Health and Quality of Life Outcomes最新文献

Background: To measure and value the health-related quality of life (HRQOL) of Chinese Multiple sclerosis (MS) patients, and to explore the influencing factors.

Methods: A national online survey amongst the patients was conducted in July 2022. Information on patient demographics, clinical characteristics (MS subtype and disability status), and the HRQOL measured by EQ-5D-5L were collected. Disability status was classified based on the self-reported Expanded Disability Status Scale (EDSS). Both the Tobit and logistic regression models were adopted to assess the impact of clinical characteristics on HRQOL with the adjustment of demographic characteristics.

Results: A total of 733 eligible patients (mean age 34.31 years; 67.7% females) were included in the analysis. The mean EQ-5D-5L health utility score (HUS) and VAS score were 0.73(SD:0.29) and 68.7(SD:23.9), respectively. MS patients reported a high prevalence of health problems in all the EQ-5D dimensions, ranging from 25.6% (self-care) to 74.9% (anxiety/depression). According to Tobit regression analyses, secondary progressive MS was associated with lower VAS compared to relapsing-remitting MS. Worse disability status measured by EDSS was related to the lower HUS and VAS scores. Demographic characteristics including younger age, higher education level, and employment were also identified as protective factors of the patients' HRQOL.

Conclusions: This study assessed HRQOL of Chinese MS patients using the EQ-5D-5L. Our finding revealed that MS subtypes and disability status are the most important factors affecting their HRQOL.

Background: Lung cancer is one of the most frequently diagnosed cancers, and the leading cause of cancer deaths worldwide. Surgical resection is the primary curative treatment. The World Health Organization (WHO) recommends that all adults, including cancer survivors, should engage in at least 150 to 300 min of moderate-intensity aerobic physical activity per week. Positive associations have been found between self-reported physical activity and health-related quality of life (HRQoL) after lung cancer surgery. However, there is a lack of studies concerning objectively measured physical activity levels, and longer follow-ups are also missing. This study investigated the relationship between objectively measured physical activity levels and HRQoL in patients 3 and 12 months after lung cancer surgery.

Methods: Utilizing a cross-sectional design, patients were followed up 3 (n = 83) and 12 (n = 57) months after lung cancer surgery. HRQoL was assessed with the cancer-specific questionnaire EORTC QLQ-C30 and the lung-cancer-specific module LC13. Physical activity was measured with a tri-axial accelerometer (ActiGraph GT3X+).

Results: At 3 months after surgery, 51% (n = 42) of the patients reached the level of physical activity recommended by the WHO; the corresponding result at 12 months was 42% (n = 24). Patients who reached the recommended level of physical activity reported a better HRQoL, with better global health status and physical function as well as lower symptoms of fatigue, at both 3 and 12 months postoperatively.

Conclusions: Physical activity was positively associated with HRQoL. Encouraging and supporting patients to engage in regular physical activity could contribute to better HRQoL after lung cancer surgery.

Trial registration: The trial was registered at ClinicalTrials.gov (NCT01961700), registration date 20,131,009.

Objective: With survival steadily improving among people living with HIV(PLWH), quality of life (QoL) has emerged as the ultimate benchmark of therapeutic success. We therefore aimed to develop and validate machine learning models that predict QoL trend in PLWH, identifying key determinants to inform personalized interventions and optimize long-term well-being.

Methods: In this longitudinal observational study, PLWH were recruited from March 2024 to December 2024. Sociodemographic and clinical variables were collected, and the 31-item WHOQOL-HIV BREF was adopted as the QoL measure. The symptom experience was assessed using the Self-Report Symptom Scale (SRSS). All variables were incorporated into machine learning models to develop predictive algorithms.

Results: This study included 676 eligible participants with HIV in the cohort. The Gaussian Process (GP) model demonstrated the highest testing AUC of 0.811 and 0.815 in the training dataset. The GP model excels in metrics such as accuracy, AUC, recall, precision, F1 score, Kappa, MCC, Log Loss, and Brier score. In the decision curve analysis (DCA), the five machine learning models exhibited similar net benefits over a broad range of threshold probabilities (ranging from 0.2 to 0.8) compared to the Random Forest (RF) model. The GP and the MLP showed enhanced net benefits at intermediate to high threshold probabilities (30 ~ 60%). The SHAP technique identified the top four predictors of QoL, ranked by importance, with symptom burden being highlighted as the most critical predictor variable.

Conclusions: The machine-learning model, predominantly a GP model, demonstrated the better predictive performance among the six models evaluated, for detecting the QoL predictor in PLWH, indicating that symptom burden influences QoL level. Our findings highlight a non-linear relationship between ART duration and QoL, with diminished well-being during mid-treatment (6 ~ 10 years) linked to treatment fatigue and cumulative toxicities, emphasizing the necessity of dynamic psychosocial support and tailored interventions to sustain long-term QoL in HIV care.

Background: Preference-based measures of health-related quality of life (HRQoL), such as the Short Form Six-Dimension (SF-6D) is essential for health economic evaluations. However, these measures are rarely included in clinical trials for lung cancer. This study aims to develop mapping algorithms to predict SF-6D health utility scores from the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core (EORTC QLQ-C30) and Quality of Life Questionnaire-Lung Cancer 13 (QLQ-LC13).

Method: The study sample comprised a Chinese population with lung cancer (n = 625). Traditional regression techniques, including Ordinary Least Squares regression, Generalized Linear Model, as well as machine learning techniques, such as Gradient Boosting Tree, Support Vector Regression, Ridge Regression are used. Five-fold cross-validation was performed. The performance metrics used to evaluate the models including R², root mean square error (RMSE),mean absolute error (MAE) and mean absolute percentage error (MAPE) were used to screen the optimal model.

Results: The mean and median of SF-6D health utility values were 0.774 (SD = 0.154) and 7.795, respectively. The model with the best mapping performance was the Ridge regression model Five-fold cross-validation (CV) results show that the Ridge regression model has the best mapping performance, the final prediction indexes are R² = 0.753, RMSE = 0.074, MAE = 0.057, MAPE = 8.169%.

Conclusions: This study developed an optimized mapping algorithm to predict the utility index from the QLQ-C30 QLQ-LC13 to the SF-6D. This algorithm offers provides an effective alternative for estimating SF-6D estimation when the preference-based health utility values are unavailable.

Background: Children and adolescents represent a distinct population with specific healthcare needs, requiring appropriate consideration in health-related quality of life (HRQoL) measurements and economic evaluations. In Pakistan, the absence of local value sets for children and adolescent health states and the limited application of health technology assessment (HTA) pose challenges to informed equitable decision-making and resource allocation. Valuing children and adolescents' health involves methodological and ethical complexities, particularly in determining whose preferences should be considered and how trade-offs between length and quality of life should be addressed. This study aimed to explore the views of key national stakeholders on these valuation issues to inform the development of a localized EQ-5D-Y-3 L value set for Pakistan.

Methods: A total of 12 stakeholders were identified via the investigators' network from different cities in Pakistan and diverse backgrounds. An in-person 3.5-hour meeting was held in Islamabad to discuss a range of topics including (a) the need for a Pakistani value set for the EQ-5D-Y-3 L, (b) willingness to pay more for quality-adjusted life-year (QALY) gains for children versus adults, (c) source of health preferences (adults vs. children), (d) potential ethical concerns and, (e) other challenges in a youth valuation to obtain deeper insights for understanding of the health valuation. The session was recorded, transcribed, and summarized.

Results: Stakeholders confirmed that QALYs have not yet been widely used in Pakistan's healthcare system, although HRQoL instruments like EQ-5D-3 L and EQ-5D-5 L are increasingly applied by researchers for evidence generation. Stakeholders agreed that adolescents aged 11 and above can complete valuation tasks and should be involved in data collection. Moreover, 33% of stakeholders (4 out of 12) specifically recommended using adult preferences initially due to budgetary and technical constraints, while 66% (8 out of 12) did not explicitly oppose using adult preferences initially, they emphasized the importance of involving adolescents in the process either concurrently or in subsequent phases. Participants acknowledged that societal willingness to pay more per QALY for children varied, with some viewing it as a strategic investment. Ethical concerns about life-year trade-offs for children were not seen as major barriers in the local context. Parents or caregivers were deemed the most appropriate proxy respondents when self-reporting was not possible. Challenges identified included limited awareness of QALYs among policymakers, scarce local utility data, technical capacity gaps, and constrained health budgets.

Conclusion: Pakistani stakeholders encouraged the use of health valuation data such as the EQ-5D-Y-3 L measures in decision-making and provided useful perspectives to youth valuat

Background: Physical symptoms negatively affect lung cancer patients' emotional well-being and quality of life. It remains understudied about what psychosocial factors may buffer the negative impact of physical symptoms. This study examines how illness perceptions moderate the impact of physical symptoms on depression and quality of life, and further considers gender differences.

Methods: A cross-sectional study was conducted on 316 lung cancer patients from Shanghai Chest Hospital in Shanghai, China, between July and September 2021. Participants completed questionnaires assessing physical symptoms, depression, quality of life, and illness perceptions.

Results: Hierarchical regression analyses revealed significant two-way interactions between physical symptoms and illness timeline perceptions on both depression (β = 0.12, P = 0.028) and quality of life (β = -0.13, P = 0.010). Additionally, significant three-way interactions involving physical symptoms, illness perceptions, and gender were found. Specifically, illness consequences perceptions interacted with physical symptoms and gender to predict depression (β = 0.17, P = 0.012), while personal control (β = 0.14, P = 0.022) and treatment control (β = 0.17, P = 0.017) interacted similarly to predict quality of life. Simple slope analyses indicated that positive illness perceptions alleviated the negative effects of physical symptoms on depression and quality of life, particularly in females.

Conclusions: These findings indicate that facilitating positive illness perceptions may buffer the adverse effects of physical symptoms on depression and quality of life. Personalized psychological interventions aimed at enhancing patients' illness beliefs through positive psychological and behavioral strategies may contribute to improved coping and overall well-being.

Background: Obstructive sleep apnea (OSA), a serious sleep disorder, can lead to comorbidities and decreased quality of life if untreated. Poor sleep quality from OSA affects concentration, cognitive function, and mental health, contributing to conditions such as depression and anxiety. OSA prevalence increases with age, and middle-aged adults are particularly at risk owing to age-related social and physical changes. Enhancing sleep quality is essential for improving overall quality of life. The aim of this study was to investigate the relationship between OSA risk and quality of life among middle-aged and older adults in South Korea.

Methods: This study utilized data from the 8th Korea National Health and Nutrition Examination Survey for 2019 and 2021 to investigate the relationship between OSA and health-related quality of life (HRQoL). After excluding missing values, the analysis included 8,109 adults aged ≥ 40 years. The primary variable of interest was OSA risk, with HRQoL measured using the HINT-8 index. Chi-square tests, binary logistic regression, and multinomial logistic regression analyses were conducted to examine the association between OSA and HRQoL.

Results: In this study of 4,831 participants, 59.6% were classified as high-risk for OSA. Low quality of life was significantly associated with high-risk OSA (adjusted odds ratio [aOR], 1.17: 95% confidence interval [CI], 1.03-1.33). Subgroup analyses showed higher odds of low quality of life in high-risk OSA individuals, particularly among those not engaged in economic activity (aOR, 1.39; 95% CI, 1.15-1.67), those who consumed alcohol (aOR, 1.24; 95% CI, 1.03-1.49), and those with limited physical activity (aOR, 1.21; 95% CI, 1.03-1.43). Higher OSA risk correlated with poorer quality of life, especially in the lowest quality of life category (aOR, 2.49; 95% CI 1.18-3.43).

Conclusions: The study found that middle-aged and older adults in South Korea at high risk for OSA had a lower quality of life than those at low risk. High-risk individuals who were economically inactive, consumed alcohol, or engaged in low physical activity also showed a lower quality of life. Future research should focus on accurately measuring OSA and further exploring its impact on quality of life in this population.

Background: The AP-7D is a preference-based measure that was recently developed for use in East and Southeast Asia. This study investigated the reliability and convergent validity of the new instrument.

Methods: For this, surveys were conducted in Japan, Korea, China, Thailand, and Singapore. In each country, 500 respondents were selected using quota sampling and were stratified by sex and age. We conducted a face-to-face survey in Japan and a web-based survey in the remaining countries at two time points. The AP-7D and the EQ-5D-5L were collected from all countries, and the SF-6D was only collected in Japan. The instruments' reliabilities were confirmed by comparing the responses using self-report test-retest methods. For convergent validity, we compared responses provided to the AP-7D with those provided to the EQ-5D-5L and the SF-6D based on predetermined hypotheses.

Results: The percentage of agreement between the two surveys (in separate categories) was 73.9% (pain/discomfort), 71.2% (mental health), 68.6% (energy), 89.6% (mobility), 82.1% (work/school), 84.3% (social relations), and 86.4% (burden to others) in the five countries. These values demonstrate equivalent performance to those of the EQ-5D-5L. The kappa coefficients for the AP-7D items were similar to those for the EQ-5D-5L. In the correlation matrix between the AP-7D and EQ-5D-5L, correlation exceeded 0.5 in the following items: 0.69 between "mental health" (AP-7D) and "anxiety/depression" (EQ-5D-5L), 0.54 for "pain/discomfort" in both, 0.51 between "energy" (AP-7D) and "anxiety/depression" (EQ-5D-5L), and 0.50 for "mobility" in both.

Conclusions: The results of this survey showed the good test-retest reliability and convergent validity of the AP-7D. The basic psychometric properties of the new instrument were confirmed.