Health and Quality of Life Outcomes最新文献

Background: Older people (aged 65 years and over) frequently present to urgent or emergency care settings, often with multiple health and social care needs. Despite this, their quality-of-life (QOL) is rarely assessed in a systematic or meaningful way. Capturing QOL in these settings is essential for delivering person-centred care for guiding improvements in service planning and delivery. This study aimed to evaluate the construct validity of the Quality-of-life - Aged Care Consumers, (QOL-ACC), an older people specific QOL instrument, in the context of urgent or emergency care.

Methods: Data were collected via an online survey which included demographic questions, the QOL-ACC, the EQ-5D-5L (a health-specific measure), the Urgent Care Questionnaire (UCSQ) and global self-reported health and QOL questions. Construct validity was assessed through Convergent and known-group validity. Convergent validity was assessed using 13 a priori hypotheses predicting correlations between the QOL-ACC and its dimensions and the other validated instruments. Known group validity was assessed with four a priori hypotheses comparing QOL-ACC scores across subgroups defined by self-rated health and QOL, areas of socio-economic advantage and disadvantage care needs at home.

Results: Among 205 respondents (mean age 75 ± 6.0 years, 59% female), 37 (18.0%) were receiving home-based aged care services. The QOL-ACC utility scores demonstrated moderate correlation with the EQ-5D-5L (ρ = 0.60) and the EQVAS (ρ = 0.57). Low to moderate correlation was demonstrated with the 3 dimensions of the UCSQ (ρ = 0.27 ρ = 0.34, ρ = 0.37). The QOL-ACC was able to discriminate between groups with different self-rated health and QOL levels (P < 0.001). No significant differences were observed by areas of socio-economic advantage and disadvantage nor by care needs at home.

Conclusions: The QOL-ACC demonstrated strong construct validity for assessing QOL in older people accessing urgent or emergency care. Its ability to distinguish between self-rated health and QOL, with consistent scores across socio-economic groups and care use, supports its broad applicability. Further research is needed to assess its reliability and responsiveness in these settings.

Background: The quality of life of schizophrenics is an important public health issue, but studies exploring the mechanisms that contribute to the quality of life are still lacking. We aimed to investigate the relevance of social support, anxiety and depression symptoms on the quality of life in community-dwelling schizophrenics, particularly the mediating roles of these symptoms between social support and quality of life.

Methods: Data were collected from a cohort study of community-dwelling schizophrenics in west China. The relationship between main variables was discussed through correlation analysis. Causal mediation analysis was used to explore the direct effect of social support on patients' quality of life and the indirect effect through anxiety and depression symptoms.

Results: Of 915 included participants, the mean age was 50.85 (SD = 12.48) years, and 437 (47.76%) were males. Social support was negatively correlated with anxiety and depression symptoms and positively correlated with quality of life. Anxiety and depression symptoms were both negatively correlated with quality of life. The results of parallel multiple mediation analysis showed that anxiety and depression symptoms jointly mediated this association. The total natural indirect effect of social support on physical health was 0.060 (95%CI: 0.036, 0.089) and on mental health was 0.084 (95%CI: 0.046, 0.127). But no significant direct effect was found in the multiple mediation analysis of social support on mental health.

Conclusions: Social support can affect quality of life either directly or indirectly through anxiety and depression symptoms in community-dwelling schizophrenics. It may provide references for subsequent studies on related mechanisms of action.

Objective: The aim of this study was to adapt the original English Breakthrough Pain Assessment Tool (BAT) into a Chinese version (BAT-C), following Beaton's cross-cultural adaptation guidelines, and evaluate its psychometric properties among cancer patients, thereby providing a foundation for the standardized and evidence-based assessment of breakthrough pain in this population.

Methods: This study employed a cross-sectional design for psychometric validation. The English BAT underwent cultural adaptation according to Beaton' s cross-cultural adaptation framework to develop the BAT-C. A convenience sampling strategy was utilized to recruit 310 cancer patients with breakthrough pain from four tertiary hospitals in Hebei Province, with data collected to examine the psychometric properties (reliability and validity) of the BAT-C.

Results: Pre-test analysis revealed no significant ceiling or floor effects. The BAT-C comprises nine items organized into two dimensions-Severity and Impact of Breakthrough Pain, Onset Characteristics and Medication Effectiveness-alongside five open-ended items. Item-level content validity indices (I-CVI) ranged from 0.833 to 1.000, while the scale-level content validity index (S-CVI/Ave) reached 0.976. Exploratory factor analysis extracted two common factors explaining 82.521% of the cumulative variance. Confirmatory factor analysis confirmed acceptable model fit, with indices as follows: χ²/df = 1.733, RMSEA = 0.061, CFI = 0.988, TLI = 0.983, IFI = 0.988, and GFI = 0.953. Convergent validity was confirmed by composite reliability (CR) values of 0.927 and 0.900, and average variance extracted (AVE) values of 0.724 and 0.648. The scale demonstrated a Cronbach' s α of 0.869 (95% CI: 0.85-0.89, SE: 0.012), with dimension-specific coefficients of 0.937 and 0.861. McDonald' s ω was 0.947, with a hierarchical ω of 0.675; the Spearman-Brown coefficient was 0.828. Known-groups validity analysis indicated that, after controlling for confounding variables, the BAT-C significantly differentiated patients across ECOG performance statuses (P < 0.05, partial η² = 0.021).

Conclusion: The BAT-C exhibited robust psychometric properties in this sample, providing preliminary support for its clinical utility as an assessment instrument for breakthrough pain in Chinese cancer patients; however, further validation is warranted in larger and more diverse populations.

Objective: To develop algorithms mapping the Functional Assessment of Cancer Therapy-General Scale (FACT-G) onto the EuroQol 5-Dimension 5-level (EQ-5D-5 L) and the Short-Form Six-Dimension version 2 (SF-6Dv2) for patients with breast or colorectal cancers.

Methods: An online survey was conducted to collect responses to FACT-G, EQ-5D-5L, and SF-6Dv2 from cancer patients in Quebec, Canada (N = 202). Linear models including ordinary least squares (OLS), Censored Least Absolute Deviations (CLAD), the robust MM-estimator model (MM), as well as mixture models including two-part model (TPM), and beta-based mixture (betamix) model were used. Mean absolute error (MAE), root mean squared error (RMSE), R2, Bayesian information criteria (BIC), and limits of agreement (LOA) calculated using the five cross-validation to assess the predictive ability of the models. Furthermore, the distribution of observed versus predicted values was assessed using Bland-Altman plot.

Results: Based on RMSE and MAE, mixture models better performed than linear models. The betamix model with truncation that included domains and squared terms was the best-performing algorithm for EQ-5D-5 L (MAE = 0.0518, RMSE = 0.0744, R2 = 46.40%, and LOA=-0.166 to 0.165) and SF-6Dv2 (MAE = 0.1375, RMSE = 0.1764, R2 = 35.32%, and LOA=-0.356 to 0.337). EQ-5D-5 L and SF-6Dv2 utility scores for better health states and more severe health states were underestimated and overestimated, respectively.

Conclusion: This study developed robust algorithms to estimate EQ-5D-5 L and SF-6Dv2 utilities from FACT-G. Consistent with the recent literature, the betamix model outperformed all other econometric models considered in this study. This suggests that mixture models generally exhibit higher performance and are the best choice for mapping.

Objectives: This study aimed to assess the psychometric properties of the ICEpop CAPability measure for Adults (ICECAP-A) in patients with coeliac disease (CD) and compare its performance with EQ-5D-5L.

Methods: An online cross-sectional survey was conducted among 312 adult patients with CD in Hungary, who completed both the ICECAP-A and EQ-5D-5L. Psychometric properties assessed included distributional characteristics, convergent validity with the Gastrointestinal Symptom Rating Scale (GSRS), Satisfaction with Life Scale (SWLS), and known-group validity.

Results: Mean age was 35.8 years (range: 18-80), and 70.2% were female. On the ICECAP-A, 51% (attachment) to 81% (stability) of patients reported limitations, while on the EQ-5D-5L, 2% (self-care) to 41% (pain/discomfort) reported problems. Ceiling effect was not observed for the ICECAP-A (6.7%), but reached 38.8% for EQ-5D-5L. The mean index value was 0.85 for the ICECAP-A and 0.92 for the EQ-5D-5L. ICECAP-A correlated strongly with SWLS (r=0.698), moderately with EQ-5D-5L (r=0.551) and weakly with GSRS (r=-0.284). Both the ICECAP-A and EQ-5D-5L were able to differentiate between known groups based on general health status and relevant clinical variables (e.g. symptoms, comorbidities, duration on gluten-free diet and adherence to it); however, the EQ-5D-5L typically showed somewhat larger effect sizes.

Conclusion: This study is the first to validate ICECAP-A in patients with CD, demonstrating good psychometric performance, including strong convergent and known-group validity. Its ability to capture broader aspects of well-being supports its use as a valuable tool in outcome assessments for this patient population.