Browsing by Subject "Quality of Life"
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- ItemOpen AccessHealth-related quality of life and its association with medication adherence in active pulmonary tuberculosis– a systematic review of global literature with focus on South Africa(2016) Kastien-Hilka, Tanja; Abulfathi, Ahmed; Rosenkranz, Bernd; Bennett, Bryan; Schwenkglenks, Matthias; Sinanovic, EdinaIntroductionTuberculosis (TB) is a leading cause of morbidity and mortality in South Africa. Clinical parameters are important objective outcomes in TB; however they often are not directly correlated with subjective well-being of the patient, but can be assessed using patient-reported outcome (PRO) measures. Health-related quality of life (HRQOL) is a specific PRO generally multi-dimensional in nature and includes physical, mental and social health domains. The inclusion of HRQOL PROs in trials and clinical practice can provide additional information beyondclinical and microbiological parameters. Furthermore, HRQOL may be associated with medication adherence. This review focuses on patient-reported HRQOL and its association with medication adherence in TB patients in South Africa.MethodsA comprehensive search strategy was developed focusing on the impact of TB on patient-reported HRQOL,the existence of a conceptual framework of TB-specific HRQOL, determinants of medication adherence and the association of HRQOL with medication adherence. Data were extracted from all identified articles and additionaldata extraction was performed by two independent reviewers with special focus on longitudinal studies in order to understand changes of HRQOL and adherence over time. Research gaps were identified with regard to patient-reported HRQOL and medication adherence.ResultsA total of 66 articles met the eligibility criteria. Ten HRQOL studies and one adherence study used a longitudinal design, none of these in South Africa. A variety of different generic and disease-specific HRQOL measures were identified in the articles. In South Africa four HRQOL and five adherence studies (non-longitudinal) were published. Similar factors (socio-demographic, socio-economic, disease-related, therapy-related and psycho-social aspects) affect HRQOL and adherence. Although standard TB treatment improved all health domains, psychological well-being and social functioning remained impaired in microbiologically cured patients after treatment.ConclusionWhile evidence of TB impact on HRQOL and medication adherence and their association exists, it is verylimited for the South African situation. No valid and reliable TB-specific HRQOL measures were identified in this systematicreview. An assessment of HRQOL in TB patients in South Africa is required as this may assist with improving current disease management programmes, medication adherence and national treatment guidelines.Electronic supplementary materialThe online version of this article (doi:10.1186/s12955-016-0442-6) contains supplementary material, which is available to authorized users.
- ItemOpen AccessImpact of childhood trauma on functionality and quality of life in HIV-infected women(BioMed Central Ltd, 2011) Troeman, Zyrhea; Spies, Georgina; Cherner, Mariana; Archibald, Sarah; Fennema-Notestine, Christine; Theilmann, Rebecca; Spottiswoode, Bruce; Stein, Dan; Seedat, SorayaBACKGROUND:While there are many published studies on HIV and functional limitations, there are few in the context of early abuse and its impact on functionality and Quality of Life (QoL) in HIV. METHODS: The present study focused on HIV in the context of childhood trauma and its impact on functionality and Quality of Life (QoL) by evaluating 85 HIV-positive (48 with childhood trauma and 37 without) and 52 HIV-negative (21 with childhood trauma and 31 without) South African women infected with Clade C HIV. QoL was assessed using the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q), the Patient's Assessment of Own Functioning Inventory (PAOFI), the Activities of Daily Living (ADL) scale and the Sheehan Disability Scale (SDS). Furthermore, participants were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D) and the Childhood Trauma Questionnaire (CTQ). RESULTS: Subjects had a mean age of 30.1 years. After controlling for age, level of education and CES-D scores, analysis of covariance (ANCOVA) demonstrated significant individual effects of HIV status and childhood trauma on self-reported QoL. No significant interactional effects were evident. Functional limitation was, however, negatively correlated with CD4 lymphocyte count. CONCLUSIONS: In assessing QoL in HIV-infected women, we were able to demonstrate the impact of childhood trauma on functional limitations in HIV.
- ItemOpen AccessKnowledge and understanding of an HIV/AIDS education workshop in a multinational organisation : an evaluation of the AIDS Champions workshop at Shell Southern Africa(2003) Mulenga, Chao Feramo Nkhungulu; Bothma, HazelHIV/AIDS poses a global medical epidemic threatening social and economic development in most developing countries. Sub-Saharan Africa currently bears the brunt of the epidemic with close to 30 million people infected with the disease. South Africa has the second fastest growing infection rates in the world as at December 2002. Currently no known cure for the disease exists. Interventions involve education and awareness programs and multiple therapy medical treatment. The aim of this thesis is to evaluate the perceptions and knowledge of participants at the Shell AIDS Champions workshop. The research used a triangulatory approach utilizing pre-test and post-test survey questionnaires group discussions, participant observation and semi-structured interviews. 22 participants from Shell Southern Africa and Easigas attended the workshop. Statistical techniques were applied to the questionnaire findings. Content analysis was used to analyse the qualitative data. Findings from the evaluation indicate that participant perceptions show agreement with current Shell policy on HIV/AIDS. The findings show that the major impact of the workshop was observed on the knowledge-based section of the evaluation. The results of the evaluation confirm that participant knowledge was increased through participation in the AIDS Champions workshop.
- ItemOpen AccessQuality of life among patients receiving palliative care in South Africa and Uganda: a multi-centred study(BioMed Central Ltd, 2011) Selman, Lucy; Higginson, Irene; Agupio, Godfrey; Dinat, Natalya; Downing, Julia; Gwyther, Liz; Mashao, Thandi; Mmoledi, Keletso; Moll, Tony; Sebuyira, Lydia; Ikin, Barbara; Harding, RichardBACKGROUND:Quality of life (QOL) is a core outcome of palliative care, yet in African settings there is a lack of evidence on patients' levels of QOL. We aimed to describe QOL among patients with incurable, progressive disease receiving palliative care in South Africa and Uganda, to compare QOL in cancer and HIV, to determine how domains of QOL correlate with overall QOL, and compare levels of QOL in this population with those in other studies using the same tool. METHODS: A cross-sectional survey was conducted using the Missoula Vitas Quality of Life Index (MVQOLI), a 26-item QOL questionnaire with five subscales (Function, Symptom, Interpersonal, Well being, Transcendent) covering physical, social, psychological and spiritual domains and one global QOL item. One item in each subscale assesses the subjective importance of the domain on a score from 1 (least important) to 5 (most important), used to weight the contribution of the subscale towards the Total QOL score. The tool was translated into 6 languages and administered to consecutively recruited patients at four facilities in South Africa and one in Uganda. RESULTS: 285 patients were recruited, with a mean age of 40.1; 197 (69.1%) were female. Patients' primary diagnoses were HIV (80.7%), cancer (17.9%) and other conditions (1.4%). The mean global QOL score was 2.81 (possible range 0 (worst) to 5 (best)); mean Total score 17.32 (possible range 0 to 30). Patients scored most poorly on Function (mean 0.21), followed by Well being (2.59), Symptoms (5.38), Transcendent (5.50), Interpersonal (9.53) (possible range for subscale scores -30 to 30). Most important to patients were: close relationships (mean 4.13), feeling at peace (4.12), sense of meaning in life (4.10), being active (3.84), physical comfort (2.58). Cancer patients were predominantly recruited at three of the sites; hence comparison with HIV-infected patients was restricted to these sites. HIV+ patients (n = 115) scored significantly worse than cancer patients (n = 50) on Well being (Z = -2.778, p = 0.005), Transcendence (Z = -2.693, p = 0.007) and Total QOL (Z = -2.564, p = 0.01). Global QOL score was most weakly correlated with Total QOL (r = 0.37) and the Transcendent subscale was most highly correlated (r = 0.77) (both p < 0.001). Patients receiving palliative care in South Africa and Uganda exhibited significantly poorer QOL compared to similar populations in the USA. CONCLUSIONS: Feeling at peace and having a sense of meaning in life were more important to patients than being active or physical comfort, and spiritual wellbeing correlated most highly with overall QOL. It is therefore vital to identify and meet the psychological and spiritual care needs of patients, as well as to assess and treat pain and other symptoms. Our finding that patients scored most poorly on the Function domain warrants further research.
- ItemOpen AccessQuality of life of HIV-infected individuals in a community-based antiretroviral programme(BioMed Central Ltd, 2008) Pitt, Jennifer; Myer, Landon; Wood, RPurpose of the study: The impact of HAART on health-related quality of life (HRQoL) has been widely researched in the developed world, however, there is limited data coming out of the developing world and, in particular, sub-Saharan Africa, where the vast majority of HIV-infected individuals live. This study examined HRQoL among HIV-positive individuals initiating HAART at the Hannan Crusaid Treatment Centre in Gugulethu, Cape Town, and explored the impact of HAART-related drug toxicities on HRQoL. Methods: HRQoL was assessed using a standardised questionnaire, the Medical Outcomes Survey Short Form 36 (MOS SF36). Physical health summary (PHS) scores and mental health summary (MHS) scores were compared pre-HAART and at regular intervals during the first 48 weeks of HAART. The impact of drug toxicities on HRQoL was described and assessed both in unadjusted bivariate and adjusted multivariate analyses. Summary of results: This study reported a significant increase in HRQoL during the first 48 weeks on HAART with the bulk of this increase occurring during the first 16 weeks. Although there was a general improvement in HRQoL on HAART, 23% of participants reported a decline in PHS score, and 34% a decline in MHS score. Average drops in median PHS and MHS scores were 8.4 units (SD 9.31) and 9.9 units (SD 11.4), respectively. Eleven (4%) participants reported drug toxicity. Most toxicities (63%) occurred between weeks 32 and 48, and 73% were related to stavudine. Participants who experienced drug toxicity reported lower PHS scores than participants without a drug toxicity at all time points. However, only 27% (three) of participants with drug toxicity reported a decline in HRQoL between pre-HAART and week 48. Drug toxicities had little impact on MHS scores. Conclusion: This study confirmed the HRQoL benefits of HAART in a community ARV clinic in South Africa. While the majority of patients experienced a significant improvement in HRQoL on HAART, up to a third of patients reported declines in HRQoL. HAART-related drug toxicities (including those secondary to the use of stavudine) did not have a significant negative impact on HRQoL during the first 48 weeks of HAART supporting the ongoing use of stavudine in the national ARV roll-out programme.
- ItemOpen AccessThe use of the EQ-5D-Y health related quality of life outcome measure in children in the Western Cape, South Africa: psychometric properties, feasibility and usefulness - a longitudinal, analytical study(2017) Scott, Des; Ferguson, Gillian D; Jelsma, JenniferAbstract Background The EQ-5D-Y, an outcome measure of Health Related Quality of Life (HRQoL) in children, was developed by an international task team in 2010. The multinational feasibility, reliability and validity study which followed was undertaken with mainly healthy children. The aim of this study was to investigate the psychometric properties of the EQ-5D-Y when used to assess the HRQoL of children with different health states. Method A sample of 224 children between eight and twelve years were grouped according to their health state. The groups included 52 acutely ill children, 67 children with either a chronic health condition or disability and 105 mostly healthy, mainstream school children as a comparator. They were assessed at baseline, at three months and at six months. An analysis of the psychometric properties was performed to assess the reliability, validity and responsiveness of the EQ-5D-Y in the different groups of children. Cohen’s kappa, the intraclass correlation coefficient, Pearson Chi-square, Kruskal-Wallis ANOVA and effect size of Wilcoxon Signed-rank test were used to determine the reliability, validity and responsiveness of the instrument. Results The EQ-5D-Y dimensions were found to be reliable on test-retest (kappa varying from 0.365 to 0.653), except for the Usual Activities dimension (kappa 0.199). The Visual Analogue Scale (VAS) was also reliable (ICC = 0.77). Post-hoc analysis indicated that dimensions were able to discriminate between acutely ill and healthy children (all differences p < 0.001). The acutely ill children had the lowest ranked VAS (median 50, range 0–100), indicating worst HRQoL and was the only group significantly different from the other three groups (p < 0.001 in all cases). Convergent validity between all similar EQ-5D-Y and PedsQL, WeeFIM and Faces Pain Scale dimensions was only evident in the acutely ill children. As expected the largest treatment effect was also observed in these children (Wilcoxon Signed-rank test for VAS was 0.43). Six of the nine therapists who took part in the study, found the measure quick and easy to apply, used the information in the management of the child and would continue to use it in future. Conclusions The EQ-5D-Y could be used with confidence as an outcome measure for acutely-ill children, but demonstrated poorer psychometric properties in children with no health condition or chronic conditions. It appears to be feasible and useful to include the EQ-5D-Y in routine assessments of children.
- ItemOpen AccessValidation of a guideline-based composite outcome assessment tool for asthma control(2007) Spencer, Sally; Mayer, Bhabita; Bendall, Kate L; Bateman, Eric DBackgroundA global definition of asthma control does not currently exist. The purpose of this study was to validate two new guideline-based composite measures of asthma control, defined as totally controlled (TC) asthma and well controlled (WC) asthma.MethodsWe used data from 3416 patients randomised and treated in the multi-centre Gaining Optimal Asthma controL (GOAL) study. The criteria comprising the asthma control measures were based on Global Initiative for Asthma/National Institutes of Health guidelines. This validation study examined the measurement properties of the asthma control measures using data from run-in, baseline, 12 and 52 weeks. Forced expiratory volume in 1 second (FEV1) and the Asthma Quality of Life Questionnaire (AQLQ) were used as the reference criteria in the validation analysis.ResultsBoth measures had good discriminative ability showing significant differences in FEV1 and AQLQ scores between control classification both cross-sectionally and longitudinally (p < 0.001). Overall both of the composite measures accounted for more of the variance in FEV1 after 52 weeks than the individual components of each asthma control measure. Both of the reference criteria were independently related to each asthma control measure (p < 0.0001). The measures also had good predictive validity showing significant differences in FEV1 and AQLQ scores at 52 weeks by control classification at 12 weeks (p < 0.0001).ConclusionThe guideline-based composite asthma control measures of WC asthma and TC asthma have good psychometric properties and are both valid functional indices of disease control in asthma.