Atopic dermatitis is the commonest skin disease in children, causing psychological, social and functional disability to them and their families. This study assessed the family impact and quality of life using the translated Malay version of The Dermatology Family Impact (DFI) and The Children's Dermatology Life Quality Index (CDLQI) questionnaires. Seventy-two children, aged between 6 months and 16 years attending the Paediatric Dermatology Clinic at the Paediatric Institute and the Dermatology Department, Hospital Kuala Lumpur participated in this study. Thirty-nine patients (54.2%) were males and 33 patients (45.8%) were females. The median age of the patients was 74 months (Q1 6, Q3 104 months). The median age of diagnosis was 22 months (Q1 1, Q3 36 months). The median disease duration was 44 months (Q1 3, Q3 65). The severity of eczema was assessed using the SCORAD severity index (maximum score = 83). The median SCORAD (European Task Force On Atopic Dermatitis) score was 36 (n = 72, SD = 16.2). The majority of patients in this study suffered from moderately severe eczema (n = 40, mean, SCORAD = 29.3) followed by severe eczema (n = 27, mean SCORAD = 54.3). The mildly affected patients formed the minority group (n = 5, mean SCORAD = 9.0). The family impact was shown to be greater in severe atopic dermatitis compared to moderate atopic dermatitis (Anova, p = 0.02). The children's quality of life impairment was also greater in severe atopic dermatitis compared to moderate atopic dermatitis (Anova p = 0.08). This study confirms that quality of life and family impact are related to the severity of atopic dermatitis.
The cornerstone of asthma management is achieving adequate symptom control and patient education. We studied in our local population of asthmatic patients how well their symptoms were controlled with currently prescribed treatment and their insight into the disease and its management. Over a 6-month period, 93 asthmatics recruited from two local government health clinics and a state hospital were interviewed using a standard questionnaire. Patients were classified into 4 groups based on the treatment they were on according to Global Initiative for Asthma (GINA) treatment guidelines. The number of patients in Step 1 (rescue medication alone), Step 2 (1 controller medication), Step 3 (2 controller medications) and Step 4 (at least 3 controller medications) were 8, 39, 34 and 12, respectively. Except for day symptoms in Step 1 group, fewer than 50% achieved minimum day or night symptoms and no restriction of daily activities. Questions on patient insight were only available for 50 patients. Weather change (74%), air pollution (66%) and physical stress (46%) were the three highest ranked common asthma triggers. More than half correctly recognized the important symptoms of a serious asthma attack but fewer than 15% were familiar with the peak flow meter and its use or with the asthma self-management plan. Most patients perceived that their treatment had helped reduce disease severity and exacerbations. We conclude that symptom control and some aspect of patient education are still lacking in our local asthmatics.
Study site: Hospital Tuanku Jaafar, Seremban, Negeri Sembilan; Klinik Kesihatan Seremban; Klinik Kesihatan Ampangan, Malaysia
The objective of this study was to examine the reliability and validity of the Malay version of the 18-item Audit of Diabetes Dependent Quality of Life (the Malay ADDQOL). Patients with type 2 diabetes mellitus who fulfilled the inclusion criteria were systematically selected. The Malay ADDQOL linguistically validated from the 18-item English version ADDQOL was self-administered twice at a 1-week interval. Two hundred eighty-eight respondents were included in the study. Analysis involved checking the feasibility, floor and ceiling effects, internal consistency, test-retest reliability and factor analysis. Item means and standard deviations fulfilled the Likert scale assumptions. The Cronbach's alpha was 0.943 (lower bound of the 95% CI of 0.935) and the intraclass correlation coefficient was 0.81 (95% CI from 0.72 to 0.87). Exploratory one factor analysis showed factor loadings above 0.5 for all the 18 items. The Malay ADDQOL has acceptable linguistic validity. It is feasible, has excellent reliability, content, construct validity, and is recommended to be used among Malay-speaking diabetic patients.
Between July 1999 to November 2000, 115 patients undergoing radiotherapy were evaluated for the development of treatment-related fatigue, using a modified Piper's fatigue scale. The above scale determines 4 dimensions of fatigue ie behavioral severity (6 items), affective meaning (5 items), sensory (5 items), and cognitive mood (6 items). Radiotherapy was delivered to the head and neck, breast, pelvis, and miscellaneous sub-sites. The area of the radiation field ranged from 25 to 480 cm2 (median 156 cm2). Forty-three percent of patients experienced significant fatigue, which altered their work environment. The individual components of fatigue were behavioral severity 25%, affective meaning 21%, sensory 18%, and cognitive mood 16%. Significant radiotherapy-related fatigue was higher in patients treated with advanced-stage disease, large radiotherapy field area, and low pre-radiotherapy hemoglobin level.
The subjective quality of life (QOL) of diabetic patients on oral hypoglycaemics was compared to schizophrenic patients who were well controlled with their antipsychotic medications. This comparison was made using the generic quality of life questionnaire produced by the World Health Organization QOL (WHOQOL) group, namely the WHOQOL-100. Statistical analysis showed that there was no significant difference in the psychological well-being and level of independence between the two groups. However, such measures revealed that the most impaired aspect of well-being in the schizophrenic group was the social relationship. Subjective QOL assessment is able to reveal deficits or handicaps that are obscure and probably difficult to appreciate on objective social and clinical evaluation. Such findings are valuable in planning the rehabilitative need of schizophrenic patients in the community.