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Purpose: Comprehensive assessment of stuttering requires consideration of a wide range of behaviors that impact outcomes, and the Overall Assessment of the Speaker's Experience of Stuttering (OASES) is an assessment tool that accomplishes such. The purpose of this study was to determine how the individual components of the test contribute to the OASES' impact score., Method: Data collected at a university speech-language and hearing clinic from 29 adults were used for a relative weight analysis (RWA). RWA was utilized to determine the relative contributions of the OASES' subtests to the OASES' impact score. Confidence intervals for the individual relative weights were calculated for each OASES subtest and significance tests based on bootstrapping with 10,000 replications., Results: Differences were present in contributions of the OASES' subtests to the OASES' overall impact score, where the following explained a significant amount of variance in the OASES' impact score: Speaker's Reactions; Daily Communication; and Quality of Life. However, contribution of the subtest, "General Information", was not significant., Conclusion: Through examination of relative contributions to the impact of stuttering using the OASES, this project has identified differences in contributors to the overall impact of the disorder of stuttering. This information is beneficial to researchers and clinicians alike in that it gives specific guidance into what determines increased impact in adults who stutter (AWS). Future works should pursue clarification of these differences with an end goal of identifying and overcoming barriers to positive outcomes while also identifying and nurturing facilitators to optimal management., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Recent studies have shown that stroke has a differential impact in women compared to men. Women are more likely to survive strokes than men, yet they experience more severe strokes resulting in greater poststroke disability. However, few studies have characterized sex differences in functional ability after stroke. This study examined sex differences in long-term disability among stroke survivors., Methods: This was a retrospective analysis of the 2015 National Health Interview Survey. Respondents were asked to rate their ability to perform 11 functional tasks. Univariate comparisons were completed to evaluate sex differences in performance, and multinomial logistic regression was used to determine the odds of reporting functional limitations., Results: Five hundred fourteen men and 641 women stroke survivors completed the survey (mean age: 66.9 years). Approximately 75% of the sample reported having hypertension, 61% high cholesterol, 33% diabetes, 24% heart disease, 21% heart attack, and 16% chronic obstructive pulmonary disease. In the predictive models, men were less likely to report "very difficult/can't do at all" in walking ¼ mile (odds ratios [OR] = 0.68, 95% CI 0.51-0.90), climbing 10 steps (OR = 0.65, 95% CI 0.49-0.85), standing 2 hours (OR = 0.66, 95% CI 0.50-0.87), stooping (OR = 0.51, 95% CI 0.39-0.68), reaching overhead (OR = 0.69, 95% CI 0.49-0.97), carrying 10 pounds (OR = 0.45, 95% CI 0.34-0.59), and pushing large objects (OR = 0.37, 95% CI 0.28-0.5) compared to women., Conclusions: The functional outcomes of men stroke survivors were significantly greater than women. The specific factors that contribute to sex differences in stroke-related outcomes are not entirely clear. Future research is needed to better understand these differences to ensure that equity of care is received.

Purpose of the Study: Converging evidence from large community-based samples, Internet studies, and Veterans Health Administration data suggest that transgender adults have high rates of U.S. military service. However, little is known about the role of prior military service in their mental health later in life, particularly in relation to identity stigma. In this article, we examine relationships between prior military service, identity stigma, and mental health among transgender older adults., Design and Methods: We used a subsample of transgender older adults (n = 183) from the 2014 survey of Aging with Pride: National Health, Aging, and Sexuality/Gender Study (NHAS). We employed weighted multivariate linear models to evaluate the relationships between psychological health-related quality of life (HRQOL), depressive symptomatology (Center for Epidemiological Studies Depression Scale [CES-D] scores), identity stigma, and prior military service, controlling for background characteristics., Results: Identity stigma was significantly related with higher depressive symptomatology and lower psychological HRQOL. Having a history of prior military service significantly predicted lower depressive symptomatology and higher psychological HRQOL. The relationships between psychological HRQOL, identity stigma, and prior military service were largely explained by depressive symptomatology. Prior military service significantly attenuated the relationship between identity stigma and depressive symptomatology., Implications: By identifying the role of military service in the mental health of transgender older adults, this study provides insights into how prior military service may contribute to resilience and positive mental health outcomes. Directions for future research are discussed., (© The Author 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Studies of poststroke quality of life (QOL) have not consistently identified which factors are most likely to independently influence the physical and mental aspects of QOL. In this study, we sought to identify which sociodemographic, comorbid disease conditions, and disability factors independently influenced the physical and mental aspects of poststroke QOL., Methods: We completed a cross-sectional study of 666 US adults with a history of stroke from the 2007 Medical Expenditure Panel Survey (MEPS). We used sequentially built multiple linear regression models to identify sociodemographic, comorbidity, and stroke-related disability factors that independently affected short form-12 (SF-12) physical component summary (PCS) and mental component summary (MCS) scores. STATA software (version 10; StataCorp LP, College Station, TX) was used to perform the analysis to account for the complex survey design of the MEPS., Results: In fully adjusted models using a nationally representative sample of US adults, being non-Hispanic black (β = 3.58), 45 to 64 years of age (β = -3.48), 65 years of age or older (β = -2.90), married (β = -3.50), middle (β = 2.78) and high income (β = 3.73), or having hypertension (β = -2.25), cardiovascular disease (β = -2.05), arthritis (β = -4.49), depression (β = -2.98), physical limitations (β = -7.60), social limitations (β = -4.12), and a need for assistance with instrumental activities of daily living (β = -4.49) were independently correlated with PCS scores. Being 45 to 64 years of age (β = 3.96), depressed (β = -15.92), or having social limitations (β = -3.62) were independently correlated with MCS scores., Conclusions: Sociodemographic, comorbidity, and stroke-related disability factors have differential effect on physical and mental aspects of QOL in poststroke patients., (Published by Elsevier Inc.)

Aim: The study aims to examine the association between major depression, healthcare behaviors, and quality of life indices among adults with stroke., Methods: Data from 5869 participants with stroke in the 2006 Behavioral Risk Factor Surveillance Survey were examined. Multiple logistic regression was used to assess the independent association between depression status, self-care and preventive health behaviors, and quality of life indices, after accounting for relevant covariates., Results: In multivariate models, individuals with major depression were less likely to engage in physical activity (odds ratio 0·41; 95% confidence interval 0·29, 0·56) than those without major depression. Women with major depression were also less likely to have received a mammogram in the past two-years (odds ratio 0·61; 95% confidence interval 0·40, 0·96 for women ≥ age 40 and odds ratio 0·58; 95% confidence interval 0·36, 0·72 for women ≥ age 50) and a pap smear in the past three-years (odds ratio 0·40; 95% CI 0·22, 0·72). In comparisons of quality of life, individuals with major depression were less likely to perceive their health as excellent/very good/good (odds ratio 0·36; 95% confidence interval 0·25, 0·53), to report being satisfied with life (odds ratio 0·13; 95% confidence interval 0·08, 0·20), and to report receiving needed social support (odds ratio 0·42; 95% confidence interval 0·28, 0·63). Individuals who were depressed were also more likely to report one or more poor physical and poor mental health days in the past 30 days (odds ratio 4·56; 95% confidence interval 3·08, 6·76 and odds ratio 10·97; 95% confidence interval 7·75, 15·52, respectively)., Conclusions: In adults with stroke, major depression is associated with decreased engagement in stroke-specific and gender-specific self-care and preventive health behaviors, as well as a broad range of quality of life indices., (© 2011 The Authors. International Journal of Stroke © 2011 World Stroke Organization.)

Objective: To examine the association between major depression and preventive care practices and quality-of-life indices among adults with diabetes., Methods: Data from 16,754 participants with diabetes in the 2006 Behavioral Risk Factor Surveillance Survey were examined. Multiple logistic regression was used to assess the independent association between the presence of major depression and a range of (1) preventive care behaviors and (2) quality-of-life indices, after accounting for relevant covariates., Results: With regard to preventive care practices, women with major depression were less likely to have received a mammogram in the past 2 years [OR 0.60 (95% CI 0.45-0.79) for women age 40 years and older and OR 0.52 (95% CI 0.37-0.71) for women age 50 and older] relative to their counterparts without major depression. With regard to quality-of-life indices, individuals with major depression were less likely to perceive their health as good [OR 0.24 (95% CI 0.19-0.31)], to report being satisfied with life [OR 0.10 (95% CI 0.07-0.14)] and to report receiving needed social support [OR 0.29 (95% CI 0.22-0.38)] relative to individuals without major depression. Individuals with major depression were also more likely to report one or more poor physical and poor mental health days in the past 30 days [OR 4.36 (95% CI 3.33-5.72) and OR 9.77 (95% CI 7.81-12.22), respectively] than those without major depression., Conclusions: Major depression in adults with diabetes is associated with decreases in a wide range of quality-of-life indices as well as preventive self-care practices that were not entirely limited to diabetes-specific disease management., (Copyright © 2010 Elsevier Inc. All rights reserved.)

Background: The objective of this study was to assess differences in metabolic control and health-related quality of life (QOL) among depressed and nondepressed adults in an indigent population with type 2 diabetes., Research Design and Methods: Subjects completed validated surveys to assess depression and QOL. Depression was assessed with the Center for Epidemiological Studies-Depression Scale and defined as a score of > or =16. Metabolic control (hemoglobin A1C, total cholesterol, low-density lipoprotein [LDL] cholesterol, and high-density lipoprotein [HDL] cholesterol) measures were abstracted from medical records. We compared demographic characteristics, metabolic control, and QOL by depression status. Ordinary least squares regression was used to assess differences in QOL scores and metabolic control levels by depression status adjusting for covariates., Results: In the study sample (n = 201), approximately 20% (n = 40) were depressed. In unadjusted analyses, subjects with depression had significantly lower SF-12 physical component summary (PCS) scores (30.4 +/- 7.3 vs. 39.6 +/- 11.8, P < 0.001) and mental component summary (MCS) scores (32.8 +/- 10.5 vs. 48.9 +/- 9.2, P < or = 0.001) and significantly higher total cholesterol (209.3 +/- 72.1 vs. 186.6 +/- 50.9, P = 0.024) compared to those without depression. No significant differences were observed by depression status in hemoglobin A1C, LDL cholesterol, and HDL cholesterol. After adjustment for relevant covariates, depressed individuals continued to have lower SF-12 PCS (36.1 vs. 39.0, P < or = 0.001) and MCS (41.6 vs. 46.8, P < or = 0.001) scores, but the difference in total cholesterol levels was no longer significant., Conclusions: In an indigent sample with type 2 diabetes, depression is significantly associated with decreased physical and mental components of QOL. This finding further reinforces the importance of addressing depression in all populations with type 2 diabetes.

Introduction: Chronic plaque psoriasis has a profound impact on patient quality of life (QOL), including adverse psychosocial effects, impaired daily activities, anxiety, and depression., Objective: To assess health-related QOL in a randomized phase II trial of alefacept (human LFA-3/IgG(1) fusion protein), a selective immunomodulator for psoriasis., Study Design: Multicenter, randomized, placebo-controlled, double-blind trial., Methods: 229 patients with moderate to severe psoriasis were randomized to alefacept (0.025, 0.075, or 0.150 mg/kg) or placebo by 30-second intravenous bolus once weekly for 12 weeks and followed for 12 additional weeks. Patients completed a general (SF-36) Health Survey) and dermatology-specific (Dermatology Life Quality Index [DLQI] and Dermatology Quality Of Life Scales [DQOLS]) QOL surveys at each study visit., Results: Patients treated with alefacept had significantly greater improvements on dermatology-specific QOL scales compared with patients receiving placebo (p < 0.05). Patients who achieved a >or=50% or a >or=75% reduction in Psoriasis Area and Severity Index (PASI) reported similar improvement in QOL, which was significantly greater than that of other patients., Conclusions: The clinical effect of alefacept on psoriasis is associated with an improvement in patients' QOL. Among patients with moderate to severe psoriasis, an improvement in PASI of 50% or more is associated with better QOL scores.

Aphasia is a disorder that results from damage to portions of the brain that are responsible for language and can vary significantly by type and severity. Differences in aphasia outcomes are influenced by the social determinants of health (SDOH). The SDOH are structural, environmental, and personal determinants that influence health outcomes. Intersectionality, or how one's social and political identities interact to influence individual life outcomes and/or advantage in our society, provides a way to examine the varying levels of the SDOH. However, intersectionality is complex, difficult to measure, and has not yet been explored in post-stroke aphasia outcomes. This article reviews the relationship of race and aphasia outcomes and the SDOH and aphasia outcomes. Additionally, we provide a novel current approach to examine the SDOH and aphasia outcomes. Lastly, we discuss the need for evaluation of intersectionality in aphasia and aim to provide a leveled social–ecological framework to examine aphasia-related outcomes. With notable individual differences among aphasia outcomes, we present a framework to support optimizing research and clinical aphasia care in speech-language pathology. [ABSTRACT FROM AUTHOR]

Purpose: Changes in quality of life (QoL) in persons with aphasia (PWA) has emerged as a key metric of aphasia treatment effectiveness. Several tools have been designed to measure aphasia related QoL and offer the appropriate compensation for communication issues that frequently exclude persons with aphasia (PWA) from participation of such studies. The purpose of this study was to measure post--aphasia treatment change in QoL and calculate the efficiency and cost of QoL change. Method: In this study, we measured change in aphasia-related QoL as a metric of post--aphasia treatment efficiency using the American Speech-Language-Hearing Association Quality of Communication Life Scale. We also calculated the associated cost of that change in relationship with the change of aphasia impairment using a sample of PWA who received community-based telerehabilitation. Cost of QoL improvement from the intervention was calculated accounting for differences in age, time post onset, aphasia severity, and aphasia type. Results: PWA that exhibited more severe aphasia impairment experienced larger QoL improvement than those at lower impairment levels. Similarly, the average cost of improvement in QoL was lower for those more severe aphasia. Conclusions: Changes in aphasia-related QoL captures the impact of communication disorders on QoL, and the cost associated with the change. Measurement of aphasia-related QoL will allow clinicians and researchers to measure aphasia treatment outcomes and the cost effectiveness of those treatments using a commonly reported patient outcome--QoL. [ABSTRACT FROM AUTHOR]

Context: Aphasia is a post-stroke condition that can dramatically impact a person with aphasia's (PWA) communication abilities. To date, few if any studies have considered the cost and cost-effectiveness of functional change in aphasia nor considered measures of patient's value for aphasia treatment. Objective: To assess the cost, cost-effectiveness, and perceived value associated with improved functional communication in individuals receiving telerehabilitation treatment for aphasia. Design: Twenty PWA completed between 5 and 12 telehealth rehabilitation sessions of 45–60 minutes within a 6-week time frame using a Language-Oriented Treatment (LOT) designed to address a range of language issues among individuals with aphasia. National Outcomes Measures (NOMS) comprehension and verbal expression and the ASHA Quality of Communication Life (QCL) were completed prior to and at the completion of rehabilitation to obtain baseline and treatment measures. Results: Age, education, and race are significantly correlated with improvement in the NOMS verbal expression. African Americans (OR = 2.0917) are twice as likely as Whites to experience improvement after treatment. The likelihood of improvement also increases with each additional year of education (OR = 1.002) but decrease with age (OR = 0.9463). A total of 15 PWA showed improvement in NOMS comprehension and nine patients showed improvement in NOMS verbal expression. Improving patients attended between five and 12 treatment sessions. The average cost of improvement in NOMS comprehension was $1,152 per patient and NOMS verbal expression was $1,128 per patient with individual treatment costs varying between $540 and $1,296. However, on average, the monetary equivalent in patient's improved QCL was between $1,790.39 to $3,912,54—far exceeding the financial cost of treatment. Conclusions: When measuring the functional improvement of patients with aphasia, patient's quality of communication life received from treatment exceeded financial cost of services provided. [ABSTRACT FROM AUTHOR]

Background: Moderate to severe plaque psoriasis (with or without psoriatic arthritis) places significant burden on patients’ lives.Objective: Explore and document patients’ experiences of living with psoriasis, including symptoms, treatments, impact on daily lives and patient-reported functioning.Methods: In a US-based, non-interventional study, narrative interviews were conducted at baseline and again within 16 weeks. In interviews, patients with moderate to severe psoriasis indicated symptoms, ranked symptoms according to level of bother and indicated areas of their lives affected by psoriasis. Transcripts of interviews were coded for themes. Measurements of psoriasis severity including BSA, PGA and PASI were recorded.Results: Symptoms reported most frequently included flaking/scaling (non-scalp areas), itching/scratching and rash, while the most bothersome symptoms were itching/scratching, flaking/scaling (non-scalp areas) and skin pain. Frequently reported impact areas were social and emotional.Conclusion: Broad-reaching interviews with patients with psoriasis show that these patients suffer in many aspects of their lives and in ways not indicated by typical psoriasis severity measures. Patients with psoriatic arthritis reported symptoms and disease-related complications at higher rates than those without arthritis. Physicians’ explorations of the effect of psoriasis on patients’ life events could aid in managing these patients. [ABSTRACT FROM AUTHOR]

Objective: This study describes the development and validation of the Diabetes Fatalism Scale (DFS) in adults with type 2 diabetes.Methods: Thirty-five items were derived from focus groups, literature review, and expert opinion. The items were pilot tested on 20 adults with diabetes and then administered to 216 primary care patients with type 2 diabetes to assess the validity and reliability of the scale. Exploratory factor analysis (Principal Component Analysis with Varimax rotation) yielded a 12-item scale with three subscales. Pearson's correlation was used to test the DFS's association with diabetes self-care, HbA1c and quality of life. Multiple linear regression was used to assess association between the DFS and HbA1c controlling for demographics, comorbidity and insulin use.Results: Cronbach's alpha for the 12-item DFS scale was 0.804 indicating internal consistency. The DFS is scored in such a way that higher scores represent greater diabetes fatalism. The DFS scores were not significantly correlated with age, years of education, or diabetes duration. Whites, men, those with government or no insurance, and those with 3+ comorbid conditions had significantly higher DFS scores. DFS was significantly correlated with self management understanding (r = -0.35, p < 0.001), control problems (r = 0.22, p = 0.002), self-care ability (r = -0.30, p < 0.001), and self-care adherence (r = -0.23, p < 0.001). The DFS was significantly correlated with HbA1c (r = 0.20, p = 0.004) and mental health component of SF-12 (r = -0.24, p = 0.001). In multivariate models, adjusting for demographics, comorbidity and insulin use, the DFS was independently associated with increased HbA1c (beta 0.21, p = 0.005).Conclusions: The DFS is a valid and reliable measure of diabetes fatalism. Diabetes fatalism is associated with self-care problems, poor glycemic control, and decreased quality of life. [ABSTRACT FROM AUTHOR]

Assessment of a patient's disease severity is an essential component of formulating therapeutic strategies. However, disorders of the skin are often not amenable to strict classification criteria, and the dermatologist relies upon personal thresholds of severity when assessing the patient's overall condition. A number of grading systems have arisen, primarily from the need for standardized end points in clinical trials; in some circumstances, these severity assessments may assist the clinician in the evaluation and treatment of dermatologic disease. In this review, we will summarize the results of available severity scores of frequently encountered dermatologic disorders and discuss their utility in the management of disease in a clinician's office. [ABSTRACT FROM AUTHOR]

Abstract: Background: Binge and heavy drinking are noted in the literature for their relatively high prevalence and adverse health-related effects. Design and participants: We used data from the 2006 Behavioral Risk Factor Surveillance Survey (BRFSS) to determine the associations between binge and heavy drinking and a wide range of health-related variables, including positive and negative health behaviors, preventive care practices, and quality of life indices in a nationally representative sample of 344,793 adults. Results: Rates of binge and heavy drinking in the current sample were 15% and 5%, respectively. Binge and heavy drinking were more common among men, younger adults, and individuals with higher incomes and at least some college education. After controlling for relevant demographic variables, binge and heavy drinking were associated with a number of adverse health-related and preventive care behaviors (e.g., smoking, failing to receive a mammogram), as well as less life satisfaction and a greater number of poor mental health days than those who did not engage in these drinking behaviors. Interestingly, binge and heavy drinking were also associated with some positive health-related variables (e.g., recent physical activity, positive perceptions of one''s own health). Conclusions: The current study findings provide additional information regarding the relations between health-related attitudes and behaviors and binge and heavy drinking in the U.S. population. Implications of study findings are discussed. [Copyright &y& Elsevier]