Browsing by Subject "functional outcomes"

Now showing 1 - 5 of 5
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    Body Mass Index and Overall Outcome Following Subarachnoid Hemorrhage: An Obesity Paradox?
    (Elsevier, 2020) Damodara, Nitesh; Amuluru, Krishna; Nuoman, Rolla; Bowers, Christian A.; Khandelwal, Priyank; Moseley, Sydney; Al-Shammari, Hussein; El-Ghanem, Mohammad; Gandhi, Chirag D.; Al-Mufti, Fawaz; Neurology, School of Medicine
    Background Conventional understanding of obesity demonstrates negative consequences for overall health, whereas more modern studies have found that it can provide certain advantages. The current literature on the effect of body mass index (BMI) in subarachnoid hemorrhage (SAH) is similarly inconsistent. Methods cohort of 406 patients with SAH were retrospectively reviewed and stratified into 3 BMI categories: normal weight, 18.5–24.9 kg/m2; overweight, 25–29.9 kg/m2; and obese, >30 kg/m2. Neurologic status, the presence of clinical cerebral vasospasm, and outcome as assessed by the modified Rankin scale (mRS) were obtained. Results Statistical differences were evident for all outcome categories. A categorical analysis of the different groups revealed that compared with the normal weight group, the overweight group had an odds ratio (OR) for mortality of 0.415 (P = 0.023), an OR for poor mRS score at 90 days of 0.432 (P = 0.014), and an OR for poor mRS score at 180 days of 0.311 (P = 0.001), and the obese group had statistically significant ORs for poor mRS score at 90 days of 2.067 (P = 0.041) and at 180 days of 1.947 (P = 0.049). These significant ORs persisted in a multivariable model controlling for age and Hunt and Hess grade. Conclusions The overweight group exhibited strikingly lower odds of death and poor outcome compared with the normal weight group, whereas the obese group demonstrated the opposite. These associations persisted in a multivariable model; thus, BMI can be considered an important predictor of outcome after SAH.
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    A conceptual model of mental illness stigma constructs
    (Office of the Vice Chancellor for Research, 2015-04-17) Adams, Erin L.; Salyers, Michelle P.
    Mental illness (MI) stigma negatively impacts a range of psychosocial and functional outcomes, and has yielded a significant volume of empirical literature. In a recent meta-analysis of 256 studies of mental health providers’ stigma towards their own patients, over 90 named stigma instruments were identified and 85 publications created their own instrument to be used in a single study. The exceptional number of stigma instruments in the literature raises questions about the conceptualization of stigma and limits the conclusions that can be drawn across studies. Current literature broadly conceptualizes stigma towards MI as consisting of stereotypes (beliefs), prejudice (emotions), and discrimination (actions). The current analysis expands this framework by categorizing each instrument into primary, secondary, and tertiary stigma categories to produce a model displaying the variety of constructs being assessed (briefly outlined below). Understanding the diversity of these constructs may allow for a nuanced interpretation of existing literature, and may spark discussion as to the centrality of certain constructs within MI stigma. Understanding the current stigma measurement landscape may allow for a reduction in the number of instruments currently in use, enhancing consistency and interpretability of empirical results. Stereotype instruments assess beliefs about the abilities or fundamental qualities of individuals with MI. Four secondary categories emerged. Negative Attributes measures undesirable personal characteristics of individuals with MI and contains four tertiary categories: dangerousness, personal control (i.e., MI symptoms are volitional), moral failing (i.e., symptoms are due to a weakness in character), and resistance to treatment. Prognosis measures beliefs about outcomes and future functioning of individuals with MI within two tertiary categories: optimism for treatment outcome and stability. Present Functioning requires respondents to estimate patients’ likely social integration and quality of life. Competence assesses beliefs about general intelligence, talents, and abilities of individuals with MI. Prejudice instruments assess emotion-based reactions to those with MI. The two secondary categories that emerged were Emotional Reactions and Beliefs about Managing Mental Illness. Emotional Reactions includes the tertiary categories of empathy, negative emotions (i.e., fear, disgust, anger), and professional burnout. Beliefs about Managing Mental Illness measures emotional- and value-based approaches to societal management of individuals with MI and contained four tertiary categories. Authoritarianism emphasizes individuals with MI are inferior and should be handled in a restrictive or coercive manner. Benevolence encompasses paternalistic pity and the belief that individuals with MI must be cared for like children. The prosocial view espouses a Community Mental Health Ideology, in that individuals with MI are just like anyone else and treatment should be integrated into the community and society. Finally, some instruments assess whether it is worthwhile to treat MI. Discrimination instruments assess intent or desire to treat individuals with MI differently from others. The three secondary categories that emerged were Social Distance, Willingness to Treat, and Civil Rights. Social Distance describes the desire to limit social contact with individuals with MI, while Willingness to Treat assesses whether mental health professionals are willing to care for individuals with MI. Civil Rights instruments assess restriction of patients’ human rights within four tertiary categories, including whether individuals with MI should be allowed to: engage in common social roles (e.g. parent, spouse, citizen, employee); participate in their own care; and refuse treatment. These instruments also assess whether patients should be forcibly restrained or secluded. Instruments with items that fell into at least two primary stigma categories and assessed a range of emotions, intended behavior, and beliefs about MI were categorized as General stigma.
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    Health-related Quality of Life in a Prospective Study of Ultrasound to Detect Cystic Fibrosis-related Liver Disease in Children
    (Wiley, 2022-09-06) Schwarzenberg, Sarah Jane; Palermo, Joseph J.; Ye, Wen; Huang, Suiyuan; Magee, John C.; Alazraki, Adina; Freeman, A. Jay; Harned, Roger; Karmazyn, Boaz; Karnsakul, Wikrom; Leung, Daniel H.; Ling, Simon C.; Masand, Prakash; Molleston, Jean P.; Murray, Karen F.; Navarro, Oscar M.; Nicholas, Jennifer L.; Otto, Randolph K.; Paranjape, Shruti M.; Siegel , Marilyn J.; Stoll, Janis; Towbin, Alexander J.; Narkewicz, Michael R.; Alonso, Estella M.; Pediatrics, School of Medicine
    Background: Cystic fibrosis-related liver disease (CFLD) begins early in life. Symptoms may be vague, mild or nonexistent. Progressive liver injury may be associated with decrements in patient health before liver disease is clinically apparent. We examined Health-Related Quality of Life (HRQOL) in children enrolled in a multi-center study of cystic fibrosis-related liver disease (CFLD) to determine the impact of early CFLD on general and disease-specific QOL. Methods: US patterns of normal (NL), heterogeneous (HTG), homogeneous (HMG), or nodular (NOD) were assigned in a prospective manner to predict those at risk for advanced CFLD. Parents were informed of results. We assessed parent/child-reported (age≥5 y) HRQOL by PedsQL 4.0 Generic Core and CF Questionnaire-revised (CFQ-R) prior to US and annually. HRQOL scores were compared by US pattern at baseline (prior to US), between baseline and 1-year and at 5 years. Multivariate analysis of variance (MANOVA) with Hotelling-Lawley trace tested for differences among US groups. Results: Prior to US, among 515 participants and their parents there was no evidence that HTG or NOD US was associated with reduced PedsQL/CFQ-R at baseline. Parents of NOD reported no change in PedsQL/CFQ-R over the next year. Child-report PedsQL/CFQ-R (95 NL, 20 NOD) showed improvement between baseline and year 5 for many scales, including Physical Function. Parents of HMG children reported improved CFQ-R scores related to weight. Conclusions: Early undiagnosed or pre-symptomatic liver disease had no impact on generic or disease-specific HRQoL, and HRQoL was remarkably stable in children with CF regardless of liver involvement.
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    Increased Sensitivity to Physical Activity in Healthy Older Adults Predicts Worse Pain and Functional Outcomes
    (Office of the Vice Chancellor for Research, 2016-04-08) Miller, Leah K.; Naugle, Kelly M.
    Prior research indicates older adults with knee osteoarthritis (OA) have increased sensitivity to physical activity (SPA) and respond to physical activities of stable intensity with increases in pain. SPA predicted self-reported pain and function in older adults with knee OA. It is unknown whether SPA is present in healthy older adults without chronic pain and predicts functional outcomes. The purpose of this study was to determine if SPA in response to a standardized 6-minute Walk Test cross-sectionally predicted selfreported pain, physical function, and physical activity behaviors in healthy older adults. Forty-two older adults (age=67.5±5 years) completed the Pain subscale of the Quality of Well Being scale (QWB–measures the frequency and severity of pain during common daily activities), the Short Form Health Survey (SF-36–measure of physical function), the 6-Minute Walk Test (6MWT), and wore an accelerometer on the hip for 7 days. Subjects rated overall bodily discomfort (0-100 scale) prior to and during each minute of the 6MWT. RPE was recorded at the end of the walk. An SPA index was created by subtracting the initial bodily discomfort ratings from the peak ratings. Average moderate to vigorous physical activity/day (MVPA) and steps/day were recorded from the accelerometer. Dependent variables were analyzed with hierarchical linear regressions with SPA as the final predictor. Sixty percent of older adults experienced SPA (SPA=9.5±15.6). After accounting for age, sex, BMI, and meters walked on the 6MWT, SPA significantly predicted steps and MVPA per day, RPE on the 6MWT, and severity and frequency of activity related pain on the QWB scale. These results revealed that increased SPA in healthy older adults was associated with fewer steps and MVPA per day, greater exertion on 6MWT, and greater self-reported activity-related pain. This study was funded by the IUPUI School of PETM Faculty Research Opportunity Grant.
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    Influencing functional outcomes: a look at role performance and satisfaction with life following liver transplant
    (2008-09) Scott, Patricia J.; Misra, Vijay Laxmi; Mangus, Richard S.; Tector, A. Joseph; Lacerda, Marco A.; Vinayek, Rakesh; Munsch, Linda; Musick, Beverly; Kwo, Paul
    Abstract 572 The success of orthotopic liver transplantation (OLT), originally measured as survival, now extends to quality of the life saved. Return to work (RTW) is also a desired outcome. Our AIM was to explore the relationship between 5 pre-OLT factors & 5 post-OLT quality of life (QOL) domains with life satisfaction and primary productive role to better understand how to improve both. METHODS: Patients (pts)1-3 yrs post-OLT filled QOL form during follow-up clinic visits between 7/04 to 6/05. The Liver transplantation Database-Quality of life (LTD-QOL) form yielded data on 5 domains: measure of disease (MOD), psychological distress/well-being (PDW), personal function (PF), social/role function (SRF) & general health perception (GHP). Results: 229 pts were first categorized as satisfied overall with life (79%), or dissatisfied, and then assigned to groups based on primary productive role (51%), no primary productive role, or retired. Pre-OLT variables were age, gender, marital status, education, & etiology of liver disease; HCV (33%), alcohol liver disease (ALD)(11%), HCV+ALD (10%), & others (46%). Marital status & age were not significantly related to the outcome variables. Etiology of liver disease, education, and time since OLT and 5 post-OLT QOL domains were significantly associated with both outcome variables; satisfaction and primary productive role (p<.0001).To understand the differences, the 5 physical & men-tal QOL domains were regressed on primary productive role and satisfaction. Pts (mean age 54 yrs (19-74 yrs), males, 70%) fell into the category of primary productive role rates (51%). Pts transplanted for ALD were significantly (p<.05) more likely to be satisfied with life, whereas individuals with HCV±ALD, had lowest satisfaction and were most likely to be unable/uninterested in work. Stepwise logistical regression analysis of satisfaction demonstrated that GHP and SRF correlated most highly. Although satisfaction was significant in bivariate analysis, regression analysis of the influence of domains of QOL, as well as employment, demonstrated that SRF & GHP correlated most highly with life satisfaction. CONCLUSIONS: SRF and GHP correlate with good QOL post OLT. HCV patients have low levels of satisfaction whereas the highest level of satisfaction is in the ALD group. Further studies should address methods to improve satisfaction in those with HCV.