Quality of life in end stage renal disease patients.

AIM: To understand factors associated with quality of life (QOL), examine types of QOL instruments, and determine need for further improvements in QOL assessment. METHODS: The method used databases (Pubmed, Google scholar) and a bibliographic search using key words QOL, end stage renal disease, Hemodialysis, Peritoneal dialysis, instruments to measure QOL, patients and qualitative/quantitative analysis published during 1990 to June 2014. Each article was assessed for sample size, demographics of participants, study design and type of QOL instruments used. We used WHO definition of QOL. RESULTS: For this review, 109 articles were screened, out of which 65 articles were selected. Out of 65 articles, there were 19 reports/reviews and 12 questionnaire manuals. Of the 34 studies, 82% were quantitative while only 18% were qualitative. QOL instruments measured several phenomenon such as physical/psychological health, effects and burdens of kidney disease, social support etc. those are associated with QOL. Few studies looked at spiritual beliefs, cultural beliefs, personal concerns, as per the WHO definition. Telemedicine and Palliative care have now been successfully used however QOL instruments seldom addressed those in the articles reviewed. Also noticed was that longitudinal studies were rarely conducted. Existing QOL instruments only partially measure QOL. This may limit validity of predictive power of QOL. CONCLUSION: Culture and disease specific QOL instruments that assess patients' objective and subjective experiences covering most aspects of QOL are urgently needed.

Public awareness and perception of clinical trials: Quantitative study in Pune.

CONTEXT: Studies have reported that clinical research has experienced tremendous growth during past few decades with many multinational pharmaceutical companies recruiting millions of Indians in clinical trials (CTs). However, there is hardly any literature that talks about the participants, their knowledge, and awareness of CTs. It is important that the general public is aware about CTs so that they can take their own informed decision to participate in CTs. AIM: To assess public awareness, perceptions, and attitudes toward CTs and their views on various methods to create awareness about CTs. MATERIALS AND METHODS: Cross sectional survey was conducted with 200 non trial participants (NTPs) and 40 trial participants (TPs). RESULTS: TPs were significantly (P < 0.0001) older than NTPs. More than 80% of both TPs and NTPs mentioned participation in CT helps advance medical science and strongly felt that there is a need to create awareness about CTs. Nearly 70% of TPs could not remember the phase of the trial while 20% did not know which type of trial they had participated. The main reason for participation in the trial was physician's advice. About 80% of both TPs and NTPs felt that participation in CT will increase with free medications and advice from friends/relatives who had good experience with trial. CONCLUSION: Results of this pilot study revealed need to create CT awareness among the general public. However, considering ethno-cultural, regional, and literacy-level differences throughout the country, a nationwide study would be appropriate to provide reliable results about awareness of CTs among Indians.

Validity and reliability of English and Marathi Oswestry Disability Index (version 2.1a) in Indian population.

STUDY DESIGN: A total of 200 patients with low back pain (LBP) completed an English and Marathi Oswestry Disability Index (ODI) questionnaires (100 each), visual analogue scale, and Roland-Morris Disability Questionnaire. OBJECTIVE: To validate the English and Marathi versions of ODI (version 2.1a). SUMMARY OF BACKGROUND DATA: Patient-orientated assessment methods are important in the evaluation of treatment outcome. The ODI is one of the condition-specific questionnaires recommended for the use of patients with LBP. METHODS: An adaptation of the ODI (version 2.1a) for Marathi language was carried out according to established guidelines. RESULTS: Average age of patients who answered the English ODI was 42 ± 15, whereas that of Marathi-speaking patients was 52 ± 15 years. About 40% were males. The Cronbach α reliability score was 0.877 for English and 0.943 for Marathi. Forty-seven and 53 of these patients were retested with English and Marathi ODI within 2 weeks (to assess test-retest reliability). The intraclass correlation coefficient (ICC) for the test-retest reliability of the questionnaire was 0.877 and 0.943 for English and Marathi respectively. The ODI scores correlated with visual analogue scale pain intensity (r = 0.67, P < 0.0001) and Roland-Morris Disability Questionnaire score (r = 0.71, P < 0.0001) for English and visual analogue scale (r = 0.325, P < 0.001) and Roland-Morris Disability Questionnaire scores (r = 0.503, P < 0.0001) for Marathi. The receiver operating characteristic curve analysis showed comparable performance in discriminating the existence of sign and symptoms (area under curve = 0.947, P < 0.0001, 95% confidence interval: 0.893-0.999 for English and Marathi (area under curve: 0.834, P < 0.0001, 95% confidence interval: 0.735-0.933) for severe compared with nonsevere LBP proving discriminative validity. Results showed that English ODI is valid and reliable. CONCLUSION: The Marathi version of Oswestry questionnaire is reliable and valid, and shows psychometric characteristics as good as the English version. It should represent a valuable tool for use in future patient-orientated outcome studies for population with LBP in India.

Limited knowledge of chronic kidney disease among primary care patients--a cross-sectional survey.

BACKGROUND: Kidney disease is the 9th leading cause of death in Singapore. While preventive effects have focused on early detection and education, little is known about the knowledge level of chronic kidney disease (CKD) locally. We seek to evaluate the knowledge of CKD among primary care patients. METHODS: We conducted a cross-sectional survey of a convenience sample of 1520 patients from 3 primary care centers. Those with existing CKD or on dialysis were excluded. Knowledge was assessed based on 7 questions on CKD in the self-administered questionnaire. One point was given for each correct answer with a maximum of 7 points. RESULTS: 1435 completed all 7 questions on CKD. Mean age was 48.9 ± 5.0 (SD) years. 50.9% were male. 62.3% had a secondary and below education and 52.4% had a monthly household income of ≤ $2000. 43.7% had chronic diseases. Mean score was 3.44 ± 1.53 (out of a maximum of 7). Median score was 4. In multivariate logistic regression, being older {>60 years [Odds Ratio (OR) 0.50, 95% Confidence Interval (CI) 0.32-0.79]; 40-60 years (OR 0.62, 95% CI 0.43,0.89)}, less educated [up to primary education (OR 0.33, 95% CI 0.22-0.49)], having a lower monthly household income [

Factors influencing living kidney donation in Singapore.

CONTEXT: Kidney transplantation is the best treatment option for kidney failure, but the supply of donor kidneys remains small. OBJECTIVE: To understand the public's attitude toward living donor kidney donation in Singapore. DESIGN, SETTING AND PARTICIPANTS, INTERVENTION, OUTCOME MEASURES: A crosssectional study of a convenience sample of 1520 members of the general public seeking care at local medical centers. A self-administered questionnaire included questions on demographics and subjects' willingness and unwillingness to donate a kidney. Respondents were aged at least 18 years and did not have underlying chronic kidney disease, end-stage renal disease requiring dialysis, or history of kidney transplant. RESULTS: Overall mean age of respondents was 49 (SD, 15) years and 50% were male. Response rate to the question on "willingness to donate kidney while alive" was 96% (1460); 707 (48.4%) were willing to donate a kidney while alive. Respondents who were willing to donate were younger (<40 years; P<.001); had above a secondary level education (P<.001); had monthly household income 2000 SGD (or US$1660; exchange rate at 1 SGD = US$0.83) or higher (P<.001); were not married, single, or divorced (P<.001); and were professionals (P<.001). Fear of surgical risks (86.5% strongly agree or agree) and poorer health consequent to donation (87.5% strongly agree or agree) were the main reasons for not considering being a living kidney donor. Demographic factors and concerns of surgical risks and ill health after transplant influenced willingness to donate a kidney while alive. Addressing these concerns may alleviate anxiety with regard to living kidney donation.

Validation of the kidney disease quality of life-short form: a cross-sectional study of a dialysis-targeted health measure in Singapore.

BACKGROUND: In Singapore, the prevalence of end-stage renal disease (ESRD) and the number of people on dialysis is increasing. The impact of ESRD on patient quality of life has been recognized as an important outcome measure. The Kidney Disease Quality Of Life-Short Form (KDQOL-SF™) has been validated and is widely used as a measure of quality of life in dialysis patients in many countries, but not in Singapore. We aimed to determine the reliability and validity of the KDQOL-SF™ for haemodialysis patients in Singapore. METHODS: From December 2006 through January 2007, this cross-sectional study gathered data on patients ≥21 years old, who were undergoing haemodialysis at National Kidney Foundation in Singapore. We used exploratory factor analysis to determine construct validity of the eight KDQOL-SF™ sub-scales, Cronbach's alpha coefficient to determine internal consistency reliability, correlation of the overall health rating with kidney disease-targeted scales to confirm validity, and correlation of the eight sub-scales with age, income and education to determine convergent and divergent validity. RESULTS: Of 1980 haemodialysis patients, 1180 (59%) completed the KDQOL-SF™. Full information was available for 980 participants, with a mean age of 56 years. The sample was representative of the total dialysis population in Singapore, except Indian ethnicity that was over-represented. The instrument designers' proposed eight sub-scales were confirmed, which together accounted for 68.4% of the variance. All sub-scales had a Cronbach's α above the recommended minimum value of 0.7 to indicate good reliability (range: 0.72 to 0.95), except for Social function (0.66). Correlation of items within subscales was higher than correlation of items outside subscales in 90% of the cases. The overall health rating positively correlated with kidney disease-targeted scales, confirming validity. General health subscales were found to have significant associations with age, income and education, confirming convergent and divergent validity. CONCLUSIONS: The psychometric properties of the KDQOL-SF™ resulting from this first-time administration of the instrument support the validity and reliability of the KDQOL-SF™ as a measure of quality of life of haemodialysis patients in Singapore. It is, however, necessary to determine the test-retest reliability of the KDQOL-SF™ among the haemodialysis population of Singapore.

Validity and reliability of the expectations regarding aging (ERA-12) instrument among middle-aged Singaporeans.

INTRODUCTION: The 12-item Expectations Regarding Aging (ERA-12) instrument measures expectations that individuals have about how their health and cognitive function will be when they age. To date, primarily assessed among older adults in Western settings, expectations regarding ageing have been associated with physical activity and healthcare seeking behaviour. It has been suggested that it may be possible to develop interventions that promote positive expectations about ageing. Assessment of expectations regarding ageing among today's middle-aged population would allow for earlier interventions to help give them positive (but realistic) ageing expectations, and age successfully. We assess the reliability and validity of ERA-12 for middle-aged Singaporeans. MATERIALS AND METHODS: A questionnaire that included ERA-12 was administered to 1020 patients aged 41 to 62 years attending 2 SingHealth polyclinics in Singapore. Data from 981 respondents who completed the ERA-12 instrument were analysed. ERA-12's construct validity was determined using Exploratory Factor Analysis (EFA), and through its correlation with depressive symptoms, and self-rated health and education. Internal consistency reliability was assessed using Cronbach's alpha. RESULTS: EFA confirmed that the ERA-12 consisted of 3 factors (each with 4 items)--expectations regarding physical health, mental health and cognitive function, together explaining 64% of the variance in ERA-12 total score with high factor loadings (range, 0.6 to 0.8). The ERA-12 total score was positively correlated with self-rated health (r = 0.13) and education (r = 0.19), and negatively correlated with depressive symptoms (r = -0.25). Cronbach's alpha exceeded 0.7 for ERA-12 overall, and for each subscale. CONCLUSION: ERA-12 can be used to evaluate expectations regarding ageing not only among elderly populations in the West, but also among middle-aged Singaporeans.

Prevalence and risk factors of undetected proteinuria in an elderly South-East Asian population.

BACKGROUND: Urinalysis is not a standard component of health screening in the elderly population. OBJECTIVE: We investigated the prevalence and risk factors of undetected renal disease as defined by proteinuria (PR) in an elderly South-East Asian population. METHOD: There were 19,848 participants of age >or=65 years in National Kidney Foundation's Nationwide Screening programme at Singapore. Mean age was 70.6 +/- 5.3 years. After excluding the 1.1% who had pre-existing renal disease, 8.5% were identified to have previously undetected PR defined as >or=1+ protein on urine dipstick analysis. Multivariate regression revealed that male gender (OR = 1.2, reference category (Ref): female), known diabetes (odds ratio (OR) = 2.28; P < 0.0001), hypertension (OR = 1.62; P = 0.0001), presence of elevated blood pressure (BP) (>or=120/90 mmHg) on screening (OR = 1.38, 1.89, 3.45 for mild, moderate and severe BP, respectively, all P < 0.0001), elevated body mass index (BMI) (OR = 1.3 for BMI >or=23 vs BMI < 23 kg/m(2)), and smoking (OR = 1.2, ref: non-smokers) were significantly associated with PR. Finally, a progressive increase in OR for PR was observed with stepwise increase in age (years) (OR for 67-68.9: 1.2, P = 0.025; 69-72.9, 1.49, P = 0.49; >or=73: 1.56, P < 0.0001, Ref: 65-66.9 years). CONCLUSION: We conclude that there is high prevalence of previously undetected proteinuria in elderly South-East Asians. Because proteinuria is a risk factor for cardiovascular disease, our findings support inclusion of urinalysis in routine health screening for this population.