A Matter of Taste? Quality of Life in Day-to-Day Living with ALS and a Feeding Tube

Although people often refer to quality of life and there is a respectable research tradition to establish it, the meaning of the term is unclear. In this article we qualitatively study an intervention of which the quantitative effects are documented as indecisive. We do this in order to learn more about what the meaning of the term quality of life means when it is studied in daily life. With the help of these findings we reflect on the intricacies of objectifying and measuring quality of life using quantitative research designs. Our case is the feeding tube for patients suffering from ALS, a severe motor neuron disease that rapidly and progressively incapacitates patients. We studied how these patients, who lived in the Netherlands, anticipated and lived with a feeding tube in the course of their physical deterioration. Our analysis shows that the quality of life related to the feeding tube has to be understood as a process rather than as an outcome. The feeding tube becomes a different thing as patients move through the various phases of their illness, due to changes in their condition, living circumstances, and concerns and values. There are very different appreciations of the way the feeding tube changes the body’s appearance and feel. Some patients refuse it because they feel it disfigures their body, whereas others are indifferent to its appearance. Our conclusion is that these differences are difficult to grasp with a quantitative study designs because ‘matters of taste’ and values are not distributed in a population in the same ways as physiological responses to medication. Effect studies assume physiological responses to be more or less the same for everyone, with only gradual differences. Our analysis of quality in daily life, however, shows that what a treatment comes to be and how it is valued shows shows generalities for subgroups rather than populations.     

Patients with Asthma and Comorbid Allergic Rhinitis: Is Optimal Quality of Life Achievable in Real Life?

Objectives

Asthma trials suggest that patients reaching total disease control have an optimal Health Related Quality of Life (HRQoL). Moreover, rhinitis is present in almost 80% of asthmatics and impacts asthma control and patient HRQoL. We explored whether optimal HRQoL was reachable in a real-life setting, and evaluated the disease and patient related patterns associated to optimal HRQoL achievement.

Methods and Findings

Asthma and rhinitis HRQoL, illness perception, mood profiles, rhinitis symptoms and asthma control were assessed by means of validated tools in patients classified according to GINA and ARIA guidelines. Optimal HRQoL, identified by a Rhinasthma Global Summary (GS) score ≤20 (score ranging from 0 to 100, where 100 represents the worst possible HRQoL), was reached by 78/209 (37.32%). With the exception of age, no associations were found between clinical and demographic characteristics and optimal HRQoL achievement. Patients reaching an optimal HRQoL differed in disease perception and mood compared to those not reaching an optimal HRQoL. Asthma control was significantly associated with optimal HRQoL (χ² = 49.599; p<0.001) and well-controlled and totally controlled patients significantly differed in achieving optimal HRQoL (χ² = 7.617; p<0.006).

Conclusion

Approximately one third of the patients in our survey were found to have an optimal HRQoL. While unsatisfactory disease control was the primary reason why the remainder failed to attain optimal HRQoL, it is clear that illness perception and mood also played parts. Therefore, therapeutic plans should be directed not only toward achieving the best possible clinical control of asthma and comorbid rhinitis, but also to incorporating individualized elements according to patient-related characteristics.     

Can Research Assessments Themselves Cause Bias in Behaviour Change Trials? A Systematic Review of Evidence from Solomon 4-Group Studies

Background

The possible effects of research assessments on participant behaviour have attracted research interest, especially in studies with behavioural interventions and/or outcomes. Assessments may introduce bias in randomised controlled trials by altering receptivity to intervention in experimental groups and differentially impacting on the behaviour of control groups. In a Solomon 4-group design, participants are randomly allocated to one of four arms: (1) assessed experimental group; (2) unassessed experimental group (3) assessed control group; or (4) unassessed control group. This design provides a test of the internal validity of effect sizes obtained in conventional two-group trials by controlling for the effects of baseline assessment, and assessing interactions between the intervention and baseline assessment. The aim of this systematic review is to evaluate evidence from Solomon 4-group studies with behavioural outcomes that baseline research assessments themselves can introduce bias into trials.

Methodology/Principal Findings

Electronic databases were searched, supplemented by citation searching. Studies were eligible if they reported appropriately analysed results in peer-reviewed journals and used Solomon 4-group designs in non-laboratory settings with behavioural outcome measures and sample sizes of 20 per group or greater. Ten studies from a range of applied areas were included. There was inconsistent evidence of main effects of assessment, sparse evidence of interactions with behavioural interventions, and a lack of convincing data in relation to the research question for this review.

Conclusions/Significance

There were too few high quality completed studies to infer conclusively that biases stemming from baseline research assessments do or do not exist. There is, therefore a need for new rigorous Solomon 4-group studies that are purposively designed to evaluate the potential for research assessments to cause bias in behaviour change trials.     

Empathy among Medical Students: Is There a Relation with Quality of Life and Burnout?

Background

We aimed to assess medical students'' empathy and its associations with gender, stage of medical school, quality of life and burnout.

Method

A cross-sectional, multi-centric (22 medical schools) study that employed online, validated, self-reported questionnaires on empathy (Interpersonal Reactivity Index), quality of life (The World Health Organization Quality of Life Assessment) and burnout (the Maslach Burnout Inventory) in a random sample of medical students.

Results

Out of a total of 1,650 randomly selected students, 1,350 (81.8%) completed all of the questionnaires. Female students exhibited higher dispositional empathic concern and experienced more personal distress than their male counterparts (p<0.05; d≥0.5). There were minor differences in the empathic dispositions of students in different stages of their medical training (p<0.05; f<0.25). Female students had slightly lower scores for physical and psychological quality of life than male students (p<0.05; d<0.5). Female students scored higher on emotional exhaustion and lower on depersonalization than male students (p<0.001; d<0.5). Students in their final stage of medical school had slightly higher scores for emotional exhaustion, depersonalization and personal accomplishment (p<0.05; f<0.25). Gender (β = 0.27; p<0.001) and perspective taking (β = 0.30; p<0.001) were significant predictors of empathic concern scores. Depersonalization was associated with lower empathic concern (β = −0.18) and perspective taking (β = −0.14) (p<0.001). Personal accomplishment was associated with higher perspective taking (β = 0.21; p<0.001) and lower personal distress (β = −0.26; p<0.001) scores.

Conclusions

Female students had higher empathic concern and personal distress dispositions. The differences in the empathy scores of students in different stages of medical school were small. Among all of the studied variables, personal accomplishment held the most important association with decreasing personal distress and was also a predicting variable for perspective taking.     

Bismuth and Silver in Cosmetic Products: A Source of Environmental and Resource Concern?

Bismuth (Bi) and silver (Ag) are used in increasing amounts and are consequently being emitted from various sources and showing high accumulation rates in soils when sewage sludge is applied on arable land. This study aimed to analyze the amounts of Bi and Ag in three cosmetic products (foundation, powder, and eye shadow) in order to study the flows in urban wastewater in Stockholm, Sweden. Analyses showed that Bi was present in very high concentrations (7,000 to 360,000 milligrams per kilogram) in one third of the analyzed foundation and powder samples, whereas Ag concentrations all were below the detection limit. These cosmetic products explained approximately 24% of the measured total Bi amounts per year reaching the WWTP (wastewater treatment plant), making cosmetics a major Bi source, whereas for Ag the corresponding contribution was <0.1% of the measured annual Ag amounts. The results were roughly adapted for Europe and the United States, estimating the Bi flows from cosmetics to WWTPs. On a global scale, these flows correspond to a non‐negligible part of the world Bi production that, every year, ends up in sewage sludge, limiting the reuse of a valuable metal resource. From an environmental and resource perspective, foundations and powder products should be considered as significant sources of measured Bi amounts in sludge. This large Bi flow must be considered as unsustainable. For Ag, however, the three analyzed cosmetic products are not a significant source of the total Ag load to WWTPs.     

Overnutrition in Prenatal and Neonatal Life: A Problem?

In most areas of the world nutritional problems are related to quantitative and qualitative deficiencies. However, in North America the possible harmful effects of overnutrition deserve careful consideration.Little information is available concerning overnutrition during prenatal and neonatal life. The author draws attention to this possibility by outlining clinical and biochemical disorders occurring in the newborn which are related to excessive ingestion of calories, fat, protein, vitamins and minerals before and after birth. Particular reference is made to the ingestion of nutritional substances during pregnancy in amounts that are relatively innocuous to the mother but may be harmful to the infant in utero.Further research in this interesting field is needed in an attempt to assess the effect on the fetus of qualitative overnutrition during pregnancy.     

Dynamics of Attentional Bias to Threat in Anxious Adults: Bias towards and/or Away?

The aim of the present study was to question untested assumptions about the nature of the expression of Attentional Bias (AB) towards and away from threat stimuli. We tested the idea that high trait anxious individuals (N = 106; M(SD)_age = 23.9(3.2) years; 68% women) show a stable AB towards multiple categories of threatening information using the emotional visual dot probe task. AB with respect to five categories of threat stimuli (i.e., angry faces, attacking dogs, attacking snakes, pointed weapons, violent scenes) was evaluated. In contrast with current theories, we found that 34% of participants expressed AB towards threat stimuli, 20.8% AB away from threat stimuli, and 34% AB towards some categories of threat stimuli and away from others. The multiple observed expressions of AB were not an artifact of a specific criterion AB score cut-off; not specific to certain categories of threat stimuli; not an artifact of differences in within-subject variability in reaction time; nor accounted for by individual differences in anxiety-related variables. Findings are conceptualized as reflecting the understudied dynamics of AB expression, with implications for AB measurement and quantification, etiology, relations, and intervention research.     

The State of Ethnoprimatology: Its Use and Potential in Today’s Primate Research

The human–primate interface is an increasingly relevant theme in primatological research. To understand the extent of ethoprimatological studies in contemporary primatology, we explored 7 years of primatological literature through a systematic review. We reviewed original research papers published in the American Journal of Primatology, the International Journal of Primatology, Primates, and Folia Primatologica between January 2010 and December 2016 for the presence of 14 search terms relevant to the ethnoprimatological approach. We sorted research papers into topical categories to identify trends in the recent primatological literature. Of the 1551 papers that met the criteria for inclusion in this review, 12 papers (0.8%) self-identified as an ethnoprimatological study by using the term in the title or keywords, and only 17 papers (1.1%) used the term anywhere in their text. However, the presence of other relevant keywords—anthropogenic (16.3%), crop (9.1%), disturbance (18.7%), conflict (6.2%), human–nonhuman (0.5%), human–primate (1.0%), interface (1.5%), perception (2.5%), culture (2.6%), ethnography (0.1%), trade (6.8%), provision (16.1%), and tourism (4.6%)—in a variety of research papers suggests that the human–primate dimension is salient for many, if not most, areas of primatological interest. The ethnoprimatological approach is relevant to every research trend we identified in today’s primatology. We highlight existing literature that exemplifies ethnoprimatological engagement and present potential research questions in each area, demonstrating that primatology as a whole would benefit from greater attention to the human dimension.     

Does Future Diabetes Risk Impair Current Quality of Life? A Cross-Sectional Study of Health-Related Quality of Life in Relation to the Finnish Diabetes Risk Score (FINDRISC)

Objectives

Present study examines the relationship between the estimated risk of developing type 2 diabetes (T2D) and health-related quality of life (HRQoL). We quantify the association between Finnish Diabetes Risk Score (FINDRISC) and HRQoL, and examine the potential use of FINDRISC as tool to evaluate HRQoL indirectly.

Methods

We conducted a cross-sectional study comprising 707 Finnish people without a diagnosis of T2D between the ages of 51 and 75 years. The risk of developing T2D was assessed using the validated and widely used FINDRISC (range 0–26 points), and quality of life was measured using two preference-based HRQoL instruments (15D and SF-6D) and one health profile instrument (SF-36). Effects of the individual FINDRISC items and demographic and clinical characteristics, such as co-morbidities, on HRQoL were studied using multivariable Tobit regression models.

Results

Low HRQoL was significantly and directly associated with the estimated risk of developing T2D. An approximate 4–5 point change in FINDRISC score was observed to be associated with clinically noticeable changes in the preference-based instrument HRQoL index scores. The association between HRQoL and the risk of developing T2D was also observed for most dimensions of HRQoL in all applied HRQoL instruments. Overall, old age, lack of physical activity, obesity, and history of high blood glucose were the FINDRISC factors most prominently associated with lower HRQoL.

Conclusions

The findings may help the health care professionals to substantiate the possible improvement in glucose metabolism and HRQoL potentially achieved by lifestyle changes, and better convince people at high risk of T2D to take action towards healthier lifestyle habits. FINDRISC may also provide an accurate proxy for HRQoL, and thus by estimating the risk of T2D with the FINDRISC, information about patients’ HRQoL may also be obtained indirectly, when it is not feasible to use HRQoL instruments.     

Impact of Weight Loss and Regain on Quality of Life: Mirror Image or Differential Effect?

Objective: To compare the impact of weight regain and weight loss on health‐related quality of life. Research Methods and Procedures: Subjects were 122 (106 women, 16 men) overweight and obese participants in a weight reduction program (phentermine‐fenfluramine and dietary counseling) who had initially lost at least 5% of their total body weight and then regained at least 5% of their weight during the follow‐up period. Follow‐up periods ranged from 10 to 41 months (mean, 28 months). Participants completed the Impact of Weight on Quality of Life‐Lite, an obesity‐specific health‐related quality of life (HRQOL) measure, at 3‐month intervals. Results: Mean BMI at baseline was 40.9 ± 6.6 kg/m² (range, 29.2 to 63.7 kg/m²). Average weight loss from entry was 18.8 ± 6.7% (range, 6.0% to 43.7%), and average regain was 10.1 ±4.4% of baseline weight (range, 5.0% to 30.6%). The effects of weight regain on HRQOL mirrored the effects of weight loss—rates of HRQOL change were similar in magnitude but different in direction for comparable weight loss and regain. Those with more severe initial impairments in HRQOL experienced greater improvements in HRQOL during weight loss as well as greater deterioration during weight regain than those with less severe impairments. Discussion: Weight loss and regain produced mirror image changes in HRQOL. The initial severity of HRQOL impairment had a greater impact on the magnitude of HRQOL change than the direction of weight change. Findings underscore the importance of maintaining weight loss for the purposes of retaining obesity‐specific HRQOL benefits.     

Pain in Parkinson′s Disease: A Cross-Sectional Study of Its Prevalence,Types, and Relationship to Depression and Quality of Life

Pain is an important and distressing symptom in Parkinson’s disease (PD). Our aim was to determine the prevalence of pain, its various types and characteristics, as well as its impact on depression and quality of life (QoL) in patients with PD. How pain differs in early- and advanced-stage PD and male and female PD patients was of special interest. One hundred PD patients on dopaminergic medications had a neurological examination and participated in a structured interview on pain characteristics and completed standardized questionnaires. A total of 76% of the patients had pain. The following types of pain were present: musculoskeletal pain accounted for 41% of the total pain, dystonic pain for 17%, central neuropathic pain for 22%, radicular pain for 27%, and other pains (non-radicular low back pain, arthritic, and visceral pain) made up 24%. One type of pain affected 29% of all the subjects, two types 35%, three types 10%, and four types of pain were reported by 2%. All types of pain were more prevalent in advanced-stage PD subjects than in early-stage PD subjects, except for arthritic pain (subclassified under”other pain”). The frequency and intensity of actual, average, and worst experienced pain were significantly more severe in advanced-stage subjects. PD subjects with general pain and in advanced stages were more depressed and had poorer QoL. Depression correlated with worst pain in the last 24 hours and with pain periodicity (the worst depression score in patients with constant pain). QoL correlated with average pain in the last 7 days. Pain is a frequent problem in PD patients, and it worsens during the course of the disease.     

Bias in vegetation databases? A comparison of stratified‐random and preferential sampling

Aim: Vegetation plots collected since the early 20th century and stored in large vegetation databases are an important source of ecological information. These databases are used for analyses of vegetation diversity and estimation of vegetation parameters, however such analyses can be biased due to preferential sampling of the original data. In contrast, modern vegetation survey increasingly uses stratified‐random instead of preferential sampling. To explore how these two sampling schemes affect vegetation analyses, we compare parameters of vegetation diversity based on preferentially sampled plots from a large vegetation database with those based on stratified‐random sampling. Location: Moravian Karst and Silesia, Czech Republic. Methods: We compared two parallel analyses of forest vegetation, one based on preferentially sampled plots taken from a national vegetation database and the other on plots sampled in the field according to a stratified‐random design. We repeated this comparison for two different regions in the Czech Republic. We focussed on vegetation properties commonly analysed using data from large vegetation databases, including alpha (within‐plot) diversity, cover and participation of different species groups, such as endangered and alien species within plots, total species richness of data sets, beta diversity and ordination patterns. Results: The preferentially sampled data sets obtained from the database contained more endangered species and had higher beta diversity, whereas estimates of alpha diversity and representation of alien species were not consistently different between preferentially and stratified‐randomly sampled data sets. In ordinations, plots from the preferential samples tended to be more common at margins of plot scatters. Conclusions: Vegetation data stored in large databases are influenced by researcher subjectivity in plot positioning, but we demonstrated that not all of their properties necessarily differ from data sets obtained by stratified‐random sampling. This indicates the value of vegetation databases for use in biodiversity studies; however, some analyses based on these databases are clearly biased and their results must be interpreted with caution.     

Anxiety and Depression Mediate the Health-Related Quality of Life Differently in Patients with Cardiovascular Disease and Stroke–Preliminary Report of the Yilan Study: A Population-Based Community Health Survey

Background

Cardiovascular disease and stroke have emerged as substantial and growing health challenges to populations around the world. Besides for the survival and medical prognosis, how to improve the health-related quality of life (HRQoL) might also become one of the goals of treatment programs. There are multiple factors that influence HRQol, including comorbidity, mental function and lifestyle. However, substantial research and investigation have still not clarified these underlying pathways, which merit further attention. The purpose of this study was to determine how psychological factors affect the link between cardiovascular disease and stroke with HRQoL.

Methods and Result

A total of 1,285 elder subjects at least 65 years of age (47.2% male) were enrolled. The mental function and HRQol of each patient was then measured using the Hospital Anxiety and Depression Scale and Short Form-12. After multiple regression analysis, anxiety, depression, cardiovascular disease, stroke, education level and age were shown to be associated with both mental component score (MCS) and physical component score (PCS). In the mediation analysis using the SPSS macro provided by Preacher and Hayes, cardiovascular disease and stroke affected HRQoL via anxiety and depression, respectively.

Conclusions

These results suggest that cardiovascular disease and stroke have negative impacts on patient MCS and PCS through different underlying pathways. Cardiovascular disease influences the HRQoL both directly and indirectly with the mediation of anxiety, and stroke influences the HRQoL by way of depression. These findings support the proposition that different combinations of both physical and psychological support are necessary to best manage these diseases.     

Schistosomiasis,Soil-Transmitted Helminthiasis,and Sociodemographic Factors Influence Quality of Life of Adults in C?te d'Ivoire

Background

Burden of disease estimates are widely used for priority setting in public health and disability-adjusted life years are a powerful “currency” nowadays. However, disability weights, which capture the disability incurred by a typical patient of a certain condition, are fundamental to such burden calculation and their determination remains a widely debated issue.

Methodology

A cross-sectional epidemiological survey was conducted in the recently established Taabo health demographic surveillance system (HDSS) in south-central Côte d''Ivoire, to provide new, population-based evidence on the disability caused by schistosomiasis and soil-transmitted helminthiasis. Parasitological results from stool, urine, and blood examinations were juxtaposed to quality of life (QoL) questionnaire results from 187 adults. A multivariable linear regression model with stepwise backward elimination was used to identify significant associations, considering also sociodemographic characteristics obtained from the Taabo HDSS database.

Principal Findings

Prevalences for hookworm, Plasmodium spp., Trichuris trichiura, Schistosoma haematobium and Schistosoma mansoni were 39.0%, 18.2%, 2.7%, 2.1% and 2.1%, respectively. S. mansoni and T. trichiura infections of any intensity reduced the participants'' self-rated QoL by 16 points (95% confidence interval (CI): 4–29 points) and 13 points (95% CI: 1–24 points), respectively, on a scale from 0 (worst QoL) to 100 points (best QoL). The only other statistically significant effect was a 1-point (95% CI: 0.1–2 points) increase on the QoL scale per one unit increase in a calculated wealth index.

Conclusions/Significance

We found consistent and significant results on the negative effects of schistosomiasis and soil-transmitted helminthiasis on adults'' self-rated QoL, also when taking sociodemographic characteristics into account. Our results warrant further investigation on the disability incurred by helmintic infections and the usefulness of generic QoL questionnaires in this endeavor.     

Caesarean Section: Could Different Transverse Abdominal Incision Techniques Influence Postpartum Pain and Subsequent Quality of Life? A Systematic Review

The choice of the type of abdominal incision performed in caesarean delivery is made chiefly on the basis of the individual surgeon’s experience and preference. A general consensus on the most appropriate surgical technique has not yet been reached. The aim of this systematic review of the literature is to compare the two most commonly used transverse abdominal incisions for caesarean delivery, the Pfannenstiel incision and the modified Joel-Cohen incision, in terms of acute and chronic post-surgical pain and their subsequent influence in terms of quality of life. Electronic database searches formed the basis of the literature search and the following databases were searched in the time frame between January 1997 and December 2013: MEDLINE, EMBASE Sciencedirect and the Cochrane Library. Key search terms included: “acute pain”, “chronic pain”, “Pfannenstiel incision”, “Misgav-Ladach”, “Joel Cohen incision”, in combination with “Caesarean Section”, “abdominal incision”, “numbness”, “neuropathic pain” and “nerve entrapment”. Data on 4771 patients who underwent caesarean section (CS) was collected with regards to the relation between surgical techniques and postoperative outcomes defined as acute or chronic pain and future pregnancy desire. The Misgav-Ladach incision was associated with a significant advantage in terms of reduction of post-surgical acute and chronic pain. It was indicated as the optimal technique in view of its characteristic of reducing lower pelvic discomfort and pain, thus improving quality of life and future fertility desire. Further studies which are not subject to important bias like pre-existing chronic pain, non-standardized analgesia administration, variable length of skin incision and previous abdominal surgery are required.     

Potential problems of ascorbate and iron supplementation: pro-oxidant effect in vivo?

The comparison was undertaken between the effects of ascorbate versus ascorbate plus iron supplementation on DNA damage. Twenty healthy subjects with initial levels of plasma ascorbate of 67.2 +/- 23.3 micromol/l were randomly assigned to and cycled through one of three supplementation regimes: placebo, 260 mg/d ascorbate, 260 mg/d ascorbate plus 14 mg/d iron for 6 weeks separated by 8-week washout periods. Supplementation did not cause a rise in total oxidative DNA damage measured by GC-MS. However, a significant decrease occurred in levels of 8-oxo-7,8-dihydroguanine by ascorbate supplementation and 5-hydroxymethyl uracil by both ascorbate and ascorbate plus iron supplementation, relative to the pre-supplemental levels but not to the placebo group. In addition, levels of 5-hydroxymethyl hydantoin and 5-hydroxy cytosine increased significantly, only relative to pre-supplementation, by ascorbate plus iron treatment. No compelling evidence for a pro-oxidant effect of ascorbate supplementation, in the presence or absence of iron, on DNA base damage was observed.