Wobbe P. Zijlstra

A high level of fatigue among long-term survivors of non-Hodgkin's lymphoma : Results from the longitudinal population-based PROFILES registry in the south of the Netherlands

The course of fatigue and quality of life in survivors of non-Hodgkin’s lymphoma is unknown. The aims of this study were, therefore, to assess fatigue and quality of life in patients with non-Hodgkin’s lymphoma following primary treatment, compare fatigue and quality of life in these patients with those of an age- and sex matched normative population to assess the severity of concerns and identify associations with fatigue of survivors who remained fatigued. The population-based Eindhoven Cancer Registry was used to select all patients diagnosed with non-Hodgkin’s lymphoma from 1999–2009. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire and the Fatigue Assessment Scale were completed once by 824 survivors of non-Hodgkin’s lymphoma (80% response rate); 434 survivors completed these questionnaires again 1 year later. Survivors of non-Hodgkin’s lymphoma reported more clinically relevant fatigue up till 10 years post-diagnosis compared to a normative population (P<0.001). Mean fatigue scores remained fairly stable over time (T1: x ¯=28, SD=26; T2:=30, SD=27, P=0.14): 22–28% of survivors reported deterioration, 19–23% reported improvement and 44–54% reported constant fatigue. Survivors who reported constant fatigue were more often diagnosed with stage IV disease and had more comorbid diseases. They were additionally more often female and divorced. Having comorbidities and being without a partner were also associated with constant fatigue in the normative population. In conclusion, six out of every ten responding non-Hodgkin’s lymphoma survivors reported a high level of fatigue up till 10 years after diagnosis. Mean fatigue scores remained stable over time and survivors reporting constant fatigue more often had stage IV disease at diagnosis and comorbidities.

Disease‐specific health status as a predictor of mortality in patients with heart failure: a systematic literature review and meta‐analysis of prospective cohort studies

Some, but not all, studies have shown that patient‐reported health status, including symptoms, functioning, and health‐related quality of life, provides additional information to traditional clinical factors in predicting prognosis in heart failure patients. To evaluate the overall evidence, the association of disease‐specific health status on mortality in heart failure was examined through a systematic review and meta‐analysis.

Higher levels of psychological distress are associated with a higher risk of incident diabetes during 18 year follow-up : Results from the British Household Panel Survey

BackgroundReviews have shown that depression is a risk factor for the development of type 2 diabetes. However, there is limited evidence for general psychological distress to be associated with incident diabetes. The aim of the present study was to test whether persons who report higher levels of psychological distress are at increased risk to develop type 2 diabetes during 18 years follow up, adjusted for confounders.MethodsA prospective analysis using data from 9,514 participants (41 years, SD=14; 44% men) of the British Household Panel Survey. The General Health Questionnaire 12 item version was used to assess general psychological distress, diabetes was measured by means of self-report. Cox proportional hazards regression models were used to calculate the multivariate-adjusted hazard ratio (HR) of incident diabetes during 18 years follow up, comparing participants with low versus high psychological distress at baseline (1991).ResultsA total of 472 participants developed diabetes 18 year follow up. Those with a high level of psychological distress had a 33% higher hazard of developing diabetes (HR=1.33, 95% CI 1.10–1.61), relative to those with a low level of psychological distress, adjusted for age, sex, education level and household income. After further adjustment for differences in level of energy, health status, health problems and activity level, higher psychological distress was no longer associated with incident diabetes (HR=1.10, 95% CI 0.91-1.34).ConclusionsHigher levels of psychological distress are a risk factor for the development of diabetes during an 18 year follow up period. This association may be potentially mediated by low energy level and impaired health status.

Neutrophil Gelatinase-Associated Lipocalin and depression in patients with chronic heart failure.

Depression adversely affects prognosis in heart failure (HF) patients. Inflammation is indicated as potential biological pathway in this co-morbidity. Since increased levels of the cytokine Neutrophil Gelatinase-Associated Lipocalin (NGAL) are predictive for HF prognosis, and recently indicated in patients with major depression, this study examined the association of serum NGAL levels with symptoms of depression in patients with HF. Serum NGAL levels were measured in 104 patients with HF (left ventricular ejection fraction, LVEF⩽40). Depression, evaluated using the Beck Depression Inventory (BDI; total score, somatic and cognitive component), and the Hamilton Depression Rating scale (HAMD), at baseline and 12months follow-up, was associated with NGAL levels using mixed model analysis. Analyses were adjusted for demographics measures, disease severity indicators, inflammation, comorbidity and medication. Increased serum NGAL levels were significantly associated with depression measured by HAMD (baseline: r=0.25, p<.05) and BDI (baseline: r=0.22, p<.05; 12months: r=0.37, p<.01). This association remained significant after adjustment for covariates; age, sex, time, LVEF, and creatinine (HAMD, t=2.01, p=.047; BDI, t=2.28, p=.024). NGAL was significantly associated with somatic- (p=0.004), but not cognitive depressive symptoms (p=0.32). NGAL levels were associated with the experienced HF-related functional limitations (6min walk test), rather than the severity of cardiac dysfunction (LVEF). This study indicates that depression in patients with chronic HF is associated with elevated NGAL levels, independent of clinical severity of the underlying disease.

Outliers in Questionnaire Data Can They Be Detected and Should They Be Removed

Outliers in questionnaire data are unusual observations, which may bias statistical results, and outlier statistics may be used to detect such outliers. The authors investigated the effect outliers have on the specificity and the sensitivity of each of six different outlier statistics. The Mahalanobis distance and the item-pair based outlier statistics were found to have the best combination of specificity and sensitivity. Next, it was investigated how outliers influenced the bias in the percentile rank score, Cronbach’s alpha, and the validity coefficient. Outliers due to random responding and faking produced considerable bias, and outliers due to extreme responding produced little bias. Finally, the influence of removing discordant observations on bias was studied. Removing observations due to random responding identified by means of the Mahalanobis distance, the local outlier factor, and the item-pair based outlier statistic reduced bias.

The minimal clinical important difference in the World Health Organization Quality of Life instrument—100

PurposeThe aim of this study was to estimate the minimal clinical important difference (MCID) of the World Health Organization Quality of Life assessment instrument (WHOQOL-100) for women with early-stage breast cancer. If the MCID is known, then the instrument is also useful for individual patients and thus useful in clinical practice. In this study, the MCID is the smallest change in quality of life (QOL) scores considered clinically relevant for patients.MethodsData were derived from a prospective study in which 223 women with early-stage breast cancer and 383 women with benign breast problems completed the WHOQOL-100. MCID values were determined by two distribution-based methods (0.5 standard deviation (SD) and 1 standard error of measurement (SEM)) and an anchor-based method.ResultsFor 0.5 SD, MCID estimates ranged from 0.64 to 0.94, and for 1 SEM, MCID estimates ranged from 0.69 to 1.18. The anchor-based approach resulted in MCID estimates ranging from −1.56 to −0.71 for decline and from 0.51 to 1.27 for improvement.ConclusionA change in score of 1 on the WHOQOL-100 is proposed as the MCID for women with early-stage breast cancer.

Trajectories of Patient-Reported Health Status in Patients With an Implantable Cardioverter Defibrillator

To date, no study has assessed the course of patient-reported health status in patients with an implantable cardioverter defibrillator (ICD). Studying health status trajectories and their baseline determinants would permit the identification of patients at risk for poor health outcomes after ICD implantation. A combined cohort of 1,222 patients with an ICD (79% men; age = 61.4 [11.2] years) completed the 12-Item Short-Form Health Survey at baseline and 2 to 3 months and 12 to 14 months after implantation. Latent class analyses were used to identify trajectories and predictors of health status over time. Most health status trajectories showed a stable pattern after short-term follow-up, with differences between trajectories being mainly related to differences in absolute levels of health status. Seven trajectories were identified for physical health status. Being unemployed, symptomatic heart failure, ICD shock, psychotropic medication, negative affectivity, and type D personality were identified as independent determinants of poorer physical health status. For mental health status, 6 trajectories were identified. Younger age, low educational level, symptomatic heart failure, renal failure, no use of ACE inhibitors, psychotropic medication, negative affectivity, and type D personality were identified as independent determinants of poorer mental health status. In conclusion, the population with an ICD seems to be heterogeneous in terms of patient-reported physical and mental health status. Patients with an ICD who present with poor health status and a distressed personality profile should be timely identified and monitored as they may benefit from cardiac rehabilitation in combination with behavioral intervention.

Impaired health status, psychological distress, and personality in women and men with nonobstructive coronary artery disease : Sex and gender differences: The TWIST (Tweesteden Mild Stenosis) study

Background— Patients with nonobstructive coronary artery disease (NOCAD; wall irregularities, stenosis <60%), and women with NOCAD in particular, remain underinvestigated. We examined sex and gender (S&G) differences in health status, psychological distress, and personality between patients with NOCAD and the general population, as well as S&G differences within the NOCAD population. Methods and Results— In total, 523 patients with NOCAD (61±9 years, 52% women) were included via coronary angiography and computed tomography as part of the TWIST (Tweesteden Mild Stenosis) study. Generic health status (12-item Short Form physical and mental scales and fatigue), psychological distress (Hospital Anxiety and Depression Scale anxiety and depressive symptoms and Global Mood Scale negative and positive affect), and personality (Type D personality) were compared between patients with NOCAD and an age- and sex-matched group of 1347 people from the general population. Frequency matching was performed to obtain a similar sex distribution in each age–decile group. Both men and women with NOCAD reported impaired health status, more psychological distress, and Type D personality compared with men and women in the reference group. Women reported more psychosocial distress compared with men, but no significant sex-by-group interaction effects were observed. Women with NOCAD reported impaired health status, more anxiety, and less positive affect, but no differences in depressive symptoms, angina, or Type D personality when compared with men with NOCAD. Age, education, employment, partner, and alcohol use explained these S&G differences within the NOCAD group. Conclusions— In both men and women, NOCAD was associated with impaired health status, more psychological distress, and Type D personality when compared with a reference population. Factors reflecting S&G differences explained these S&G findings in patient-reported outcomes. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT01788241.

The effects of background music on the evaluation of crying faces

This exploratory study was designed to determine the effects of background music of different valence on the perception of tearful faces and other emotional expressions. Participants (154 men, age range 9–64 years, and 208 women, age range 9–77 years) rated photographs of crying, smiling, anger expressing and yawning unique men and women (N = 12 each) on the following three dimensions: kindness, attractiveness and pleasantness, while concurrently being exposed to happy, angry, sad and calm music, or a no-music condition. Mixed models analysis revealed that observers made more favourable judgments about a crier when listening to sad and calm background music. This particularly concerned the ratings on the dimensions kindness and pleasantness, while calm music additionally increased ratings of attractiveness. Opposite effects were found for angry faces, for which lower ratings were obtained on all three dimensions with calm music. We speculate that calm background music may be helpful to boost social bonding and empathy, when people are in tears.

Robust Mokken Scale Analysis by Means of the Forward Search Algorithm for Outlier Detection.

Exploratory Mokken scale analysis (MSA) is a popular method for identifying scales from larger sets of items. As with any statistical method, in MSA the presence of outliers in the data may result in biased results and wrong conclusions. The forward search algorithm is a robust diagnostic method for outlier detection, which we adapt here to identify outliers in MSA. This adaptation involves choices with respect to the algorithms objective function, selection of items from samples without outliers, and scalability criteria to be used in the forward search algorithm. The application of the adapted forward search algorithm for MSA is demonstrated using real data. Recommendations are given for its use in practical scale analysis.