Surgical treatment of nutcracker syndrome results in improved pain and quality of life.

BACKGROUND: Left renal vein (LRV) compression, or nutcracker phenomenon, describes the compression of the LRV, most commonly between the aorta and the superior mesenteric artery. The outflow obstruction that occurs from the compression causes venous hypertension leading to the development of pelvic collaterals, lumbar vein engorgement and gonadal vein reflux. The symptoms associated with LRV compression include abdominal pain, left flank pain, back pain, headache, pelvic pain/pressure, and hematuria. Symptomatic LRV compression can cause chronic pain and disability that impedes activities of daily living. Left renal auto transplantation (LR-AT) is one mode of treatment, leading to decreased pain with no significant vascular or urological complications. Herein we present a five patient case series with symptomatic LRV compression who underwent LR-AT with improved pain and quality of life after surgery. METHODS: Five patients underwent LR-AT between June 2020-December 2020 to resolve their symptomatic LRV compression. These patients were given three validated surveys pre- and post- intervention, then again at their three month follow up visit to assess their pain and health-related quality of life. RESULTS: The five patients were all female with the average age of 36.8 years old (36-41) and underwent LR-AT to treat their symptomatic LRV compression. The average Numeric Rating Scale (NRS) pain score pre intervention was 8.3 (range 6.7 to 10) which improved to pain rating 5.22 (range 2.7 to 6) post intervention, p-value = 0.013. The average pain NRS score at 3 month follow up was 3.86 (range 1.3-6), p-value = 0.006 when compared to pre-intervention pain scores. The average pain intensity pre intervention was 4.5 (4 to 5) and 2.7 (1 to 4.3) post intervention, p-value = 0.024. The average pain intensity score at 3 month follow up was 2.24 (range 1.3-3.3), p-value = 0.002 when compared to pre-intervention. The VascuQoL-6 survey score pre intervention averaged score of 9.6 (range 7-12) which improved to an average score of 20.6 (range 18-24), p-value = 0.001. The average VascuQoL score at 3 month follow up was 22.6 (range 22-24), p-value = < 0.001 when compared to pre intervention QoL scores all showing a statistically significant improvement of health-related quality of life. CONCLUSION: The diagnosis of LRV compression can be challenging due to the non-descript symptoms and overall lack of awareness. Understanding venous tributary pathways and drainage can help clarify why patients present with unusual symptoms. Surgical treatment of LRV compression through LR-AT can improve patients' pain and improve vascular quality of life.

A 6-Week Program to Strengthen Resiliency Among Women With Metastatic Cancer: A Randomized Clinical Trial.

PURPOSE: The objective of this study was to evaluate the effect of an intervention (Growing Resilience And CouragE; GRACE) on spiritual well-being, quality of life, and general well-being in women with metastatic cancers reporting existential or spiritual distress. PATIENTS AND METHODS: Prospective, randomized, wait-list control clinical trial. Women with metastatic cancer experiencing existential or spiritual concerns were randomized to GRACE or waitlist control. Survey data were collected at baseline, end of program, and 1-month follow-up. Participants included English-speaking women, 18 or older, with metastatic cancer, existential or spiritual concerns, and reasonable medical stability. Eighty-one women were assessed for eligibility; 10 were excluded (not meeting exclusion criteria, refusal to participate, and death). The primary outcome was spiritual well-being measured pre- and post-program. Secondary measures assessed quality of life, anxiety, depression, hopelessness, and loneliness. RESULTS: Seventy-one women (aged 47-72) were enrolled (GRACE n = 37, waitlist control n = 34). GRACE participants demonstrated significant improvements in spiritual well-being compared to control at end of program (parameter estimate (PE), 16.67, 95% CI, 13.17, 20.16) and 1-month follow-up (PE, 10.31, 95% CI, 6.73, 13.89). Additionally, significant improvements were demonstrated in quality of life at the end of program (PE, 8.51, 95% CI, 4.26, 12.76) and 1-month follow-up (PE, 6.17, 95% CI, 1.75, 10.58). GRACE participants also demonstrated improved depression and hopelessness at follow-up, as well as improved anxiety. CONCLUSIONS: Findings suggest the value of evidence-based psychoeducational and experiential interventions for improving the well-being and quality of life of women with advanced cancer. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02707510.

The Outcomes of an e-Wellness Program for Lupus Patients in Thailand: A Participatory Action Research Approach.

OBJECTIVES: Systemic lupus erythematosus (SLE) or lupus patients usually experience various physical and psychological challenges. Since the coronavirus disease 2019 pandemic, these challenges have become even harsher. Using the participatory action research approach, this study evaluated how an e-wellness program (eWP) impacted SLE-related knowledge and health behaviors, mental health, and quality of life among lupus patients in Thailand. METHODS: A 1-group, pretest-posttest design study was conducted among a purposive sample of lupus patients who were members of Thai SLE Foundation. The 2 main intervention components were: (1) online social support, and (2) lifestyle and stress management workshops. Sixty-eight participants completed all the study requirements, including the Physical and Psychosocial Health Assessment questionnaire. RESULTS: After being in the eWP for 3 months, participants' mean score for SLE-related knowledge increased significantly (t=5.3, p<0.001). The increase in sleep hours was statistically significant (Z=-3.1, p<0.01), with the percentage of participants who slept less than 7 hours decreasing from 52.9% to 29.0%. The percentage of participants reporting sun exposure decreased from 17.7% to 8.8%. The participants also reported significantly lower stress (t(66)=-4.4, p<0.001) and anxiety (t(67)=-2.9, p=0.005). The post-eWP quality of life scores for the pain, planning, intimate relationship, burden to others, emotional health, and fatigue domains also improved significantly (p<0.05). CONCLUSIONS: The overall outcomes showed promising results of improved self-care knowledge, health behaviors, mental health status, and quality of life. It is recommended that the SLE Foundation continues to use the eWP model to help the lupus patient community.

Return to work and everyday life following out-of-hospital cardiac arrest. Results from the national survey, DenHeart.

BACKGROUND: With increasing survival rates following out-of-hospital cardiac arrest (OHCA), knowledge on return to everyday life, including return to work, should be getting increasing attention. OBJECTIVES: To i) describe patterns of labor market affiliation up to 12 months after discharge among a workforce population and to, ii) investigate the association between clinical and sociodemographic characteristics, self-reported health at discharge and a composite endpoint of prolonged sick leave and leaving the workforce after 3 and 12 months. METHODS: Data from the national survey, DenHeart, were used, including measures of self-reported health: HeartQoL and the Hospital Anxiety and Depression Scale (HADS), combined with register-based follow-up. RESULTS: During the study period, n = 572 OHCA patients were discharged from five Heart centres, n = 184 were part of the workforce. At discharge, 60% were on paid sick leave, and 20% at 12 months. Age (per one year older) increased the odds of experiencing the composite endpoint at 3 and 12 months (3 months: OR 1.06 95%CI 1.03-1.10, 12 months: OR 1.06 95%CI 1.03-1.09) among the total population (n = 184). Self-reported health at discharge was not associated with the endpoint. CONCLUSION: One-fifth of the OHCA survivors at a working-age prior to the OHCA was still on paid sick leave after 12 months. Increasing age was the only characteristic associated with a composite endpoint of prolonged sick leave or leaving the workforce at 3 and 12 months after discharge. With increasing survival rates, healthcare professionals need to support the population in resuming daily life, including returning to the workforce, when relevant.

Avaliação antropométrica e fatores motivacionais de praticantes de hidroginástica e caminhada em Guarapuava, Paraná / Anthropometric evaluation and motivational factors of water aerobics and walking in Guarapuava, Paraná / Evaluación antropométrica y factores motivacionales de practicantes de hidroginástica y caminata en Guarapuava, Paraná

Objetivo: comparar a avaliação antropométrica e fatores motivacionais de praticantes de hidroginástica e caminhada. Método: pesquisa quase experimental, sem grupo controle e de cunho quantitativo, realizada em Guarapuava, Paraná. Analisou-se o IMC, porcentagem de gordura, circunferências, relação cintura quadril, teste de força com preensão manual e teste de flexibilidade com o banco de wells. Aplicou-se também, o questionário de motivação (IMPRAF-54). Após a coleta de dados, foi realizada a análise estatística através do teste T, comparando as medidas entre os grupos. Resultados: foi observado que a motivação mais prevalente para praticar as atividades físicas foi o fator saúde. Na avaliação antropométrica, as praticantes de hidroginástica possuíam índices superiores. Nos testes de força e flexibilidade as praticantes de hidroginástica apresentaram maior força em membros superiores, enquanto que as praticantes de caminhada maios flexibilidade em membros inferiores. Conclusão: a hidroginástica possui benefícios extras em comparação à caminhada e a motivação das participantes para praticar essas atividades físicas indica sua preocupação com a condição e qualidade de vida.(AU)

Objective: to compare the anthropometric evaluation and motivational factors of water aerobics and walking practitioners. Method: almost experimental research, with no control group and quantitative, performed in Guarapuava, Paraná. The BMI, fat percentage, circumference, waist hip ratio, strength test with manual grip and flexibility test with the wells bench were analyzed. The motivation questionnaire (IMPRAF-54) was also applied. After the data collection, the statistical analysis was performed through the T test, comparing the measurements between the groups. Results: it was observed that the most prevalent motivation to practice physical activities was the health factor. In the anthropometric evaluation, the hydrogymnastics practitioners had higher indices. In the tests of strength and flexibility, water aerobics practitioners showed greater strength in the upper limbs, whereas those who practice walking have greater flexibility in the lower limbs. Conclusion: water aerobics has extra benefits compared to walking and the motivation of the participants to practice these physical activities indicates their concern with the condition and quality of life.(AU)

Objetivo: comparar la evaluación antropométrica y factores motivacionales de practicantes de hidroginástica y caminar. Método: investigación casi experimental, sin grupo control y de cuño cuantitativo, realizada en Guarapuava, Paraná. Se analizó el IMC, porcentaje de grasa, circunferencias, relación cintura cadera, prueba de fuerza con asimiento manual y prueba de flexibilidad con el banco de wells. Se aplicó también el cuestionario de motivación (IMPRAF-54). Después de la recolección de datos, se realizó el análisis estadístico a través de la prueba T, comparando las medidas entre los grupos. Después de la recolección de datos, se realizó el análisis estadístico a través de la prueba T, comparando las medidas entre los grupos. Resultados: se observó que la motivación más prevalente para practicar las actividades físicas fue el factor salud. En la evaluación antropométrica, las practicantes de hidroginástica poseían índices superiores. En las pruebas de fuerza y flexibilidad las practicantes de hidroginástica presentaron mayor fuerza en miembros superiores, mientras que las practicantes de caminata maios flexibilidad en miembros inferiores. Conclusión: la hidroginástica posee beneficios extras en comparación con la caminata y la motivación de las participantes para practicar esas actividades físicas indica la preocupación por la condición y calidad de vida.(AU)

Does higher screw density improve radiographic and clinical outcomes in adolescent idiopathic scoliosis? A systematic review and pooled analysis.

OBJECTIVE The radiographic and clinical outcomes of low-density (LD) versus high-density (HD) screw constructs in patients with adolescent idiopathic scoliosis (AIS) treated with all-pedicle screw constructs are still controversial. A systematic review and pooled analysis were performed to compare radiographic, perioperative, and quality-of-life (QOL) outcomes and complications in patients with moderate AIS treated with LD or HD screw constructs. METHODS The MEDLINE, Embase, and Web of Science databases were searched for English-language articles addressing LD versus HD screw constructs in AIS patients treated with all-pedicle screw constructs. The division of LD and HD groups was based on relative screw density and screw techniques. This systematic analysis strictly followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, and all articles included in the analysis met the criteria specified in the guidelines. Two reviewers independently assessed the quality of the studies using the Newcastle-Ottawa Scale. Date on radiographic, perioperative, and QOL outcomes and complications were extracted from the included studies. RESULTS Twelve studies, involving a total of 827 patients (480 treated with LD constructs, 347 with HD), were analyzed-1 randomized controlled trial, 1 quasi-randomized controlled trial, and 10 retrospective studies. The patients' age at surgery, preoperative Cobb angle of the major curve, amount of thoracic kyphosis, and major curve flexibility were reasonably distributed, and no statistically significant differences were found. Regarding the outcomes at most recent follow-up, there were no significant differences in the Cobb angle of the major curve (mean difference 0.96°, 95% CI -0.06° to 1.98°, p = 0.06, I2 = 1%), major curve correction (mean difference -0.72%, 95% CI -2.96% to 1.52%, p = 0.53, I2 = 0%), thoracic kyphosis (mean difference -1.67°, 95% CI -4.59° to 1.25°, p = 0.26, I2 = 79%), complications (odds ratio [OR] 0.66, 95% CI 0.31-1.42, p = 0.29, I2 = 0%), and QOL outcomes. Reduced operative time (mean difference -48.56 minutes, 95% CI -82.69 to -14.43 minutes, p = 0.005, I2 = 87%), blood loss (mean difference -77.85 ml, 95% CI -153.10 to -2.60 ml, p = 0.04, I2 = 0%), and hospital charges (mean difference -$5.92K, 95% CI -$6.59K to -$5.26K, p < 0.00001, I2 = 0%) were found in the LD group, compared with the HD group. CONCLUSIONS LD and HD screw constructs are both associated with satisfactory radiographic and QOL outcomes with few complications. This study supports the use of LD screw constructs for the treatment of moderate AIS, because they resulted in reduced operative time, blood loss, and hospital charges while maintaining radiographic and QOL outcomes and complication rates similar to those achieved with HD screw constructs.

Allergic Rhinitis: Burden of Illness, Quality of Life, Comorbidities, and Control.

Allergic rhinitis is a highly prevalent and costly condition. The disease burden suffered by patients includes the morbidity of the nasal symptoms, the impairment of multiple domains of quality of life, and numerous comorbidities. The goal of therapy is long-term good control.

Correlation of personality characteristics and quality-of-life in patients with chronic urticaria / 中华全科医师杂志

WHO quality-of-life scales (WHOQOL-BREF) and Eysenck personality questionnaire (EPQ) were used for evaluating the quality-of-life and personality characteristics of 60 outpatients with chronic urticaria.According to statistical correlation analysis, a positive correlation existed between education level and psychological field (P ＜ 0.05).And there were negative correlations between N scale, P scale and psychological field (P ＜ 0.05, P ＜ 0.01).The incidence and incurability of chronic urticaria was more correlated with anxiety and depression.The patients with chronic urticaria were more likely to have a worse quality-of-life than normal population.