The impact of New Families home visiting program on first-time mothers' quality of life and its association with social support: a non-randomized controlled study.

BACKGROUND: The transition to motherhood is characterized by physical, psychological, social, and relational changes. Quality of life (QoL) changes substantially during this transition. Higher QoL is associated with social support, essential for coping with the challenges and changes of becoming a mother. An early universal home visiting program (New Families) is developed to strengthen and support families. The study aims to evaluate the impact of New Families on first-time mothers' QoL and to investigate the association between their QoL, social support, and selected possible predictive factors. METHODS: A prospective non-randomized controlled study with parallel group design. Child Health Services in five city districts of Oslo were matched in intervention and control groups. First-time mothers were allocated based on the residential area and assessed at pregnancy week 28 (N = 228), six weeks postpartum (N = 184), and three months postpartum (N = 167). Measures of the World Health Organization Quality of Life brief, Perinatal Infant Care Social Support Scale, and background variables were collected from October 2018 to June 2020. Multivariate linear regression models were applied to examine intervention impact and assess associations. RESULTS: Our data did not reveal a significant association between New Families intervention and the QoL levels of first-time mothers at three months postpartum. Thus, we analyzed the whole sample together. Emotional support was significantly associated with higher QoL levels in the physical health (B = 0.19, 95%CI [0.04 to 0.34]) and social relationships (B = 0.40, 95%CI [0.20 to 0.60]) domains. Appraisal support was significantly associated with higher QoL levels in the psychological (B = 0.34, 95%CI [0.18 to 0.50]) and environment (B = 0.33, 95%CI [0.19 to 0.48]) domains. QoL levels in pregnancy were significantly associated with QoL levels postpartum, showing small to medium effect size (ES = 0.30 to 0.55), depending on the domain. CONCLUSIONS: Further research, including qualitative interviews, could provide more insights into the impact of New Families on QoL. A positive association between QoL levels in pregnancy and postpartum suggests that postnatal interventions targeting improved QoL could potentially improve postpartum QoL. Emotional and appraisal support seems beneficial for first-time mothers' QoL and could be provided and facilitated by public health nurses. TRIAL REGISTRATION: clinicaltrial.gov NCT04162626.

Quality of life in Norwegian pregnant women and men with pregnant partners, and association with perception of sleep and depressive symptoms: a cross-sectional study.

BACKGROUND: Pregnant women and men with pregnant partners experience variations in quality of life (QoL) during pregnancy, a period characterized by physical, psychological, and social changes. Pregnancy is associated with reduced QoL, depressive symptoms, and sleep problems. This study aimed to: (1) determine whether Norwegian pregnant women and men with pregnant partners differed in QoL levels in the third trimester of pregnancy; (2) determine whether the relationship between perception of sleep and QoL is moderated by depressive symptoms, when analyzed separately in pregnant women and men with pregnant partners; and (3) determine whether selected possible predictive factors were associated with QoL when stratified by level of depressive symptoms, in pregnant women and men with pregnant partners separately. METHODS: A cross-sectional study conducted between October 2018 and January 2020 included 228 pregnant women and 197 men with pregnant partners in the third trimester of pregnancy. The age range was 22-50 years. QoL was assessed using the World Health Organization Quality of Life Questionnaire brief version, depressive symptoms using the Edinburgh Postnatal Depression Scale, and perception of sleep by a single item. Data were analyzed in SPSS version 28 using descriptive statistics, the PROCESS macro for moderation analyses, and multivariate linear regression. The level of statistical significance was p < 0.05. RESULTS: Pregnant women reported significantly lower QoL scores on the physical health and psychological domains than the men with pregnant partners. Our data did not reveal any moderating effect of depressive symptoms on the relationship between the perception of sleep and QoL. Depressive symptoms in the pregnant women were found to be a significant predictor of lower QoL in all domains. In the men with pregnant partners, getting enough sleep was a significant predictor of higher QoL in all domains. In the pregnant women without depressive symptoms, higher QoL in the physical health domain was significantly associated with the perception of getting enough sleep. CONCLUSION: Women in the final trimester of pregnancy experience poor QoL compared to the men with pregnant partners. Pregnant women with depressive symptoms have lower QoL compared to those without depressive symptoms. The perception of getting enough sleep was associated with better QoL.

Quality of Life instruments and their psychometric properties for use in parents during pregnancy and the postpartum period: a systematic scoping review.

PURPOSE: To identify instruments used to measure parents' Quality of Life (QoL) during pregnancy and the postpartum period, and to describe their characteristics and psychometric properties. METHODS: For this scoping review we conducted systematic literature searches in MEDLINE, EMBASE, PsychINFO, CINAHL and HaPI in mid-December 2020, to identify studies evaluating psychometric properties. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) were used to define and categorize psychometric properties. Two reviewers screened the studies independently, and customized screening questions were used to assess eligibility against inclusion criteria. Data were systematically extracted into a predesigned data charting matrix, and descriptively analyzed. RESULTS: The searches identified 5671 studies, of which 53 studies met the inclusion criteria. In total, there were 19 QoL instruments: 12 generic and seven period specific. The most reported instruments were SF-36, SF-12 and WHOQOL-BREF, and the most evaluated instruments were SF-12, WHOQOL-BREF, QOL-GRAV, and PQOL. We found that none of the identified instruments had been evaluated for all nine psychometric properties recommended by the COSMIN. The most reported psychometric properties were internal consistency and structural validity. The instruments were primarily assessed in parents residing in Asia (50%), and 83% of the studies were conducted from 2010 to 2020. Only three studies included psychometric measures assessed on fathers. CONCLUSION: Our review shows there is extensive evidence on the internal consistency and structural validity of QoL instruments used on parents during pregnancy and the postpartum period, but that the evidence on other psychometric properties is sparse. Validation studies and primary studies are needed to provide evidence on the reliability, validity, responsiveness, and interpretability of QoL instruments for this target group, in particular for fathers and partners.

Symptom Clusters From Dialysis to Renal Transplantation: A Five-Year Longitudinal Study.

CONTEXT: Patients on dialysis experience multiple concurrent and often related symptoms defined as symptom clusters. Renal transplantation (RTX) is thought to reduce symptom experience and improve health-related quality of life. No longitudinal study has assessed symptoms and symptom clusters in patients in the transition from dialysis to RTX. OBJECTIVES: We aimed to assess changes in symptom prevalence, identify symptom clusters after RTX, and evaluate the effect of the treatment conversion on predefined symptom clusters. METHODS: A cohort of patients on chronic dialysis (n = 110) was followed prospectively with measurements of health-related quality of life using the Kidney Disease and Quality of Life-Short Form (KDQOL-SF) during dialysis (baseline) and after subsequent RTX. Predefined symptom clusters based on 11 symptoms listed in KDQOL-SF were previously generated using principal component analysis with varimax rotation, that is, uremic (nausea, lack of appetite, dizziness, feeling squeezed out, shortness of breath, and chest pain), neuromuscular (numbness, sore muscle, and cramps), and skin (itching and dry skin) clusters. Stratified analyses were undertaken to identify characteristics associated with change in the symptom clusters after RTX. Cohen's d was used as effect size. RESULTS: Of the 110 patients, mean age was 51.3 ± 14.4 years, and 66% were males. After RTX, the estimated glomerular filtration rate was 54 (interquartile range [IQR] 45-72) mL/minute/1.73 m2. Median follow-up time from assessments during dialysis was 55 (IQR 50-59) months, and follow-up time after RTX was 41 (IQR 34-51) months. The total symptom score improved (73 ± 16 vs. 82 ± 15, P = 0.001, and Cohen's d = 0.6), and the number of symptoms was reduced (6.5 ± 2.6 vs. 4.7 ± 3.0, P = 0.001). Seven symptoms improved statistically after RTX, but only two with Cohen's d > 0.5 (itching and cramps). The scores of the predefined symptom clusters improved after RTX: uremic (82 ± 16 vs. 85 ± 17, P = 0.008, and Cohen's d = 0.2), neuromuscular (66 ± 24 vs. 79 ± 18, P = 0.001, and Cohen's d = 0.6), and skin cluster (62 ± 27 vs. 78 ± 22, P = 0.001, and Cohen's d = 0.6). Symptom clusters could not be generated after RTX. CONCLUSION: Although symptoms and symptom clusters were reduced after RTX, the clinical relevance of the reductions was ambiguous. Symptom clusters could not be generated after RTX, suggesting that use of the KDQOL-SF may not be optimal to assess symptoms in RTX patients.

Symptom clusters predict mortality among dialysis patients in Norway: a prospective observational cohort study.

CONTEXT: Patients with end-stage renal disease on dialysis have reduced survival rates compared with the general population. Symptoms are frequent in dialysis patients, and a symptom cluster is defined as two or more related co-occurring symptoms. OBJECTIVES: The aim of this study was to explore the associations between symptom clusters and mortality in dialysis patients. METHODS: In a prospective observational cohort study of dialysis patients (n = 301), Kidney Disease and Quality of Life Short Form and Beck Depression Inventory questionnaires were administered. To generate symptom clusters, principal component analysis with varimax rotation was used on 11 kidney-specific self-reported physical symptoms. A Beck Depression Inventory score of 16 or greater was defined as clinically significant depressive symptoms. Physical and mental component summary scores were generated from Short Form-36. Multivariate Cox regression analysis was used for the survival analysis, Kaplan-Meier curves and log-rank statistics were applied to compare survival rates between the groups. RESULTS: Three different symptom clusters were identified; one included loading of several uremic symptoms. In multivariate analyses and after adjustment for health-related quality of life and depressive symptoms, the worst perceived quartile of the "uremic" symptom cluster independently predicted all-cause mortality (hazard ratio 2.47, 95% CI 1.44-4.22, P = 0.001) compared with the other quartiles during a follow-up period that ranged from four to 52 months. The two other symptom clusters ("neuromuscular" and "skin") or the individual symptoms did not predict mortality. CONCLUSION: Clustering of uremic symptoms predicted mortality. Assessing co-occurring symptoms rather than single symptoms may help to identify dialysis patients at high risk for mortality.

From dialysis to transplantation: a 5-year longitudinal study on self-reported quality of life.

BACKGROUND: Little is known how health related quality of life (HRQOL) change in the transition from dialysis to renal transplantation (RTX). Longitudinal data addressing the patient-related outcomes are scarce, and particularly data regarding kidney-specific HRQOL are lacking. Thus, the aim of the current study was to assess HRQOL in patients followed from dialysis to RTX. Furthermore, to compare HRQOL in RTX patients and the general population. METHODS: In a prospective study, HRQOL was measured in a cohort of 110 patients (median age 53.5 (IQR 39-62) years, GFR 54 (45-72) ml/min/1.73 m2) in dialysis and after RTX using the self-administered Kidney Disease and Quality of Life Short Form version 1.3 (KDQOL-SF). Generic HRQOL in the RTX patients was compared to that of the general population (n=5903) using the SF-36. Clinical important change after RTX was defined as difference in HRQOL of SD/2. RESULTS: Follow-up time was 55 (IQR 50-59) months, and time after RTX was 41 (34-51) months. Four of nine domains in kidney-specific HRQOL improved after RTX, i.e. burden of kidney disease, effect of kidney disease, symptoms and work status. In SF-36, general health, vitality, social function and role physical improved after RTX, but none of the domains improved sufficiently to be regarded as clinically relevant change. There were highly significant differences in HRQOL between RTX patients and the general population after adjustment for age and gender for all items of SF-36 except for bodily pain and mental health. CONCLUSIONS: HRQOL improved in the transition from dialysis to transplantation, but clinical relevant change was only obtained in the kidney specific domains. HRQOL was perceived considerably poorer in RTX patients than in the general population. Our observations point to the need of improving HRQOL even after RTX, and should encourage further longitudinal research and clinical attention during treatment shift.

Symptom clusters in patients on dialysis and their association with quality-of-life outcomes.

BACKGROUND: Patients who are on dialysis report multiple symptoms. The aim of the study was to explore and identify symptom clusters (co-occurring symptoms) in patients on dialysis and their possible associations with depressive symptoms and health-related quality-of-life (HRQOL) outcomes. METHODS: In a cross-sectional study of 301 prevalent patients on dialysis, physical symptoms, depressive symptoms and HRQOL were assessed using the Beck Depression Inventory (BDI) and the Kidney Disease and Quality-of-Life-Short Form version 1.3 (KDQOL-SF36) questionnaires. Symptom clusters were identified using principal component analysis with varimax rotation. Multivariate linear regression analyses were carried out to evaluate the relationships between symptom clusters and depressive symptoms and HRQOL outcomes. RESULTS: The majority of patients (63.5%) rated their symptoms in the 'very much' to 'extremely bothersome' range, and 29.4% had significant depressive symptoms. Three symptom clusters were identified and were named uraemic (nausea, lack of appetite, dizziness/faintness, feeling squeezed out, shortness of breath, chest pain), neuromuscular (numbness in extremities, sore muscles, cramps) and skin (itching, dry skin) clusters. The three clusters were associated with BDI, physical component summary (PCS) and mental component summary (MCS) scores. After multiple adjustments, the uraemic and neuromuscular clusters remained independently associated with BDI and PCS scores and the uraemic and skin clusters with MCS scores. CONCLUSION: The strong associations between symptom clusters and depressive symptoms and the physical and mental domains of HRQOL should lead to an increased focus on symptom-alleviating interventions. Additional research is warranted to determine whether treatment of symptom clusters rather than single symptoms will improve HRQOL.

Self-perceived quality of sleep and mortality in Norwegian dialysis patients.

Sleep complaints are prevalent and associated with poor health-related quality of life (HRQoL), depression and possibly mortality in dialysis patients. This study aimed to explore possible associations between sleep quality, daytime sleepiness and mortality in dialysis patients. In this study, 301 dialysis patients were followed up to 4.3 years. HRQoL was evaluated at baseline with the Kidney Disease and Quality of Life--Short Form (KDQoL-SF), depression with Beck Depression Inventory (BDI), sleep quality with Pittsburgh Sleep Quality Index and daytime sleepiness with Epworth Sleepiness Scale. The single item "on a scale from 0-10, how would you evaluate your sleep?" in the sleep subscale in KDQoL-SF was used to identify poor (0-5) and good sleepers (6-10). A total of 160 patients (53.3%) were characterized as poor sleepers. They were younger (r = 0.241, P < 0.001), had more depression (BDI: 8.72 ± 6.79 vs. 13.60 ± 8.04, P < 0.001), a higher consumption of hypnotics and antidepressants and reduced HRQoL (Mental Component Summary score: 45.4 ± 11.0 vs. 50.0 ± 10.4, P < 0.001. Physical Component Summary score: 35.0 ± 9.9 vs. 38.5 ± 10.5, P = 0.004). In multivariate analyses, poor sleepers had nearly a twofold increase in mortality risk (hazard ratio [HR] 1.92, confidence interval [CI] 1.10-3.35, P = 0.022). Daytime sleepiness was not related to mortality (HR 1.01, CI 0.95-1.08, P = 0.751). Sleep complaints predicted increased mortality risk in dialysis patients and should therefore be routinely assessed. Further studies are needed to find suitable treatment options for poor sleep in dialysis patients as it may affect both HRQoL and survival.

Sleep complaints, depression and quality of life in Norwegian dialysis patients.

BACKGROUND: This study explores sleep problems in dialysis patients and the associations to health-related quality of life (HRQoL) and depression. A comparison between different validated sleep questionnaires was done in order to find an appropriate diagnostic tool in clinical practice. METHODS: In a cross-sectional study of 301 prevalent dialysis patients, sleep problems were elaborated with Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS). Poor sleep was defined as PSQI score > 5 and daytime sleepiness as ESS > 10. HRQoL, including quality of sleep, was evaluated with the Kidney Disease and Quality of Life - Short Form (KDQoL-SF), and physical (PCS) and mental component summary scores (MCS) were computed. Depression was assessed with Beck Depression Inventory (BDI). RESULTS: Poor sleep and excessive daytime sleepiness was found in 74.3% and 22.2%, respectively. Depression was common (29.5%) and associated with reduced sleep quality (ρ = 0.49, p < 0.001). Poor sleepers had significantly lower MCS (51.8 ± 9.6 vs. 46.6 ± 10.6, p = 0.001) and PCS (41.8 ± 9.6 vs. 35.2 ± 10.0, p < 0.001) compared to good sleepers. PSQI scores were independently associated with PCS (p = 0.001), but not MCS (p = 0.468) in multivariate analyses. The sleep subscale from KDQoL-SF was strongly correlated to PSQI (r = -0.75, p < 0.001). CONCLUSIONS: As sleep complaints, daytime sleepiness and depression were prevalent, all dialysis patients should routinely be screened for self-perceived sleep problems with a simple Questionnaire.