BackgroundThere is limited evidence about the impact of specific patterns of multi-morbidity on health-related quality of life (HRQoL) from large samples of adult subjects.MethodsWe used data from the English General Practice Patient Survey 2011–2012. We defined multi-morbidity as the presence of two or more of 12 self-reported conditions or another (unspecified) long-term health problem. We investigated differences in HRQoL (EQ-5D scores) associated with combinations of these conditions after adjusting for age, gender, ethnicity, socio-economic deprivation and the presence of a recent illness or injury. Analyses were based on 831,537 responses from patients aged 18 years or older in 8,254 primary care practices in England.ResultsOf respondents, 23 % reported two or more chronic conditions (ranging from 7 % of those under 45 years of age to 51 % of those 65 years or older). Multi-morbidity was more common among women, White individuals and respondents from socio-economically deprived areas. Neurological problems, mental health problems, arthritis and long-term back problem were associated with the greatest HRQoL deficits. The presence of three or more conditions was commonly associated with greater reduction in quality of life than that implied by the sum of the differences associated with the individual conditions. The decline in quality of life associated with an additional condition in people with two and three physical conditions was less for older people than for younger people. Multi-morbidity was associated with a substantially worse HRQoL in diabetes than in other long-term conditions. With the exception of neurological conditions, the presence of a comorbid mental health problem had a more adverse effect on HRQoL than any single comorbid physical condition.ConclusionPatients with multi-morbid diabetes, arthritis, neurological, or long-term mental health problems have significantly lower quality of life than other people. People with long-term health conditions require integrated mental and physical healthcare services.

Common Patterns of Morbidity and Multi-Morbidity and Their Impact on Health-Related Quality of Life

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The Industrial Revolution in World History

Objective: Lifetime prevalence of infertility among couples is approximately 10–15%, but studies addressing their health behavior are few. Our aim was to describe health and life style of Finnish men and women who had experienced infertility. Design: Cross-sectional survey. Setting: Finland. Population and methods: Data from a population-based survey ( n =7021) was utilized. Life style of infertile men ( n =289) and women ( n =155) were compared to other men and fertile women. Main outcome measures: Life style (dietary factors, use of alcohol, physical activity), reproductive factors, other diseases and symptoms. Results: After adjusting for age, area and education, infertile women under 50years consumed more polyunsaturated fat (OR 1.23, 95% CI 1.03–1.46), less saturated fat (OR 0.83, 95% CI 0.74–0.92) and had experienced more hangovers during previous year (OR 1.02, 95% CI 1.00–1.05) than fertile women. Infertile men under 50years consumed more total fat (OR 1.06, 95% CI 1.03–1.10), polyunsaturated fat (OR 1.20, 95% CI 1.05–1.37) and monounsaturated fat (OR 1.17, 95% CI 1.06–1.28) compared to other men. Infertile men did not consume more alcohol nor smoke more cigarettes but reported more often allergies than fertile men. Infertile women also had Chlamydia trachomatis infection, benign tumor in their uterus and intestinal disease more often than fertile women. Infertile women over 50years were more often current smokers than fertile women, but the differences in other age-groups were not significant. Conclusions: Women with infertility experience reported more diseases and less use of oral contraceptives than other women, possibly reflecting reasons to infertility. Since both infertility and unhealthy use of alcohol are an increasing public health issues in western societies, more attention should be paid towards life style, especially alcohol use of infertile women.

Health and life style among infertile men and women

Background 

Despite advances in cancer diagnosis and treatment have significantly improved survival rates, patients post-treatment-related health needs are often not adequately addressed by current health services. The aim of the Women’s Wellness after Cancer Program (WWACP), which is a digitised multimodal lifestyle intervention, is to enhance health-related quality of life in women previously treated for blood, breast and gynaecological cancers.

 Methods 

A single-blinded, multi-centre randomized controlled trial recruited a total of 330 women within 24 months of completion of chemotherapy (primary or adjuvant) and/or radiotherapy. Women were randomly assigned to either usual care or intervention using computer-generated permuted-block randomisation. The intervention comprises an evidence-based interactive iBook and journal, web interface, and virtual health consultations by an experienced cancer nurse trained in the delivery of the WWACP. The 12 week intervention focuses on evidence-based health education and health promotion after a cancer diagnosis. Components are drawn from the American Cancer Research Institute and the World Cancer Research Fund Guidelines (2010), incorporating promotion of physical activity, good diet, smoking cessation, reduction of alcohol intake, plus strategies for sleep and stress management. The program is based on Bandura’s social cognitive theoretical framework. The primary outcome is health-related quality of life, as measured by the Functional Assessment of Cancer Therapy-General (FACT-G). Secondary outcomes are menopausal symptoms as assessed by Greene Climacteric Scale; physical activity elicited with the Physical Activity Questionnaire Short Form (IPAQ-SF); sleep measured by the Pittsburgh Sleep Quality Index; habitual dietary intake monitored with the Food Frequency Questionnaire (FFQ); alcohol intake and tobacco use measured by the Australian Health Survey and anthropometric measures including height, weight and waist-to-hip ratio. All participants were assessed with these measures at baseline (at the start of the intervention), 12 weeks (at completion of the intervention), and 24 months (to determine the level of sustained behaviour change). Further, a simultaneous cost-effectiveness evaluation will consider if the WWACP provides value for money and will be reported separately.

 Discussion 

Women treated for blood, breast and gynaecological cancers demonstrate increasingly good survival rates. However, they experience residual health problems that are potentially modifiable through behavioural lifestyle interventions such as the WWACP.

The women’s wellness after cancer program: A multisite, single-blinded, randomised controlled trial protocol

Lowder J1, Berry A2, Brady S3, Fok C3, Gahagan S4, Hebert-Beirne J5, Lewis J6, Lewis B7, Low L8, Palmer M9, Smith A10, Lukacz E4 1. Washington University in St Louis, 2. The Children's Hospital of Philadelphia, 3. University of Minnesota, 4. UC San Diego Health System, 5. University of Illinois at Chicago, 6. Yale University, 7. University of Alabama at Birmingham, 8. University of Michigan, 9. University of North Carolina at Chapel Hill, 10. University of Pennsylvania

Defining Bladder Health in Women and Girls: Implications for Research, Clinical Practice, and Public Health

Background Pain comorbid with depression is frequently encountered in clinical settings and often leads to significant impaired functioning. Given the complexity of comorbidities, it is important to address both pain and depressive symptoms when evaluating treatment options. Aim To review studies addressing pain comorbid with depression, and to report the impact of current treatments. Method A systematic search of the literature databases was conducted according to predefined criteria. Two authors independently conducted a focused analysis of the full-text articles and reached a consensus on 28 articles to be included in this review. Results Overall, studies suggested that pain and depression are highly intertwined and may co-exacerbate physical and psychological symptoms. These symptoms could lead to poor physical functional outcomes and longer duration of symptoms. An important biochemical basis for pain and depression focuses on serotonergic and norepinephrine systems, which is evident in the pain-ameliorating properties of serotonergic and norepinephrine antidepressants. Alternative pharmacotherapies such as ketamine and cannabinoids appear to be safe and effective options for improving depressive symptoms and ameliorating pain. In addition, cognitive-behavioral therapy may be a promising tool in the management of chronic pain and depression. Conclusion The majority of the literature indicates that patients with pain and depression experience reduced physical, mental, and social functioning as opposed to patients with only depression or only pain. In addition, ketamine, psychotropic, and cognitive-behavioral therapies present promising options for treating both pain and depression.

Leslie Aguilar-Hernandez

Papers

Pain and Depression: A Systematic Review.

Wellness Interventions in Patients Living with Chronic Medical Conditions