Health and Quality of Life Outcomes最新文献

Background: Parkinson's disease (PD) considerably impacts health-related quality of life (HRQoL) through motor and non-motor symptoms. The Parkinson's Disease Questionnaire-39 (PDQ-39) is the most widely used tool to assess HRQoL, encompassing eight dimensions and a Summary Index providing an overall score. Despite advances in machine learning (ML) for predicting disease symptoms and progression, its application to predict HRQoL across these dimensions remains underexplored.

Methods: This study uses complete-case data for 478 of 861 patients from PRISM, a cross-sectional observational survey conducted in six European countries in 2018-2019. Participants were adults with PD recruited through advocacy groups and clinical centers who completed online assessments, providing data on demographics, medication, comorbidities, and disease characteristics (Tolosa et al., 2021). ML models were trained to predict PDQ-39 dimensions and Summary Index scores (0-100; higher = worse HRQoL). Features were preselected using the Boruta algorithm on the training data. Model selection was based on the lowest mean RMSE from 100 bootstrap resamples on the training set. Selected models were then retrained using 1000 bootstrap resamples for robust performance estimation. Final performance was evaluated on a held-out 20% validation set using R², MAE, and RMSE. Feature importance was assessed using permutation importance with MAE loss (100 permutations) on the held-out validation set. Factor Analysis of Mixed Data (FAMD) was used to explore patterns between non-motor symptoms and PDQ-39.

Results: Selected models: xgbTree (Summary Index; Activities of Daily Living) and gaussprPoly (all other PDQ-39 dimensions). On the validation set, Summary Index/ Cognitions showed the strongest performance with R² = 0.56/0.53, MAE = 9.60/12.39, RMSE = 12.66/16.20. Permutation feature importance ranked the Non-Motor Symptoms Questionnaire score (sum of 30 non-motor symptoms, range 0-30) as the most important predictor across all models. FAMD showed clustering of Social Support, Bodily Discomfort, and Stigma dimensions with Anxiety.

Conclusions: Our findings demonstrate the critical role of non-motor symptoms in predicting HRQoL in patients with PD. While ML models effectively predict overall HRQoL and cognitive aspects, achieving comparable performance on other dimensions may require additional variables to reduce error. These insights emphasize comprehensive treatment strategies addressing both motor and non-motor symptoms.

Background: Postoperative symptom burden is considerable and markedly undermines the quality of life of esophageal cancer (EC) survivors. This study aimed to examine symptom clusters and the interrelationships among symptoms in postoperative EC survivors, with the goal of identifying core symptoms.

Methods: A cross-sectional study was conducted using the European Cancer Life Questionnaire and the EC-Specific Supplementary Questionnaire. EC survivors were recruited in Shandong between February 2023 and February 2024. Principal component analysis (PCA) was utilized to identify symptom clusters, while Gaussian graphical network models were used to estimate the network structure.

Results: A total of 460 EC survivors were included in the study, revealing three distinct symptom clusters: the reflux-dysphagia cluster, the respiratory-related symptom cluster, and the recovery-fatigue cluster. The final network model demonstrated interconnections among these symptoms. "Fatigue" (FA) exhibited the highest strength centrality, identifying it as the most prominent core symptom in the network. "Emotional functioning" (EF), "Fatigue" (FA), and "cognitive functioning" (CF) ranked highest in terms of bridge strengths. Additionally, the model showed excellent network stability.

Conclusions: EC survivors experienced significant postoperative symptom burden, with symptom network analysis revealing the complex interrelations among postoperative symptoms. This approach also identified core symptoms that play a crucial role in the network. Fatigue emerged as the most influential core symptom, highlighting the significance of targeted interventions to mitigate negative symptom interactions and improve quality of life.

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.