Anne-Sophie E. Darlington

Male sex and low physical activity are associated with reduced spine bone mineral density in survivors of childhood acute lymphoblastic leukemia.

Survivors of acute lymphoblastic leukemia (ALL) are at risk of osteoporosis and obesity. We studied bone mineral density (BMD), percent of fat mass (%FM), and activity levels in survivors of ALL treated without radiotherapy. Lumbar and total areal BMD (g/cm2) and %FM were measured in 28 survivors (aged 5.7‐14.7 years) of childhood ALL by dual‐energy X‐ray absorptiometry (DXA) scan (GE Lunar, Prodigy) an average of 5 years after completion of chemotherapy (UK Medical Research Council randomized trial protocol XI [UKALL XI]). One boy fractured his arm during treatment. Apparent volumetric lumbar BMD (BMD vol; g/cm3) was calculated and %FM was adjusted for sex and age (%FM adj). Physical activity was measured by accelerometer and questionnaire. The results were compared with 28 sex‐ and age‐matched healthy controls. Total body and lumbar areal BMD (g/cm2) were not different between the ALL group and the control group. However, mean lumbar BMD vol in survivors of ALL was significantly lower than in controls (0.303 ± 0.036 g/cm3 vs. 0.323 ± 0.03 g/cm3; p < 0.01), which mostly was caused by the difference in boys (0.287 ± 0.032 g/cm3 vs. 0.312 ± 0.027 g/cm3; p < 0.05). Weekly activity score by questionnaire was significantly lower in the ALL group than in the control group (geometric mean 50 vs. geometric mean 74; p < 0.05). Male gender, low activity levels and an intravenous (iv) high dose of methotrexate were associated with low lumbar BMD vol. Patients who received an iv high dose of methotrexate (n = 18) had significantly higher %FM adj than those with intrathecal methotrexate only (n = 10; 141 ± 70% vs. 98 ± 37%; p < 0.05). In conclusion, male survivors of childhood ALL have reduced lumbar BMD vol, whereas no such difference was seen in girls. Overall, survivors of ALL were physically less active than their healthy controls and lower activity correlated with lower lumbar BMD vol and higher %FM adj.

Coping strategies as determinants of quality of life in stroke patients: a longitudinal study

Background: Quality of life (QoL) is reduced for stroke patients and coping strategies have been suggested as determinants of QoL. Thus far the relationship between coping and QoL has only been examined in small-scale cross-sectional designs. Therefore, the current study set out to examine this relationship in a longitudinal setting. Methods: Stroke patients who were discharged home were interviewed at 4 different time points; just before discharge (T1), and 2 months (T2), 5 months (T3) and 9–12 months after discharge (T4). QoL was measured by the EQ-5D index score and the SF-36 utility score and coping expressed in terms of tenacious goal pursuit and flexible goal adjustment. Modified Rankin scale was assessed as a measure of general functioning. Results: Eighty stroke patients were included. Coping was not predictive of QoL at T1 and T2 but rather at T3 and T4. At T4 both coping strategies determined the levels of QoL as measured with the EQ-5D index score; higher levels of tenacious goal pursuit as well as flexible goal adjustment were associated with higher levels of QoL. This regression model explained 44% of the variance. Conclusions: Coping is a powerful determinant of QoL, but only more than 5 months after discharge; before this time QoL is mainly determined by general functioning. Both coping strategies were important determinants of QoL.

Determinants of quality of life in chronic liver patients

Health‐related quality of life of patients with chronic liver disease has been shown to be impaired in numerous studies. However, the factors which influence health‐related quality of life in treated chronic liver patients are not quite known. This is the first study to assess the impact of physical and psychosocial determinants on a weighted score of health‐related quality of life in patients with chronic liver disease.

Quality of life implications as a consequence of surgery: limb salvage, primary and secondary amputation.

Purpose. We investigated self-reported quality of life (QoL), body image and daily competence of patients as a consequence of limb salvage surgery (LSS), primary or secondary amputation, and the views of patients following secondary amputation. Patients. Patients (n=37) had all been treated for osteosarcoma or Ewings sarcoma in the lower limb. Methods. QoL was measured by questionnaire. A separate interview to determine satisfaction with decision-making was conducted with those treated for secondary amputation. Results. For the total group, QoL was below that expected from population norms. There were no differences in QoL between those undergoing LSS surgery compared with amputation. However, LSS reported better daily competence and were less likely to use a walking aid. For the total group, body image and daily competence were associated with better QoL. Discussion. All these patients are at risk of compromised QoL following surgery. Our data are in line with previous work suggesting outcomes may be better for LSS compared with amputation. Following secondary amputation, most patients (80%) did not regret initial LSS treatment, but felt that the time gained allowed them to come to terms with subsequent surgery.

The influence of temperament on weight gain in early infancy.

ABSTRACT. Difficult temperament has been associated with fast weight gain and slow weight gain, although the latter mostly in referred subjects studies in late infancy. The current study set out to investigate early weight gain in relation to all domains of temperament in a community-screened sample. Weight gain from birth to 8 weeks was assessed in 75 infants recruited from local health care clinics who had demonstrated slow, average, or fast weight gain. Mothers completed a temperament questionnaire and a 2-day diary recording infant behaviors (sleeping, feeding, fussing, and crying). Weight gain from birth to 8 weeks was significantly related to infant temperament. The temperament dimension fear (acceptance or rejection of new objects or persons) was related to slow weight gain and the temperament dimension distress to limitations (negative emotionality and the infants reaction to frustrating situations) was related to fast weight gain. The regression model explained 59% of the variance, with the temperament dimensions explaining 11%. Diary data showed that infants who scored high on fear tended to cry a lot, while infants with high scores on distress to limitations tended to sleep less and cry and fuss more. The results emphasize that different temperament domains influence slow and fast weight gain. In addition, the data suggest that infant temperament plays a part in physical development in early infancy.

A systematic review of health-related quality of life instruments in patients with cancer cachexia

PurposeAssessing the health-related quality of life (HRQOL) of cancer patients with cachexia is particularly important because treatments for cachexia are currently aimed at palliation and treatment efficacy must be measured in ways other than survival. The aim of this systematic review was to evaluate HRQOL assessment in cancer patients with cachexia.MethodsUsing guidance from the Centre for Reviews and Dissemination, relevant databases were searched from January 1980 to January 2012 with terms relating to cancer, cachexia and HRQOL for papers including adult cancer patients with cachexia or documented weight loss at baseline.ResultsWe found one cachexia-specific instrument, the Functional Assessment of Anorexia/Cachexia Therapy, but the tool has not been fully validated, does not cover all the relevant domains and the consensus-based standards for the selection of health status measurement instruments checklist highlighted a number of weaknesses in the methodological quality of the validation study. Sixty-seven studies assessed HRQOL in cachectic or weight-losing cancer patients. Most used generic cancer HRQOL instruments, limiting the amount of useful information they provide. A modified version of the Efficace minimum data checklist demonstrated that the quality of reporting on HRQOL tool use was inadequate in many of the studies. A negative relationship between HRQOL and weight loss was found in 23 of the 27 studies which directly examined this.ConclusionThere is a pressing need for a well-designed HRQOL tool for use with this patient group in both clinical trials and clinical practice.

Postpartum Depression After Mild and Severe Preeclampsia

OBJECTIVE To describe the prevalence of postpartum depressive symptoms after preeclampsia, to assess the extent to which the prevalence of postpartum depressive symptoms differs after mild and severe preeclampsia, and to investigate which factors contribute to such differences. METHODS Women diagnosed with preeclampsia (n=161) completed the Edinburgh Postnatal Depression Scale (EPDS) at 6, 12, or 26 weeks postpartum. Multiple logistic regression analysis was used to investigate the association between severity of preeclampsia, contributing factors and postpartum depression (PPD) (1) at any time during the first 26 weeks postpartum and (2) accounting for longitudinal observations at three time points. RESULTS After mild preeclampsia, 23% reported postpartum depressive symptoms at any time up to 26 weeks postpartum compared to 44% after severe preeclampsia (unadjusted odds ratio [OR] 2.65, 95% confidence interval [CI] 1.16-6.05) for depression at any time up to 26 weeks postpartum (unadjusted OR 2.57, 95% CI, 1.14-5.76) while accounting for longitudinal observations. Admission to the neonatal intensive care unit (NICU) (adjusted OR 3.19, 95% CI 1.15-8.89) and perinatal death (adjusted OR 2.96, 95% CI 1.09-8.03) contributed to this difference. CONCLUSIONS It appears that not the severity of preeclampsia itself but rather the consequences of the severity of the disease (especially admission to the NICU and perinatal death) cause postpartum depressive symptoms. Obstetricians should be aware of the high risk of postpartum depressive symptoms after severe preeclampsia, particularly among women whose infant has been admitted to the NICU or has died.

A PROSPECTIVE STUDY ON COPING STRATEGIES AND QUALITY OF LIFE IN PATIENTS AFTER STROKE, ASSESSING PROGNOSTIC RELATIONSHIPS AND ESTIMATES OF COST-EFFECTIVENESS

OBJECTIVE To examine the prognostic value of coping strategies of patients after stroke at time of discharge on quality of life approximately one year later. In addition, we estimated the maximum cost of improving quality of life by enhancing coping strategies using strict assumptions. METHODS Eighty patients with a stroke completed several questionnaires, at discharge to home and 9-12 months later (follow-up). Questionnaires measured quality of life, coping strategies Tenacious Goal Pursuit and Flexible Goal Adjustment. First, a regression analysis was carried out predicting quality of life at follow-up from coping strategies at discharge. Secondly, a maximum in terms of acceptable cost was calculated for several possible effect sizes. RESULTS Both coping strategies at discharge were positively associated with quality of life at follow-up. With regards to cost-effectiveness, a medium effect size would result in an increase in quality of life of approximately 10%. The maximum acceptable cost of an intervention for a single patient is therefore set at euro2500, assuming a benefit of one year and a cost per quality adjusted life year of euro25,000. CONCLUSION Coping strategies at discharge are predictive of quality of life one year later. The costs of improving quality of life are thought to be within the limits that determine a cost-effective intervention.

Psychological Determinants of Health-Related Quality of Life in Patients With Chronic Liver Disease

Background: The negative impact of chronic liver disease on health-related quality of life (HRQoL) of patients with chronic liver disease (CLD) has long been established, and treatable physiological or psychological factors may potentially influence HRQoL. Objective: The authors assessed the interrelationships of multiple psychological factors and HRQoL in patients with CLD. Method: Both direct and indirect relationships among HRQoL, depression, anxiety, coping, and self-efficacy in 164 patients with CLD were assessed. Results: Depression, largely determined by low self-efficacy and, possibly, by use of maladaptive coping strategies, influenced HRQoL in three groups of liver patients. Conclusion: HRQoL in CLD patients may be positively affected by enhancing coping and self-efficacy skills, thus improving levels of depression. (Psychosomatics 2010; 51:157–165)

Determinants of Somatic Complaints in 18-month-old Children: The Generation R Study

OBJECTIVE To investigate the effect of child temperament, maternal psychologic symptoms, maternal chronic pain, and parenting stress on childrens somatic complaints. METHODS The study was embedded in the Generation R Study, a population-based cohort study. Child somatic complaints were assessed via mother-report in 5,171 children of 18 months of age. Questionnaires assessed maternal somatic symptoms, symptoms of depression, anxiety during pregnancy and 2 months after delivery, maternal chronic pain during pregnancy, parenting stress 18 months after birth, and mother-reported child temperament 6 months after birth, as the determinants. RESULTS Fearful temperament, temperamental falling reactivity, maternal somatic symptoms, anxiety symptoms, and parenting stress each independently and prospectively increased the likelihood of childrens somatic complaints at 18 months of age. CONCLUSIONS In toddlers, temperament, maternal stress, and maternal somatic symptoms seem particularly important for the development of somatic complaints, but long-term research is needed to establish causality and predictive value of these factors.