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Quality of life is an important indicator in assessing the burden of disease, especially for chronic conditions. The Health Utilities Index (HUI) is a recently developed system for measuring the overall health status and health-related quality of life (HRQL) of individuals, clinical groups, and general populations. Using the HUI (constructed based on eight attributes: vision, hearing, speech, mobility, dexterity, cognition, emotion, and pain/discomfort) to measure the HRQL for chronic disease patients and to detect possible associations between HUI system and various chronic conditions, this study provides information to improve the management of chronic diseases. This study is of interest to data analysts, policy makers, and public health practitioners involved in descriptive clinical studies, clinical trials, program evaluation, population health planning, and assessments. Based on the Canadian Community Health Survey (CCHS) for 2000-01, the HUI was used to measure the quality of life for individuals living with various chronic conditions (Alzheimer/other dementia, effects of stroke, urinary incontinence, arthritis/rheumatism, bowel disorder, cataracts, back problems, stomach/intestinal ulcers, emphysema/COPD, chronic bronchitis, epilepsy, heart disease, diabetes, migraine headaches, glaucoma, asthma, fibromyalgia, cancers, high blood pressure, multiple sclerosis, thyroid condition, and other remaining chronic diseases). Logistic Regression Model was employed to estimate the associations between the overall HUI scores and various chronic conditions. The HUI scores ranged from 0.00 (corresponding to a state close to death) to 1.00 (corresponding to perfect health); negative scores reflect health states considered worse than death. The mean HUI score by sex and age group indicated the typical quality of life for persons with various chronic conditions. Logistic Regression results showed a strong relationship between low HUI scores (< or = 0.5 and 0.06-1.0) and certain chronic conditions. Age- and sex-adjusted Odds Ratio (OR) and p values showed an effect among individuals diagnosed with each chronic disease on the overall HUI score. Results of this study showed that arthritis/rheumatism, heart disease, high blood pressure, cataracts, and diabetes had a severe impact on HRQL. Urinary incontinence, Alzheimer/other dementia, effects of stroke, cancers, thyroid condition, and back problems have a moderate impact. Food allergy, allergy other than food, asthma, migraine headaches, and other remaining chronic diseases have a relatively mild effect. It is concluded that major chronic diseases with significant health burden were associated with poor HRQL. The HUI scores facilitate the measurement and interpretation of results of health burden and the HRQL for individuals with chronic diseases and can be useful for development of strategies for the prevention and control of chronic diseases.
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PMID:Using Health Utility Index (HUI) for measuring the impact on health-related quality of Life (HRQL) among individuals with chronic diseases. 1534 14

Female sexual dysfunction (FSD) is a multifactorial set of conditions associated with multiple anatomical, physiological, biological, medical and psychological factors that can have major impact on self-esteem, quality of life, mood and relationships. Studies indicate that FSD is commonly seen in women who report a low level of satisfaction with partner relationship and in women with male partners who have erectile dysfunction. This complexity of FSD is augmented by the presence of chronic disease. Negative sexual effects are widely reported in studies of women with chronic diseases (such as metabolic syndrome, diabetes mellitus, chronic kidney disease, cancer, spinal cord injury, lupus, rheumatic diseases, Parkinson's disease, fibromyalgia and chronic pain) as compared to a general healthy female population. Physical problems, emotional problems and partnership difficulties arising from disease-related stress contribute to less active and less enjoyable sex life. Chronic pain, fatigue, low self-esteem as well as use of medications might reduce sexual function. These effects of chronic diseases on female sexual function still remain largely unstudied. The study by Manor and Zohar published in this issue of Harefuah draws our attention to the sexual dysfunction of women with breast cancer and examines their needs for information regarding their sexual function. In the absence of definite treatment evidence, psychological counseling, improved vaginal lubrication, low dose of hormonal therapy can be used to relieve FSD. Physicians must consider integrating diagnosis of their female patients' sexual needs and dysfunction, especially women with chronic diseases. Patients' education and counseling may contribute to a better quality of life in spite of their chronic disease.
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PMID:[Female sexual function and chronic disease]. 1650 15

Invisible and incurable, this disorder can wreak havoc with your patient's life. Find out how to get her back on track. Fibromyalgia, a complex, chronic disorder of pain processing, is thought to be the most common cause of generalized musculoskeletal pain in women ages 20 to 55. This disorder, which affects the muscles, ligaments, and tendons, occurs in 3 to 6 million Americans, mostly women. Some patients are affected only mildly, but up to 30% have symptoms that seriously impair their quality of life.
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PMID:Getting the point about fibromyalgia. 1727 86

The etiology of fibromyalgia as a chronic disease is still unexplained. This article gives an overview of the newest treatment methods of behavioral medicine of the fibromyalgia syndrome with regard to the state of research of etiology and diagnosis of this disease. Methods such as operant conditioning, cognitive-behavioral approaches, patient education and relaxation methods are discussed.
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PMID:[Fibromyalgia: behavioral medicine interventions]. 1782 10

Fibromyalgia is a condition with widespread muscle pain. Prevalence studies showed that 2% to 7% of the population have fibromyalgia, which affects approximately one million Canadians. Fibromyalgia is most common in women, but it also involves men and children. As with most chronic illnesses, the causes of fibromyalgia are unknown. However, recent research supports underlying abnormalities in the central nervous system, which supports fibromyalgia as a chronic disease state and valid clinical entity. Pain is the primary symptom, often accompanied by overwhelming fatigue, sleep dysfunction and cognitive impairment. In 1990, the American College of Rheumatology developed diagnostic criteria for the diagnosis of fibromyalgia. Lifestyle changes, including pacing of activities and aerobic exercise, are very important in managing fibromyalgia symptoms. Emotional and behavioural therapy can also be helpful. Controlled trials of antidepressants, gabapentinoids, tramadol, zopiclone and sodium oxybate have shown effectiveness in fibromyalgia patients. Pregabalin and duloxetine were recently approved in the United States. Effective management of fibromyalgia is complex and requires a multidisciplinary treatment approach. Response and tolerance of different therapeutic interventions vary from patient to patient. Recent advances in the pathophysiology of fibromyalgia offer hope for new and improved therapies in the management of this disabling condition.
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PMID:Fibromyalgia: presentation and management with a focus on pharmacological treatment. 1922 4

Fibromyalgia Syndrome is a chronic disorder characterized by abnormal pain, fatigue, depression, cognitive dysfunction and sleep disturbance. The body's immune, hormonal, and nervous systems are involved. The author proposes a model from his clinical practice where a relapsing human Herpesvirus 4 infection of ss-lymphocytes causes inappropriate activation of immune system components, thus leading to typical FMS signs and symptoms. This clinical model was subsequently embodied in a computer based on the author's human nervous system function emulator, which imitates the brain's biochemicalneural-cognitive operations. This Forth language emulator program runs on a multiprocessor network recently enhanced with 8-core 32-bit CPUs. Supplemental analog circuit boards provide support for an artificial neural network, synthetic emotion and cellular substrate-receptor binding activity simulation. The effects of antiviral antibiotics and other chemicals on this disease are included in the emulator.
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PMID:Multi-system fibromyalgia syndrome emulator - biomed 2009. 1936 78

Fibromyalgia syndrome is a chronic disease of widespread and debilitating pain whose cause is unknown and whose risk factors are poorly understood. It is often comorbid with rheumatoid and other pain disorders as well as psychiatric disorders such as anxiety and depression. Although they are not officially approved for this indication, antiepileptics and antidepressants are often used to treat fibromyalgia. The tricyclic antidepressants (TCAs), particularly amitriptyline, are among the most common treatment strategies. Because of the poor tolerability of the tricyclics, the newer antidepressants have been widely tested in fibromyalgia. The selective serotonin reuptake inhibitors (SSRIs) and the reversible monoamine oxidase inhibitors do not seem to be particularly helpful. The serotonin and norepinephrine reuptake inhibitors (SNRIs), duloxetine and milnacipran, on the other hand, have been shown in placebo-controlled trials to offer significant relief to patients suffering from fibromyalgia. Although no direct comparative studies have been performed, these compounds appear to be as effective as the TCAs but much better tolerated. The effectiveness of the SNRIs as well as other dual acting antidepressants, such as mirtazapine, but not the SSRIs, implies that a dysfunction of both serotonin and norepinephrine neurotransmission probably exists in fibromyalgia. The effectiveness of antidepressants appears to be independent of their effect on comorbid depression.
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PMID:Antidepressants in the treatment of fibromyalgia. 1941 2

Widespread pain and chronic fatigue are common in the general population. Previous research has demonstrated co-occurrence of syndromes that are associated with pain and fatigue (fibromyalgia and chronic fatigue syndrome), but there is limited existing data on the co-occurrence of these symptoms in general. This study investigates the co-occurrence of pain and fatigue, and characterises people with these symptoms individually, and in combination. A postal questionnaire was sent to a random sample of 4741 community dwelling Dutch adults registered with five general practices. There were 2447 participants (adjusted response=53.5%). Persistent fatigue was reported by 60% of the 451 subjects with chronic widespread pain. Chronic widespread pain was reported by 33% of the 809 responders with persistent fatigue. Anxiety and depression were more common in subjects who reported both symptoms than those who reported either one or neither. Participants who had chronic disease, high body mass index, low activity levels or did not perceive ability to influence health had higher adjusted odds of reporting both symptoms (but not one alone) than subjects not having these characteristics. Pain and fatigue occur more often than would be expected by chance and there are a number of reasons for this. Clinicians should be aware that co-occurrence of the symptoms is common, especially in people who have high BMI or chronic disease, and that people with both symptoms are often anxious or depressed. Further work should address longitudinal associations of pain and fatigue.
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PMID:Co-occurrence and associations of pain and fatigue in a community sample of Dutch adults. 1954 Jan 39

Systemic lupus erythematosus (SLE) is a chronic disease affecting the physical, social, and psychological well-being of patients. Different instruments have been developed to measure health-related quality of life, some of which are SLE-specific. Contributors to poor quality of life in patients with SLE include fatigue, fibromyalgia, depression, and cognitive dysfunction. Health-related quality of life is not strongly associated with disease activity or organ damage. The Medical Outcomes Survey Short Form 36 is the most common instrument used to measure quality of life in SLE.
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PMID:Quality-of-life measurements versus disease activity in systemic lupus erythematosus. 2058

Mindfulness-based stress reduction (MBSR) is a structured group program that uses mindfulness meditation to improve well-being and alleviate suffering. This article reviews the impact of MBSR for people with chronic diseases. The review includes original research that was published in English and peer-reviewed and reported outcomes for adults with chronic diseases who had participated in an MBSR program. Fifteen studies were identified. Outcomes related to mental and physical health, well-being, and quality of life. The studies included different research designs, and used self-report and physiological outcome measures. Participants' clinical diagnoses included fibromyalgia, chronic pain, rheumatoid arthritis, type 2 diabetes, chronic fatigue syndrome, multiple chemical sensitivity, and cardiovascular diagnoses. All 15 studies found that participation in an MBSR program resulted in improvements. No negative change was reported between baseline and follow up. Outcomes in regard to specific variables were difficult to compare and equivocal. Overall, positive change predominated. Chronic diseases are associated with a range of unwelcome psychological and physical consequences. Participation in an MBSR program is likely to result in coping better with symptoms, improved overall well-being and quality of life, and enhanced health outcomes. As an adjunct to standard care, MBSR has potential for much wider application in Australian primary care settings.
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PMID:Mindfulness-based stress reduction for people with chronic diseases. 2081 88


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