Does a telephone follow-up intervention for patients discharged with acute myocardial infarction have long-term effects on health-related quality of life? A randomised controlled trial.

AIMS: An earlier combined proactive and reactive telephone follow-up intervention for acute myocardial infarction patients after discharge from hospital showed positive effects after six months. The aim of the present study was to assess whether the intervention has long-term effects up to 18 months after discharge. DESIGN: A prospective randomised controlled trial with 18 months follow-up. METHOD: The trial was conducted with 288 patients allocated to a telephone follow-up intervention group (n = 156) or control group (n = 132). The primary endpoint was health-related quality of life using the SF-36. Secondary endpoints included smoking and exercise habits, return to work and rehospitalisation due to chest pain. RESULTS: There were significant improvements over time on most dimensions of health-related quality of life in both the intervention and control group to US norm population levels on most SF-36 dimensions and summary scores. The intervention group showed no overall significant improvement beyond six months in the physical or mental summary scores, but there was a significant effect for those aged 70 or above. Although there was a promising effect for rehospitalisation due to chest pain, no significant differences were found between the groups on the secondary endpoints after six months. CONCLUSION: This study demonstrated that despite positive short-term effects at six months, the telephone follow-up intervention had no long-term effects on health-related quality of life or secondary endpoints. However, the potential for improvement beyond six months was less than anticipated reflecting a reduced morbidity among acute myocardial infarction patients. RELEVANCE TO CLINICAL PRACTICE: Telephone follow-up after discharge from hospital is an easy implementable follow-up intervention enabling individualised provision of information and support in a time often experienced as stressful by patients. Our study indicates that six months is an adequate support period. Despite positive results six months after discharge no significant added long-term effects of telephone follow-up, compared to usual care were found in this study.

Cancer patients' barriers to pain management and psychometric properties of the Norwegian version of the Barriers Questionnaire II.

The Barriers Questionnaire II (BQ-II) was developed to assess barriers to effective pain management. The purpose of this study was to evaluate the psychometric properties of the BQ-II in a sample of Norwegian cancer patients. The BQ-II was translated into Norwegian and pilot tested with eight oncology outpatients. Then, a convenience sample of 321 cancer patients from two different sites was recruited to maximize the number of questionnaires available for the psychometric analyses. Patients were included if they: were >18 years of age; had a diagnosis of cancer; and self-reported pain and/or use of analgesics. Construct validity of the Norwegian version of the BQ II (NBQ-II) was evaluated using an exploratory factor analysis. A seven-factor solution was found that was more consistent with the original version of the BQ. Construct validity of the NBQ-II was demonstrated through positive correlations between most of the subscale and total scores on the NBQ-II and pain intensity and pain interference scores. Finally, Cronbach's α coefficients of ≥0.7 for six of the seven subscales and 0.89 for the total scale demonstrated acceptable levels of internal consistency. In conclusion, the NBQ-II demonstrated adequate psychometric properties. However, further revision and testing of the questionnaire should be performed to confirm the factor structure that was identified in this study.

What determines subjective health status in patients with chronic obstructive pulmonary disease: importance of symptoms in subjective health status of COPD patients.

BACKGROUND: Subjective health status is the result of an interaction between physiological and psychosocial factors in patients with chronic obstructive pulmonary disease (COPD). However, there is little understanding of multivariate explanations of subjective health status in COPD. The purpose of this study was to explore what determines subjective health status in COPD by evaluating the relationships between background variables such as age and sex, predicted FEV1%, oxygen saturation, breathlessness, anxiety and depression, exercise capacity, and physical and mental health. METHODS: This study had a cross-sectional design, and included 100 COPD patients (51% men, mean age 66.1 years). Lung function was assessed by predicted FEV1%, oxygen saturation by transcutaneous pulse oximeter, symptoms with the St George Respiratory Questionnaire and the Hospital Anxiety and Depression Scale, physical function with the Incremental Shuttle Walking Test, and subjective health status with the SF-36 health survey. Linear regression analysis was used. RESULTS: Older patients reported less breathlessness and women reported more anxiety (p < 0.050). Women, older patients, those with lower predicted FEV1%, and those with greater depression had lower physical function (p < 0.050). Patients with higher predicted FEV1%, those with more breathlessness, and those with more anxiety or depression reported lower subjective health status (p < 0.050). Symptoms explained the greatest variance in subjective health status (35%-51%). CONCLUSION: Symptoms are more important for the subjective health status of patients with COPD than demographics, physiological variables, or physical function. These findings should be considered in the treatment and care of these patients.

Prevalence rates for and predictors of self-reported adherence of oncology outpatients with analgesic medications.

OBJECTIVES: Inadequate adherence with an analgesic regimen may be a reason why oncology patients experience unrelieved pain. However, only a limited number of studies have evaluated the prevalence rates for adherence and no studies have attempted to determine predictors of adherence in patients with cancer pain. On the basis of concepts from the Health Belief Model, the purposes of this study were to describe oncology outpatients' level of adherence with an analgesic regimen and to evaluate the direct and indirect effects of selected demographic variables, pain characteristics, barriers to pain management, and self-efficacy (SE) on adherence with an analgesic regimen. METHODS: A descriptive, cross-sectional study recruited outpatients from oncology clinics in a large, tertiary referral cancer hospital in Norway. A sample of 174 oncology outpatients completed a demographic questionnaire, the Brief Pain Inventory, 2 self-reported adherence measures, the Barriers Questionnaire, and a SE questionnaire. RESULTS: Only 41% of the patients were adherent with their analgesic regimen. In the regression analysis, 29.9% of the variance in adherence was explained. Higher adherence scores were associated with male sex, and also lower SE for physical function scores, higher average pain intensity scores, higher pain relief scores, and the use of strong opioid analgesics. CONCLUSIONS: Improvements in pain management may occur if clinicians routinely assessed patients' level of adherence with their analgesics regimen.

Quality of life in chronic low back pain patients treated with instrumented fusion.

AIM: The aim of this study was to examine pain and quality of life in a group of preoperative chronic low back pain patients (n = 25) and a group of postoperative chronic low back pain patients (n = 101) treated with instrumented fusion 1-8 years ago. BACKGROUND: Reduced quality of life is common in chronic low back pain patients and the aim of treatment is to improve quality of life. DESIGN: In the present study, a comparative survey design was used. METHODS: The McGill Pain Questionnaire and the SF-36 Health Survey were used to examine pain and quality of life. RESULTS: The pre- and postoperative groups did not differ with regard to age, gender, education, other chronic conditions or previous spinal surgery. Compared with the preoperative group, the postoperative group reported significantly lower total, sensory, affective and evaluative pain, used less pain medication (p < 0.05) and reported better scores in all SF-36 components (p < 0.05), except for general health. The effect size was > or =0.8 for all pain components and > or =0.4 for all SF-36 components, except for general health (effect size = 0.009). With regard to long-term follow-up, patients who underwent surgery 5-8 years ago reported better physical role functioning (p < 0.05) compared with those who underwent surgery 1-2 years ago. CONCLUSION: Results showed that the postoperative group reported significantly less pain and better physical and mental health compared with the preoperative group. However, despite surgery, the postoperative group reported suffering from pain and reduced quality of life. Relevance to clinical practice. Psychosocial interventions focusing on psychosocial consequences of pain are needed to modify the pain experience and increase the quality of life in patients who have undergone this kind of surgery.

Demographic, clinical, and pain characteristics are associated with average pain severity groups in a sample of oncology outpatients.

UNLABELLED: Cut-points (CP) for pain severity are useful because they may help clinicians to identify patients with clinically significant pain. However, a need exists to evaluate whether different pain severity groups differ on selected demographic, clinical, and pain characteristics, as well as on factors that may be amenable to psychoeducational interventions such as self-efficacy for pain management, coping strategies, and barriers to pain management. In this cross-sectional study of 210 oncology outpatients with pain, an optimal CP of 4 was found using ratings of average pain intensity. The variables that provided a unique contribution to the prediction of membership in the >4 CP group were gender, presence of breakthrough pain, comorbidities, barriers to pain management, and total self-efficacy for pain management. In addition, patients in the >4 CP group reported lower scores on physical, role, cognitive, and global health function. PERSPECTIVE: An average pain CP of >4 could be used to screen oncology outpatients with clinically significant pain. Clinicians must consider a number of demographic, clinical, and pain characteristics as part of their pain assessment procedures. The effectiveness of psychoeducational interventions aimed at barriers and patients self-efficacy for pain management need to be tested.

Self-reported prevalence, etiology, and characteristics of pain in oncology outpatients.

PURPOSE: To determine the self-reported prevalence rates for cancer, non-cancer, and both cancer and non-cancer pain and to determine if there were differences in demographic, clinical, and pain characteristics among the three pain groups. METHODS: Patients were screened in outpatient oncology clinics for the presence of pain and/or analgesic use. Patients who reported pain completed the study questionnaires. RESULTS: A total of 1790 patients were available for screening in the outpatient clinics and 1549 (86.5%) completed the screening questionnaire. Out of them, 332 (21.4%) reported pain or used analgesics. Of the 217 patients who completed the study questionnaires, 53% had only cancer pain (pain due to cancer and/or treatment), 25.3% had non-cancer pain, and 21.7% had both cancer and non-cancer pain. No differences were found, among the three pain groups, in pain intensity or pain duration. However patients in the cancer and non-cancer pain group had higher pain interference scores, higher severity scores for various pain descriptors, and a higher number of pain locations. CONCLUSIONS: These findings suggest that outpatients with a combination of cancer and non-cancer pain may be at greater risk for under-treatment of pain. Oncology clinicians and primary care providers need to perform a comprehensive pain assessment of all oncology patients in order to be able to formulate an effective pain management plan.

Follow-up interviews of 12 living kidney donors one yr after open donor nephrectomy.

Very few studies have prospectively followed living kidney donors the first year after donor surgery. In 2003, we in-depth interviewed living kidney donors one wk after donation to explore their immediate experiences of going through nephrectomy. The aim of the current investigation was to explore experiences regarding physical and psychosocial health during the first year after donor surgery. Twelve donors going through open donor nephrectomy were interviewed by telephone at one yr after donation. The analysis was carried out with an empirical phenomenological method. All participants expressed an overall positive experience about being a donor a year after transplantation. However, several participants experienced physical disincentives longer than expected post-donation. Emotional distress, such as mild depression and a feeling of loss, was also part of the donor experiences. Donors experiencing unsuccessful recipient outcome reported severe physical and mental reactions. This study provides insights on the physical and mental cost to living kidney donation. Awareness of how donors may experience their situations can help transplantation professionals in their efforts to understand and provide support.

Quality of life after randomization to laparoscopic versus open living donor nephrectomy: long-term follow-up.

BACKGROUND: The aim of this randomized study was to compare patient-reported outcome after laparoscopic versus open donor nephrectomy during 1 year follow-up. The evidence base has so far not allowed for a decision as to which method is superior as seen from a long-term quality of life-perspective. METHODS: The donors were randomized to laparoscopic (n=63) or open (n=59) nephrectomy, with follow-up at 1, 6, and 12 months. Primary outcomes were health status (SF-36) and overall quality of life (QOLS-N). Secondary outcomes were donor perception of the surgical scar, the donation's impact on personal finances, and whether the donor would make the same decision to donate again. RESULTS: There was a significant difference in favor of laparoscopic surgery regarding the SF-36 subscale bodily pain at 1 month postoperatively (P<0.05). Analysis based on intention to treat revealed no long-term differences between groups in SF-36 scores. When subtracting the reoperated/converted donors of the laparoscopic group, significant differences in favor of laparoscopy were revealed in the subscales bodily pain at 6 months (P<0.05) and social functioning at 12 months (P<0.05). No significant differences were found in QOLS-N scores between groups. CONCLUSIONS: Laparoscopic donor nephrectomy is an attractive alternative to open donor nephrectomy because of less postoperative pain. However, long-term comparison only revealed significant differences in favor of laparoscopy when adjusting for reoperations/conversions. Both groups reached baseline scores in most SF-36 subscales at 12 months and this may explain why possible minor benefits are hard to prove.

Health-related quality of life among patients with diabetes and foot ulcers: association with demographic and clinical characteristics.

OBJECTIVE: The purpose of the study was to describe the sociodemographic variables, clinical characteristics, and treatment factors in patients with diabetic foot ulcers (DFU) and to explore the associations between these factors and the patients' health-related quality of life (HRQL). MATERIALS AND METHODS: Cross-sectional data were obtained from 127 patients consecutively recruited from six hospital outpatient clinics. The patients were over 20 years of age, had current DFU, and had been diagnosed with diabetes of either Type 1 or Type 2. Data were obtained by clinical and laboratory examination and by self-completed questionnaires (SF-36). Descriptive analyses, bivariate analyses, and hierarchical regression analyses in three blocks were performed. RESULTS: The patients' mean age was 60 years (S.D., 13.8 years); 72% were men, and 29% had Type 1 diabetes. The most important variables explaining the variance in HRQL were the presence of biochemical signs of inflammation as measured by the detection of C-reactive protein (CRP) >10 mg/l, an ankle-brachial index (ABI) <0.9, an ulcer size > or =5 cm(2), nephropathy, and a body mass index <25 kg/m(2). The strongest association occurred between biochemical signs of inflammation CRP >10 mg/l, ABI <0.9, ulcer size >5 cm(2), and HRQL on physical functioning (adjusted r(2)=24). A major part of the variance remained unexplained and should be investigated in future studies. CONCLUSION: The findings may tend to identify the most vulnerable subgroups among those with DFU and may be useful in the formulation of strategies to improve function and HRQL in these patients.

Improving outcomes after myocardial infarction: a randomized controlled trial evaluating effects of a telephone follow-up intervention.

BACKGROUND: Providing information is an important part of standard care and treatment for acute myocardial infarction inpatients. Evidence exists indicating that acute myocardial infarction patients experience an information gap in the period immediately after discharge from the hospital. The aim of this study was to assess the short-term effects of a nurse-led telephone follow-up intervention to provide information and support to patients with acute myocardial infarction after their discharge from hospital. DESIGN AND METHOD: A prospective randomized, controlled trial with a 6-month follow-up was conducted. A total of 288 patients were allocated to either an intervention group (n=156) or a control group (n=132). The latter received routine post-discharge care. The primary endpoint measured at 3 and 6 months after discharge was the health-related quality of life using the 36-item Short Form Health Survey. Secondary endpoints included smoking and exercise habits. RESULTS: In both groups, health-related quality of life improved significantly over time on most subscales. A statistically significant difference in favour of the intervention group was found on the 36-item Short Form Health Survey Physical Health Component Summary Scale (P=0.034) after 6 months. No difference was found between the groups on the Mental Health Component Summary Scale. We found a significant difference with respect to frequency of physical activity in favour of the intervention group after 6 months (P=0.004). More participants in the intervention group than the control group had ceased smoking at the 6-month follow-up (P=0.055). CONCLUSION: A nurse-led systematic telephone follow-up intervention significantly improved the physical dimension of health-related quality of life in patients in the intervention group compared with usual care patients. Participation in this intervention also seemed to promote health behaviour change in patients after acute myocardial infarction.

Risk perception, worry and satisfaction related to genetic counseling for hereditary cancer.

In this multi center study, genetic counseling for hereditary cancer was evaluated by assessing patients' worry, perceived risk of developing cancer and satisfaction with genetic counseling. An overall aim was to identify characteristics of vulnerable patients in order to customize genetic counseling. In addition, agreement between patients' and counselors' scores was measured. A total of 275 Norwegian patients were consecutively recruited, and 213 completed questionnaires before and after genetic counseling. Patients' perceived risk decreased after the genetic counseling session. There was incongruence between risk perception expressed as a percentage and in words. Patients were significantly less worried after counseling. Higher levels of worry were predicted by low instrumental satisfaction with counseling, high degree of perceived risk of developing cancer and younger age. In conclusion, counselors met the patients' psychological needs to a satisfactory degree during counseling. However, patients did not fully understand their risk of developing cancer.

Quality of life among Norwegians with chronic mental health problems living in the community versus the general population.

We used the Quality of Life Scale to assess quality of life among 107 Norwegians with chronic mental health problems (MHP) from the community health care system versus 1893 general population adults. The groups differed in quality of life, including broader life domains. Age and quality of life were more strongly positively correlated in the MHP group than in the general population. Mental symptoms (measured by the Symptom Checklist-90 Revised) and quality of life were strongly negatively correlated in the MHP group. Services for people with chronic MHP should focus on enhancing quality of life and on its role as an outcome variable.

Long-term risk factors for impaired burn-specific health and unemployment in patients with thermal injury.

The success of acute burn therapy has led to an increased demand for high-quality rehabilitation. When optimizing burn care programs, knowledge of long-term risk factors associated with impaired health and unemployment of the patient may be significant. The health and work status of 95 patients (82.1% males; mean age 43.7 (S.D.: 14.5) years; mean total body surface burn 18.5 (S.D.: 14.2) % were assessed 47.0 (S.D.: 23.8) months after injury, using the Norwegian version of the abbreviated burn-specific health scale (BSHS-N) and a questionnaire asking for socio-demographic and medical characteristics. A regression model demonstrated that the BSHS-N total score was significantly reduced by chronic pain (P<0.001), psychological illness (P<0.001), and living alone (P=0.030), as well as full-thickness facial (P=0.011) and foot (P=0.013) burns. Unemployment was significantly associated with housing and economic problems (P=0.001), chronic pain (P=0.001), the extent of full-thickness injury (P=0.005), the presence of deformities (P=0.037), the number of operations (P=0.001) and the length of hospital stay (P=0.016). Thus, socio-demographic factors, non-burn-related morbidity and the injury itself significantly impaired long-term physical and psychosocial health and work status.

A comparison of the health-related quality of life in patients with diabetic foot ulcers, with a diabetes group and a nondiabetes group from the general population.

OBJECTIVE: The aim of this study was to describe health-related quality-of-life (HRQL) in patients with diabetic foot ulcers by comparing their HRQL with that of a sample from the general population without diabetes (general population) and a subgroup with diabetes (diabetes population), and to examine the differences between groups by sociodemographic characteristics and lifestyle factors. DESIGN AND METHODS: A cross-sectional study was made of 127 adults with current diabetic foot ulcer, recruited from six hospital outpatient clinics, a control sample categorized as a diabetes population (n = 221) from the Norwegian Survey of Level of Living, and a sample from the general population (n = 5903). Data on sociodemographic characteristics (sex, age, cohabitation, education and employment) and lifestyle (body mass index [BMI] and smoking status) and HRQL (SF-36) were obtained. RESULTS: In all the SF-36 subscales and in the two SF-36 summary scales, the patients with diabetic foot ulcer reported significantly poorer HRQL than the diabetes population. The most striking differences were for role limitation-physical (32.1 vs. 62.2, p < 0.001), physical functioning (57.5 vs. 77.3, p < 0.001) and role limitation-emotional (57.4 vs. 72.0, p < 0.001). The patients with foot ulcer had significantly lower HRQL than the general population on all scales, and in particular on role limitation-physical (32.1 vs. 74.3, p < 0.001), physical functioning (57.5 vs. 85.2, p < 0.001) and general health (50.1 vs. 74.3, p < 0.001). The most important sociodemographic characteristic that differed between the diabetic foot ulcer patients and the diabetes population was that significantly more of the foot ulcer patients were men living alone. The largest differences between the foot ulcer patients and the general population were that more of the foot ulcer patients were men, older, living alone, less well educated, and not working. The diabetic foot ulcer patients, the diabetes population and the general population differed in BMI: 28 kg/m(2) in the foot ulcer patients, 27 kg/m(2) in the diabetes population and 25 kg/m(2) in the general population. CONCLUSION: Diabetic foot ulcer patients had much worse HRQL compared with the diabetes population and the general population, especially in physical health. Foot ulcer patients were more often men living alone, and obesity was a problem in both the foot ulcer patients and the diabetes population.

Impaired generic health status but perception of good quality of life in survivors of burn injury.

BACKGROUND: Although it is recognized that burn survivors face a variety of challenges related to physical, psychologic and social late-effects of their injury, the impact of thermal injury on the lives of patients is not fully understood. To learn more about burn patient needs and to obtain information relevant to the design of clinical programs for treatment and aftercare, self-reports on how burn patients perceive their health and quality of life may be of significant value. METHODS: The generic health status (evaluated by SF-36) and overall quality of life (evaluated by the Quality of Life Scale [QOLS]) of 95 adult burn patients (total body surface area burned = 18.5 +/- 14.2% [mean +/- SD]; 82.1% men) were assessed 47.0 +/- 23.8 months postburn and compared with population norms. RESULTS: The burn patient generic health status was significantly poorer than expected from general population scores, with reduced scores in the Physical Function (p < 0.001), Role Physical (p < 0.01), General Health (p < 0.001), Social Function (p < 0.001), and Role Emotional (p < 0.001) domains of the SF-36. Despite their reduced health status, overall quality of life was perceived as good, with QOLS scores similar to those of the general population. Patients living alone, unemployed, having nonburn physical illness, psychologic disorders, chronic pain, or having sustained full thickness injuries were found to be at particular risk. CONCLUSIONS: Forty-seven months postinjury, burn patients still experienced a significant reduction of generic health, reporting limitations related to both physical and psychosocial SF-36 domains. On the other hand, the patients as a group reported overall quality of life similar to that of the norm population, suggesting that they were able to feel satisfaction with their new situation of life. Identification of several risk factors for reduced generic health status and overall quality of life support the need for specialized multidisciplinary aftercare for burn patients.

The role of the student: salutogenic or pathogenic?

Associations between sense of coherence (SOC) and school-related resources (supportive school environment, adequate learning conditions) and stress (pressure of schoolwork, bored of school) were explored in a representative sample of 4116 Norwegian school adolescents, aged 11, 13 and 15 years. The students participated in the World Health Organization Cross-National Survey 'Health Behaviour in School-Aged Children 1997/98 (HBSC)'. Multiple linear regression analyses were applied. In unadjusted analyses, all resources and stress factors were significantly related to SOC. In analyses adjusted for all these factors, support from teacher was the only variable that did not remain significant. The strongest and most adverse association with SOC was seen in the relation with feeling pressured by schoolwork among both genders. The next strongest associations were found with support from peers and adequate expectations. In general, the associations with SOC were stronger among girls than boys, but a similar tendency was found for both genders. Implications for school health promotion are discussed.

The prevalence and occurrence of diabetic foot ulcer pain and its impact on health-related quality of life.

UNLABELLED: This study describes the prevalence and occurrence of diabetic foot ulcer (DFU) pain and the impact of DFU pain on health-related quality of life (HRQL) using generic and disease specific instruments. Data were obtained from 127 patients with DFU who were recruited from 6 hospital-based diabetic outpatient clinics. HRQL was measured using the Medical Outcome Study-Short Form (SF-36) and the Diabetes Foot Ulcer Scale (DFS). Occurrence of pain was assessed using 2 items from the DFS (ie, pain while walking and/or standing and pain during the night related to foot ulcer problems). Seventy-five percent reported some pain related to DFU and 57% reported DFU pain while walking and/or standing and also during the night. Twenty-five percent reported pain none of the time. A higher percentage of patients with pain reported having a prescription for an analgesic medication than those without pain. Patients who reported pain most or all of the time had statistically and clinically significantly poorer HRQL than those who did not report pain. These findings suggest that pain associated with DFU is a significant clinical problem. Additional research is warranted to further characterize the pain associated with DFU and its impact on patient outcomes and HRQL. PERSPECTIVE: Numerous basic and clinical studies have focused on pain associated with diabetic peripheral neuropathy. Findings from this study suggest a new pain problem in patients with diabetes, namely, pain associated with foot ulcers, that warrants further investigation.

Preoperative cerebral ischemic lesions predict physical health status after on-pump coronary artery bypass surgery.

BACKGROUND: Risk assessment is integral to patient selection and counseling before coronary artery revascularization. We studied the predictive ability of cerebral magnetic resonance imaging of preoperative and postoperative cerebral ischemic injury on self-reported physical and mental health at 3 months after coronary artery bypass surgery with or without use of cardiopulmonary bypass. METHODS: In a prospective clinical trial comparing on-pump and off-pump surgery, 120 patients responded to a questionnaire for self-report of angina (Canadian Cardiovascular Society scale) and physical and mental health status (Short Form 36) at baseline before preoperative cerebral magnetic resonance imaging. Preoperative sets of both magnetic resonance imaging and self-assessments were available for 103 (85.8%) patients. These patients were grouped according to classification of preoperative cerebral magnetic resonance imaging findings. Analysis of covariance determined the association of (1) preoperative magnetic resonance imaging status, (2) new postoperative cerebral lesions, and (3) actual use of cardiopulmonary bypass to physical and mental health. RESULTS: At 3 months after surgical intervention, 98 of 103 patients completed follow-up. The analysis revealed an interaction effect of preoperative cerebral ischemic injury and use of cardiopulmonary bypass on physical health (F = 9.07, P = .003) independent of age. No independent effects on health status were found of baseline magnetic resonance imaging or new cerebral lesions at 3 months. CONCLUSIONS: This study strongly suggests that the combination of preoperative cerebral ischemic injury and use of cardiopulmonary bypass can predict postoperative health status at 3 months. Cerebral magnetic resonance imaging might be a more specific indicator than age for preoperative assessment of vulnerability or resilience during rehabilitation after on-pump cardiac surgery.

Age and the experience of chronic pain: differences in health and quality of life among younger, middle-aged, and older adults.

OBJECTIVES: To describe age differences in chronic pain and to evaluate for differences in demographic and health-related variables among younger (18-39 years), middle-aged (40-59 years), and older adults (60-81 years) who reported chronic pain. METHODS: A total of 4000 Norwegian citizens were mailed a questionnaire that measured pain, quality of life, mood, and demographic and health-related variables. RESULTS: Of the total sample (n = 1912), 19.2% of the younger age group, 27.5% of the middle-aged group, and 31.2% of the older group reported chronic pain (ie, >3 months duration). A total of 58.9% of the participants in chronic pain reported having a chronic disease, with the most common being musculoskeletal problems, chronic pain disorder, and osteoarthritis. Participants in the older age group reported pain of longer duration and more comorbidities and received pain treatment more often. They had higher total quality of life scores, were more satisfied with their material comforts and social life, and reported better mood. The middle-aged group reported the largest number of pain locations, reported having fibromyalgia more frequently, and reported that the cause of their pain was not known. They were less satisfied with their social life than the older age group. The younger age group reported the highest rates of injury and accidents as the cause of their pain, and almost 43% of this age group was not receiving any treatment of their chronic pain. CONCLUSION: This study found that the prevalence rates for chronic pain do vary with age and that the middle-aged group may be a high-risk group of patients with chronic pain.