King's Sarcoidosis Questionnaire (KSQ) - Validation study in Serbian speaking population of sarcoidosis patients.

INTRODUCTION: Sarcoidosis is a multiorgan, multisystem chronic disease of unknown etiology and unpredictable course. Health status is reduced in sarcoidosis and assessing it is a difficult multitask effort due to many faces this disease might have. Recently, a new questionnaire for assessing health status in sarcoidosis was developed by a group of authors from England-King's Sarcoidosis Questionnaire (KSQ). The benefit of KSQ is the ability to develop the best care plan for the patient, as well as to differentiate the efficacy of the administered treatment. OBJECTIVE: The aim of this study was to validate the KSQ in Serbian speaking population of sarcoidosis patients. The test itself is a modular, multi-organ health status measure for patients with sarcoidosis for use in clinic and the evaluation of therapies. The correlation of KSQ with different clinical course of sarcoidosis (acute vs chronic disease) and with the clinical outcome status (COS) in sarcoidosis was also investigated. METHODS: A total of 159 biopsy positive sarcoidosis patients participated in this study. The average age of the participants was 49.67, majority was female (67.3%) and majority had only pulmonary form of sarcoidosis (71.7%). KSQ - new disease-specific health status instrument, was compared with 5 other already existing instruments already used and validated in sarcoidosis (Saint George Respiratory Questionnaire- SGRQ, Daily Activity List -DAL, Fatigue Assessment Scale- FAS, Medical Research Council dyspnea scale-MRC, Borg Dyspnea Scale and 15D as general questionnaire. RESULTS: KSQ has significant correlation with other quality of life questionnaires already used in sarcoidosis. Translated version of KSQ shows significant internal reliability, similar to the original KSQ. Serbian version of KSQ has significant correlation with different clinical course of sarcoidosis and with COS as well. The translated version of KSQ is reliable sarcoidosis specific instrument for assessing health status in these patients.

Predictors of cough-specific and generic quality of life in sarcoidosis patients.

BACKGROUND: Cough is frequent symptom in sarcoidosis and its impact on patient's quality of life (QoL) has not been adequately addressed so far. OBJECTIVES: The goal of this study was to determine the significant predictors of cough-specific and generic QoL in sarcoidosis patients. METHODS: In the prospective study 275 sarcoidosis patients administered Patient Reported Outcomes instruments for measurement of dyspnea (Borg and MRC scales) and fatigue (Fatigue Assessment Scale (FAS) and Daily Activity List (DAL)), as well as patients' QoL (cough-specific Leicester Cough Questionnaire (LCQ) and generic tool - 15D). The LCQ contains 3 domains covering physical, psychological and social aspects of chronic cough. Pulmonary function tests (spirometry and diffusing capacity for carbon monoxide) and serum angiotensin converting enzyme (sACE) were also measured. RESULTS: Dyspnea measured by Borg scale and impairment of daily activities determined by DAL instrument as well as sACE were the strongest predictors of all cough-specific QoL domains. Mental aspect of patients' fatigue was significantly correlated with all domains except with psychological LCQ domain. Regarding the generic QoL, the following significant predictors were: dyspnea measured by MRC scale, overall fatigue determined by FAS and physical domain of the LCQ. CONCLUSION: It is important to measure both cough-specific and generic QoL in sarcoidosis patients since they measure different health aspects and their predictors can be different. We demonstrated that physical domain of cough-specific QoL is significant predictor of generic QoL. (Sarcoidosis Vasc Diffuse Lung Dis 2020; 37 (2): 158-168).

Socioeconomic and therapy factor influence on self-reported fatigue, anxiety and depression in rheumatoid arthritis patients / Influência de fatores socioeconômicos e de tratamento sobre a fadiga, ansiedade e depressão autorrelatadas em pacientes com artrite reumatoide

Abstract Introduction: Fatigue, anxiety and depression are very frequent symptoms in patients with rheumatoid arthritis (RA). Goals: In this study we evaluated the influence of socioeconomic characteristics, therapy and comorbidities on the self-reported high fatigue, anxiety and depression in patients with RA. Method: Multicenter cross-sectional study was performed in 22 health institutions in Serbia during the period from April-August 2014 in population of older RA patients. Self-reported patients health status was measured by: Fatigue Assessment Scale, Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7. Treatment modalities were defined as: (1) non-steroidal anti-inflammatory drugs (NSAIDs) and/or analgesics and/or corticosteroids; (2) synthetic disease-modifying antirheumatic drugs (DMARDs) alone or in combination with corticosteroids and/or NSAIDs and (3) any RA treatment which includes biologic DMARDs. Results: There were significant predictors of high depression: synthetic DMARDs therapy in combination with corticosteroids and/or NSAIDs, physiotherapist self-payment, frequent taxi use, alternative treatment and employment status. The need for another person's assistance, supplemental calcium therapy and professional qualifications were the predictors of a high fatigue, whereas the age above 65 years had the protective effect on it. Anxiety was an independent high fatigue predictor. The predictors of a high anxiety were: gastroprotection with proton-pump inhibitors and patient occupation. Conclusion Socioeconomic predictors of self-reported high depression, anxiety or fatigue are different for each of the mentioned outcomes, while accompanied with the basic RA treatment they exclusively explain a high depression. The anxiety, jointed with the socioeconomic variables and supplemental therapy, is a significant fatigue predictor in RA patients.

Resumo Introdução: A fadiga, a ansiedade e a depressão são sintomas muito frequentes em pacientes com artrite reumatoide (AR). Objetivos: Neste estudo, avaliou-se a influência de características socioeconômicas, características de tratamento e comorbidades na elevação na fadiga, ansiedade e depressão autorrelatadas em pacientes com AR. Método: Este estudo transversal multicêntrico foi feito em 22 instituições de saúde na Sérvia de abril a agosto de 2014 na população de pacientes idosos com AR. O status de saúde autorrelatado dos pacientes foi medido pelos instrumentos Fatigue Assessment Scale, Patient Health Questionnaire-9 e Generalized Anxiety Disorder-7. As modalidades de tratamento foram definidas como: 1) anti-inflamatórios não esteroides (AINE) e/ou analgésicos e/ou corticosteroides; 2) fármacos antirreumáticos modificadores da doença sintéticos (DMARD) isoladamente ou em combinação com corticosteroides e/ou AINE e 3) qualquer tratamento para a AR que incluísse DMARD biológicos. Resultados: Houve preditores significativos de depressão elevada: tratamento com DMARD sintéticos em combinação com corticosteroides e/ou AINE, pagamento particular de fisioterapia, uso frequente de serviços de táxi, terapias alternativas e status ocupacional. A necessidade de assistência de outra pessoa, o tratamento suplementar com cálcio e as qualificações profissionais foram os preditores de fadiga elevada. A idade acima de 65 anos teve um efeito protetor sobre a fadiga elevada. A ansiedade foi um preditor independente de fadiga elevada. Os preditores ansiedade elevada foram: gastroproteção com inibidores da bomba de prótons e ocupação do paciente. Conclusão: Os preditores socioeconômicos de níveis elevados de depressão, ansiedade ou fadiga autorrelatadas são diferentes para cada um dos desfechos mencionados; quando acompanhados do tratamento básico para a AR, esses preditores socioeconômicos explicam exclusivamente uma depressão elevada. A ansiedade, associada às variáveis socioeconômicas e ao tratamento complementar, é um importante preditor da fadiga em pacientes com AR.

Socioeconomic and therapy factor influence on self-reported fatigue, anxiety and depression in rheumatoid arthritis patients.

INTRODUCTION: Fatigue, anxiety and depression are very frequent symptoms in patients with rheumatoid arthritis (RA). GOALS: In this study we evaluated the influence of socioeconomic characteristics, therapy and comorbidities on the self-reported high fatigue, anxiety and depression in patients with RA. METHOD: Multicenter cross-sectional study was performed in 22 health institutions in Serbia during the period from April-August 2014 in population of older RA patients. Self-reported patients health status was measured by: Fatigue Assessment Scale, Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7. Treatment modalities were defined as: (1) non-steroidal anti-inflammatory drugs (NSAIDs) and/or analgesics and/or corticosteroids; (2) synthetic disease-modifying antirheumatic drugs (DMARDs) alone or in combination with corticosteroids and/or NSAIDs and (3) any RA treatment which includes biologic DMARDs. RESULTS: There were significant predictors of high depression: synthetic DMARDs therapy in combination with corticosteroids and/or NSAIDs, physiotherapist self-payment, frequent taxi use, alternative treatment and employment status. The need for another person's assistance, supplemental calcium therapy and professional qualifications were the predictors of a high fatigue, whereas the age above 65 years had the protective effect on it. Anxiety was an independent high fatigue predictor. The predictors of a high anxiety were: gastroprotection with proton-pump inhibitors and patient occupation. CONCLUSION: Socioeconomic predictors of self-reported high depression, anxiety or fatigue are different for each of the mentioned outcomes, while accompanied with the basic RA treatment they exclusively explain a high depression. The anxiety, jointed with the socioeconomic variables and supplemental therapy, is a significant fatigue predictor in RA patients.

Administering the Sarcoidosis Health Questionnaire to sarcoidosis patients in Serbia.

OBJECTIVE: The aim of this study was to use a Serbian-language version of the disease-specific, self-report Sarcoidosis Health Questionnaire (SHQ), which was designed and originally validated in the United States, to assess health status in sarcoidosis patients in Serbia, as well as validating the instrument for use in the country. METHODS: This was a cross-sectional study of 346 patients with biopsy-confirmed sarcoidosis. To evaluate the health status of the patients, we used the SHQ, which was translated into Serbian for the purposes of this study. We compared SHQ scores by patient gender and age, as well as by disease duration and treatment. Lower SHQ scores indicate poorer health status. RESULTS: The SHQ scores demonstrated differences in health status among subgroups of the sarcoidosis patients evaluated. Health status was found to be significantly poorer among female patients and older patients, as well as among those with chronic sarcoidosis or extrapulmonary manifestations of the disease. Monotherapy with methotrexate was found to be associated with better health status than was monotherapy with prednisone or combination therapy with prednisone and methotrexate. CONCLUSIONS: The SHQ is a reliable, disease-specific, self-report instrument. Although originally designed for use in the United States, the SHQ could be a useful tool for the assessment of health status in various non-English-speaking populations of sarcoidosis patients.

Can didactic continuing education improve clinical decision making and reduce cost of quality? Evidence from a case study.

INTRODUCTION: Administration of human serum albumin (HSA) solutions for the resuscitation of critically ill patients remains controversial. The objective of this study was to assess the effect of continuing medical education (CME) on health care professionals' clinical decision making with regard to HSA administration and the costs of quality (COQ). A quasi-experimental study of time series association of CME intervention with COQ and use of HSA solution was conducted at the Surgery Department of the Hospital Valjevo, Serbia. The CME contained evidence-based criteria for HSA solution administration in surgical patients. The preintervention period was defined as January 2009 to May 2011. CME was provided in June 2011, with the postintervention period June 2011 to May 2012. METHODS: Total mortality rate, the rate of nonsurgical mortality, the rate of surgical mortality, the rate of sepsis patient mortality, index of irrational use of HSA solutions, and number of hospital days per hospitalized patient were collected for each month as quality indicators. Statistical analysis was performed by multivariate autoregressive integrated moving average (MARIMA) modeling. The specification of the COQ was performed according to a traditional COQ model. RESULTS: The CME intervention resulted in an average monthly reduction of the hospital days per hospitalized patient, the rate of sepsis patient mortality, index of irrational use of HSA solutions, and COQ for $593,890.77 per year. DISCUSSION: Didactic CME presenting evidence-based criteria for HSA administration was associated with improvements in clinical decisions and COQ. In addition, this study demonstrates that models combining MARIMA and traditional COQ models can be useful in the evaluation of CME interventions aimed at reducing COQ.

Fatigue in sarcoidosis: detection and treatment.

Fatigue is a prominent symptom in a large number of medical conditions, malignant and infectious diseases. Fatigue is also a prominent symptom of sarcoidosis. The occurrence of fatigue in sarcoidosis is well known but exact incidence has not been established and varies from 30-70% of patients depending on age, sex and organ involvement by the granulomatous process. The exact definition of fatigue varies broadly. It can be both physical and mental. The patients describe their sensation of fatigue qualitatively different from that fatigue they experienced before they became sick. Fatigue has a major impact on the quality of life in sarcoidosis. Establishing the extent of fatigue in sarcoidosis provides relevant insight regarding the patient's quality of life. Unfortunately there is no objective parameter for assessing fatigue in sarcoidosis. Generally, fatigue is detected by means of questionnaires. Regarding the therapy, there is no effective treatment for fatigue in sarcoidosis.

[Importance of early detection of lung cancers with initial paraneoplastic manifestations].

INTRODUCTION: Lung cancers are mostly detected in the developed clinical stages, with clearly manifested pulmonary, extrapulmonary or metastatic manifestations. In the early disease stages, radiographic and clinical manifestations may be absent or mimicked. OBJECTIVE: The aim of this study was the timely detection of early pulmonary, extrapulmonary and paraneoplastic manifestations of lung cancers in order to apply the most appropriate treatment protocols. METHODS: We examined 230 patients with lung cancer, among them 125 of the working study group with minimal pulmonary and/or initial paraneoplastic symptoms, and 105 patients in the control group with clear tumour manifestations. RESULTS: The symptom analysis revealed a statistically significantly lesser presence of the respiratory symptoms in the working study group (68%) in comparison with the control group of patients (97%) (chi2 = 29.996; p < 0.001). The analysis of radiographic presentations of lung cancer showed that there were significantly more patients with normal findings in the working group (6.4%) than in the control group--1.9% (p > 0.05), and a positive bronchoscopic finding of the centrally localized tumour (mainly right upper lobe) was confirmed in patients of both groups with normal radiographic findings. The number of diagnosed patients in earlier clinical disease stages (I, II, IIIa) with better prognosis in non-small cell lung cancer was significantly higher (chi2 = 19.149; p < 0.001) in the working group (71.1%) in comparison with the control group (38.1%). Small cell lung cancer was more frequently diagnosed in the stage of limited disease in the working (80%) than in the control group (38.1%) (chi2 = 10.039; p < 0.05). With regard to treatment administration, there is a statistically significant difference (chi2 = 4.013; p = 0.0452) in the frequency between the use of chemotherapy and highly significant difference (chi2 = 22.044; p < 0.001) in the frequency of use of surgical treatment in the working group in comparison with the control group--both chemotherapy and surgery treatment were more frequent in the patients of the working group. CONCLUSION: Recognizing the initial pulmonary, extrapulmonary or paraneoplastic manifestations as well as performing diagnostic procedures in due time represent the most important guidelines in early detection and the most efficacious therapeutic choice in lung cancer.

Development and evaluation of the nurse quality of communication with patient questionnaire.

INTRODUCTION: Nurse/patient relationship as a complex interrelation or as an interaction of the factor patient and factor nurse has been a subject of a number of studies during the past ten years. Nurse/patient communication is a special entity, usually observed within a framework of the wider nurse/patient relationship. In that regard, we wanted to develop a standardized questionnaire that could reliably measure the quality of communication between nurse and patient, and be used by nurses. OBJECTIVES: The main goal of this study was to develop and evaluate construct validity of the Nurse Quality of Communication with Patient Questionnaire (NQCPQ), as well as to evaluate its reliability. The goal was also to establish a measure of inter-raters reliability, using two repeated measurements of results by items and scores of the NQCPQ, on the same observed units by two assessors. METHODS: The starting NQCPQ that consists of 25 items, was filled in by two groups of nurses. Each nurse was questioned during morning and afternoon shifts, in order to evaluate their communication with hospitalized patients, using marks from 1 to 6. To evaluate construct validity, we used the analysis of main components, while reliability was assessed using intraclass correlation coefficient and Cronbach-alpha coefficient. To evaluate interraters reliability, we used Pearson correlation coefficient. RESULTS: Using a group of 118 patients, we explained 86% of the unknown, regarding the investigated phenomenon (communication nurse/patient), using one component by which we separated 6 items of the questionnaire. Inter-item correlation (alpha) in this component was 0.96. Pearson correlation coefficient was highly significant, value 0.7 by item, and correlation coefficient for scores at repeated measurements was 0.84. CONCLUSION: NQCPQ is 6-item instrument with high construct validity. It can be used to measure quality of nurse/patient communication in a simple, fast and reliable way. It could contribute to more adequate research and defining of this problem, and as such could be used in studies of interaction of psychometric, clinical, biochemical, socio-cultural, demographic and other parameters as well.

[Association between tobacco smoking and pulmonary tuberculosis].

BACKGROUND/AIM: Numerous studies evaluate the influence of tobacco smoking on the tuberculosis (TB) development, with the results indicating that smoking can be also considered as important risk factor in TB. The aim of this study was to assess the influence of tobacco smoking as the risk factor in the development of TB as well as in its clinical course. METHODS: We analyzed data from the medical records of 192 consecutively hospitalized TB patients (124 males and 68 females) in the Institute of Pulmonary Diseases and Tuberculosis, Clinical Center of Serbia, Belgrade in the period from 2005 to 2007. RESULTS: Among the analyzed TB patients there were more smokers (63.5%) than nonsmokers (36.5%). The majority of the smokers (73.8%) belonged to a middle age group (35-54 years) while the majority of nonsmokers (64.3%) were older than 55 years. Sex ratio among the smokers showed the domination of males (80.3%). There were significantly more males in the smoking group and more females in the nonsmoking group (chi2 = 34.402, p < 0.0001). Most smokers (68.9%) smoked more than 20 cigarettes daily. The average index of pack/years among all of the examinated patients was 32.75 +/- 18.26. Cavitary pulmonary lesions were more frequently verified in the smokers (64.2%) than in the nonsmokers (35.8%). The sputum acid-fast bacillus smear-positive finding was more frequent in the smokers (78%) than in the nonsmokers (22%). The nonsmoking TB patients had more accompanied immunodeficient diseases (34%) than the smoking ones (19%). Body-mass index was lower in the smokers (21.75) than in the nonsmokers (23.80), although this difference did not reach the statistical significance. CONCLUSION: There are more smokers than nonsmokers in TB patients. Smokers more frequently have cavitary forms of TB with sputum acid-fast bacillus smear--positive finding than nonsmokers.

Health related quality of life regarding to gender in sarcoidosis.

Evaluation of the health-related quality of life (HRQoL) in patients with respiratory diseases has been increasingly included into regular clinical studies, and HRQL in sarcoidosis has been evaluated since not a long ago. The aim of the study was to evaluate HRQoL in patients with sarcoidosis regarding gender differences, pre and after therapy. We investigated 202 pathohistologically verified sarcoidosis patients (154 female and 48 male) without comorbidities. HRQL was assessed by the disease-specific Sarcoidosis Health Questionnaire (SHQ), which contains 29 items, and cover three domains: everyday functioning, physical activities and emotional state. Total score, as well as the scores for each SHQ domains were calculated. HRQoL was estimated pre and after three months of therapy. At the study start, the lowest score value for the whole group was reported in SHQ emotional state domain (4.24), and the highest in domain of physical functioning (4.7). After three months, the lowest values were reported in domain of everyday activities, while the highest scores were found in emotional domain; all SHQ scores increased, but reached the statistical significance only in the everyday functioning and the physical activities domains. Analyzing mean SHQ scores in male and female sarcoidosis pts before therapy we found high statistically lower emotional and total score in female pts, as well as lower physical score. After the three months therapy we found high statistical difference in physical domain (i.e. women had lower physical score than men). Female sarcoidosis pts showed lower emotional, physical and total score before therapy. After the three-month therapy we found that women had lower physical score than men. SHQ showed good measurement properties both in the cross-sectional and longitudinal assessment of sarcoidosis patients.

Health-related quality of life of general practitioners--family physicians in south-eastern Europe.

INTRODUCTION: An insight into the health-related quality of life (HRQL) provides information on the extent of activities and everyday functioning restriction by deteriorated health. OBJECTIVE: The purpose of the paper was to analyze the HRQL of general practitioners-family physicians of the southeastern Europe and compare it with HRQL of controls, the subjects of the same educational background, geographical area, sex and age, but different working activities. METHOD: The study"Health-related quality of life of general practitioners-family physicians in the south-eastern Europe" (HERQUL study) was performed in Serbia, Republic of Srpska, Montenegro, Macedonia and Bulgaria during February-September 2004. Study instrument was a standardized generic questionnaire for the measurement of HRQL SF-36, which subjest's health status assesses across eight different domains. RESULTS: The study included 1141 doctors (337 male and 804 female) and the same number of controls.The deteriorated physical health affected HRQL of controls, but more significantly of physicians. The deteriorated mental health affected HRQL of both physicians and controls regardless of age and sex. The lowest HRQL scores of physicians due to lowered vitality was reported in all studied countries, excluding subjects from Montenegro. Better social functioning HRQL domain was recorded in males regardless of profession. The deteriorated physical and mental health as well as social functioning mostly influenced HRQL of physicians aged 55-59, and in controls this applied to those older than 60, regardless of sex. Emotional health HRQL domain scores were better in the control group than in physicians, regardless of sex. CONCLUSION: Studies of physicians' HRQL, particularly doctors of general practitioners-family physicians, are scarce. The results of the HERQUL study could be the impetus to obtain support for the improvement of HRQL of this important group of health professionals from the relevant government institutions.

Differences in symptom severity and health status impairment between patients with pulmonary and pulmonary plus extrapulmonary sarcoidosis.

BACKGROUND: Although sarcoidosis most commonly affects the lungs, it is a multisystemic disease that often involves other organs. In this study, we compared fatigue, dyspnea, and the impact upon the activities of daily living and health status scores between patients with isolated pulmonary and pulmonary plus extrapulmonary sarcoidosis. METHODS: In this cross-sectional study, we investigated 81 biopsy proven sarcoidosis patients. Fatigue was assessed by the standardized Fatigue Scale (FS). Dyspnea was determined by the Baseline Dyspnea Index (BDI) and the Modified Medical Research Council (MRC) Dyspnea Scale. Activities of daily living were assessed with the List of Daily Activities (DAL). Health status was measured by two standardized questionnaires: a generic measure--fifteen-dimensional measure of health-related quality of life (15D), and a respiratory-specific measure--St George's Respiratory Questionnaire (SGRQ). Patients were excluded if they had an associated illness that could influence their health status. RESULTS: Statistically significant differences were demonstrated between the isolated pulmonary group and the pulmonary plus extrapulmonary group for fatigue (FS-total score: 2.4+/-0.64 vs. 2.8+/-0.62, p=0.007), dyspnea (BDI: 8.45+/-2.44 vs. 5.92+/-1.84, p<0.001; there was no statistically significant difference in MRC), activities of daily living (DAL: 4.33+/-2.93 vs. 5.87+/-2.40, p=0.014), and health status (SGRQ-total score: 33.07+/-22.81 vs. 43.69+/-21.55, p=0.04). CONCLUSION: There are significant and clinically relevant differences in the severity of symptoms, restrictions of activities of daily living and impairment of health status between the patients with isolated pulmonary and pulmonary plus extrapulmonary sarcoidosis. Patients with pulmonary plus extrapulmonary sarcoidosis are more impaired in all these categories.

[Relationship between degree of dyspnoea and health-related quality of life in patients with chronic obstructive pulmonary disease].

INTRODUCTION: Dyspnoea is a characteristic symptom of chronic obstructive pulmonary disease (COPD), which impairs everyday functioning of patients. OBJECTIVE: The aim of our study was to evaluate the relationship between the degree of dyspnoea of COPD patients and their health-related quality of life. METHOD: We measured the degree of dyspnoea and health-related quality of life in 85 COPD outpatients (46 male; mean age was 58 +/- 12 years; mean forced expiratory volume in one second (FEV,) was 47.9 +/- 18.6% predicted). The degree of dyspnoea was assessed by Baseline Dyspnoea Index (BDI), List of Daily Activities (DAL), Visual Analogue Scale (VAS), Modified MRC Dyspnoea Scale, and Borg Category Scale (BCS). The patients filled two standardized questionnaires for measuring health-related quality of life: the generic one--15D, and the respiratory specific one--the St. George's Respiratory Questionnaire (SGRQ). Total 15D and SGRQ scores, as well as the scores for individual domains of SGRQ (symptoms, activity and impact scores) for each patient were calculated. In 40 out of 85 patients, the same procedure was repeated at the follow-up, with a mean 4-week interval between the visits. RESULTS: There were statistically highly significant correlations (p < 0.01) between values of all dyspnoea scale scores evaluated and all the health-related quality of life scores. The highest degree of correlation of both total SGRQ and 15D scores was found for the values of BCS (r = 0.731 and -0.776, respectively). A statistically significant correlation between the changes of all SGRQ (but not 15D) scores and all dyspnoea score changes (except for MRC) were also recorded. CONCLUSION: The degree of dyspnoea of COPD outpatients that could be well-determined by the scales used in our study clearly reflects the impairment of their health-related quality of life as assessed by the instruments used. All of the questionnaires we used in this study have good measurement properties for their purposes.

[The effect of metformin on fasting and postprandial insulin secretion in obese patients with diabetes mellitus type 2].

INTRODUCTION: The main causes of reduced glucose levels during metformin therapy appear to be an increase in insulin action in peripheral tissues and reduced hepatic glucose output due to inhibition gluconeogenesis. OBJECTIVE: The purpose of the study was to establish the effect of metformin on fasting and postprandial insulin secretion. METHOD: The study carried out was double blind, controlled, comparative, randomized, multicentric, including two groups of out-patient department (OPD) patients. 43 patients were administered metformin (Tefor ICN Canada), and 46 patients were given placebo. Patients enrolled in the study were newly diagnosed with diabetes mellitus (DM) type 2, glycaemia < 12 mmol/l, and had the Body Mass Index (BMI) > 30 kg/m2. Before treatment, blood biochemistry was done: fasting and postprandial glycaemia, glycosylated haemoglobin (HbA1c) value, fasting and postprandial insulinaemia, blood lipids (total cholesterol, total triglycerides, HDL cholesterol, and LDL cholesterol), and gamma glutaryl transferase (GGT) level. BMI was also established. After 42 days of treatment, fasting and postprandial insulinaemia were tested again. Analysis of the effects of therapy, and identification of co-variants for fasting and postprandial insulinaemia, were done by ANOVA two way and ANCOVA method. RESULTS: It was shown that metformin accompanied by diet, as compared to placebo accompanied by diet, lowered the fasting insulinaemia value during six weeks of therapy in obese patients with DM type 2 (24.392 mU/l vs. 25.667 mU/l), interacting both with BMI pre-therapy, and interacting with fasting insulinaemia pre-therapy (p < 0.001). A significant effect of the interaction of covariants BMI and GGT was defined. As for the effect of therapy on postprandial insulinaemia, it was found that there was a high statistical significance of the effect of BMI interacting with initial values for postprandial insulinaemia before therapy, and interacting with therapy (p < 0.01). Adjusted mean values for postprandial insulinaemia after therapy in the placebo group were lower as compared to the metformin group (44.807 mU/l vs. 47.114 mU/l). CONCLUSION: It can be concluded that, as compared to place- bo, metformin is more efficient in reducing insulin resistance in obese patients with DM type 2. In addition, as compared to placebo, metformin maintains more efficient productive insulin secretion, indicating that metformin protects the pancreas from beta cell depletion.

[Relationship between respiratory symptoms and satisfaction with inhaled asthma medication].

INTRODUCTION: Asthma is the chronic inflammatory disease of the airways, and the inhalation treatment is the most convenient way to deliver the medication directly to the airways. OBJECTIVE: The aim of our study was to evaluate the relationship between respiratory symptom scores in asthmatic outpatients and their satisfaction with inhaled asthma medication. METHOD: In 124 patients, (39 males; mean age 45 +/- 18 years; mean forced expiratory volume in one second (FEV) 71.8 +/- 23.4% predicted), respiratory symptoms were determined by 4-item questionnaire for most frequent asthma symptoms--cough, wheezing, dyspnea and chest tightness (all of them graded from 1--without symptoms, 2--mild, 3--moderate, and 4--severe symptoms), with overall score (from 4 to 16), as well as by scale for assessment of sinonasal symptoms--the 20-item sinonasal outcome test (SNOT-20) (in 65 out of 124 patients). SNOT-20 scores ranged from 0 to 5, where higher score indicated more manifested symptom. Patients' satisfaction was measured by standardized "Satisfaction with Inhaled Asthma Treatment Questionnaire" (SATQ), which scores were calculated for the overall satisfaction as well as for individual domains (effectiveness of treatment, easy application, medication burden, and side-effects and related worries). The bigger the score the better the satisfaction, and vice versa. RESULTS: The highest degree of correlation with overall satisfaction scores was found (using the Pearson's coefficient of linear correlation) for the scores of wheezing (r = -0.271; p = 0.002). SNOT-20 scores best correlated with side-effects and worries domain scores. CONCLUSION: The severity of respiratory symptoms in the asthmatics is strongly correlated with satisfaction with inhaled medication. Improving the asthmatic symptoms results in enhancement of their satisfaction with inhaled medication and compliance.

[Quality-of-life assessment in patients with pulmonary diseases].

INTRODUCTION: Quality-of-life assessment as a measure of clinical and therapeutic outcome, is increasingly used in different branches of medicine. In contrast to conventional indicators of the disease and its objective outcomes, health related quality of life (HRQL) focuses on the patient's own assessment. This provides for the more active involvement of a patient, where the advantages of certain medication or therapeutic regimes over another are considered by a doctor. QUALITY-OF-LIFE QUESTIONNAIRES: Quality-of-life questionnaires have been developed to assess health related quality of life, and provide methodology for processing and interpretation. This kind of assessment is proved useful not only in clinical drug trials, but also efficacy in routine medical practice and in the evaluation of the health services. Quality-of-life assessment is widely used in all chronic pulmonary diseases, especially in asthma and chronic obstructive pulmonary diseases. Sarcoidosis is a great challenge for researchers in quality of life, since it is a chronic multisystem disease, not only a respiratory disorder. CONCLUSION: Evaluation of quality of life in sarcoidosis patients is possible only using generic health questionnaires. However, in 2003, validated disease-specific questionnaires for sarcoidosis were developed, and they will make our approach to these patients easier.

[Application of measuring instruments--quality of life questionnaires in patients with chronic sarcoidosis].

INTRODUCTION: Health-related quality of life in interstitial lung diseases, especially in sarcoidosis, has hardly received appropriate attention in clinical studies due to lack of validated methods of measurement. Until now, in patients with sarcoidosis and interstitial lung diseases, several generic and respiratory specific quality-of-life instruments were used in order to discover the most valid and reliable quality-of-life instrument. Sarcoidosis is a multi-system disease that affects quality of life in many different ways. MATERIAL AND METHODS: In this study the Sarcoidosis Health Questionnaire was used to evaluate the quality of life in sarcoidosis patients. 89 biopsy positive sarcoidosis patients were analyzed (16 male, 73 female); their mean age 46.15 +/- 11.11 years. 34 (39%) patients presented with acute sarcoidosis, 53 (61%) with chronic sarcoidosis and 46 patients (51.7%) had extrapulmonary disease. In regard to treatment, 51 (57%) patients were treated with corticosteroids 18 (20%) with methotrexate and in 20 (23%) spontaneous remission was reported. All analyses were performed using the Statistical Package for Social Science Software: A probability value less than 0.01 considered being statistically significant. RESULTS: Statistically significant correlation was found between the sarcoidosis health questionnaire scores and chronic sarcoidosis. daily 0.001, emotional 0.014 and total 0.01. In regard to treatment, significant difference between groups was found in the domain of physical (sig 0.006) emotional (sign 0.005) and total (sign 0.001) scores. CONCLUSION: The first sarcoidosis specific questionnaire shows perfect correlation with the possible clinical course in patients with sarcoidosis.

[The role of EQ5D self-classifier in assessing quality of life in patients with sarcoidosis].

INTRODUCTION: In medicine, quality of life is a very important issue. Nowdays, in our circumstances, it is an important part of diagnostic and therapeutic procedures. The aim of this study was to analyze the role of EQ5D questionnaire in patients with sarcoidosis. MATERIAL AND METHODS: EQ5D self-questionnaire was used in patients with sarcoidosis and we analyzed the obtained data. RESULTS: The analysis included patients with previously proved sarcoidosis--pulnmonary and extrapulmonary (bronchoscopy and other biopsies). All patients were treated at the Institute of Tuberculosis and Lung Diseases. We analyzed a group of 84 (19 male and 65 female) patients with average age of 45 years. Most patients had a chronic state of disease and were nonsmokers. In regard to the radiographic stage of pulmonary sarcoidosis, levels of disease activity (acute, chronic and relapse), levels of sACE, levels of sIgE, smokers--non smokers, and in regard to obtained scores, no statistically significant difference was found in examined groups, except in the group of patients with low level sIgE (score 0.276). CONCLUSION: EQ5D questionnaire is a good tool for analyzing the health status of patients with sarcoidosis, but still a more specific questionnaire should be designed for this multisystem disease.

[St. George's respiratory questionnaire (SGRQ) in sarcoidosis patients].

INTRODUCTION: Sarcoidosis is a chronic multisystem disorder which has a great impact on health-related quality of life (HRQL). Patients with sarcoidosis very often present with bronchial obstruction. The purpose of this study was to assess the impact of respiratory disorder on general HRQL using St. George's respiratory questionnaire (SGRQ). MATERIAL AND METHODS: We examined 129 patients with histologically proven sarcoidosis. All patients underwent clinical examination, chest X-ray and spirometry, and in all skin prick tests and sera ACE and IgE were determined. Afterwards, they filled out SGRQ, and scores were compared with clinical and radiological findings, and also with serum markers of the disease. RESULTS: Mean activity score values were significantly lower in men, in patients with newly diagnosed disease, and in patients with elevated ACE. Patients with extrathoracic disease had significantly higher scores. Clinical course showed significant correlation with impact and total score, and the number of relapses with the activity score. SGRQ scores significantly correlated with serum IgE and with most spirometric parameters. CONCLUSION: Our data revealed a high validity of SGRQ in patients with sarcoidosis and a great influence of respiratory disorders on general health-related quality of life in these patients. However, reproducibility and responsiveness of SGRQ is yet to be established in patients with sarcoidosis.