Anna-Mari Aalto

Quality of life and cost-effectiveness of levonorgestrel-releasing intrauterine system versus hysterectomy for treatment of menorrhagia: a randomised trial

BACKGROUND Heavy menstrual blood loss is a common reason for women to seek medical care. The levonorgestrel-releasing intrauterine system (IUS) is an effective medical treatment for menorrhagia. We report a randomised comparison of this approach with hysterectomy in terms of the quality of life of women with menorrhagia and cost-effectiveness. METHODS Of 598 women referred with menorrhagia to five university hospitals in Finland, 236 were eligible and agreed to take part. They were randomly assigned treatment with the levonorgestrel-releasing IUS (n=119) or hysterectomy (n=117). The amount of menstrual blood loss was objectively measured. The primary outcome measure was health-related quality of life at 12-month follow-up. Analyses were by intention to treat. FINDINGS In the group assigned the levonorgestrel-releasing IUS, 24 (20%) women had had hysterectomy and 81 (68%) continued to use the system at 12 months. Of the women assigned to the hysterectomy group, 107 underwent the operation. Health-related quality of life improved significantly in both the IUS and hysterectomy groups (change 0.10 [95% CI 0.06-0.14] in both groups) as did other indices of psychological wellbeing. There were no significant differences between the treatment groups except that women with hysterectomy suffered less pain. Overall costs were about three times higher for the hysterectomy group than for the IUS group. INTERPRETATION The significant improvement in health-related quality of life highlights the importance of treating menorrhagia. During the first year the levonorgestrel-releasing IUS was a cost-effective alternative to hysterectomy in treatment of this disorder.

Health related quality of life among insulin-dependent diabetics: disease-related and psychosocial correlates

This crossectional questionnaire study examined the associations of health factors and psychosocial factors with Health Related Quality of Life (HRQOL) in a sample of adult type I diabetic patients (n = 385). Health related quality of life was measured by the Finnish version of MOS SF-20. Psychosocial measures were general social support, diabetes-specific social support, diabetes locus of control (DCL), self-efficacy, diabetes health beliefs and self-care practices. In multivariate analyses, limitations in physical functioning showed strong associations with perceived health (beta = -0.33, P < 0.001), role functioning (OR = 38.54, 95% CL 10.73-139.56), social functioning (OR = 7.05, 95% CL 2.88-17.27) and pain (OR = 7.89, 95% CL 4.26-14.47), and was moderately associated to mental health (beta = -0.12, P < .01). Duration of diabetes and glycemic control were not related to HRQOL dimensions. Adequacy of social support was related to all HRQOL domains apart from pain and role functioning. The most important diabetes-related psychosocial factors were self-efficacy, and diabetes-related social support. Diabetes-specific factors were more important among those in good physical condition.

Depression and C-reactive protein: population-based Health 2000 Study.

Objective: To test whether depression is independently associated with elevated levels of C-reactive protein (CRP) in a large nationwide population-based sample. Methods: Depression and CRP were assessed in 6005 Finns aged >30 years, as part of the ongoing population-based Health 2000 Study. Depression was determined by responses to the Beck’s Depression Inventory (BDI-21) and by Composite International Diagnostic Interview (CIDI). Results: Higher scores on BDI-21 were related to higher CRP levels (&bgr; = 0.12, p < .001) in men and (&bgr; = 0.08, p < .001) in women. In men, but not in women, this relationship persisted after adjustment for a number of other known risk factors. In men, the more recent dysthymic disorder or at least moderate depressive episode defined using CIDI was related to elevated CRP levels (&bgr; = 0.06, p = .006). Conclusions: Depressive symptoms may be partly responsible for inflammatory processes, and inflammatory processes may induce depressive symptoms in men. CRP = C-reactive protein; LDL = low-density lipoprotein; HDL = high-density lipoprotein; CHD = cardiovascular heart disease.

Is the Evaluation of the Global Quality of Life Determined by Emotional Status

The present study investigated relationships between global QOL perceptions and well-being dimensions. Especially our goal was to evaluate the impact of generally recognised four broad dimensions of QOL (physical, functional, social and emotional well-being) on global QOL perceptions, additionally persons satisfaction with life achievements and economical situation were measured as well as social demographic variables. The subjects were a representative sample of Finns (n = 4613, from 25 to 65 years) of the FINRISK-97 study. Correlation coefficients and models of hierarchical regression indicated that physical, functional and social well-being as well as sociodemographic factors and satisfaction with life achievements are important factors of global QOL perceptions both among males and females. However percentages of variances explained with these measures were only moderately high, ranging from 1 to 10%. After measures of emotional well-being were entered into the models of hierarchical analyses of regression, variances explained grew dramatically over 20%. The results of the study indicated that global QOL judgements are likely to be based on current emotional state.

Physical activity and change in quality of life during menopause -an 8-year follow-up study

Background and objectivesThe aim of this study was to study the role of menopausal status and physical activity on quality of life.MethodsA total of 1,165 Finnish women aged 45-64 years from a national representative population-based study were followed up for 8 years. Study participants completed the Health 2000 study questionnaire and follow-up questionnaire in 2008. Ordinal logistic regression analysis was used to measure the effect of menopausal status on global quality of life (QoL). Other variables included in the analyses were age, education, change of physical activity as assessed with metabolic equivalents, change of weight and hormone therapy (HRT) use.ResultsPeri- and postmenopausal women increased their physical activity (28% and 27%) during the eight-year follow up period slightly more often than premenopausal (18%) women (p = 0.070). Menopausal status was not significantly correlated with change of QoL. QoL of the most highly educated women was more likely to improve than among the less educated (eb = 1.28, 95%CI 1.08 to 1.51 p = 0.002). Women whose physical activity increased or remained stable had greater chances for improved QoL than women whose physical activity decreased (eb = 1.49, 95%CI 1.23 p < 0.001 to 1.80, eb = 1.46, 95%CI 1.24 to 1.73 p < 0.001 respectively). Women whose weight remained stable during follow-up also improved their QoL compared to women who gained weight (eb = 1.26, 95%CI 1.07 to 1.50 p > 0.01). Women who had never used HRT had 1.26 greater odds for improved QoL (95%CI 1.02 to 1.56 p = < 0.05).ConclusionImprovement of global QoL is correlated with stable or increased physical activity, stable weight and high education, but not with change in menopausal status.

General health and quality-of-life measures in active, recent, and comorbid mental disorders: a population-based health 2000 study.

AIMS We studied the impact of comorbidity and recency in psychiatric disorders on psychological well-being, perceived health, and quality of life and compared their effect with the effect of a chronic medical condition, type 2 diabetes mellitus. METHODS Established instruments for psychological distress (12-item General Health Questionnaire [GHQ-12]), self-rated general health, and health-related quality of life (EQ-5D and 15D) were administered for the participants of the nationwide Finnish Health 2000 survey. The diagnoses of depressive, anxiety, and alcohol use disorders and their unique comorbid combinations were based on the Munich version of the Composite International Diagnostic Interview (M-CIDI). RESULTS People with comorbid anxiety and depressive disorders had the highest distress and lowest health and quality-of-life ratings on all scales. The effects of mental disorders on health-related quality of life and self-rated health were comparable to the effects of diabetes. Type 2 diabetes mellitus and alcohol use disorder were associated with minimal, although statistically significant, increase of psychological distress. Symptom recovery from an active depressive disorder associated with improved well-being on all measures, but residual ill-being was also remarkably common among the partly or fully recovered in all disorder categories. CONCLUSIONS Even in comparison with a chronic physical illness such as diabetes, comorbid psychiatric disorders have a high impact on psychological well-being, perceived health, and quality of life, when evaluated by simple, useful, and feasible self-rating scales. The scales used may be useful in monitoring the severity and course of psychiatric conditions. Recognizing and treating psychiatric comorbidity is important in improving the quality of life of psychiatric patients.

Ways of coping with asthma in everyday life: Validation of the Asthma Specific Coping Scale

OBJECTIVE This study examines the validity of the Asthma Specific Coping Scale. METHODS Study samples were comprised of persons with drug-treated asthma (n=3464) drawn from the Drug Reimbursement Registry and asthma rehabilitation participants [brief (n=278) and comprehensive (n=316) intervention]. Data were collected by questionnaires. RESULTS The expected structure of the six subscales (restricted lifestyle, hiding asthma, positive reappraisal, information seeking, ignoring asthma, and asthma worry) was supported. The Cronbachs alpha reliabilities of the subscales ranged from .63 to .84. Concurrent validity was supported by meaningful correlations between asthma coping scales and psychosocial resources, health-related quality of life, and general coping. The asthma coping scales discriminated between the intervention participants and the population-based sample. Four out of six subscales also showed sensitivity to change after rehabilitation. CONCLUSION Though further longitudinal studies are needed, this scale seems to be a promising instrument to be used in surveys and outcome studies.

Carrier testing of children for two X linked diseases in a family based setting: a retrospective long term psychosocial evaluation

The question of whether genetic carrier testing should be performed on children has been the subject of much debate. However, one important element has been lacking from this debate. There has been practically no knowledge of how those tested in childhood have experienced carrier testing. Twenty three subjects in families affected by Duchenne muscular dystrophy and 23 in families affected by haemophilia A, all of whom had been tested during childhood for carriership in the Department of Medical Genetics, University of Helsinki, from 1984 to 1988, participated in our study. We investigated long term psychosocial consequences of carrier testing in childhood. A questionnaire relating to sociodemographic background and life situation was used, together with assessment of health related quality of life (HRQOL) using the RAND 36 item Health Survey 1.0 (RAND). RAND results showed that the emotional, social, and physical well being of the young female subjects was not statistically different from those of control female subjects at a similar age. We also found no statistically significant differences in means in any RAND dimension (p<0.146) between carriers, non-carriers, and a group in which carrier status was uncertain. However, two out of seven carriers reported that they were worried and three that they were slightly worried about the test result. Four out of 22 young female subjects in the uncertain group reported being worried and 11 reported being slightly worried.

Developing a short measure of organizational justice: a multisample health professionals study

Objectives: To develop and test the validity of a short version of the original questionnaire measuring organizational justice. Methods: The study samples comprised working physicians (N = 2792) and registered nurses (n = 2137) from the Finnish Health Professionals study. Structural equation modelling was applied to test structural validity, using the justice scales. Furthermore, criterion validity was explored with well-being (sleeping problems) and health indicators (psychological distress/self-rated health). Results: The short version of the organizational justice questionnaire (eight items) provides satisfactory psychometric properties (internal consistency, a good model fit of the data). All scales were associated with an increased risk of sleeping problems and psychological distress, indicating satisfactory criterion validity. Conclusion: This short version of the organizational justice questionnaire provides a useful tool for epidemiological studies focused on health-adverse effects of work environment.

Structural and functional aspects of social support as predictors of mental and physical health trajectories: Whitehall II cohort study

Background Social support is associated with better health. However, only a limited number of studies have examined the association of social support with health from the adult life course perspective and whether this association is bidirectional. Methods Participants (n=6797; 30% women; age range from 40 to 77 years) who were followed from 1989 (phase 2) to 2006 (phase 8) were selected from the ongoing Whitehall II Study. Structural and functional social support was measured at follow-up phases 2, 5 and 7. Mental and physical health was measured at five consecutive follow-up phases (3–8). Results Social support predicted better mental health, and certain functional aspects of social support, such as higher practical support and higher levels of negative aspects in social relationships, predicted poorer physical health. The association between negative aspects of close relationships and physical health was found to strengthen over the adult life course. In women, the association between marital status and mental health weakened until the age of approximately 60 years. Better mental and physical health was associated with higher future social support. Conclusions The strength of the association between social support and health may vary over the adult life course. The association with health seems to be bidirectional.