Impacts of a health literacy-informed intervention in people with chronic obstructive pulmonary disease (COPD) on hospitalization, health literacy, self-management, quality of life, and health costs - A randomized controlled trial.

OBJECTIVE: To compare the effect of motivational interviewing (MI) and tailored health literacy (HL) follow-up with usual care on hospitalization, costs, HL, self-management, Quality of life (QOL), and psychological stress in people with chronic obstructive pulmonary disease (COPD). METHODS: A RCT was undertaken in Norway between March 2018-December 2020 (n = 127). The control group (CG, n = 63) received usual care. The intervention group (IG, n = 64) received tailored HL follow-up from MI-trained COPD nurses with home visits for eight weeks and phone calls for four months after hospitalization. Primary outcomes were hospitalization at eight weeks, six months, and one year from baseline. The trial was registered with ClinicalTrials.gov (NCT03216603) and analysed per protocol. RESULTS: Compared with the IG, the CG had 2.8 higher odds (95% CI [1.3 to 5.8]) of hospitalization and higher hospital health costs (MD=€ -6230, 95% CI [-6510 to -5951]) and lower QALYs (MD=0.1, 95% CI [0.10 to 0.11]) that gives an ICER = - 62,300. The IG reported higher QOL, self-management, and HL (p = 0.02- to <0.01). CONCLUSION: MI-trained COPD nurses using tailored HL follow-up is cost-effective, reduces hospitalization, and increases QOL, HL, and self-care in COPD. PRACTICE IMPLICATION: Tailored HL follow-up is beneficial for individuals with COPD and the healthcare system.

Mastery and Depressive Symptoms: How Does Mastery Influence the Impact of Stressors From Midlife to Old Age?

OBJECTIVE: The objective of this research is to study depressive symptoms (DS) among adults aged 40 to 79 years and examine how mastery influences the impact of sociodemographic, socioeconomic, and health factors on DS. METHOD: We used a sample of the Norwegian Life Course, Generation, and Gender (LOGG) study ( N = 6,879) and analyzed how mastery influences the independent variables on DS via regression analyses. RESULTS: Mastery affected DS directly and influenced the effects of sociodemographic, socioeconomic, and health factors on DS. There was a stronger relationship between stressors and DS among respondents with low than high mastery. DS were most prevalent among people aged 70 to 79 years. When mastery was also controlled for, the oldest group (70-79 years) had significantly fewer DS than those aged 40 to 49 years. DISCUSSION: The influence of mastery and stressors on DS seems to vary along the life span. The result that mastery was a relatively stronger buffer against DS in midlife than in old age is discussed.

Medical and sociodemographic factors predict persistent smoking after coronary events.

BACKGROUND: Understanding the determinants of persistent smoking after a coronary event constitutes the basis of modelling interventions of smoking cessation in secondary prevention programs. We aim to identify the potentially modifiable medical, sociodemographic and psychosocial factors, comprising the study factors, associated with unfavourable risk factor control after CHD events. METHODS: A cross-sectional explorative study used logistic regression analysis to investigate the association between study factors and smoking status in 1083 patients hospitalized with myocardial infarction and/or coronary revascularization. Hospital record data, a self-report questionnaire, clinical examination and blood samples were applied. RESULTS: At the index hospitalization, 390 patients were smoking and at follow-up after 2-36 months 167 (43%) of these had quit, while 230 reported persistent smoking. In adjusted analyses, unemployed or disability benefits (Odds ratio (OR) 4.1), low education (OR 3.5), longer smoking duration (OR 2.3) and not having ST-elevation myocardial infarction (STEMI) as index event (OR 2.3) were significantly associated with persistent smoking. Psychosocial factors at follow-up were not associated with persistent smoking. Smokers reported high motivation for cessation, with 68% wanting help to quit. Only 42% had been offered nicotine replacement therapy or other cessation aids. Smokers rated use of tobacco as the most important cause of their coronary disease (6.8 on a 1-10 Likert scale). CONCLUSIONS: Low socioeconomic status, prior duration of smoking, and not having STEMI as index event were associated with persisting smoking. Persistent smokers in this study seem to have an acceptable risk perception and were motivated to cease smoking, but needed assistance through cessation programs including prescription of pharmacological aids. TRIAL REGISTRATION: Registered at ClinicalTrials.gov: NCT02309255 , registered retrospectively.

Depression-A Major Contributor to Poor Quality of Life in Patients With Advanced Cancer.

CONTEXT: Quality of life (QoL) and depression are important patient-reported outcomes in cancer care. However, the relative importance of depression severity in predicting QoL remains unclear because of few methodologically sound studies. OBJECTIVES: To examine whether depression contributes to impairment of QoL irrespective of prognostic factors and symptom burden. METHODS: A total of 563 patients were included from the European Palliative Care Research Collaborative-Computerized Symptom Assessment Study, an international, multi-center, cross-sectional study. The relative importance of prognostic factors (systemic inflammation [modified Glasgow Prognostic Score-mGPS]), co-morbidities and physical performance (Karnofsky Performance Status), symptom burden (loss of appetite, breathlessness, nausea [Edmonton Symptom Assessment Scale], and pain [Brief Pain Inventory]), and depression severity (Patient Health Questionnaire 9) in predicting Global Health/QoL (European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire [EORTC-QLQ-C30]) were assessed using hierarchical multiple regression models. RESULTS: Fifty-five percent were women, median age was 64 years, 87% had metastatic disease, median Karnofsky Performance Status was 70, and mean global QoL was 50.5 (SD = 23.3). Worse QoL was associated with increased systemic inflammation (mGPS = 1 ß = -0.12, P = 0.003; mGPS = 2 ß = -0.09, P = 0.023), lower physical performance (ß = 0.17, P < 0.001), reduced appetite (ß = -0.15, P < 0.001), breathlessness (ß = -0.11, P = 0.004), pain (ß = -0.14, P = 0.002), and higher depression severity (ß = -0.27, P < 0.001). The full model accounted for 29% of the observed variance in QoL scores. The strongest predictor was depression severity, accounting for 5.8% of the variance. CONCLUSION: Depression severity was the strongest single predictor of poorer QoL in this sample of patients with advanced cancer, after accounting for a wide range of clinically relevant variables. Future studies should investigate the contribution of psychosocial variables on QoL. Our findings emphasize the importance of managing depression to achieve the best possible QoL for these patients.

Clinical characteristics associated with illness perception in psoriasis.

Knowledge of illness perception may aid the identification of groups of patients with a higher risk of coping poorly with the demands of their illness. This study aims to investigate associations between illness perception, clinical characteristics, patient knowledge, quality of life and subjective health in persons with psoriasis. The present study was based on cross-sectional data from patients awaiting climate therapy in Gran Canaria. We included 254 eligible patients (74%) who completed a questionnaire including the revised Illness Perception Questionnaire, the Psoriasis Knowledge Questionnaire, and the Dermatological Life Quality Index. Disease severity was measured using the Psoriasis Area and Severity Index. Several statistically significant associations between clinical characteristics, knowledge and various illness perception dimensions were found. Illness perception was also significantly related to disease-specific quality of life and subjective health. These findings contradict previous findings, which suggested that objective disease factors are not relevant to illness perception in psoriasis.

Assessment of response criteria to cardiac resynchronization therapy (CRT) and prediction of response.

AIMS: Approximately 30% of patients treated with cardiac resynchronization therapy (CRT) do not respond. We evaluated response to CRT at six and 12 months, tested a novel response criterion and evaluated different clinical and echocardiographic predictors of response. METHODS AND RESULTS: Eighty one patients were enrolled. A definition of response to CRT was predefined as a combination of 1) a reduction of LV end-systolic volume of ≥10% and 2) either an improvement in NYHA class by ≥1 or an increase in peak oxygen consumption of ≥1 ml/kg/min. Pre-and postoperatively at six and 12 months we also evaluated the most commonly employed definitions of response in our material: NYHA class, quality of life, left ventricular (LV) performance and functional capacity. After six and 12 months of CRT, 42 (52%) and 48 patients (59%) were responders, respectively. Employing different criteria, response ranged from 33-96% and 31-94% at six and 12 months, respectively. In our material a large pre-operative interventricular motion delay (IVMD) was a predictor of response to CRT (p<0.05). CONCLUSIONS: Fifty two percent and 59% were responders to CRT at six months and one year given a predefined novel endpoint. Different response criteria to CRT gave response rates ranging from 33-96% and 31-94% at six and 12 months, respectively. A large IVMD predicts response to CRT at six and 12 months.

Current somatoform disorders in Norway: prevalence, risk factors and comorbidity with anxiety, depression and musculoskeletal disorders.

BACKGROUND: The future existence of somatoform disorders (SDs) has recently been debated. The objectives of this study were to investigate the prevalence of current SDs (defined as the presence of multisomatoform disorder [MSD] or somatoform disorders not otherwise specified [SDnos], without psychosocial impairment) and severe current SDs (MSD or SDnos with psychosocial impairment) in Norway. Differences in markers of severe current SDs, anxiety/depression and self-reported musculoskeletal disorders were explored. In addition, psychological distress and utilization of healthcare in subclasses (defined according to comorbidity with anxiety, depression and musculoskeletal disorders) of severe current SDs were examined. METHODS: We interviewed 1,247 respondents using the Composite International Diagnostic Interview (CIDI) in the Oslo-Lofoten general population survey in 2000-2001. Six-month prevalence rates (%) and 95% confidence intervals (CIs) for current SDs were investigated by gender and age. Risk factors of disorders, psychological distress, healthcare utilization and use of medication were explored using logistic regression analyses. RESULTS: The overall prevalence rate for severe current SDs was 10.2%. When psychosocial impairment was excluded as a criterion, the rate increased to 24.6%. Anxiety was strongly correlated with severe current SDs. Comorbidity of severe current SDs with anxiety/depression was 45%, and with musculoskeletal disorders, 43%. Analysis of healthcare utilization and use of medication showed that the presence of a comorbid psychiatric condition was more important than the presence of somatoform disorders alone. CONCLUSION: Somatoform symptoms alone (with no psychiatric comorbidity) should not be considered a psychiatric disorder.

A comparison of the health-related quality of life in patients with diabetic foot ulcers, with a diabetes group and a nondiabetes group from the general population.

OBJECTIVE: The aim of this study was to describe health-related quality-of-life (HRQL) in patients with diabetic foot ulcers by comparing their HRQL with that of a sample from the general population without diabetes (general population) and a subgroup with diabetes (diabetes population), and to examine the differences between groups by sociodemographic characteristics and lifestyle factors. DESIGN AND METHODS: A cross-sectional study was made of 127 adults with current diabetic foot ulcer, recruited from six hospital outpatient clinics, a control sample categorized as a diabetes population (n = 221) from the Norwegian Survey of Level of Living, and a sample from the general population (n = 5903). Data on sociodemographic characteristics (sex, age, cohabitation, education and employment) and lifestyle (body mass index [BMI] and smoking status) and HRQL (SF-36) were obtained. RESULTS: In all the SF-36 subscales and in the two SF-36 summary scales, the patients with diabetic foot ulcer reported significantly poorer HRQL than the diabetes population. The most striking differences were for role limitation-physical (32.1 vs. 62.2, p < 0.001), physical functioning (57.5 vs. 77.3, p < 0.001) and role limitation-emotional (57.4 vs. 72.0, p < 0.001). The patients with foot ulcer had significantly lower HRQL than the general population on all scales, and in particular on role limitation-physical (32.1 vs. 74.3, p < 0.001), physical functioning (57.5 vs. 85.2, p < 0.001) and general health (50.1 vs. 74.3, p < 0.001). The most important sociodemographic characteristic that differed between the diabetic foot ulcer patients and the diabetes population was that significantly more of the foot ulcer patients were men living alone. The largest differences between the foot ulcer patients and the general population were that more of the foot ulcer patients were men, older, living alone, less well educated, and not working. The diabetic foot ulcer patients, the diabetes population and the general population differed in BMI: 28 kg/m(2) in the foot ulcer patients, 27 kg/m(2) in the diabetes population and 25 kg/m(2) in the general population. CONCLUSION: Diabetic foot ulcer patients had much worse HRQL compared with the diabetes population and the general population, especially in physical health. Foot ulcer patients were more often men living alone, and obesity was a problem in both the foot ulcer patients and the diabetes population.

Methodological issues concerning lifetime medically unexplained and medically explained symptoms of the Composite International Diagnostic Interview: a prospective 11-year follow-up study.

OBJECTIVE: The objectives of this study were (a) to elucidate the methodological problems arising when examining lifetime symptom data by exploring the accuracy of recall of medically unexplained symptoms (MUS) and medically explained symptoms (MES) in the general population, based on interviews using the Composite International Diagnostic Interview (CIDI) Somatoform Section C, in 1990 and 2001, and (b) to find predictors for failure at follow-up to recall symptoms reported previously at baseline (i.e., symptoms "lost"). METHODS: Four hundred twenty-one persons (response rate, 69.6%; 242 women and 179 men) were reinterviewed in 2001 from a baseline population of 605. Thirty-eight clinically significant MUS and MES were assessed. Linear multiple regression analyses with the numbers of MUS-lost (medically unexplained symptoms lost to recall) and MES-lost (medically explained symptoms lost to recall) as dependent variables were undertaken to find factors affecting symptom loss. RESULTS: A wide range of individual symptoms (22-100%) were lost to recall at follow-up, indicating a large degree of measurement error, mainly due to faulty recall. The number of symptoms recalled when they were grouped was better (approximately 50% for "1-3" symptoms). Recall variability and MUS/MES transition over time undermined the credibility of this distinction. Gender and age emerged as significant (P<.01) predictors for MUS-lost, and a decrease in physical morbidity for MES-lost. Men tended to forget more symptoms than women, and younger respondents with high levels of baseline MUS remembered slightly better at follow-up. CONCLUSION: Lifetime symptom data elicited in community surveys by such instruments as the CIDI should be viewed with caution. Methodological errors weakening data credibility could lead to false impressions of true change over time. A MUS/MES distinction is difficult to maintain.

Hope in the general Norwegian population, measured using the Herth Hope Index.

OBJECTIVE: The aims of this study were to describe hope in a large sample that was drawn from the general Norwegian population and to examine how sociodemographic and health-related variables were related to hope. METHODS: Of 4,000 adult citizens, randomly drawn from the National Register, 1,912 (49%) returned the Norwegian version of the Herth Hope Index (HHI). RESULTS: When demographic and health-related variables were controlled for, age, gender, marital status, and employment status were significantly related to hope. The most important health-related variable was self-assessed health status, with participants who were satisfied with their health reporting significantly higher levels of hope. Participants who indicated that they had a chronic disease reported significantly higher hope scores compared to those without a chronic disease. Older men, individuals who were receiving a pension or were unemployed, and individuals who were widowed or unmarried reported the lowest levels of hope. In this study, an individual's subjective evaluation of his/her health was the most important health-related predictor of hope. SIGNIFICANCE OF THE RESEARCH: The most important health-related variable that predicted hope was self-assessed health in that participants who were satisfied with their health reported higher levels of hope. This finding suggests that an individual's subjective assessment of health is a better predictor of hope than the presence a chronic disease. Knowledge about levels of hope in the general population can be used as reference values against which an individual score or a group mean may be compared.