Paraskevi Theofilou

Measuring health: related quality of life in hemodialysis patients. Psychometric properties of the Missoula-VITAS Quality of Life Index (MVQOLI-15) in Greece

Different measuring tools have been used to understand the outcomes of end-stage renal disease (ESRD) therapies. However, survival, cost-effectiveness and quality of life (QOL) are the main parameters to evaluate treatment of ESRD. The current study meant to assess the psychometric properties (reliability and validity) of the Missoula-VITAS Quality of Life Index (MVQOLI-15) translation to Greek in patients undergoing hemodialysis (HD). A total sample of 79 HD patients voluntarily participated in this pilot study. Domain analysis of MVQOLI-15-Greek was conducted based on the collected data at initial assessment. The reliability properties of the instrument were tested using the following measures; internal consistency, repeatability, test-retest reliability and convergent validity. Domain analysis demonstrated that all domains of the questionnaire had good variability. MVQOLI-15-Greek internal consistency was satisfactory with an overall Cronbach’s a at 0.74. Pearson’s r and intraclass correlation coefficient revealed strong correlations (ranging from 0.91 to 0.98) between initial assessment and re-assessment. MVQOLI-15-Greek convergent validity analysis indicated that the domains were strongly related to the same construct. The findings of the study indicate that the Greek version of MVQOLI-15 provided satisfactory psychometric properties supporting its use within pathological populations and in the context of national QOL measurement.

Assessment of Burn-Out and Quality of Life in Nursing Professionals: The Contribution of Perceived Social Support.

Burnout has received increased research attention in recent years. The aim of the present study is to examine levels of burnout as well as quality of life (QOL) in nursing staff in Greece. The association of social support with burnout and QOL is also investigated. One-hundred individuals working in Mental and General Hospitals in the broader area of Athens will participate in this study. The measurement tools include i) the Maslach Burnout Inventory, ii) the SF-36 Health Survey and iii) the Multidimensional Scale of Perceived Social Support. Burnout and QOL are expected to be related to the evaluation of social environment.

Improvement of diabetic patients nursing care by the development of educational programs

Diabetes is a major health problem with many social and economic consequences in general population. The importance of education in the diabetic patient and his family, led to the development of diabetes clinical nurse specialist. The role of diabetes clinical nurse specialist is essential and crucial to the hospitals and the community, in order to form a relationship with the diabetic patient and his/her family. In this way health is promoted to the maximum extent possible. In conclusion educational programs help patients with diabetes to obtain information about their condition and improve their self-care skills.

Measuring Pain Self-Efficacy and Health Related Quality of Life Among Hemodialysis Patients in Greece: A Cross-Sectional Study.

Patients suffering from end-stage kidney disease often complain about pain. It is also known that the presence of chronic pain greatly impacts upon patients’ quality of life (QOL) and can play a crucial role in the co-morbidity of mental health symptoms such as depression and anxiety. The main aim of this study protocol is the investigation of pain self-efficacy, QOL as well as their relation in patients undergoing hemodialysis treatment. The final sample size will be around 70-80 patients. Each subject’s QOL and pain self-efficacy will be measured using the following instruments: i) the Missoula- ITAS Quality of Life Index-15 and ii) the Pain Self-Efficacy Questionnaire. QOL is expected to be related to pain self-efficacy scores. This probable association will be indicated performing regression as well as correlation analysis after controlling for gender, age, education and marital status.

Adherence and physical activity

Exercise training is an integral component in the management of many chronic, lifestyle - related diseases. Therapeutic exercise training is an accepted adjunct to medical therapy for two of the four leading causes of death - cardiovascular disease and chronic obstructive pulmonary disease (COPD) - and is considered one of the three cornerstones of treatment for diabetes mellitus. For each of these chronic conditions, the scientific literature clearly demonstrates that exercise is both beneficial and safe when applicable guidelines are followed.1-4 There is also abundant evidence supporting the health benefits of physical activity, including reduced risk for stroke, some cancers, osteoporosis, hypertension, high cholesterol, obesity, osteoarthritis, and all-cause mortality.5 Physical activity is also associated with improved psychological health and functional status,3 as well as reduced health - care expenditures.6 However, data show that a large proportion of adults do not meet physical activity recommendations, and this is a significant public health problem.7 These data also likely underestimate the problem of non-adherence, as adults tend to overreport physical activity levels in comparison to objective measures.8,9 Research suggests that inadequate adherence to exercise during the intervention period might attenuate the effectiveness of intervention.10,11 There are many categories of factors related to non-adherence to physical activity, e.g. demographic, health-related and biological, cognitive and psychological, behavioral, program-related and environmental.12,13 Social factors that have been studied as correlates of physical activity include exercise group cohesion, physician influence, and social support. Group cohesion has shown a modest positive correlation with adherence in some studies.14 However, physician influence and social supportive environment have been stronger and more consistent correlates of physical activity level and adherence.14 Physician advice to exercise has been reported as a correlate of physical activity among the general adult population.15 Social support has been significantly associated with physical activity in cross-sectional and prospective studies, both in community samples and within organized exercise groups.16 While both family and friend support for physical activity appear to be influential,14 the role of the spouse seems to be particularly important.16 Communication between the patient and the clinician is considered to be central to establishing effective patient rapport.17 Pizzari et al.18 have indicated that patients who had a positive relationship with their physiotherapists felt more inclined to attend their clinic appointments and complete their rehabilitation activities during these sessions. Also, adherence to physiotherapy exercise programs was found to be significantly greater when physiotherapists gave patients positive feedback, asked them for feedback about their progress and treatment, regularly monitored their exercise performance and frequently motivated them to do their home exercises.19 Conversely, physicians can be responsible for poor levels of adherence if they give patients too much information and if that information is not specific to their needs and disorder.20 Evaluation of patients’ exercise adherence as a factor in treatment success or failure is thus potentially complex, difficult, and time consuming.13 Future efforts to improve adherence may require individually - targeted interventions that consider important patient and disease characteristics.

Mental health, loneliness, and illness perception outcomes in quality of life among young breast cancer patients after mastectomy: the role of breast reconstruction

PurposeΤο explore the relationship between mental health (depression, anxiety, and stress), loneliness, and illness perception with health-related quality of life (HRQoL) in young breast cancer patients, within a year after mastectomy, and to investigate the role of breast reconstruction.MethodsEighty-one women with stage II breast cancer—35 with breast reconstruction and 46 without breast reconstruction—completed the Missoula-VITAS Quality of Life Index-15, the Depression Anxiety Stress Scale 21, the UCLA Loneliness Scale, the Brief Illness Perception Questionnaire, and a questionnaire with demographic and medical information. Statistical analysis was performed using IBM SPSS Statistics version 20.ResultsBreast reconstruction was a significant predictor of total HRQoL and its domains. Women with breast reconstruction had better HRQoL, significantly better mental health, less stress and anxiety levels but experienced more physical discomfort and perceived higher level of physical distress compared to the ones without breast reconstruction. On the contrary, patients without breast reconstruction had higher level of loneliness, which was found to be correlated with poor HRQoL and higher levels of anxiety. Negative illness perceptions were associated with poor HRQoL for both groups.ConclusionsBreast reconstruction is not a panacea for patients in improving HRQoL.

A modified version of the Greek Simplified Medication Adherence Questionnaire for hemodialysis patients

Non-adherence to the therapeutic regimen is an increasingly growing problem especially among patients undergoing hemodialysis. The aim of this study was to modify the Greek version of Simplified Medication Adherence Questionnaire (GR-SMAQ) for patients undergoing hemodialysis (GR-SMAQ-HD) and explore its validity and reliability. Between June 2016 and November 2016 a group of patients undergoing hemodialysis (N=107) completed the Greek version of SMAQ. The study was carried out in three Dialysis Units of Hospitals of Athens and Peloponnese region, Greece. The form of GR-SMAQ was modified specifically for renal patients while four additional items were added so as the tool study all aspects of adherence to hemodialysis regimen. Construct validity was checked through exploratory factor analysis with principal Component Analysis with the Equamax method. Test-retest reliability and internal consistency were tested. Statistical analysis was performed using the IBM SPSS Statistics version 21. The significance level was set up at 5%. The Greek version of SMAQ for patients undergoing hemodialysis includes eight questions. Three factors emerged from factor analysis. Cronbach’s a coefficient was 0.742 for the whole scale and for each subscale was for Medication Adherence 0.75, for Attendance at hemodialysis session 0.856 and for Diet/Fluid restriction was 0.717. The total mean score was 6.29 (±1.82). GR-SMAQ-HD is a reliable and valuable tool that can be used by hemodialysis nurses and students of nursing for detection of adherence levels in clinical practice.

The relation of psychological and sociodemographic variables to medication adherence in chronic obstructive pulmonary disease patients: a cross-sectional study in Greece

Several studies have shown that non- adherence is a common and increasing problem regarding the individuals with chronic illnesses, including chronic obstructive pulmonary disease (COPD) patients. The present study aimed to investigate the influence of psychological and sociodemographic variables on medication adherence among patients with COPD. A sample of 177 participants was recruited from three General Hospitals in the broader area of Athens, consisting of COPD patients. Measurements were conducted with the following instruments: the Medication Adherence Rating Scale (MARS), the Center for Epidemiologic Studies Depression Scale (CES-D) and the Multidimensional Health Locus of Control (MHLC). The results indicated that medication adherence was associated positively with the dimensions of internal health locus of control and doctors, measured by MHLC questionnaire. It was also related negatively to depression, measured by CES-D scale. The present study demonstrates the importance of depression in understanding medication adherence of COPD patients as well as the contribution of heath beliefs.

Perception of pain self-efficacy and fatigue in Greek patients with multiple sclerosis: a study protocol

The examination of the perception of pain and fatigue in patients with various health problems has received increased research attention in recent years. The aim of the present study protocol is to examine levels of pain self-efficacy and fatigue in a sample of Greek patients suffering from multiple sclerosis. The association of years and severity of diagnosis with the perception of pain self-efficacy and fatigue will be also investigated. Forty patients from the 3nd Neurological Department, Aristotle University of Thessaloniki (Greece) will participate in this study. The measurement tools include i) the Fatigue Assessment Scale, ii) the Pain Self Efficacy Questionnaire and iii) the Expanded Disability Status Scale. Test-retest reliability of the first two questionnaires will be assessed with the same patients rating their situation in a 10 days interval from the first examination in order to examine consistency over time.

Quality of Life Research: Interview with Professor Robert Cummins.

Health-related quality of life (HRQOL) is a fundamental concept in the field of clinical medicine and has been studied during the last years by psychologists, sociologists, economists and managers. The concept of HRQOL includes those aspects of overall QOL that can be indicated to have an impact on patients’ health, either physical or psychological. Concerning the individuals, this incorporates physical and mental health cognitions, including sociodemographic factors, sexual functioning, fatigue, sleep disorders and functional status. One of the most eminent experts in the world in the field of QOL is Prof. Robert Cummins [Professor of Psychology at Deakin University in Australia (School of Psychology, Deakin University, 221 Burwood Highway, Victoria 3125 Melbourne, Australia. E-mail: robert.cummins@deakin.edu.au)] who kindly accepted to answer our questions in the con- text of this special edition.