Search

In this European Public Health news, health is put at the centre of society as it is impacting us from birth until death. Jakab emphasizes the importance of investing in health over the life-course, whilst McKee demonstrates that the whole society impacts health. A strong, unified health care system and seeing healthy people as the cornerstone of healthy economies is the key message in the contribution by Andriukaitis, the newly elected EU Commissioner for Health and Food Safety. Making the voice of public health visible, both nationally and internationally and facilitating a strong and unified voice is what Zeegers and Barnhoorn see as the core activities of EUPHA and the EPH Conference Foundation. # President's Column {#article-title-2} A new year is a time for both reflection and anticipation. Reflection on what has gone well, or not so well in the past year and anticipation of the challenges and opportunities we will face in the year ahead. For EUPHA, we have much to celebrate from the past year and much to look forward to in 2015. In my last column, I wrote about our conference in Glasgow, where a combination of excellent organization and outstanding content created an event that will be remembered for many years. Now we are looking forward to Milan, with a programme that promises to be every bit as imaginative and informative. One of the streams will be on communication and advocacy in public health, something that I am particularly looking forward to, given its importance in making the world a better place. We have a new President Elect, Natasha Muscat, who is already making an invaluable contribution to our work, stimulating our thinking about how we can take EUPHA to ever greater heights. We also have a new website and logo, two things among many for which we are grateful …

Sexual dysfunction is very commonly reported by people with multiple sclerosis (MS). However, this problem often remains under-diagnosed and under-treated. Furthermore, still very little is known about protective psychosocial factors that may help to improve sexual functioning in MS patients. Thus, we aimed to assess the associations between social support, self-esteem and sexual functioning in MS patients when controlled for clinical and sociodemographic variables. The Expanded Disability Status Scale (EDSS), the Multidimensional Scale of Perceived Social Support (MSPSS), and the Rosenberg Scale of Self-esteem (RSE) were used to assess the independent variables. Sexual functioning was assessed by the Incapacity Status Scale (ISS). We found a significant association between social support and sexual functioning (p

Background Previous studies have shown conflicting results on the effect of continuous positive airway pressure (CPAP) on quality of life (QoL) in obstructive sleep apnoea (OSA) patients. Objectives To evaluate the effect of CPAP on QoL in OSA patients compared to sham CPAP, placebo pills, and conservative treatment. Methods Studies were identified via Web of Knowledge, PubMed, PsychInfo, CINAHL, EMBASE, OpenGrey, and the Cochrane Library. Subgroup analyses and sensitivity analyses were conducted to assess the robustness of the findings. Results Meta-analysis of 13 randomised controlled trials showed no significant differences in overall and psychological QoL comparing values of CPAP treated patients with controls; however, physical QoL improved. CPAP significantly affected the overall QoL in studies with controls receiving sham CPAP, parallel design, low risk of bias, and mild OSA patients. Conclusion CPAP treatment may help to improve physical symptoms of OSA, whereas impaired psychological QoL still cannot be alleviated.

Background Optimal self-management seem to be protective factor of health-related quality of life and psychological well-being in many chronic conditions. However, the results in people with multiple sclerosis (MS) are still inconclusive. Thus, the aim of this study is to assess the associations between self-management, self-esteem and psychological well-being in people with MS when controlled for sociodemographic and clinical variables. Methods A total of 165 people with MS filled in The Multiple Sclerosis Self-Management Scale, Rosenberg Self-Esteem scale, and General Health Questionnaire-28, to assess main variables under study. Functional status was measured by Kurtzke disability Status Scale. Results We found significant associations between self-esteem and somatic symptoms, anxiety/insomnia, social dysfunction and severe depression. Explained variance of the models ranged from 16% to 38% for somatic symptoms and severe depression, respectively. Self-management significantly contributed to the explained variance in all models sans GHQ social dysfunction. Self-esteem was significant contributor to overall variance in all models. Discussion According to our results, self-management and self-esteem were found to be associated with multiple domains of psychological well-being. These findings may be used in neurological practice, to help people with MS who report psychological distress in one or more domains.

BACKGROUND: Illness perception and self-esteem were found to improve adjustment to disease in many chronic conditions. However, so far, little is known about the role of illness-appraisal and self-appraisal factors in psychological well-being in people with multiple sclerosis (MS). Thus, we aimed to assess the association between illness perception, self-esteem and psychological well-being in people with MS while controlling for sociodemographic variables, clinical variables, and sleep-related problems. METHODS: The General Health Questionnaire-28, the Brief Illness Perception Questionnaire, the Rosenberg Scale of Self-esteem, the Expanded Disability Status Scale, the Pittsburgh Sleep Quality Index, and the Multidimensional Fatigue Inventory were used. Multiple linear regressions and mediation analyses were utilized to analyse the data. RESULTS: Positive illness perception (p0.05), poor sleep quality (p0.05), and low level of psychological well-being. Self-esteem also mediated the association between illness perception and psychological well-being. DISCUSSION: People with MS may benefit from psychological support aimed at promoting self-esteem and diminishing negative illness perception.

We aimed to assess whether hostility and coping self-efficacy are associated with psychological distress in obstructive sleep apnoea patients. Furthermore, we examined whether coping self-efficacy mediates the association between hostility and psychological distress. We included 150 obstructive sleep apnoea patients (Apnoea-Hypopnoea Index ⩾5; 68% male; mean age: 48.9 ± 9.5 years). Regression models showed that hostility and poor coping self-efficacy were strongly associated with psychological distress in obstructive sleep apnoea patients. All assessed coping self-efficacy dimensions mediated the association between hostility and psychological distress. Coping self-efficacy for stopping unpleasant emotions and thoughts showed the strongest association with a lower level of psychological distress.

Background Cardiometabolic effects of physical exercise depend on its intensity, duration, and type. Conventional cardiovascular rehabilitation (CCVR) programs have significant advantages, but non-conventional activities such as Nordic walking (NW) may offer additional health benefits. Aim The aim of this study was to determine the feasibility and effectiveness of NW on cardiovascular performance and quality of life in patients with coronary artery disease (CAD) compared to a CCVR program. Design This was a pseudo-randomized, prospective, single-blinded, parallel-group trial. Setting The study was conducted at a resort/spa type facility located in a mountainous natural environment, 650 meters above sea level. Population Eighty-three CAD patients were allocated to either a Nordic walking or a control group. Methods The NW group (N.=53; age 59.1±7.0 years) underwent a three-week outdoor exercise program consisting of 40 minutes of walking four-times per week, whereas the controls performed traditional walking instead of NW. A patient's prescribed exercise intensity was according to exertion tolerance within 50-70% of peak oxygen consumption (VO 2max ); rating of perceived exertion 'mild/moderate' (12 to 14 points) on the 0-20 Borg Scale. Primary endpoint: cardiovascular and functional performance (exercise ergometry [EE], metabolic equivalent of tasks [METs], ejection fraction [EF], Six-Minute Walking Test [6MWT]). Secondary endpoint was quality of life (Short-Form 36 Health Survey). Statistical analysis was performed by generalized estimating equations with Cohen's d effect size (ES). Results NW led to higher cardiovascular performance compared to CCVR (ΔEE: +11.0% vs. +3.2%, small ES; ΔMETs: +9.8% vs. +1.5%, medium ES) and better functional performance (Δ6MWT: +8.3% vs. +5.1%, small ES). No significant differences were detected in EF (P=0.240) and SF-36 (PCS, P=0.425; MCS, P=0.400). Conclusions A three-week NW training program had clinically important effects, above and beyond CCVR, on cardiovascular and functional performance in CAD patients. Clinical rehabilitation impact Nordic walking is an accessible, safe, and effective low-threshold cardiac rehabilitation exercise training modality that seems to be particularly well-suited for people with limited functional and motivational capacities.

We aimed to assess the prevalence of suicidal ideation and to examine the relationships between obstructive sleep apnoea severity, sleep-related problems, social support and suicidal ideation in obstructive sleep apnoea patients. We included 149 patients (68% male; mean age, 48.99 ± 9.57 years) with diagnosed obstructive sleep apnoea (Apnoea–Hypopnoea Index ⩾5) based on full-night polysomnography. The prevalence of suicidal ideation among obstructive sleep apnoea patients was 20.1 per cent. Structural equation modelling showed that suicidal ideation in obstructive sleep apnoea was strongly related to poor sleep quality and high fatigue levels. No relationship between social support and suicidal ideation in obstructive sleep apnoea patients was found.

The burden of non-communicable chronic diseases (NCDs) represents a public health issue of gigantic proportion at global level. Among others, diet has been demonstrated to be a key element to maintain health and prevent NCDs. Today's world is facing the so-called “double burden of malnutrition”, characterized by the coexistence of undernutrition along with overweight, obesity or diet-related NCDs due to a substantial shift toward unhealthy diet high in sugars and ultra-processed foods and concomitant inadequate accessibility of nutritious foods. While interventions to improve diet quality and nutrition knowledge are of paramount importance in order to decrease the burden of NCDs over the next decades, the international policy framework should aim to develop evidence-based policy approaches to reduce such burden globally. In this context, the EUPHA Food and nutrition section, the EUPHA Chronic diseases section, the EUPHA Health promotion section, in collaboration with the World Health Organization (WHO), aim to propose a joint workshop to provide the latest updates from leading scientists and experts involved in global health research, with a special focus on NCDs, obesity and nutrition-related risk factors as well as ongoing interventions aimed to reduce the double burden of malnutrition. The objectives of the present workshop are the following: To quantify the global burden and temporal trends of NCDs risk factors; To assess the impact of nutrition-related risk factors on NCDs; To provide examples of advocacy activities and actions at global level to improve nutrition education and dietary behaviors; To promote translatable information at global level and drive implementation of knowledge into policy and practice. Organizing the present workshop would provide an important occasion for gathering experts in the field and sharing opinions with the audience in light of the presented results. Given the many actors involved, the workshop will provide a unique occasion to discuss about potential policy approaches in the context of the conference. Key messages There is science-based evidence demonstrating that healthy nutrition is a key factor to maintain global health and prevent chronic non-communicable diseases. Governmental and non-governmental efforts are currently working to counteract malnutrition worldwide.

Many of today's most pressing public health challenges have a strong behavioural component. Behavioural, psychosocial, and environmental factors play a major role in the development and progression of chronic diseases. Eliminating those risks would make it possible to prevent at least 80% of cardiovascular diseases, 75% of diabetes, and 40% of cancers. Behavioural insights provide an empirically informed perspective on how individuals make decisions, including the important recognition that even subtle changes in the environment can have meaningful impacts on behaviour. This workshop will provide examples from the literature and recent government initiatives that incorporate concepts from behavioural sciences in order to improve health, decision-making, and government efficiency. The examples highlight the potential for behavioural sciences to improve the effectiveness of public health policy at low cost. Although incorporating insights from behavioural sciences into public health policy has the potential to improve population health, its integration into government public health programs and policies requires careful design and continual evaluation of such interventions. Limitations and drawbacks of the approach will be discussed. The aim of this workshop is to broaden our understanding of measures that have originated from behavioural sciences and have a lot to offer to public health. This workshop also seeks to contribute to capacity building in knowledge translation and evidence-informed decision-making in public health. The workshop will consist of five presentations providing an overview of topical issues in the field of behaviour change and knowledge translation, followed by an interactive audience discussion. The first presentations will provide insights into current behaviour change theories. The second presentation will discuss the possibilities of using behaviour change principles in the development and adoption of health policies showcasing the recently adopted Canadian Association of Cardiovascular Prevention and Rehabilitation Guide and the Food Guide. The third presentation will highlight the challenges in tackling physician's ability to effectively conduct behaviour change counselling with their patients in the context of chronic disease prevention. The fourth presentation will introduce the free academic meta-search engine - Motrial, which has a great potential in evaluating the randomized controlled trials and fuelling meta-analyses and systematic reviews in return of better quality. The fifth presentation will introduce a novel WHO/Europe guide on brief interventions for NCDs risk factors. Further to the reflection on the current knowledge base, an audience discussion will give attendees the opportunity to share their opinions regarding challenges and opportunities in behaviour change and knowledge translation to improve people's health and well-being. Key messages The application of behavioural insights into public health has its opportunities and challenges. Because behavioural insights is a very promising, yet a relatively new field, the research literature remains thin, and policy can sometimes get ahead of science.

Non-communicable chronic diseases (NCDs) represent a public health issue due to their profound impact on population health. Major NCDs risk factors, including obesity, hypertension and diabetes, represent a threat of gigantic proportion, while intervention to prevent NCDs remains of paramount importance in order to decrease their burden over the next decades. Among others, quality of diets has changed substantially and a global shift to unhealthy diet high in calories and highly processed foods mainly due to the rapid urbanisation, increasing incomes, and inadequate accessibility of nutritious foods has been observed. As the burden of NCDs across the worlds remains unacceptably high, the international policy framework should aim to develop evidence-based policy approaches to reduce such burden globally. In this context, the EUPHA Sections on Food and Nutrition and on Chronic Diseases aim to propose a joint workshop to provide the latest updates from leading scientists and experts involved in global health research, with a special focus on NCDs and nutrition-related risk factors. The objectives of the present workshop are the following: To quantify the burden and temporal trends of non-communicable chronic diseases risk factors (such as obesity, elevated blood pressure and diabetes) all around the globe, with a focus on European countries; To assess the impact of nutrition-related risk factors on non-communicable chronic diseases; To explore socio-economic and cultural correlates to dietary changes in developed and developing countries; To discuss the usage of instruments aimed to identify best practices in food policies to prevent junk food consumption. Organizing the present workshop would provide an important occasion for gathering experts in the field and sharing opinions with the audience in light of the presented results. All publication discussed have been published recently, others are ongoing projects, thus providing a unique opportunity to discuss about potential advocacy activities and policy approaches in the context of a EUPHA conference. Key messages The workshop will provide insights on the current burden of NCDs risk factors. The workshop will focus on dietary risk factors, their socio-economic determinants, and strategies to implement a healthy and sustainable diet globally.

The challenges we face are complex in nature, and require multidisciplinary and intersectoral action at different governance levels. Therefore, EUPHA will reinforce its two-tier approach. On the one hand, we will support our members in providing high quality and efficient public health and health care services in European countries, regions and local communities. On the other hand, we will advocate for health and support evidence-informed health policy-making at the international level. Stimulating and facilitating mutual learning and the exchange of knowledge and experiences across experts, members and countries will be an essential element of EUPHA’s approach. Not only with a focus on optimal support for our members, but also with an explicit focus on overcoming health inequalities within and between European countries. Our new vision is to enable everyone in Europe to achieve the highest possible level of health by providing independent and authoritative analysis of the evidence, combined with targeted advocacy to achieve co-ordinated action by all key stakeholders. Our vision: builds on the commitments of our governments and international agencies to achieve the health-related Sustainable Development Goals;recognises the importance of placing Health in All Policies;draws on the Vienna Declaration to embrace the entire range of health determinants, including the biological, social, environmental, occupational, political, and commercial, the health care system, and everything that influences the health of our planet. Our mission will be: To ensure that there is a strong evidence base, built on sustained investments in data, research capacity, and knowledge translation in all parts of Europe that can inform policies that impact on health;To identify, develop, and advocate for actionable policy recommendations to improve health;andTo support capacity-building and collaborations that can achieve public health action.

BACKGROUND: Little is known about factors associated with mental health problems (MHP) of the elderly in socioeconomically deprived neighbourhoods, and comparisons between Central European and Western European countries on this topic are lacking. We examined whether MHP occurred more frequently in deprived neighbourhoods and among deprived people. Next, we examined whether the association of MHP with area deprivation differed by country and whether this could be explained by the socioeconomic (SE) characteristics of the residents.METHODS: We obtained data on non-institutionalized residents aged 65 years and above from the EU-FP7: EURO-URHIS 2 project from Slovak (N = 665, response rate 44.0%) and Dutch cities (N = 795, response rate 50.2%). An elevated score on General Health Questionnaire-12 (≥2) indicated MHP. Education and household income with financial strain were used as measures of individual SE status. We employed multilevel logistic regression.RESULTS: Overall rates of MHP were significantly higher in Slovakia (40.6%) than in the Netherlands (30.6%). The neighbourhood unemployment rate was not associated with the mental health of elderly in either country. Rates of MHP were significantly higher among elderly with low and medium income [odds ratio (OR) = 1.75, 95% confidence interval (CI) = 1.16-2.62; OR = 1.64, 95% CI = 1.12-2.41, respectively] and financial strain (OR = 2.26, 95% CI = 1.56-3.28) when compared with those with high income and no strain, respectively. Individual-level SE characteristics explained differences between the two countries.CONCLUSION: The risk of MHP among the elderly is associated with their individual-level SE position but not with neighbourhood deprivation in both Slovakia and the Netherlands.

Purpose: To examine whether Obstructive Sleep Apnoea severity, sleep-related problems, and anxiety are associated with work functioning in Obstructive Sleep Apnoea patients, when controlled for age, gender and type of occupation. To investigate whether anxiety moderates the associations between sleep-related problems and work functioning. Materials and methods: We included 105 Obstructive Sleep Apnoea patients (70% male; mean age 46.62 ± 9.79 years). All patients completed the Pittsburgh Sleep Quality Index, the Epworth Sleepiness Scale, the Beck Anxiety Inventory, and the Work Role Functioning Questionnaire-2.0. Results: Obstructive Sleep Apnoea-severity, poor nighttime sleep quality, and anxiety were univariately associated with impaired work functioning. Multivariate analyzes revealed that poor perceived sleep quality was more strongly associated with work functioning than sleep efficiency and daily disturbances. Anxiety was strongly associated with impaired work functioning. After adding anxiety, the explained variance in work functioning increased from 20% to 25%. Anxiety moderated the association between low and medium levels of nighttime sleep quality problems and work functioning. Conclusions: Poor perceived sleep quality and anxiety were strongly associated with impaired work functioning in Obstructive Sleep Apnoea patients. These findings may help to optimize management, standard treatment, and work functioning in people with Obstructive Sleep Apnoea when confirmed in longitudinal studies.Implications for RehabilitationStudies show an impairment of functional status, including work functioning, in obstructive sleep apnea patients.Aside from physical disorders, obstructive sleep apnea patients often experience mental problems, such as anxiety.As many people with obstructive sleep apnea are undiagnosed, our results demonstrate to employers and healthcare professionals the need to encourage patients for obstructive sleep apnea screening, especially in the situation of impaired work functioning, increased anxiety, and poor sleep quality.The associations between obstructive sleep apnea, sleep and anxiety might increase the awareness of health professionals towards optimizing diagnostic accuracy and standard treatment. Studies show an impairment of functional status, including work functioning, in obstructive sleep apnea patients. Aside from physical disorders, obstructive sleep apnea patients often experience mental problems, such as anxiety. As many people with obstructive sleep apnea are undiagnosed, our results demonstrate to employers and healthcare professionals the need to encourage patients for obstructive sleep apnea screening, especially in the situation of impaired work functioning, increased anxiety, and poor sleep quality. The associations between obstructive sleep apnea, sleep and anxiety might increase the awareness of health professionals towards optimizing diagnostic accuracy and standard treatment.

Objectives: To explore the association between hostility and health-related quality of life (HRQoL) among coronary heart disease (CHD) patients, and whether these associations are mediated by sense of coherence (SOC).Background: Intervention research has shown that a decrease in levels of hostility leads to an increase of HRQoL among individuals with CHD. However, the mechanisms that link hostility and HRQoL in CHD patients are not clear.Methods: 509 CHD patients (mean age 58.8 +/- 7.3, 29.3% female) were examined.Results: Hostility was associated with poorer mental HRQoL. Adding SOC to the model weakened the strength of the association between hostility and mental HRQoL. The effect of hostility on mental HRQoL was explained for 61.9% by SOC. Neither hostility nor SOC was associated with physical HRQoL.Conclusions: Our findings indicate that low SOC may partially explain the adverse effect of hostility on low mental HRQoL in CHD patients. (C) 2016 Elsevier Inc. All rights reserved.

Social participation has been recognized as one of the key variables to be addressed in disability research yet few studies addressed the association between restriction in participation and quality of life in the context of rheumatoid arthritis. The aim of this study was to explore the associations between restrictions in social participation and health related quality of life (HRQoL) in early and established group of rheumatoid arthritis (RA) patients. Two samples with early (n = 97; age = 53 +/- 12.3 years; disease duration = 2.8 +/- 1.2 years; 76 % women) and established (n = 143; age = 58 +/- 10.3 years; disease duration = 16.1 +/- 3.6 years; 86 % women) RA patients were collected. Respondents completed questionnaires on pain (NHP), fatigue (VAS), functional disability (HAQ), depression (HADS), social participation restrictions (Participation scale) and health related quality of life (SF-36). Data were analyzed using stepwise regression models controlling for the relevant variables. Perceived social participation restrictions in the group of early patients were found to be negatively associated with the mental health component of the HRQoL (beta = -0.192; p a parts per thousand currency sign 0.05) and in the established RA group with the physical health component of the HRQoL (beta = -0.271; p a parts per thousand currency sign 0.001). These results generally suggest the importance of social participation with regard to HRQoL in RA.

BACKGROUND: Social support and mastery are important aspects in the treatment of chronic diseases, however their role in connection with Obstructive Sleep Apnoea (OSA) remains unclear.OBJECTIVES: The study examined the associations between social support, mastery, sleep-related problems and functional status in untreated OSA patients.METHODS: All patients in this cross-sectional study completed the Multidimensional Scale of Perceived Social Support, the Pearlin Mastery Scale, the Pittsburgh Sleep Quality Index, the Epworth Sleepiness Scale and the Functional Outcomes of Sleep Questionnaire. Multiple linear regression and mediation analyses were used to analyse the data.RESULTS: Participants were 150 newly diagnosed OSA patients (Apnoea-Hypopnoea Index-AHI≥5; 68% male; mean age 48.9 ± 9.5years). Compared with social support, mastery was more strongly associated with functional status. The indirect effects of sleep-related problems on functional status via mastery varied between 17.7% and 23.3%.CONCLUSIONS: Supporting OSA patients' sense of mastery may significantly contribute to better disease management.

BACKGROUND: Ethnicity is associated with differences in clinical course and outcomes of cardiac disease, often in association with a poorer socioeconomic position. The aim of this study was to compare the mortality after coronary angiography (CAG) of Roma and non-Roma patients matched for education and adjusted for gender and age.METHODS: In total, 816 patients were included in the study (167 Roma and 649 non-Roma). Data on socio-demographic background, disease history, use of drugs, coronary findings and type of treatment were obtained from medical records. Mortality was assessed up to seven years after CAG. Kaplan-Meier curves of mortality were plotted, and differences between the Roma and non-Roma patients were assessed using log-rank tests, matched for education and adjusted for gender and age.RESULTS: Mortality after CAG was significantly higher among Roma than non-Roma (log-rank test χ(2) = 7.59, P < 0.01) and remained so after matching for education and adjustment for gender, age, history of previous myocardial infarction and abnormal CAG (hazard ratio: 2.07, 95% confidence interval: 1.13-3.82).CONCLUSION: Mortality after CAG is higher among Roma, and this is not due to differences in age, gender or education. These results warrant further reconsideration of the management of Roma cardiac patients.

Aims: A high sense of coherence (SOC) has been found to be associated with favourable health-related behaviours. However, evidence is for the most part lacking on the influence of SOC on health-related behaviours among coronary heart disease patients. The aim of this study was to explore the association between SOC at baseline and smoking status, nutrition behaviour, physical exercise and alcohol consumption of coronary heart disease patients 12-28 months after they had undergone different cardiac treatments.Methods: A total of 179 coronary heart disease patients (mean age 58.32 +/- 6.54 years, 19% female) were interviewed before coronary angiography and 12-28 months after. Self-report data about health-related behaviours were obtained via a structured interview. SOC was measured using the 13-item Orientation to Life Questionnaire. The relationship between SOC and health-related behaviours was examined using regression and cross-lagged path analyses.Results: SOC at baseline predicted non-smoking and quitting smoking: odds ratio (OR) (95% confidence interval (CI)) per unit increase (over range 38-91) was 1.11 (1.03-1.19) and 1.09 (1.01-1.17), respectively. Moreover, baseline SOC predicted healthy nutrition behaviour among percutaneous coronary intervention patients: the OR per unit increase was 1.08 (95% CI: 1.01-1.15). Lastly, SOC at baseline predicted improvement in alcohol consumption at follow-up among coronary artery bypass grafting patients (standard score result: -0.15, pConclusion: Coronary heart disease patients with a low SOC before treatment are less likely to improve health behaviours after cardiac treatment and should thus get additional attention in health promotion.

BACKGROUND: Health-risk behaviours (HRB) increase the risk of disability and chronic diseases at an older age. This study aimed to compare Slovakia and the Netherlands regarding differences in the prevalence of HRB by neighbourhood and individual deprivation and to determine whether area differences could be explained by the socio-economic position (SEP) of the residents.METHODS: We obtained data on non-institutionalized residents aged ≥65 years from the EU-FP7: EURO-URHIS 2 project from Slovak (N = 665, response rate 44.0%) and Dutch cities (N = 795, response rate 50.2%). HRB concerned daily smoking, binge drinking, physical activity, consumption of fruits and vegetables and body mass index. Area deprivation was measured by the neighbourhood unemployment rate. Individual SEP was measured by education and household income with financial strain. We used multilevel logistic regression.RESULTS: In Slovakia, no HRB was associated with either neighbourhood unemployment or individual SEP. The elderly in the Netherlands from the least favourable neighbourhoods were more likely to be daily smokers [odds ratio (OR) 2.32; 95% confidence interval (CI) 1.25, 4.30] and overweight (OR 1.84; 95% CI 1.24, 2.75) than residents from the most favourable ones. For the Dutch elderly the gradients varied per HRB and per individual-level SEP indicator. Individual SEP explained country differences in the association of area unemployment with smoking and lack of physical activity but not that with overweight.CONCLUSION: Countries differed in the associations with HRB of both neighbourhood unemployment and individual SEP among the elderly urban residents. The local importance of socio-economic factors on both levels should be considered when developing health-promotion activities for the elderly.

Aim. This study explores the association between kidney function, side effects of immunosuppressive treatment, coping self-efficacy, and physical and mental HRQoL at 3 months (baseline) after kidney transplantation (KT) and their impact on patient and graft survival for up to 10 years (follow-up).Methods. A group of 151 patients provided at baseline their socioeconomic and medical (CKD-EPI) data and completed the End-Stage Renal Disease Symptom Checklist (perceived side effects), the coping self-efficacy scale, and the SF-36. At follow-up, patients' health status was noted. Univariate GLM exploring the main effects of the independent variables on physical and mental HRQoL was performed; furthermore, Cox regression analyses were performed to determine whether the early posttransplantation factors predicted patient and graft survival.Results. Less severe side effects of immunosuppressive treatment and higher efficacy in stopping unpleasant emotions were associated with both higher physical and mental HRQoL at baseline. Younger age was associated with higher physical HRQoL and older age, and lower efficacy in getting support from family and friend were associated with higher mental HRQoL Patients reporting higher physical and mental HRQoL at 3 months and with higher age and better kidney function had higher odds of surviving with a functioning graft.Conclusion. Older age, higher kidney function, and higher physical and mental HRQoL at baseline significantly improved the odds of graft and patient survival over 10 years. These results show the importance of close monitoring of early posttransplantation HRQoL along with kidney function and reported side effects because of their effect on long-term patient outcomes.

Aims. To explore the predictive value of adherence to their immunosuppressive medication in kidney transplant recipients in the first year after kidney transplantation as a determinant of graft loss and mortality up to 12 years (prospective analysis) and its association with sociodemographic and medical factors and social support (cross-sectional analysis).Background. Poor adherence to their immunosuppressive medication in kidney transplant recipients remains the leading preventable cause of poor patient outcomes.Design. Prospective and cross-sectional study.Methods. At baseline, 325 patients 3-12 months posttransplantation were invited to participate. Adherence was assessed using collateral reports a combination of patients' self-evaluation and an estimate by their nephrologist. The patients provided sociodemographic and medical data and completed the End-Stage Renal Disease Symptom Checklist and Multidimensional scale of perceived social support. At follow-up (average 7.1 years), data on patients and graft survival were obtained. All data were collected from 2002-2013. Multinomial regression analysis and Cox regression were performed.Results. A total of 297 patients (48-1 (12.8) years, 61-6% men) agreed to participate (response rate 91.4%); 67.4% were considered as fully adherent. Poor adherence was associated with higher risk of graft loss and mortality over 12 years. Female sex, higher education, higher perceived side effects of corticosteroids, better perceived cardiac and renal function and higher perceived family social support in the first year posttransplantation were associated with full adherence to immunosuppressive treatment.Conclusions. Patients with poor adherence to the immunosuppressive medication in the first year after kidney transplantation showed increased likelihood of graft loss and death over 12 years compared with the adherent patients.

Background Multiple sclerosis (MS) is a disease with serious health and social consequences which requires effective disease management. Patients engage in various coping behaviours in order to manage their disease. The aim of this study is to find out if self-esteem of patients is associated with coping strategies and if it can enhance …

International comparisons of the associations of area-level socioeconomic position (SEP) and health-risk behaviours (HRBs) are for the most part lacking. The aims of this study were to compare Slovakia and the Netherlands regarding differences in the prevalence of HRBs by neighbourhood and individual deprivation, and to determine whether area differences could be explained by the SEP of residents.We obtained data on residents aged 19-64 from Slovak and Dutch cities from the FP7 EURO-URHIS2 project and employed multilevel logistic regression.The association between neighbourhood-level unemployment and HRBs differed between countries. In the Netherlands, the prevalence of almost all HRBs was higher in deprived areas, except for the consumption of fruits and vegetables. These area effects diminished after controlling for individual-level SEP. In Slovakia, no area effects were observed, although Slovak residents showed a higher risk for most HRBs. At the individual level, an inverse SE gradient was found for almost all HRBs in both countries.Local analyses of small area health differences and health determinants are critical for efficient implementation of neighbourhood-based interventions.

Objectives Coronary heart disease (CHD) is the most common cause of mortality and morbidity world-wide. Evidence on ethnic differences between the Roma and nonRoma regarding medical risk factors is scarce. The aim of this study was to assess differences in medical risk factors and the severity of CHD in Roma compared with nonRoma CHD patients, adjusted for gender, age and education. Methods Six hundred seventy four patients were included in this cross-sectional study (132 Roma, 542 non-Roma). Data on medical risk factors, symptoms, medication and severity of CHD were obtained from medical records. After matching Roma and non-Roma according to education, linear and logistic regression analyses with adjustments for gender and age were used. Results Compared with non-Roma, Roma patients had significantly more risk factors and more severe types of CHD. They were treated less frequently with statins and beta-blockers, were more frequently left on pharmacotherapy and surgically revascularised. These differences remained after controlling for education, gender and age. Conclusions Roma CHD patients have a worse risk profile at entry of care and seem to be undertreated compared with non-Roma CHD patients.

Purpose: Fatigue is a frequent non-motor complaint of patients with Parkinson's disease (PD). Despite increasing knowledge on fatigue, the factors leading to its development are still not recognised. The aim of this investigation was to test, using structural equation modelling, the hypothesis that the influence of disease severity on fatigue is mediated by symptoms of depression in patients with PD. Method: The sample consisted of 190 PD patients (93 men, 48.9%, mean age 68.2 ± 9.3 years, mean disease duration 6.4 ± 4.7 years) recruited from hospitals and outpatient clinics in the East Slovakia region. The Multidimensional Fatigue Inventory, the Hospital Anxiety and Depression Scale and the Unified Parkinson's Disease Rating Scale were used. LISREL was used to analyse the data. Results: Disease severity was directly associated with symptoms of depression (β = 0.26) and directly affected fatigue in terms of increased levels of general fatigue (β = 0.35), physical fatigue (β = 0.22), reduced activity (β = 0.31) and mental fatigue (β = 0.29), but did not directly influence reduced motivation. Symptoms of depression mediated the impact of disease severity on general fatigue (β = 0.25), on reduced activity (β = 0.31) and on mental fatigue (β = 0.28), but not on physical fatigue. Reduced motivation was not mediated, but directly influenced by more symptoms of depression (β = 0.82). Discussion: Since increased symptoms of depression mediate the impact of disease severity on three domains of fatigue in PD patients, disease management should focus on the treatment of PD and symptoms of depression.

Purpose The aim of this study was to determine whether sense of coherence (SOC) at baseline predicts health-related quality of life (HRQoL) at 12-28-month follow-up among patients with coronary heart disease when controlled for sociodemographic and medical variables.Methods A total of 179 consecutive patients (58.28 +/- 6.52 years, 16.8% women) scheduled for coronary angiography (CAG) were interviewed before CAG and 12-28 months after. SOC was measured with the 13-item Orientation to Life Questionnaire. HRQoL was measured using the Short Form Health Survey 36 (SF-36), from which the mental and physical component summaries (MCS, PCS) were calculated. The relationship between SOC and HRQoL was examined using regression analyses.Results SOC proved to be a significant predictor of the MCS-score (B = 0.29; 95% CI = 0.17-0.41) and PCS-score (B = 0.18; 95% CI = 0.06-0.31) when not adjusted for possible confounding sociodemographic and medical variables. After adjustment for sociodemographic and medical variables, SOC remained a predictor of the MCS-score (B = 0.26; 95% CI = 0.14-0.39). SOC also remained a predictor of the PCS-score when controlled for gender, age and family income; however, the association disappeared after adjustment for functional status (B = 0.07; 95% CI = -0.05 to 0.19).Conclusions SOC is a predictor of mental and physical HRQoL at 12-28-month follow-up, crude and also after adjustment. Patients undergoing CAG with low SOC thus deserve particular attention in regard to the maintenance and improvement of their HRQoL.

Purpose: The aim of the study was to examine whether rheumatoid arthritis (RA) patients with different levels of restriction in social participation differ in disease related as well as psychosocial variables and whether a similar pattern can be found among early and established RA patients.Method: Two samples of RA patients with early (n = 97; age = 53 ± 12.3 years; disease duration = 2.8 ± 1.2 years; 76% women) and established (n = 143; age = 58 ± 10.3 years; disease duration = 16.1 ± 3.6 years; 86% women) were collected. The pattern of differences for the patients with different level of participation restriction (no restriction, mild, moderate or high restriction) was explored by the Jonckheere–Terpstra test. Results: Significant differences were found between patients with different levels of social participation restrictions in both samples in pain, fatigue, functional disability, anxiety, depression and mastery. Generally, it was found that patients with higher restrictions experienced more pain and fatigue, more anxiety and depression and reported lower mastery. Similar pattern of differences concerning disease activity and self-esteem was found mainly in the established group. Conclusions: The study shows that the level of perceived restrictions in social participation are highly relevant regarding the disease related variables such as pain, fatigue and functional disability as well as psychological status and personal resources in both early and established RA.Implications for RehabilitationSupporting involvement and participation of individuals with rheumatoid arthritis is important for decreasing the impact of RA symptoms on everyday life.Recognition and empowerment of individual resources such a mastery and self-esteem of RA patients could be beneficial for overcoming restrictions in participation.Keywords: Anxiety, depression, functional disability, participation, rheumatoid arthritis

This study explores how employment is associated with perceived physical and mental health status in people with multiple sclerosis (MS) adjusted for sociodemographic and clinical variables stratified by age. The sample consisted of 184 MS patients divided into a younger (= 45 years) age group. Respondents underwent an interview, a neurological examination on disability [Expanded Disability Status Scale (EDSS)], and completed the Short Form-36 Health Survey. Of the respondents (mean age 40.5 +/- 6.2 years), 43.5% were employed. Significant differences between younger and older patients were found in employment, EDSS, disease duration, and five Short Form-36 Health Survey dimensions. Block-step multiple regression explained 32.4% of the variance in physical health and 14.5% in mental health in the younger group. Being employed was significantly related to good physical health, whereas EDSS diminished the effect of being employed on physical health. The most important variable for mental health was employment status in the younger group. For the older age group, 19.1% of the variance in physical health and 14.0% of the variance in mental health was explained by the studied variables. Male gender and a lower EDSS were significant explanatory variables of better physical health. Male gender significantly explained mental health in the older age group. In conclusion, employment status was an explanatory variable for physical health and mental health in the younger patients. EDSS played a significant role in physical health for all patients. A vocational rehabilitation program could prevent eventual nonemployment and improve health outcomes in older MS people. International Journal of Rehabilitation Research 35: 40-47 (C) 2012 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.

The aim of this study was to examine the occurrence of end-stage renal disease (ESRD) in Slovak children, to compare it with earlier Slovak data and with data from other European countries, and to explore etiology. Over the years 2003-2009, data on the incidence and prevalence of all cases of ESRD in children from all four Slovak tertiary pediatric centers were collected. The data were compared with two earlier Slovak studies and with European data from the European Society of Paediatric Nephrology. The median annual incidence rate of ESRD in Slovak children under 15 years of age was 6.6 per million age-related population (pmarp). The prevalence rate on 31 December 2009 was 24.1 pmarp. Compared with the last study (18.6 pmarp), the differences were not statistically significant. The comparison with neighboring countries and with the European average shows no significant difference in incidence, while prevalence is significantly lower compared to neighboring Austria and some other (mostly western) European countries as well as the European average. In conclusion, during the past decade, the incidence and prevalence rates of ESRD in Slovak children have remained stable. Compared to the European average, the prevalence in Slovak children is significantly lower.

Background: This prospective study explores and compares the relationship between patients’ self-rated health (SRH) after kidney transplantation (KT) at different follow-up periods and its medical and nonmedical predictors over time. Methods: Patients (n = 128) who completed a questionnaire (the SRH question of the SF-36 and the End-Stage Renal Disease Symptom Checklist – Transplantation Module) were enrolled. Clinical data were retrieved from medical files. The sample was stratified into early (n = 89) and late (n = 39) cohorts according to time since KT at baseline. Linear regression was used to identify predictors of SRH at follow-up. Results: In both cohorts, a change in glomerular filtration rate (GFR) over time remained a predictor of SRH; in the early cohort, age was an additional predictor; in the late cohort, a change in transplantation-associated psychological distress over time and the number of late acute rejection episodes during the observation period were additional predictors. Conclusions: Improvement in GFR over time predicted better SRH at each period after KT. Decreased transplantation-associated psychological distress and fewer late acute rejection episodes seemed to predict better SRH at a later follow-up period. Despite these observations, higher SRH was associated with better clinical outcomes.

OBJECTIVE The aim of this study was to explore the relationship between self-rated health (SRH) in patients after kidney transplantation (KT) as well as graft function over time. METHODS The sample consisted of 42 patients who were examined in the 3rd month (T1) and the 12th month after KT (T2). Sociodemographic data and data on glomerular function (GF) (Cockroft-Gault) were collected. Patients completed the SF-36 questionnaire measuring SRH. Linear regression was used to identify predictors of SRH at T2. Age, gender, change in GF, and SRH at T1 were set as the independent variables. RESULTS SRH and GF improved slightly over time. The first model, consisting of age, gender, SRH at T1, and GF at T2, explained 49.9% of the variance in SRH at T2; GF at T2 did not significantly contribute to the model. The second model, consisting of age (β = –0.26, 95% CI 1.087;–0.035, p ≤ 0.05), change in GF between T2 and T1 (β = 0.31, 95% CI 9.267;63.643, p ≤ 0.01), and SRH at T1 (β= 0.5, 95% CI 0.247;0,68, p ≤ 0.001), explained 54.6% of the variance in SRH at T2. CONCLUSIONS Although SRH after transplantation is not associated with absolute levels of GF, there is a signifi-cant association with the change in GF over time.

The aim of this study was to assess whether psychosocial factors and health-related quality of life (HRQL) differ between Roma and non-Roma coronary patients and to what degree socioeconomic status (SES) explains these differences.We included 138 patients out of 437 interviewed: 46 Roma, all with low SES, 46 non-Roma with low SES, and 46 non-Roma with high SES. Groups were matched for age, gender and education. The GHQ-28 was used for measuring psychological well-being, the Maastricht interview for vital exhaustion, the type D questionnaire and the Cook-Medley scale for personality and the SF-36 for HRQL. SES was indicated by income and education, and disease severity by ejection fraction. ANOVA and linear regression were used.Roma scored poorly compared to non-Roma in psychological well-being, vital exhaustion and HRQL (p a parts per thousand currency sign 0.001); however, these differences could be to a substantial extent explained by SES. With regard to personality traits, ethnicity and SES played a less significant role.The adverse quality of life among Roma coronary patients may warrant additional care, which should target their low SES but also other factors related to their ethnic background, such as culture and living conditions.

Objectives This systematic review focuses on the role of the intensity of fear in patient’s delay in cancer and in myocardial infarction. Methods In a search of literature published between 1990 and June 2009, 161 articles were found. After the use of inclusion and exclusion criteria, 11 articles in cancer and 4 articles in myocardial infarction remained. Results High levels of fear are associated with earlier help-seeking in both diseases; for low levels of fear, the picture is unclear. Conclusion The level of fear is an important factor, which should be taken into account when facilitating help-seeking by patients.

P>Health-related quality of life (HRQoL) has become an important outcome in the evaluation of kidney transplantation (KT). Although the medical and sociodemographic predictors of HRQoL in patients after KT are well known, there is still a lack of knowledge about the psychological factors involved. This study focuses on the role of personality and actual psychological distress in predicting HRQoL after KT. Sociodemographic (gender, age, education, average income), medical (glomerular filtration, serum albumin, number of co-morbid diseases) and psychological data (neuroticism, extroversion, psychological distress) were collected from 177 (60.5% male subjects; 48 +/- 12.1 years) kidney transplant recipients, and physical and mental HRQoL were measured using the SF-36. A univariate general linear model analysis was performed. Higher physical HRQoL was associated with younger age, higher education and income, a low number of co-morbid diseases, lower neuroticism and distress. Higher mental HRQoL was associated with higher education and income, longer time from KT, higher extroversion, lower neuroticism and distress. In both physical and mental HRQoL, actual distress was the best predictor, even when controlled for neuroticism. These results confirm the importance of psychological distress in patients and its impact on their HRQoL after KT and can be applied in intervention programs focused on increasing HRQoL.

Kidney transplantation offers longer survival, less morbidity and lower costs than dialysis. It is also believed to improve quality of life. The aim of this study was to compare prospectively the perceived health status (PHS) of dialyzed patients on a waiting list with kidney transplant recipients after transplantation, matched for age, gender and comorbidity. The sample consisted of 93 dialyzed patients on a waiting list for deceased-donor kidney transplantation and 87 incident transplant recipients. A total of 62 dialyzed patients were matched for age, gender and comorbidity with 62 transplant recipients. PHS was measured using the SF-36 questionnaire. Data from baseline and after 12 months were compared between the groups. Patients on dialysis had worse physical (49 +/- 21) and mental (59 +/- 18) PHS than transplant recipients (56 +/- 21 and 64 +/- 18, p < or = 0.05), but when matched pairs were compared, no differences in PHS were found. After 12 months, PHS did not change significantly in either group. The PHS of patients after kidney transplantation is better than that of those on dialysis. However, this fact is significantly influenced by the selection procedure, as only some dialyzed patients are put onto the waiting list while others were actually transplanted. The differences disappear with matching.

This review of literature gives an overview of recent studies about perceived health status as measured by the Short-Form-36 (SF-36) Health Survey in patients with multiple sclerosis (MS). The SF-36 is one of the tools measuring health status in patients used in international research and clinical practice. It measures two main health concepts - physical and mental. The SF-36 represents a valid instrument able to detect differences in perceived health status in patients. A computer-aided search in Medline and PsycINFO resulted in 504 articles in English published from 1996 to August 2006. After the screening process on the basis of abstracts, eight articles consisting of empirical studies remained in which perceived health status was evaluated using the SF-36 Health Survey. Seven studies focused on disability and perceived health status in the SF-36. Two studies focused on the relationship between depression and perceived health status. These studies showed that MS patients with low disability and minor depression scored significantly better than patients with high disability and major depression in the SF-36 health dimensions. Gender seems to have no influence on perceived health status in MS patients. The longer the disease duration and the more severe the disease, the lower the patients scored in perceived health status. The more disabled, the more depressive and the older the patients, the poorer their perceived health status was. Health providers supporting appropriate treatment might pay more attention to more disabled and more depressive patients, with longer disease duration. Perceived health status can be a predictor of prognosis and intervention outcomes. The study shows the importance of measuring perceived health status in MS patients with implications for their quality of life and provision of care.

Background and purpose: Multiple sclerosis (MS) is a chronic disease that is difficult to predict and to cope with. Mastery refers to the extent to which patients see themselves as being in control of the forces that affect their lives. It may play an important role in perceived health status and well-being. The purpose of this study was to clarify whether mastery is associated with functional disability and perceived health status in MS patients and how such an association might function. Methods: Two hundred and three MS patients completed the Short-Form-36 Health Survey as well as the Pearlin-Schooler Mastery Scale. Functional disability was assessed using the Kurtzke Expanded Disability Status Scale. Hierarchical multiple linear regression analyses were performed on the data from two MS age groups: = 45 years of age. Results: Functional disability was negatively associated with perceived physical health status in both age groups and with perceived mental health status in younger age group. Mastery was positively associated with perceived health status in older age group. Discussion: The findings confirm that mastery might be helpful for older MS patients. Education strategies for MS patients aimed at personal empowerment for the maintaining of physical and mental well-being may be important.

Objectives: The main purpose of this paper is to explore whether unemployment influences adolescents' subjective perception of health and whether perceived financial stress and social contacts can mediate the effect of employment status on health. We are also interested in the differences in financial situation and social contacts between unemployed secondary school leavers and their employed and studying counterparts.Methods: Data were obtained from 844 adolescents (mean age 19.6) from Slovakia. The effect of unemployment on several health indicators was measured and subsequently controlled for perceived financial strain of respondents and their social contacts.Results: The results showed highest financial strain among unemployed, whereas only small differences in social contacts were found between three groups. Negative influence of unemployment on perceived health of respondents was confirmed. Nevertheless, strong influence was found only on long-term well-being and mental health. Financial situation and social contacts contributed to the prediction of almost all health outcomes, and to some extent mediated the effect of unemployment.Conclusions: Although unemployment was found to have a negative impact on health of adolescents, sufficiency of social contacts and good financial situation seem to decrease this effect and protect the health of unemployed people.

Cardiovascular disease (CVD) is the first cause of mortality and morbidity worldwide. It is responsible for 30 % of all deaths, so that more people die annually from CVD than from any other cause, and 10 % of global burden disease. Currently, the vast majority of deaths and disabilities due to CVD take place in low- and middle-income countries. CVD is largely preventable; therefore, the implementation of effective strategies for prevention and control is imperative. Both population-wide measures and improved access to individual health care interventions may result in a major reduction in the health and socioeconomic burden by CVD and its risk factors. These interventions, evidence based and extremely cost-effective, are the “best buys,” which are workable solutions and excellent economic investments, also in the poorest countries.

Patients after kidney transplantation have decreased mortality, morbidity and better quality of life compared to people on dialysis. Major efforts are being directed towards research into graft and patient survival. Research into quality of life is less intensive. The aim of this study was to explore the predictors of perceived health status (PHS) in kidney transplant recipients.Out of 218 patients after kidney transplantation 138 participated in the study. Linear regression analysis was performed to predict PHS, measured with the SF-36 questionnaire, in three age categories (40, 40-59,or=60 years). Independent variables included social support (measured with the Social Support List Discrepancies questionnaire), sociodemographic and medical variables, side effects and compliance.Predictors of better PHS in patients40 years were better social support (Por=0.001), lower creatinine (Por=0.001) and lower stress from adverse effects (Por=0.001). In the group of patients aged 40-59 years higher education (Por=0.05), increased housekeeping activities (Por=0.01) and lower stress from adverse effects (Por=0.001) predicted better PHS. In the last age group predictors of better PHS were lower rate of dialysis (Por=0.05) and posttransplant hospitalizations (Por=0.01), absence of diabetes mellitus (Por=0.01) and lower stress from adverse effects (Por=0.05).Major differences exist in PHS among kidney transplant recipients depending on their age. Side effects of therapy are the most important predictor of PHS for all age groups. PHS of young patients mostly depends on their renal function and their social support. Education and working activities are most important for middle-aged people whereas in older patients PHS is mostly affected by comorbidity.

In the time of financial crisis, an ageing population and a growing burden of chronic disease healthcare systems are under great pressure. In recent years much political attention has been given to chronic diseases, resulting in initiatives such as the Political Declaration of the 2011 UN High Level Meeting on the Prevention and Control of Non-Communicable Diseases in New York, the WHO Ministerial Conference on Non-Communicable Diseases in Ashgabat 2013, or the recent EU Summit on Chronic Diseases 2014 in Brussels. Chronic diseases are interrelated, have common risk factors and are …

Background. Social participation is considered to be an objective parameter for evaluating the success of transplantation. This study explores the association between posttransplant factors (kidney function, perceived side effects of immunosuppressive treatment, comorbidity, physical and mental health-related quality of life [HRQoL]) and social participation in patients 3 months to 6 years after kidney transplantation (baseline) and their impact on graft loss andmortality for up to 10 years (follow-up). Methods. At baseline, 331 patients provided their socioeconomic and medical data (comorbidity, kidney function) and completed the end-stage renal disease symptom checklist (perceived side effects), the Short Form Health Survey-36 and the Participation Scale. At follow-up, information on all-cause graft-loss and mortality was noted. Binary logistical regression exploring the effects of the independent variables on social participation and Cox regression analyses determining whether social participation predicted graft loss and mortality were performed. Results. Restrictions in social participation were associated with living alone, poorer kidney function, lower perceived side effects of corticosteroids, higher perceived cardiac and renal dysfunction, higher perceived posttransplantation distress, lower physical HRQoL, and fewer working hours. Restrictions in social participation increased the risk of all-cause graft loss 2.29-fold and the risk of all-cause mortality 11.94-fold during follow-up. Education, kidney function, and comorbidity also increased the risk for poor patient outcome. Conclusion. Kidney function, perceived side effects, comorbidities, and HRQoL affect social participation in patients after kidney transplantation. Additionally, social participation has a positive effect on long-term patient outcomes, decreasing the odds of graft loss and mortality over 10 years.

Aims and objectives To explore whether self-rated health acts as a potential mediator in the association between functional status and health-related quality of life in Parkinson's disease. Background Older persons (as most patients with Parkinson's disease are) who reported poor self-rated health compared with those with excellent self-rated health were two-and-a-half times more likely to have experienced a decline in functional ability. Design Cross-sectional. Methods Socio-demographic and clinical data of the patients (n=176) were obtained during a structured interview and from medical records. Functional status was measured with the Unified Parkinson's Disease Rating Scale (total score), self-rated health with the first item of the Short-Form 36-item Health Survey Questionnaire and health-related quality of life with the disease-specific questionnaire called the Parkinson's Disease Quality of Life Questionnaire-39. Multiple linear regression analyses and the Sobel test were employed to assess mediation. Results Self-rated health seems to have a mediating effect on the association between functional status and health-related quality of life. The Sobel test confirmed an indirect effect of functional status via self-rated health on health-related quality of life and showed a statistically significant indirect effect of functional status on health-related quality of life via self-rated health against the direct route without the mediator. Conclusions Self-rated health partially mediates the deteriorating effect of functional status on health-related quality of life. Relevance to clinical practice Supportive and adaptation psychosocial intervention programmes leading to restored self-rated health may enhance the quality of life regardless of disability in Parkinson's disease.

Background: Quantifying the clinical impact of multiple sclerosis (MS) is one of the most important determinants for optimizing individual patient care. Useful clinical measures for MS can be evaluated from different perspectives. Objective/Hypothesis: This cross-sectional study compared physical disability and functional status as assessed by a neurologist and by a patient and explored how they are associated with the health-related quality of life (HRQoL). Methods: We collected data from 223 patients. One neurologist scored functional disability using the Kurtzke’s Expanded Disability Status Scale (EDSS) and patients evaluated their functional status using the Incapacity Status Scale (ISS). HRQoL was assessed using the Physical and Mental Component Summary (PCS, MCS) of the Short Form-36 Health Survey (SF-36). Multiple linear regressions were applied to analyze the data. Results: Total EDSS and ISS scores correlated significantly (r 5 .67; p < .001). Regression analyses showed that EDSS was significantly related to PCS, but not to MCS. After adding ISS into the analysis the association between EDSS and PCS became non-significant. ISS contributed significantly to the explained variance in both models. The final model explained 49% of the total variance for PCS and 15% for MCS. Conclusions: Functional disability as measured by a neurologist (EDSS) is associated with PCS, but not with MCS, whereas functional disability as measured by patients (ISS) is significantly associated with both HRQoL dimensions. Neurologists should target their attention more on patients’ evaluations of their functional status in order to detect the most bothersome problems that are affecting a patient’s quality of life. 2015 Elsevier Inc. All rights reserved.