHODS: Data were obtained from 85,735 mothers in an ongoing nationwide birth cohort study in Japan. Exposures were exclusive breastfeeding (yes/no), continued breastfeeding up to 2 years (yes/no), and interaction with the baby during feeding (yes/no). Outcomes were mothers' mental and physical health 2.5 years after childbirth measured using Mental and Physical Component Summary scores (MCS and PCS scores, respectively) from the 8-item Short-Form Health Survey. Generalized additive mixed model analysis was used to derive each estimate for the three exposures and their interactions, with each "no" answer as reference. RESULTS: Exclusive breastfeeding and interaction with the baby during feeding were associated with MCS score increases of 0.28 (95%CI: 0.10-0.47) and 0.41 (95%CI: 0.29-0.54), respectively. However, no associations were found for continued breastfeeding up to 2 years and no interactions were identified. No significant differences were observed for PCS scores. LIMITATIONS: All variables were measured using a self-administered questionnaire. CONCLUSIONS: Continued exclusive breastfeeding until 6 months and interaction with the baby during feeding may help to promote mother's mental health 2.5 years after childbirth. These findings further strengthen the rationale for the World Health Organization's recommended lactation practices.

The correlation between tinnitus-specific and quality of life questionnaires to assess the impact on the quality of life in tinnitus patients.

Introduction: Subjective tinnitus is often associated with a reduction in health-related quality of life (HRQoL). The HRQoL represents the impact of tinnitus on an individual's life by addressing the physical, social, and psychological domains of 1. A limited amount of studies has investigated the association between tinnitus and HRQoL questionnaires. The aim of this study was to examine the correlation between tinnitus-specific and HRQoL questionnaires in order to shorten fulfilling questionnaires, as it is often time-consuming. Material and method: Eighty-five patients with tinnitus as primary complaint completed five questionnaires, including one general, two tinnitus-specific, and two generic HRQoL questionnaires: Tinnitus Sample Case History Questionnaire (TSCHQ), Tinnitus Functional Index (TFI), Tinnitus Handicap Inventory (THI), short version of World Health Organization Quality of Life (WHOQOL-BREF), and the eight-item Short-Form (SF-8). Four simple linear regression models were used to analyze the relationship between the THI and TFI and the WHOQOL-BREF and SF-8. Results: A negative and strong correlation was found between the tinnitus questionnaires and the SF-8. More than half of the variability in the SF-8 scores could be explained by the TFI and THI, respectively 50.6 and 54.4% (all p < 0.001). A strong negative regression was also found between the WHOQOL-BREF and the THI and TFI with a decrease in the determination coefficient of approximately 10% compared with the SF-8. The weakest correlation (regression coefficient of 0.628, p < 0.001) was observed between the WHOQOL-BREF and the TFI, indicating that the WHOQOL-BREF mean score explained 39.4% of the TFI. When looking at the subdomain scores, a strong correlation was observed between the QoL subdomain of the TFI and a combination of the physical and psychological subdomain of the WHOQOL-BREF (r = -0.627, p < 0.001). Conclusion: The QoL subdomain of the TFI gives good information about the physical and psychological health. Thus, the TFI is suitable to assess both tinnitus severity and the HRQoL. The coefficients of determination of the WHOQOL-BREF were significantly lower compared to the SF-8, suggesting that the WHOQOL-BREF provides more specific information about HRQoL. If more specific information on HRQoL, such as "environment" and "social relationships", is required, it is recommended to use the WHOQOL-BREF.

The Clinical Effect of Seasonal Flu Vaccination on Health-Related Quality of Life.

PURPOSE: This study aimed to determine the clinical effect of seasonal flu vaccination in adult outpatients based on the effect on health-related quality of life (HRQOL). PATIENTS AND METHODS: We reviewed the clinical data of adult flu outpatients with mild symptoms who presented to the outpatient clinic of Teikyo University Hospital, Tokyo, Japan, from 2018 to 2020 winter season and were enrolled in the prospective observational study of the clinical efficacy of anti-flu agents (UMIN000034896). We evaluated influenza vaccination status, clinical symptoms, and the status of HRQOL as measured by Short Form-8® (SF-8®) at first visit. The SF-8® survey generated two-component summaries; a physical component summary and a mental component summary. RESULTS: The data of 79 patients were evaluated in this study. Of the 79 patients, 37 were vaccinated for influenza at least three weeks before contracting seasonal influenza. Not every patient needed to be hospitalized for treatment. There were no significant differences in clinical backgrounds between vaccinated patients and non-vaccinated patients. Univariate analysis showed influenza vaccination was significantly associated with higher scores on the physical component summary of HRQOL (p=0.0011). CONCLUSION: Influenza vaccinations would be clinically valuable for adult outpatients with seasonal flu and mild symptoms, because they can significantly inhibit the decrease of HRQOL due to influenza infection.

Psychometric properties of the Short Form-8 Health Survey (SF-8) among diabetes and non-diabetes Iranian older people.

Background: The current study aimed to evaluate the psychometric properties of the Persian version of the 8-item Short-Form Health Survey (SF-8). For this purpose, we examined a large sample of the older adult in two different groups with and without diabetes using the YazdHealth Study (YaHS) data. Methods: Using a two-stage cluster random sampling method, 1901 older adults were recruited, according to the World Health Organization (WHO) STEPwise approach to surveillance(STEPS) guidelines. To test the scale's reliability, the internal consistency and test-retest methods were applied. The convergent validity of the entire questionnaire was evaluated by the average variance extracted (AVE) and composite reliability (CR) for each subscale. An independent samples t-test was used to assess the demographic differences between the study groups. Results: The Cronbach's alpha coefficient for the subscales of SF-8 were measured to range between 0.85 and 0.79 (physical & mental health). The test-retest reliability coefficient of the physical component summary (PCS) and (0.97) and mental component summary (MCS) (0.98)indicated the appropriate reliability of the SF-8. The CFA-concerned results indicated that the the2-factor model presented a good fit to the data for the explored diabetes and non-diabetes groups, as well as the total research participants [goodness of fit index (GFI)=0.99, comparative fit index (CFI)=0.992, normed fit index (NFI)=0.99, incremental fit index (IFI)=0.992, root mean square error of approximation (RMSEA)=0.056]. Values >0.5 and >0.7 for AVE and CR indicated the evidence of the convergent validity of the SF-8. Conclusion: The present study was the first attempt to confirm the traditional 2-factor structure of SF-8 among a large sample of Iranian older individuals. The obtained results suggested that the Persian version of the SF-8 is a reliable and valid tool for measuring health-related quality of life (HRQoL) among Iranian older adults (including the older adult with & without diabetes).

The Influence of Income and Livelihood Diversification on Health-Related Quality of Life in Rural Ethiopia.

Examining health-related quality of life (HRQOL) in a rural setting can be beneficial for improving rural household policies and fostering public health promotion. The objective of this study was to measure the HRQOL and associated socioeconomic characteristics as well as test the reliability of the Amharic version of SF-8 (eight-item short form of HRQOL survey). A cross-sectional study was employed in three agroecologically different sites in rural Ethiopia, involving 270 household heads (218 male and 52 female) with a mean age ± standard deviation of 49 ± 12.88 years. The survey material consisted of a structured questionnaire for socioeconomic characteristics and SF-8 for HRQOL. The mean physical and mental component summary score of the whole sample was 30.50 ± 12.18 and 34.40 ± 7.26, respectively, well underneath the instrument average of 50. The SF-8 items showed excellent internal consistency in terms of both Cronbach's α coefficients and item-total correlation. In stepwise multiple linear regression, the low-income group had worse self-perceived physical health than the higher-income groups. Likewise, a diversified livelihood had a profound influence on positive self-perceived physical health. These findings imply that developing and distributing wide-ranging socioeconomic and public health policies is crucial for effective health promotion in rural communities.

Factors Influencing Patient Satisfaction After Decompression Surgery Without Fusion for Lumbar Spinal Stenosis.

STUDY DESIGN: Retrospective cohort study. OBJECTIVES: Decompression without fusion is a standard surgical treatment for lumbar spinal stenosis (LSS) with reasonable surgical outcomes. Nevertheless, some studies have reported low patient satisfaction (PS) following decompression surgery. The cause of the discrepancy between reasonable clinical outcomes and PS is unknown; moreover, the factors associated with PS are expected to be complex, and little is known about them. This study aimed to identify satisfaction rate and to clarify the factors related to PS following decompression surgery in LSS patients. METHODS: We retrospectively reviewed 126 patients who underwent lumbar decompression with a minimum follow-up of 1 year. Patients were divided into 2 groups based on the PS question. The Japanese Orthopaedic Association (JOA) scores, and the Numeric Rating Scale (NRS) scores of low back pain (LBP), leg pain, and leg numbness were compared between the 2 groups preoperatively and at the latest visit. To identify the prognostic factors for dissatisfaction, multiple logistic regression analysis was performed. RESULTS: Overall satisfaction rate was 75%. The JOA recovery rate, NRS improvement, and Short Form-8 (SF-8) were significantly higher in the satisfied group. Postoperative NRS scores of LBP, leg pain, and leg numbness were significantly lower in the satisfied group. Multivariate logistic regression analysis showed that smoking and scoliosis were significant risk factors for dissatisfaction. CONCLUSIONS: Overall satisfaction rate was 75% in patients with LSS undergoing decompression surgery. This study found that smoking status and scoliosis were associated with patient dissatisfaction following decompression in LSS patients.

Patient-reported health-related quality of life up to three years after the treatment with permanent brachytherapy: Outcome of the large-scale, prospective longitudinal study in Japanese-Prostate Cancer Outcome Study by Permanent I-125 Seed Implantation (J-POPS).

PURPOSE: To evaluate long-term health-related quality of life (HRQOL) impact of I-125 permanent seed implantation (PI) in Japanese patients with localized prostate cancer. MATERIALS AND METHODS: This is a longitudinal, prospective study of 2353 patients who enrolled in the nationwide Japanese-Prostate Cancer Outcome Study by Permanent I-125 Seed Implantation (J-POPS) from July 2005 to June 2007. HRQOL was measured before and after treatment (3, 12, 24, and 36 months) using the Medical Outcomes Study 8-items Short-Form Health Survey (SF-8) and the Expanded Prostate Cancer Index Composite Japanese version questionnaire. RESULTS: Of the total of 1511 patients who returned anonymized HRQOL questionnaires to Translational Research Center for Medical Innovation, 1079 underwent PI alone (PI group) and 432 underwent combined PI and external beam radiation therapy (EBRT) treatment (EBRT combination therapy group). The mental component summary score of SF-8 was improved at 12, 24, and 36 months compared with the pretreatment level. Although the urinary summary score at 3 months in the PI group was significantly lower than that in the EBRT combination therapy group, which recovered thereafter and was comparable to the score of the EBRT combination therapy group. The bowel summary score in the PI group was significantly higher than that in the EBRT combination therapy group at 12, 24, and 36 months. CONCLUSION: This longitudinal, large-scale prospective study indicated that the general HRQOL for PI was almost maintained 3 years after treatment. These results provide important information for patients with localized prostate cancer, who may select to receive I-125 brachytherapy.

Beneficial effect of laughter therapy on physiological and psychological function in elders.

AIM: In the present study we investigated the effect of laughter therapy on physiological and psychological function in older people. DESIGN: An open-label trial. METHODS: Seventeen older people who regularly attended an elderly day care centre were recruited. Stand-up comedy as laughter therapy was performed once a week for 4 weeks. Parameters of physiological and psychological function were evaluated before and after laughter therapy. RESULTS: Laughter therapy intervention resulted in a significant reduction in systolic blood pressure and heart rate, accompanied by a significant increase in plasma concentration of serotonin and a significant decrease in salivary concentration of chromogranin A. Questionnaire surveys of SF-8, GDS-15, and Vitality Index demonstrated alleviation of depression and improvement of sociability and activity in older people. Laughter therapy could be expected to become a practical treatment to improve quality of life of older people in an elderly day care centre.