Effect of gender on health related quality of life in sarcoidosis.

BACKGROUND: Sarcoidosis has different phenotypic manifestations which may have a diverse effect on functional status and quality of life. There are few studies in sarcoidosis addressing gender disparity and its effect on Health-Related Quality of Life (HRQL) and functional status. OBJECTIVE: The purpose of this study was to investigate the effects of gender on HRQL and to identify associations between poor HRQL and the results of common clinical tests. DESIGN: We assessed HRQL for 221 patients with sarcoidosis in a prospective, cross-sectional study using the Short Form-36 Health Survey and Sarcoidosis Health Questionnaire. We evaluated the association between the scores of these measures with patient characteristics, pulmonary function test (PFT) and 6-minute walk test (6MWT) data. RESULTS: Women had lower scores than men on every measure of HRQL and weaker associations to findings from PFT and 6MWT. Multivariate linear regression analyses demonstrated that reduced 6MWT distance and DLCO were significantly associated with poor HRQL in both genders but the sensation of dyspnea played a significant role in women only. CONCLUSIONS: Our results indicate that women with sarcoidosis have a lower HRQL score and a greater degree of functional impairment than men. The factors that are associated with poor HRQL differ by gender. Predictors of poor HRQL include reduction in DLCO and 6MWT distance and an increased sensation of dyspnea.

Clinical predictors of pulmonary hypertension in sarcoidosis.

Pulmonary hypertension (PH) adversely affects outcome in sarcoidosis and is an important predictor of mortality in these patients. Early and accurate diagnosis of this complication may improve outcome. The current authors hypothesised that integration of 6-min walk test (6MWT) as part of the evaluation leads to an earlier diagnosis of this complication. A total of 162 patients with sarcoidosis underwent 6MWT. Demographic and pulmonary function results were analysed. Patients were further assessed by echocardiography and right heart catheterisation when clinically indicated. Patients with sarcoidosis-associated PH had significantly decreased results on pulmonary function testing. They also walked shorter distances and desaturated to lower levels on 6MWT. On logistic regression analyses, significant predictors of PH were oxygen saturation <90% on 6MWT (odds ratio (OR) 12.1, 95% confidence interval (CI) 3.66-19.73) and diffusing capacity of the lung for carbon monoxide <60% predicted (OR 7.3, 95% CI 1.98-24.82). Moreover, by combining the results of oxygen saturation at 6 min with those of echocardiography, the ability to correctly predict the presence of PH by right heart catheterisation was improved. Patients with diffusing capacity of the lung for carbon monoxide <60% predicted and oxygen desaturation <90% on 6-min walk test have a high likelihood of pulmonary hypertension and should undergo further evaluation for the presence of this disorder.

Intratester and intertester reliability of the Cybex electronic digital inclinometer (EDI-320) for measurement of active neck flexion and extension in healthy subjects.

This study examined the intratester and intertester reliability of the electronic digital goniometer EDI-320 for the measurement of active neck flexion and extension in healthy subjects. In the context of evidence-based practice, the EDI-320 instrument has the potential to improve patient assessment, provide a clearer picture of patient progress, and confirm the effectiveness of physiotherapy interventions. However, the psychometric properties of the EDI-320 have not yet been documented for cervical spine range of motion. Forty-four individuals with no known history of cervical disorder within the three months prior to the testing, voluntarily consented to participate in this study. Repeated measurements with the EDI-320 were taken by two trained testers (TH1 and TH2) and data were recorded by two separate observers. Subjects performed a standardized warm-up. Testers were required to repeat palpation of bony landmarks prior to each trial. Measurements were taken at the end-range of active cervical flexion and extension for each subject. Both testers measured each subject twice. The intraclass correlation coefficients (ICC) were derived from one-way ANOVA for intratester reliability and a two-way ANOVA for intertester reliability. Paired t -tests were then applied to verify for systematic error. Moderate intratester reliability was found for both testers for flexion (TH1: ICC=0.77; 95% CI: 0.62-0.87; TH2: ICC=0.77; 95% CI: 0.58-0.87). As for extension, high intratester reliability was found for TH1 (ICC=0.79; 95% CI: 0.65-0.88) and moderate for TH2: (ICC=0.83; 95% CI: 0.63-0.92). Intertester reliability results showed a moderate reliability for both flexion and extension (ICC=0.66; 95% CI: 0.24-0.84) on the first trial. On the second trial, reliability was moderate for flexion (ICC=0.73; 95% CI: 0.53-0.85) and high for extension (ICC=0.80; 95% CI: 0.64-0.89). The t -test analysis revealed the inclusion of systematic error by Tester 2 for intratester reliability. This error was also found for all but one of the intertester reliability calculations. This study has shown that the EDI-320 is a moderately reliable instrument for quantifying cervical flexion and extension range of motion. The presence of systematic error in the study highlights the importance of following standardized procedures and suggests that the EDI-320 could be more reliable than reported in this study. Further psychometric studies investigating the validity of the EDI and reliability with subjects affected by cervical pathology is warranted.

[A motivation-stress-health model applied to marital relations and work]. / Mens sana ad corpus sanum: un modèle de motivation-stress-santé appliqué au couple et au travail.

The present article takes position regarding the proverb "a healthy mind in a healthy body". A review of the literature suggests that, in fact, a healthy mind is as important if not more for a healthy body. Empirical evidence is presented to show the impact of psycho-social stressors on negative affect and on mental as well as physical health. The authors propose that motivation as well as the innate need for self-determination, competence, and relatedness play a crucial role in the understanding of the antecedants and consequences of psychological stress as well as for well-being and health. A model summarizing the theoretical and empirical work of our laboratory in the fields of relationships and work, two areas, central to adult life, is presented.