***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: We describe the relation between self-reported hypertension and measures of health-related quality of life ( HRQOL ) in a community-dwelling population . In a cross-sectional study , 1430 r and omly selected adults , aged 45 to 89 years , were interviewed to obtain a medical history and health status measures , including the SF-36 question naire , the Quality of Well Being ( QWB ) index , and time trade-off  ( TTO ) assessment s. A total of 519 participants reported being affected by hypertension ( HTN group ) . The HTN group , compared to the No HTN group , had significantly lower age-adjusted health status scores measured by the General Health scale of the SF-36 and by TTO , with differences between groups for each measure comprising approximately 5 % of the total scale . HTNs also had a significant decline in general health status measures associated with increasing numbers of antihypertensive medications but not with specific classes of medications . We conclude that hypertension and hypertension drug therapy are associated with clinical ly meaningful decreases in reported health status The Beaver Dam Health Outcomes Study ( BDHOS ) is an ongoing longitudinal cohort study of health status and health-related quality of life for a r and om sample of adults ( age range at interview was 45 to 89 years ; mean = 64.1 , SD = 10.8 ) in a community population . In a face-to-face interview lasting approximately an hour , each participant responds to several batteries of questions . Included are a history of chronic medical conditions , current medi cations , and past surgeries ; the SF-36 ( a general health-status question naire ) ; the Quality of Well-being index ; self-rated health status on a five-point scale from " excellent " to " poor " ; and evaluation of current health using the method of time tradeoffs . The authors present results from 1,356 interviews on these four principal measures , reporting mean scores by sex , by age , and for persons reporting being affected by various medical conditions . They believe data from the BDHOS will provide research ers and policy makers a reference col lection of vital statistics for health-related quality of life . Additionally , the data provide a way to compare results from studies that utilize different indices from among the four principal measures of the BDHOS . Key words : health status ; quality of life ( health-related ) ; population study ; cohort study . ( Med Decis Making 1993;13:89 - 102 OBJECTIVE To test the predictive power of comorbidity and of the interaction between age and comorbidity in geriatric patients with acute medical illness . DESIGN Prospect i ve observational study . SETTING Medical and geriatric wards of an acute-care hospital . SUBJECTS Three hundred and seventy patients over 70 years of age consecutively admitted in an 18-month period . MAIN OUTCOME MEASURE In-hospital mortality . METHOD On admission a multidimensional assessment was performed , and a  comorbidity index  and an  age-comorbidity index developed on a comparable training population were calculated . The comorbidity index is based upon a scoring system that quantifies the prognostic weight of individual diseases , while the age-comorbidity index corrects the former for the age-related increase of the risk of death . The predictive power of variables univariately correlated with the outcome was tested by logistic regression . RESULTS Death was independently predicted by clinical diagnosis of malnutrition ( odds ratio = 1.87 , confidence limits CL = 1.20 - 2.86 ) , age-comorbidity index > 7 ( odds ratio = 1.77 , CL = 1.15 - 2.72 ) , preadmission impairment in activities of daily living ( odds ratio = 1.74 , CL = 1.13 - 2.69 ) , lymphocytopenia ( odds ratio = 1.74 , CL = 1.15 - 2.61 ) . A weaker predictive model was obtained by substituting the comorbidity index for the index of age-comorbidity . Excluding comorbidity from the logistic regression greatly weakened the predictive model This article examines the main and moderating effects of 3  personality characteristics on the association between  chronic medical morbidity and health-related quality of life ( HRQL ) in a large ( N = 5,279 ) community-based older sample . Reasonably high unique contributions of neuroticism , mastery , and self-efficacy to HRQL were found . The additional amounts of variance explained beyond and above medical morbidity and age vary from about 4 % ( bodily pain ) to above 30 % ( mental health ) . Little empirical evidence was found for the moderating effects of personality . In conclusion , personality characteristics such as neuroticism , mastery , and self-efficacy influence the reported levels of HRQL . The extent to which this is due to an influence of personality on true versus perceived levels of HRQL is unclear BACKGROUND / OBJECTIVES The goal of this study was to determine the influence of chronic obstructive pulmonary disease ( COPD ) on health-related quality of life ( HRQL ) independent of comorbidity . METHODS Patients with COPD in general practice , > /=40 years , were selected . To recruit controls , a r and om sample of persons without COPD and > /=40 years , was taken . HRQL was assessed with the SF-36 and comorbidity was determined by question naire . RESULTS The influence of COPD on HRQL independent of comorbidity ( represented by adjusted regression coefficients ) was significant for physical functioning ( -27.6 ) , role functioning due to physical problems ( -21.6 ) , vitality ( -14.4 ) , and general health ( -25.7 ) , and was minor and not significant for social functioning ( -5.6 ) , mental health ( -1.3 ) , role functioning due to emotional problems ( -2.7 ) , and bodily pain ( -2.5 ) . Comorbidity contributed significantly to the HRQL of all domains ( -7.6 to -27.1 ) . CONCLUSIONS COPD patients can be impaired in all domains of HRQL . However , impairments in physical functioning , vitality , and general health are related to COPD and to some extent to comorbidity , while impairments in social and emotional functioning do not seem to be related to COPD , but only to comorbidity The final development of the Sickness Impact Profile ( SIP ) , a behaviorally based measure of health status , is presented . A large field trial on a r and om sample of prepaid group practice enrollees and smaller trials on sample s of patients with hyperthyroidism , rheumatoid arthritis and hip replacements were undertaken to assess reliability and validity of the SIP and provide data for category and item analyses . Test-retest reliability ( r = 0.92 ) and internal consistency ( r = 0.94 ) were high . Convergent and discriminant validity was evaluated using the multitrait – multi method technique . Clinical validity was assessed by determining the relationship between clinical measures of disease and the SIP scores . The relationship between the SIP and criterion measures were moderate to high and in the direction hypotheszed . A technique for describing and assessing similarities and differences among groups was developed using profile and pattern analysis . The final SIP contains 136 items in 12 categories . Overall , category , and dimension scores may be calculated STUDY OBJECTIVES Condition-specific measures of quality of life ( QOL ) for patients with COPD have been demonstrated to be highly reliable and valid , but they have not conclusively been shown to predict hospitalization or death . OBJECTIVE We sought to determine whether a brief , self-administered , COPD -specific QOL measure , the Seattle Obstructive Lung Disease Question naire ( SOLDQ ) , could accurately predict hospitalizations and death . DESIGN Prospect i ve cohort study . SETTING Patients enrolled in the primary care clinics at seven Department of Veterans Affairs ( VA ) medical centers participating in the Ambulatory Care Quality Improvement Project . PATIENTS Of 24,458 patients who completed a health inventory , 5,503 reported having chronic lung disease . The 3,282 patients who completed the baseline SOLDQ were followed for 12 months . MEASUREMENTS Hospitalization and all-cause mortality during the 1-year follow-up period . RESULTS During the follow-up period , 601 patients ( 18.3 % ) were hospitalized , 141 ( 4.3 % ) for COPD exacerbations , and 167 patients ( 5.1 % ) died . After adjusting for age , VA hospital site , distance to the VA hospital , employment status , and smoking status , the relative risk of any hospitalization among patients with scores on the emotional , physical , and coping skills scales of the SOLDQ that were in the lowest quartile , when compared to the highest quartile , were 2.0 ( 95 % confidence interval [ CI ] , 1.5 to 2.6 ) , 2.5 ( 95 % CI , 1.9 to 3.4 ) , and 1.9 ( 95 % CI , 1.5 to 2.5 ) , respectively . When hospitalizations were restricted to those specifically for COPD , the odds ratio ( OR ) for the lowest quartile of physical function was 6.0 ( 95 % CI , 3.1 to 11.5 ) . Similarly , patients in the lowest quartile of physical function also had an increased risk of death ( OR , 6.8 ; 95 % CI , 3.3 to 13.8 ) . When adjusted for comorbidity ( OR , 0.8 ; 95 % CI , 0.5 to 1.2 ) , long-term steroid use ( OR , 2.8 ; 95 % CI , 1.6 to 4.9 ) , and prior hospitalization for COPD ( OR , 4.5 ; 95 % CI , 2.2 to 9.2 ) , patients having baseline SOLDQ physical function scores in the lowest quartile had an odds of hospitalization for COPD that was fivefold higher than patients with scores in the highest quartile ( OR , 5.0 ; 95 % CI , 2.6 to 9.7 ) . CONCLUSIONS Lower QOL is a powerful predictor of hospitalization and all-cause mortality . Brief , self-administered instruments such as the SOLDQ may provide an opportunity to identify patients who could benefit from preventive interventions Longitudinal data from 195 breast cancer survivors were used to identify factors affecting the level and rate of change in quality of life after completion of treatment . Women were interviewed up to four times at approximately yearly intervals using Kaplan and  Bush  's  Quality of Well Being instrument ( QWB ) . R and om coefficient regression analysis was used to model QWB as a function of time since diagnosis and personal characteristics . QWB scores decreased over time and the rate of decline increased with age ( p = 0.032 ) . This was similar to declines in women with benign breast biopsies , but overall QWB levels were lower in women with breast cancer . Having a spouse tended to slow the rate of decline in breast cancer survivors ( p = 0.004 ) . The presence of comorbidity was associated with significantly lower QWB levels ( p = 0.037 ) but did not affect the rate of change over time . Education , family history of breast cancer , cancer stage and treatment modalities were not significantly related to QWB levels or rates of change . Breast cancer survivors experience a reduction in quality of life that persists for years after treatment and is similar in magnitude to that associated with other health problems BACKGROUND The impact of chronic conditions on the development of disability has not yet been comprehensively studied among the elderly population living in Israel . This study evaluates the prevalence of disability and morbidity among the community-dwelling oldest-old population and examines the association between medical conditions , comorbidity , and disability in basic and instrumental activities of daily living ( ADLs , IADLs ) . METHOD The data are based on a national r and om stratified sample of 1,820 Israeli Jewish individuals 75 - 94 years old , of whom 1,487 lived in the community . RESULTS Nineteen percent of the population was disabled in ADLs and 36 % in IADLs . Disability rose with age and was higher for women and among individuals of Middle Eastern and North African origin . Stepwise logistic regression indicates that the variables associated with disability in ADLs and IADLs were older age , Middle Eastern or North African origin , living with others , and the following conditions : stroke , hip fracture , diabetes , osteoporosis , anemia , and heart attack . In addition , lower education and suffering from urinary or kidney diseases , respiratory disease , and /or Parkinson 's disease were related to disability in ADLs ; being a woman and suffering from heart diseases other than heart attack were related to disability in IADLs . Comorbidity was related to increased disability only for individuals with three or more conditions . CONCLUSIONS The identification of medical conditions and sociodemographic variables related to limitations in functioning may serve as a basis for health promotion and disease prevention in elders by attempting to reduce the incidence and disabling consequences of known disabling conditions Purpose : To examine HRQoL measured by EORTC QLQ-C30 with respect to an increasing number of self-reported chronic health problems in the general Swedish population and to study the association between HRQoL , chronic health problems and age , gender , income , marital status and employment status . Method : A postal survey among a large r and om sample of 4000 adults aged 18–79 years . The study material contained EORTC QLQ-C30 core question naire supplemented by a sociodemographic question naire including questions about 13 chronic health problems of which four categories , ` No ' , ` Few ' , ` Some ' or ` A lot of ' chronic health problems were constructed . Results : Multiple chronic health problems were significantly associated with reduced HRQoL. The increased number of chronic health problems was also associated with age . When the number of chronic health problems was accounted for , the influence of age 
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Nonetheless , we did find an inverse relationship between the number of medical conditions and QOL related to physical domains .
Conclusions Our findings confirm the existence of an inverse relationship between multimorbidity or comorbidy and QOL .