Motor ability and adaptive function in children with attention deficit hyperactivity disorder

Attention deficit hyperactivity disorder (ADHD) is a common neuropsychiatric disorder. Previous studies have reported that children with ADHD exhibit deficits of adaptive function and insufficient motor ability. The objective of this study was to investigate the association between adaptive function and motor ability in children with ADHD compared with a group of normal children. The study group included 25 children with ADHD (19 boys and 6 girls), aged from 4.6 years to 8.6 years (mean ± standard deviation, 6.5 ± 1.2). A group of 24 children without ADHD (normal children) were selected to match the children with ADHD on age and gender. The Movement Assessment Battery for Children, which includes three subtests, was used to assess the motor ability of the children of both groups. The Chinese version of Adaptive Behavior Scales, which consists of 12 life domains, was used to assess adaptive function of the children with ADHD. Compared with the normal children, children with ADHD exhibited poorer motor ability on all the three subtests of motor assessment. In the ADHD group, nine (36%) children had significant motor impairments and seven (28%) were borderline cases. A total of 10 (40%) children with ADHD had definite adaptive problems in one or more adaptive domains. With statistically controlling of IQ for the ADHD group, those children with impaired motor ability had significantly poorer behaviors in the adaptive domain of home living (p = 0.035). Moreover, children with ADHD who had severely impaired manual dexterity performed worse than the control group in the adaptive domains of home living (r = −0.47, p = 0.018), socialization (r = −0.49, p = 0.013), and self-direction (r = −0.41, p = 0.040). In addition, children with poorer ball skills had worse home living behavior (r = −0.56, p = 0.003). Children who had more impaired balance exhibited poorer performance in social behavior (r = −0.41, p = 0.040). This study found significant correlation between motor ability and adaptive function in children with ADHD, especially in their adaptive domains of home living, socialization, and self-direction. In clinical settings, identification of motor difficulties may have important implications for the understanding of relative factors in effective management of the adaptive dysfunction in children with ADHD.     

哮喘对儿童生活质量的影响

支气管哮喘为儿童常见的慢性炎症性疾病，近年来其发病率在各国明显上升，影响了患儿及其家庭的生活质量。本文主要讨论哮喘给患儿家庭带来沉重的经济负担以及对家庭成员的身心健康的影响，疾病导致的缺课以及夜间的睡眠打断对患儿白天的学习表现的不良影响，患儿与同龄儿童相处的影响，以及疾病带来的不同程度体育运动受限和各种心理行为障碍。     

Obesity,self-reported symptom severity,and quality of life in people with atrial fibrillation: A community-based cross-sectional survey

Background and aimsIntentional weight loss may reduce symptom severity of atrial fibrillation (AF) in relatively young AF patients with overweight. We examined whether symptom severity and quality of life (QoL) are associated with weight status in the general population with AF.Methods and resultsPatients with electrocardiogram-confirmed AF completed validated questionnaires: the EuroQol 5 Dimensions QoL questionnaire and the Toronto Atrial Fibrillation Severity Scale (AFSS). The AFSS assessed the AF burden scoring on AF-related symptoms and the total AF burden measured as a combination of duration, frequency, and severity of an irregular heartbeat. Generalized liner models examined the association of body mass index (BMI) with AF severity and QoL adjusting for confounders. Between 2018 and 2019, 882 of 1901 (46%) mailed questionnaires were returned completed. Participants had a mean (SD) age of 74 (10) years old and a BMI of 27.4 (5.6) kg/m². Sixteen percent reported having never experienced an irregular heartbeat. A 5 kg/m² higher BMI was associated with a 0.65 (95%CI: 0.25 to 1.06) higher symptom score, where 3 points represent a clinically relevant change in state. A 5 kg/m² higher BMI was associated with a −1.61 (95%CI: −2.72 to −0.50) lower QoL score. The coefficient of the total AF burden for a 5 kg/m² higher BMI was 0.17 (95% CI: −0.01 to 0.68).ConclusionBMI was positively associated with symptoms and negatively associated with one of the two measures of QoL, but not with the total AF burden. However, the strength of association was small and not clinically meaningful.     

Gastrointestinal symptoms and quality of life in screen-detected celiac disease

Background

Active serological screening has proved an effective means of increasing the diagnostic rate in celiac disease. The effects of a long-term gluten-free diet on possible gastrointestinal symptoms and psychological well-being in screen-detected patients have nevertheless remained obscure.

Methods

Abdominal symptoms and quality of life were measured in a large cohort of treated screen-detected celiac adults. Comparisons were made with corresponding symptom-detected patients and with non-celiac controls. Dietary adherence was assessed both by structured interview and by serological testing.

Results

In both screen- and symptom-detected celiac groups, 88% of the patients were adherent. On a diet, both screen- and symptom-detected patients reported significantly more gastrointestinal symptoms than non-celiac controls. Those screen-detected patients who reported having no symptoms at the time of diagnosis, also remained asymptomatic during the diet. Despite persistent symptoms, psychological well-being in screen-detected patients was comparable with that in non-celiac controls, whereas the symptom-detected patients showed lower quality of life.

Conclusion

Long-term treated screen-detected celiac patients, especially women, suffer from gastrointestinal symptoms on a gluten free diet similarly to symptom-detected patients. However, despite a similar frequency of persistent symptoms, the quality of life was unimpaired in the screen found, but remained low in the symptom-detected group.     

Heart failure symptom clusters and quality of life

BackgroundHeart failure (HF) is a progressive symptomatic illness with reports suggesting that patients experience multiple symptoms. Symptom clusters constitute symptoms that co-occur, are related, and influence outcomes.ObjectivesThe specific aims of this study were to (1) examine prevalent symptoms experienced by persons with HF, (2) identify symptoms forming clusters, and (3) evaluate the impact of HF symptom clusters on quality of life (QOL).Methods117 participants (62% male; 50% black; age = 56) were recruited. Prevalent symptoms were evaluated; principle components analysis (PCA) was used to extract symptom clusters; regression analysis was used to evaluate factors influencing QOL, defined as life satisfaction.ResultsThree symptom clusters–sickness behavior, discomforts of illness, and GI distress–were extracted. Sickness behavior significantly influenced QOL (β = ?0.603 p = 0.0001), explaining 40% of the variance (F = 75.12; R² = 0.404; p = 0.0001).ConclusionsThe Sickness Behavior cluster had a negative impact on QOL and suggests that incorporating an evaluation of these symptoms may facilitate identification and treatment of symptoms having an additive and detrimental influence on QOL. Studies to examine the stability of the clusters are warranted.     

功能性消化不良伴体质量减轻患者的临床特征、生活质量及其精神心理因素分析

目的 探讨功能性消化不良(FD)伴体质量减轻患者的临床特征、生活质量及其精神心理因素.方法 采用多中心、前瞻性调查设计,选取2012年6月至9月广东地区3家医院消化内科门诊就诊的1341例FD患者,将资料齐全的1057例患者按体质量下降百分比分成A组(≥5％)和B组(＜5％),比较2组消化不良指数症状评分(NDI-症状评分)、食欲情况、汉密尔顿焦虑/抑郁量表(HAMA/HAMD)、匹兹堡睡眠质量指数(PSQI)、生活质量(NDI-QOL)、就诊行为等指标.结果 1057例FD患者中,伴体质量减轻者207例(占19.58％).A、B两组除NDI-症状发生频率和食欲评分为“差”、“很差”的差异有统计学意义外(t=-2.122,P=0.035x2=35.448,P=0.000x2=35.274,P=0.000),NDI-症状评分总分、症状严重程度、对生活的影响程度指标的差异均无统计学意义(t=-1.301、-0.918、0.138,P=0.193、0.359、0.890)；A、B两组抑郁、焦虑发病率和PSQI总分的差异均有统计学意义(x2=73.939,P=0.000;x2 =47.046,P=0.000;t=-4.904,P=0.000)；A、B两组NDI-QOL评分中4个维度的差异均有统计学意义(t=5.348、2.569、5.809、4.704,P=0.000、0.010、0.000、0.000)；A、B两组在就诊次数、医疗直接费用方面的差异有统计学意义(t=-4.860、-3.011,P=0.000、0.003),但A组胃镜检查次数略高于B组(t=-1.505,P=0.133).结论 FD伴体质量减轻临床并非少见,多伴有抑郁和焦虑情绪、食欲下降和睡眠障碍,严重影响生活质量,且就诊次数多和医疗耗费高,应引起临床医生的高度重视.     

Physical activity, quality of life and symptoms of depression in community-dwelling and institutionalized older adults

This study was aimed to investigate in a sample of Spanish elderly whether measures of physical activity are related to health-related quality of life (HRQoL) and symptoms of depression in community dwelling and institutionalized elderly. The sample was a cohort of 436 elderly (234 women and 202 men, aged 60-98 years) from the North of Spain. 58% were community-dwellers and 42% were institutionalized in senior residences. Participants completed measures of physical activity (Yale Physical Activity Survey, YPAS), HRQoL (Medical Outcomes Study 36-item Short Form Health Survey, SF-36) and symptoms of depression (Geriatric Depression Scale, GDS). All SF-36 domains, except role-emotional, were significantly correlated with the YPAS activity dimension summary index. Physical function, role-physical, general health and vitality correlated with total time activity, and correlations were observed between weekly energy expenditure and physical function, role physical, vitality and mental health. Depressive symptom scores correlated significantly with the YPAS activity dimension summary index and the weekly energy expenditure. Scores for various domains of the SF-36 and for depressive symptoms significantly differed among less and more active individuals of the same sex and institutionalization category. Differences generally reached a higher extent in institutionalized subjects in comparison to community dwellers. In conclusion, physical activity was related to different domains of both the physical and mental components of HRQoL and to decreased depressive symptoms. Results emphasize the positive effects of physical activity in both community-dwelling and institutionalized older adults.     

抑郁对老年高血压患者心率变异性及生活质量的影响

目的：观察抑郁对老年高血压患者心率变异性及生活质量的影响。方法：150例老年高血压患者依据汉密尔顿抑郁量表测定结果进行分组,高血压合并抑郁者为高血压抑郁组（40例）,高血压不合并抑郁者为单纯高血压组（110例）,比较两组心率变异性及36项简易健康调查表（SF-36）评分的变化。结果：与单纯高血压组比较,高血压抑郁组在心率变异性方面：24h正常RR间期标准差ESDNN,（118．90±32．63）ms比（93．95±25．98）ms]、24h每5min正常RR间期平均值的标准差[SDANN,（107．60±28．50）ms比（83．29±25．18）ms]、总频域值[TP,（2283．62±965．31）ms^2比（1492．91±1004．69）ms^2]、极低频功率[VLF,（1845．62±747．26）ms^2比（1132．41±680．34）ms^2]、低频功率ELF,（383．38±253．82）ms^2比（232．82±160．54）ms^2]明显降低（P〈0．05或P〈0．01）;在生活质量的生理机能、生理职能、躯体疼痛、总体健康、活力、社会功能、情感职能和心理健康8个维度评分亦显著降低（P〈0．05或d0．01）。结论：抑郁降低了老年高血压患者的心率变异性,严重影响老年高血压患者的生活质量,应加强患者的心理疏导和社会支持。     

Depression,functional disability and quality of life among Nigerian older adults: Prevalences and relationships

BackgroundAgeing is associated with increased morbidity, depression and decline in function. These may consequently impair the quality of life (QoL) of older adults.PurposeThis study was used to investigate the prevalence of functional disability, depression, and level of quality of life of older adults residing in Uyo metropolis and its environs, Nigeria.MethodThis cross sectional survey involved 206 (116 females and 90 males) older adults with mean age of 69.8 ± 6.7. The World Health Organization Quality of Life-OLD, Functional status Questionnaire (FSQ) and Geriatric Depression Scale (GDS) were used to measure quality of life, functional disability and depression respectively. Data was analysed using frequency counts and percentages and Spearman rank-order correlation coefficient, at 0.05 alpha level.Results45.5% of participants had depression, and at least 30% had functional disability in at least one domain, but their quality of life was fairly good (>60.0%) across all domains. Significant correlation existed between depression scores and individual quality of life and functional disability domains and between overall QoL and each functional disability domain (p < 0.001).ConclusionsDepression and functional disability were quite prevalent among sampled older adults but their QOL was not too severely affected. Since the constructs were interrelated, it seems interventions targeted at depression and functional status may invariably enhance the quality of life of the older adults.     

The lowest effective plasma concentration of atomoxetine in pediatric patients with attention deficit/hyperactivity disorder: A non-randomized prospective interventional study

Background:Atomoxetine (ATX) is used as a first-line, non-stimulant treatment for attention-deficit/hyperactivity disorder (ADHD), although no studies have systematically examined the relationship between plasma concentration and clinical efficacy. We conducted this non-randomized prospective interventional study to examine the relationship between plasma concentration of ATX and clinical efficacy.Methods:Forty-three ADHD pediatric patients received ATX, and the steady-state through plasma concentration of the last daily dose that was maintained for at least 4 weeks were determined by high-performance liquid chromatography.Results:The receiver operating characteristic curve suggested that when plasma concentration exceeded 64.60 ng/mL, scores on the ADHD-Rating Scale improved by 50% or more (P = .14). Although 6 of the 8 final responders were unresponsive at the initial dose (.72 ± .04 mg/kg [mean ± standard deviation]), they responded after increasing the ATX dose to the final dose (1.52 ± .31 mg/kg). Excluding 7 outlier participants, the concentration was 83.3 ± 32.3 ng/mL in 7 responders and was significantly higher than 29.5 ± 23.9 ng/mL (P < .01) for the 29 non-responders.Conclusions:These results suggest that a minimum effective plasma concentration of ATX is required to achieve sufficient clinical efficacy. We hypothesized a mechanism that results in the realization of a clinical effect when the plasma concentration exceeds a certain threshold in the potential response group, whereas will not improve even if the plasma concentration is increased in the unqualified non-responder group.     

The effect of physical activity on depressive symptoms and quality of life among elderly nursing home residents: Randomized controlled trial

ObjectivesPhysical activity may have positive effects on decreasing anxiety, stress and depression, maintaining mental health and ensuring psychological vitality.This study aimed to determine how a “Physical Activity Program” for elderly people in nursing homes affected their depressive symptoms and quality of life.MethodsWe included 80 individuals aged >65 years (40 in the intervention group, 40 controls) in this experimental, randomized, controlled pretest-posttest study. Besides socio-demographic data, depressive symptoms and quality of life were assessed by standardized procedures (Beck Depression Scale [BDI], SF 36 Quality of Life Questionnaire) before and after a ten-weeks lasting “Physical Activity Program”, consisting of 10 min warm-up activities, 20 mintes rhythmic exercices, 10 min cool-down exercises and a 30 mintes free walking period on four days of the week.ResultsIn contast to controls, individuals of the intervention group presented with a significant decrease in the BDI after the “Physical Activity Program”. Likewise, eight-subscales and two sub-dimensions of the SF 36 Quality of Life Questionnaire significantly improved only in the experimental group (p < 0.05).ConclusionsOur results suggest that a structured physical activity program positively impacts depressive symptoms and quality of life in elderly individuals.     

Depression and quality of life in old age: a closer look

Depressive disorders are among the most widespread mental disorders in old age, with negative consequences for quality of life (QOL). Understanding QOL as a multidimensional construct, in this article we have a closer look on what specific aspects are affected by depression. We used a representative sample of the German population (n = 805) and one of individuals diagnosed with depression (n = 106) to compare QOL using the WHOQOL-BREF and the WHOQOL-OLD. Multivariate analysis showed that individuals diagnosed with depression exhibited lower QOL with regard to WHOQOL-BREF-dimensions physical health, psychological, social relationships and global QOL and with regard to WHOQOL-OLD-facets sensory abilities, past, present, and future activities and social participation. In addition, in the regression analysis, there were no significant differences between individuals with and without depression with regard to environment (WHOQOL-BREF), autonomy, death and dying, intimacy and overall (WHOQOL-OLD). Associations between depression and QOL in older age are selective in terms of which aspects of QOL are affected. From a methodological perspective, a multidimensional approach to QOL is recommended. From a clinical perspective, our research highlights those areas of QOL that are relevant for health professionals working with older people and that could be the focus of interventions.     

The mental health and quality of life of adult patients with congenital heart disease

Background

The quality of life (QoL) of adults with congenital heart disease (CHD) has gained significant interest. In addition to medical problems, many patients with CHD face psychosocial, educational, and behavioral challenges. However, few studies have examined the relationship between disease severity and QoL in adults with CHD.

Methods

Eighty-five patients (50 men, 35 women) aged 20–52 years (median, 26.5 years) were enrolled. Patients underwent a QoL, Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) survey. The scores were compared with those of age- and gender-matched population data according to the degree of underlying CHD. Disease severity was classified in relation to initial diagnosis, illness course, and current functional status (New York Heart Association [NYHA] class, ability index, CHD functional index, ventricular ejection fraction, and peak VO₂).

Results

There was no significant correlation between disease severity and current functional status assessed by BDI and BAI. Patients who stated that they were religious had better scores for resilience (p = 0.031), physical QoL (p = 0.008), and environmental QoL (p = 0.025). Environmental QoL scores were higher in patients who fully understood their disease (p = 0.004). Current NYHA functional class was associated with scores for psychological resilience.

Conclusions

CHD severity had a detrimental impact on resilience only when measured in terms of poor functional status. The initial diagnosis and course of the illness influence QoL and perceived health. Good psychosocial adaptation could be the result of close family relationships and involvement, making mental adjustment easier.     

Construction and validation of a patient-reported outcome dedicated to chronic venous disorders: SQOR-V (specific quality of life and outcome response - venous)

BACKGROUND: Chronic venous disorders (CVD) have an impact on quality of life (QoL), both physically and psychologically. As of now, several vein specific QoL scales exist, but no patient-reported outcome (PRO) is available which takes into account altogether symptoms, impairment of activities, appearance of the legs and concerns regarding health risk. Since clinical severity and disability are mostly evaluated in severe patients, where the main outcome - namely skin changes - is obvious but rare, the authors considered that a reproducible and clinically relevant survey that could account for specific patients' complaints was needed, particularly for CEAP C0s-C3 patients. OBJECTIVES: The objective of this study was to build a specific autoquestionnaire and to establish its statistical validity and clinical relevance. METHODS: A review of existing questionnaires and an analysis of relevant literature were carried out by a committee of experts. The committee then developed a questionnaire of 46 items, with special attention to relevance for venous disorders and patients' main complaints. After construction, the French version was field-tested and results statistically analyzed. In the specific QoL & Outcome Response - Venous (SQOR-V), each item is given a value by the patient and items are grouped in five dimensions. Each dimension is weighed to a maximum value of 20, yielding an overall maximum score of 100. RESULTS: Two hundred and two questionnaires were analyzed for the initial evaluation and 152 at a second (test-retest). Determination of the Cronbach's alpha coefficient (0.96) and structural analysis demonstrated an excellent internal and structural coherence. Test-retest comparisons confirmed good reproducibility. Comparison with SF-12 and CED-D questionnaires and with CEAP classification groups verified both structural and clinical validity. CONCLUSIONS: This study demonstrates QoL impairment in patients suffering from chronic venous disorders (CVD). It also verifies the statistical validity of the SQOR-V questionnaire. More studies are needed to demonstrate the improvement in specificity and accuracy this questionnaire provides compared to existing vein-specific QoL scales, and to determine its ability to assess efficacy of any kind of treatment at any stage of the disease. Provided adequate acknowledgment of its authors, the use of SQOR-V is free. An English version is available, currently pending validation.     

Asthma control affects school absence,achievement and quality of school life: a multicenter study

Introduction and ObjectivesAsthma may have a detrimental effect on school attendance and achievement. Friend relations, attendance to school activities, quality of life (QOL) of asthmatic children may be negatively affected. The aim of this study was to evaluate factors influencing school functioning for asthmatic school-age children.Materials and MethodsFrom January to May 2019, parents and school-age children who were followed by a diagnosis of asthma for more than one year, from seven pediatric allergy centers, were given a standard questionnaire including questions about child’s disease, school performance, absenteeism, home-family-school conditions. A pediatric QOL questionnaire was filled out by children. For evaluating control in the previous year, children who had more than two exacerbations and/or had any exacerbations needing systemic corticosteroids in the previous year were defined as inadequate control. School absence over nine days was taken into account as this has been shown to bring a risk for successful school life.Results507 patients were included. Asthma control status was found to be effective on school absence (p < 0.001), on school success (especially math scores) (p < 0.001), on friend relations (p = 0.033), QOL (p < 0.001), attendance to school activities (p < 0.001). Regular follow-up (p < 0.001), regular use of asthma medication (p = 0.014), tobacco smoke exposure (p < 0.001), heating with stove at home (p = 0.01) affected asthma control. School conditions such as crowdedness (p = 0.044), humidity of the class (p = 0.025), knowledge of teacher about child’s asthma (p = 0.012) were effective on asthma control independent of home conditions and asthma treatment parameters.ConclusionSchool interventions are important to improve asthma management.     

Symptoms, myocardial ischaemia and quality of life in women: results from the NHLBI-sponsored WISE Study.

AIMS: Our goal was to evaluate health-related quality of life (QOL) in women undergoing angiography for suspected ischaemia. METHODS AND RESULTS: QOL measurements were obtained in 406 women with chest pain symptoms in the Women's Ischemia Syndrome Evaluation (WISE). QOL measures included a general rating (GR), Duke Activity Status Index (DASI), and the Beck Depression Inventory (BDI). Higher scores on the GR and DASI are indicative of better QOL and functioning. Higher scores on the BDI indicate more symptoms of depression. Women were stratified by the presence and absence of obstructive angiographic coronary artery disease (CAD) and by the presence and absence of myocardial ischaemia. Women with angiographic obstructive CAD had lower DASI and higher BDI scores compared to women without obstructive CAD (both P<0.05). Stratification by the presence and absence of ischaemia demonstrated that women with ischaemia had better QOL, evidenced by higher GR QOL scores and lower BDI scores (both P<0.05) than women without ischaemia. Symptoms of angina were significant independent predictors of QOL scores (P<0.001). CONCLUSIONS: Chest pain symptoms have a significant impact on health-related QOL in women undergoing coronary angiography for suspected myocardial ischaemia andare more important determinants of QOL than the underlying conditions of CAD or ischaemia.     

上海市女性性工作者的生存质量与抑郁现状

目的分析上海市女性性工作者（FSW）的生存质量和抑郁现状,为干预艾滋病等性传播疾病提供新的切入点。方法采用问卷调查、世界卫生组织（WHO）生存质量评估简表和ZUNG抑郁自评量表,评估调查对象的生存质量及抑郁情况。结果在150例FSW和150名对照中,与对照组相比FSW组的生存质量在生理领域及心理领域无显著差别,而在社会关系领域、环境领域得分较低（P〈0．05）,分别为（54．6±8．9）和（49．8±10．6）。两组中表现抑郁症状者分别为32．1％和46．0％,但FSW组中有更高比例的对象处于中度及重度抑郁状态（42．2%、25．0％）。结论FSW的生存质量欠佳,抑郁情况较严重,应开展相应的社会心理干预工作。