A systematic review of interventions to enhance communication in patients with a tracheostomy supports voice-facilitating devices for improved quality of life

اهداف: کیفیت زندگی، مفهومی پیچیده و چندبعدی است که تحت تأثیر مولفه هایی چون زمان و مکان، ارزش‌های فردی و اجتماعی از سوی متفکران علوم شهری و سایر اندیشمندان علوم مختلف مطرح و مورد پژوهش قرار گرفته است. تحقیق حاضر با هدف بررسی شاخص‌های کیفیت زندگی و سنجش آن در شهر مرکزی زرین دشت (حاجی‌آباد) بر مبنای 4 گروه شاخص‌های اقتصادی، اجتماعی، خدماتی و کالبدی صورت گرفته است. روش: روش تحقیق، در این مقاله توصیفی- تحلیلی و ابزار آن پرسش‌نامه می‌باشد. روایی پرسش‌نامه با استفاده از نظرات متخصصان و پایایی آن با استفاده از محاسبه آلفای کرونباخ (72%) تعیین شد. جامعۀ آماری در این پژوهش7 محله از شهر حاجی‌آباد (20000نفر) می‌باشد که با استفاده از فرمول کوکران 377 نمونه انتخاب گردید و به‌صورت تصادفی در هر محله پرسش‌نامه توزیع شد. تجزیه و تحلیل پرسش‌نامه با استفاده ازآمار توصیفی، همبستگی و رگرسیون چندگانۀ خطی انجام شد و در نهایت از روش آنتروپی شانون جهت وزن‌دهی شاخص‌ها و تکنیک پرومتی جهت رتبه‌بندی محلات به‌کار گرفته شد. یافته‌ها/نتایج: یافته‌های پژوهش نشان داد که در شهر حاجی‌آباد، محلۀ فرهنگیان بالاترین سطح کیفیت زندگی شهری و محلۀ حسین‌آباد، پایین‌ترین سطح کیفیت را در بین محلات دارد. همچنین در بررسی ابعاد چهارگانۀ شاخص کیفیت زندگی همبستگی مستقیم و معناداری وجود داشته و هر یک از این ابعاد همبستگی معناداری با رضایتمندی نهایی از کیفیت زندگی دارند و از بین شاخص‌های کیفیت زندگی، شاخص اقتصادی بیشترین تأثیر را در کیفیت محلات دارد.

Summary The concept of quality of school life is based on the more general concept of “quality of life” (Csikszentmihalyi, 1990; Land a Spilerman, 1975; Williams a Batten, 1981; cited in Linnakyla a Brunell, 1996, p.205). Quality of life is considered as a general and continual well being state and is generally determined both by positive experiences which bring happiness, pleasure and satisfaction and by negative experiences and feelings. These experiences are evaluated in terms of some concepts such as family, friends, school, work, free time etc. which are all important and meaningful for the individual (Linnakyla a Brunell, 1996, p.205). Education is also considered as an important dimension of general quality of life. Gander and Gardiner stated that (1993, p.456), school experiences clearly contributed both to the professional and social aims and to the adolescents' intellectual and esthetic development. Schools are responsible for students' social development as well as their academic development (Marks, 1998). Consequently, educational environment should help to support both their academic and social development. In their research which consisted of 5932 adolescents Mok and Flynn (1997) found that, 20% of variance in students' academic achievement can be explained by quality of school life. Besides that Wolf, Chandler and Spies (1980; cited in Mok a Flynn, 2002) asserted that, children who have a positive school life can take more responsibility of their own behaviours. Also, Perry (2000) in his research which consisted of 1500 high school students found that, quality of school life has an important role among factors which affect students' general life satisfaction. Due to its important effects on students' academic achievement and on other outputs of education, quality of school life draws attention of educators and a lot of studies about students' well being at school have been done. However, there is very few research done on this topic in Turkey. Thus, the main purpose of this study is to investigate students' perceptions about their quality of life in their high schools. In direction of this general purpose, the following questions were asked: 1. According to perceptions of students' what is the level of quality of life in high schools in the Adana central province? 2. Are there any significant differences between the male and female students' perceptions about quality of their school life 3. Are there any significant differences in the level of school life quality by SES of the schools? 4. Are there any significant differences in students' perceptions of quality of life in their schools by their grades? Method The participants of the study included a total number of 478 students; 243 of whom were female and 235 of whom were male students. They attend six different state high schools in 2004 n 2005 educational year in Adana, Turkey. 163 of these students (34.1%) attend schools of high SES, 141 of them (29.5%) attend schools of middle SES and 174 of them (36.4%) attend schools of low SES. As for distribution of them, 200 students (41.8%) were at ninth grade, 202 students (42.3%) were at tenth grade and 76 students (15.9%) were at eleventh grade. QLHSS which was developed by the researcher through adaptation of the “Quality of life in University Scale” (Doganay a Sari, 2006) was used to gather data. The scale consist of 40 items with seven dimensions (Teachers, Positive feelings about school, Negative feelings about school, Student- student interaction, School administration, Social activities and Status) after it was tested for reliability and validity. The Cronbach alpha coefficient of internal consistency of these dimensions were calculated in sequence .89, .86, .81, .86, .80, .74, .71 and for the total of the instrument was .86. These seven dimensions could be account for 46.8% of the total variance. The instrument, being a Likert type consists of five scales which are certanly not agree, not agree, undetermined, agree and certanly agree. The minimum and maximum scores which can be collected from the scale are 40 n 200 and the scores can be analysed both on the base of subscales and the total scale. To analyse the gathered data, means and standard deviation distributions were investigated and independent samples of t-test and one way analysis of variance was performed. Findings and Discussion Results demonstrated that students perceived the quality of life in their schools at an average quality. Except for the School administration and the Social activities subscales, the mean was calculated between two and three for all the other dimensions. The highest mean was calculated for the School administration subscale and the lowest for the Status subscale. There were significant differences between the perceptions of male and female students regarding the dimensions of Feelings about school in favour of male students and regarding the dimensions of Social activities in favour of female students (pl.05). Although there were not significant differences between perceptions of girls and boys generally, according to literature, girls' perceptions of quality of life in their schools are more positive than the boys'. For example, Marks (1998) and Majeed, Fraser and Aldridge (2002) found that, when compared with boys, girls perceive the quality of life of their schools more positively than boys. On the base of this result of the study, it may be said that, different factors except sex have more important influences on students' perceptions of quality of life in their high schools in Turkey. Results show that in all subscales of QLHSS, the highest means were calculated in schools have high SES and the differences were statistically significant at the .05 level. According to this results it may be said that, the higher the SES of the school, the more positive the quality of school life was perceived by students. It may be because of that the schools in high SES, have both physical and socio-cultural opportunities to establish well environment to their students. On the other hand, students gradually become pretty selector persons and they can evaluated their education process quite critically. Studies show that adolescents not believe in their important needs are met enough in schools and they are not satisfied with service submitted to them (Flanagan, 1978; cited in Karatzias et al. 2001a). The result of students in schools with low SES perceived the life quality in their schools more negatively may be reflected such a critical perceptiveness. However in the high SES, the educational level of the parents are generally high too. Marks (1998) found that, students who have more educated parents were more satisfied with their quality of life in school. In the light of all of these results, it is suggested that, it can be beneficial to take some precautions to increase the quality of life in high schools which is a critical period of time for young students. Especially, if studies which will be done focus on high schools which are in low SES, it may be help to eliminate the inequality of opportunities between students. Also it may be beneficial to carry out a series of orientation programs for students who are at 9th grade, who are new in this environment. It is clear that, programs like that may help them to know the characteristics of life of their schools closely and to come over of adaptation problems easily. In the high school period which is accepted as a critical term for identity development, it may be said that, the quality of school life which is submitted to students has an important influences on the quality of personal identities which are formed by the students. Thus, investigating this topic in more detail by scientific research may led to submit to students a school life which has superior quality and satisfying for them.

Cardiac resynchronization therapy (CRT) for the treatment of heart failure (HF) raises complex problems for informed consent. CRT with and without defibrillator backup has been demonstrated in clinical trials to improve symptoms from HF and decrease mortality.1–4 A CRT pacemaker (CRT-P) may improve symptoms and reduce mortality in selected patients, even without offering the specific protection from malignant arrhythmias afforded by a CRT defibrillator (CRT-D). Further, CRT-P may prevent disease progression even in earlier stages of HF.4,5 Implantable cardioverter-defibrillators (ICDs) alone are effective in preventing sudden cardiac death (SCD) in selected patients.6,7 Although most patients eligible for CRT-P will similarly meet guidelines for an ICD, the decision to include ICD backup with a CRT implant may not be straightforward.8 The decision for CRT-P or CRT-D implantation includes not only the medical facts, but also the important considerations based on values and principles. Patients and physicians may wrestle with fundamental questions about quality and quantity of life and struggle to come together toward a truly informed consent process. There are no formal guidelines or standards that argue for specific content to be included in the informed consent process for CRT. This article examines 4 categories of questions regarding CRT based on an understanding of autonomy and shared decision-making as elements of informed consent: (1) control over the manner of death, (2) quality versus quantity of life, (3) therapeutic flexibility, and (4) clinical uncertainty. This article may help to guide clinicians and patients by clarifying the clinical and moral considerations and the principles behind particular treatment decisions. Autonomy refers to an understanding and knowledge of available options and the ability to choose between them through rational deliberation.9,10 Respect for patient autonomy is the foundation of modern bioethics and, in …

The Effect of Quality of Work Life (QWL) Programs on Quality of Life (QOL) among Employees at Multinational Companies in Malaysia

The importance of quality of life issues in health care practice and research is steadily growing. This growing interest fits into the definition of health as proposed by the World Health Organization (WHO) in 1948 (1). The WHO defines health as 'a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity'. The attention to health-related quality of life is reflected in the increase in the use of quality-of-life evaluation as a technique of clinical research since 1973, when only five articles listed 'quality of life' as a reference key word in the Medline data base; during the subsequent five-year periods there were 195, 273, 490, and 1252 such articles (2). Also in the field of allergy it has been recognized that allergic disease comprise more than the classical signs and symptoms being part of physical disorders such as allergic rhinitis, asthma and the atopic eczema/dermatitis syndrome (AEDS) (3). In the last decades an increasing effort has been made to understand the socioeconomic burden of atopic disease in terms of effects on health-related quality of life (HRQL) and healthcare costs. It has been acknowledged in several consensus reports that rhinitis and asthma are associated with impairments in the patients' functioning in day-to-day life at home, at work and at school 4-8). With the introduction of questionnaires designed to measure asthma- 9-11) and rhinitis-associated impairments of quality of life (12) it is clear that patients may be bothered by sleep disorders, emotional problems, impairment in activities and social functioning. Also, in general terms, patients with asthma (13) and allergic rhinitis (14) are impaired in their physical and mental functioning, including vitality and the perception of general health. From daily medical practice it can be easily understood that AEDS has a major impact on HRQL. In a way, the use of questionnaires focused on skin disease 15-17) formally confirms this association. Quality of life, QOL, has divergent meanings for different people. Also, HRQL may be considered as ill-defined. More agreement has been reached about the four domains of QOL which are considered to be important: 1) physical status and functional abilities; 2) psychological status and well-being; 3) social functioning; 4) economic and/or vocational status and factors ( 18 ). As the true quality of life value cannot be measured directly, researchers and clinicians have to resort to series of questions (items) to measure this construct indirectly. Combinations of items yield scores referring to physical, mental and social domains. An HRQL instrument must meet several criteria. It should address each component (symptom, condition) that is important to the patient. Attributes of an instrument are described in Table 1. It will be clear that the construction of quality of life questionnaires is a complex task, drawing from the fields of clinimetrics, psychometrics and clinical decision-making (2). Differences in approach, for instance item selection using factor analysis vs the impact method which select items that are most frequently perceived as important by patients -- yields different questionnaires (19). In general two types of instruments, generic and specific, have been used in allergy research. Generic questionnaires measure physical, psychological and social domains in all health conditions irrespective of the underlying disease. A frequently used generic instrument is the Medical Outcomes Survey Short Form 36 (SF-36) (20). The SF-36 was developed as part of the Medical Outcomes Study and analyzes health status using 36 questions to measure nine different health dimensions. It has been used to characterize patients with asthma. Bousquet (13) compared the FEV1 and a clinical score of asthma severity for 252 asthmatic patients. There was a significant positive correlation between all nine quality of life domains of the SF-36 and the clinical score of Aas. Eight of the nine domains also correlated with the FEV1. Also in perennial rhinitis there was a significant impairment in eight of nine QOL dimensions in patients compared with healthy subjects (14). Furthermore, the SF-36 is used to evaluate the effects of a nonsedating antihistamine on quality of life. In this study all of the nine quality of life dimensions improved significantly after one and six weeks of cetirizine treatment compared with placebo (21). Other generic instruments that have been used in allergy research are the Sickness Impact Profile (SIP) (22) and the Nottingham Health Profile (NHP) (23). The 136 items in 12 categories of the SIP describe activities of everyday living. This instrument has been used to evaluate the effect of salmeterol on asthma (24). Salmeterol led to significant improvements over salbutamol on virtually all clinical outcomes. Although all four quality of life instruments used in this study showed the same trend in favor of salmeterol, only the disease-specific Asthma Quality of Life Questionnaire (AQLQ) and the Rating Scale utilities showed significantly greater improvement on salmeterol than on salbutamol. In severe AEDS it was shown, using the SIP, that cyclosporin improves quality of life significantly (25). In particular, the SIP has been used for comparison with disease-specific instruments (24, 26-28). The NHP, the only generic instrument derived entirely from lay people, has been used to validate a disease-specific instrument for patients with dermatitis and psoriasis (29). In asthma the NHP was not able to capture clinical improvement by treatment with pulmonary steroids (30). The latter observations underline the disadvantage that the generic instruments miss depth and therefore may not be responsive enough to detect changes in general health states in spite of important changes in disease-related problems (26). The advantage of generic instruments, however, is that the burden of illness across different disorders and patient populations can be compared. In a comparison between asthma and epilepsy the major finding was that children with epilepsy had a relatively more compromised quality of life in the psychological, social, and school domains (31. In contrast, children with asthma had a more compromised quality of life in the physical domain. These findings suggested that attention simply to seizure control in the clinical setting will not address the full range of quality of life problems in children with epilepsy. Specific instruments have been designed by asking patients what kind of problems they experience from their disease. Both the frequency and the importance of impairments are measured by means of the questionnaires. These instruments have the advantage that they describe the disease-associated problems of the patients. As stated above, they seem to be more responsive to changes in HRQL than do the generic instruments. Several instruments for patients with asthma have been developed. The Asthma Quality of Life Questionnaire of Juniper is focused on symptoms, emotions, exposure to environmental stimuli, and activity limitation (32). Modifications of this questionnaire have been published recently (33, 34). When using HRQL outcome in clinical trials, the question arises whether a change in HRQL is of clinical importance. For the AQLQ, which uses a seven-point scale, the minimal important difference of quality of life score per item is considered to be very close to 0.5 (35). A change of 1.0 in the score represents a moderate change and a change in score of greater than 2.0 represents a large change in HRQL. The minimal important difference as described by Juniper is based upon patient opinions. Measures such as the standardized response mean or the effect size can be used to standardize changes. These measures are based solely upon the distribution of the observed data, in particular upon the variance (36). Recently, it has been shown that both the SF-36 and AQLQ were able to characterize a group of patients with moderate asthma very well, whereas the AQLQ domains were found to have the best discriminative properties (37. The Asthma Quality of Life Questionnaire of Marks captures breathlessness, physical restrictions, mood disturbance and concerns for health (38). St. George's Respiratory Questionnaire (11) is designed for patients with asthma and chronic obstructive pulmonary disorder COPD. It can be applied in both reversible and fixed airway obstruction. In contrast to other questionnaires, the Living with Asthma Questionnaire (10) does not include impairments experienced as a direct consequence of asthma symptomatology. Other instruments are presented in Table 2. The properties of the most frequently used questionnaire are described in Table 3. Specific instruments have been developed for children and caregivers (Table 2). In addition, questionnaires have been constructed for different age-groups of patients with rhinitis (12, 39-41). A simple practical questionnaire technique for routine clinical use, the Dermatology Life Quality Index (DLQI) has been introduced to characterize patients with skin disorders (15). This instrument has been used to compare patients with psoriasis and dermatitis (42). Also versions for children are available: the Children's Dermatology Life Quality Index (CDLQI) and the Infant's Dermatology Life Quality Index (IDLQI) (16). Other questionnaires are the Skindex (43) the Dermatology-Specific Quality of Life (DSQL) (17) and the patient-generated Dermatology Quality of Life Scales (DQOLS) (44). Recently, a questionnaire has been developed to measure HRQL in patients with allergy to insect stings. Subsequently, this instrument has been used in the evaluation of venom immunotherapy (45). It appeared that venom immunotherapy resulted in a statistically and clinically significant improvement in HRQL. Both in clinical practice and in research physicians and investigators rely on physiological and objective measures, whenever possible. However in asthma an increase in FEV1 or a decrease in PC20 histamine or methacholine may occur without any improvement experienced by the patient. Medical intervention may improve physiologic measures, whereas for instance side-effects of drugs or the cumbersome aspects of subcutaneous immunotherapy may unfavorably influence day-to-day life and compliance with treatment. It has been put forward that the classical outcome variables may only partially characterize the disease of the patient. From that point of view it has been advocated to measure HRQL along with the conventional clinical indices (46). In line with this reasoning is the weak association between classical asthma measures and the outcome of HRQL questionnaires. Comparison between de AQLQ of Marks with asthma symptoms and lung function variables revealed that a change in AQLQ score was weakly correlated with change in symptom score (r = 0.37, 95% CI 0.04–0.64) and change in BHR (r = 0.38, 95% CI 0.06–0.64). The association with change in peak flow variability was weak (r = 0.12, 95% CI 0.26–0.47) (27). Similar observations have been reported by others 47-50). An interesting study shows that the mere presence of respiratory symptoms or a (gradually) reduced lung function is insufficient reason for patients to seek medical help. Subjects are more likely to consult their general practitioner once their quality of everyday life is affected or they experience variability in lung function (51). Also, rhinitis related quality of life appears to be moderately correlated to the more classical outcome variables used in clinical trials, such as daily symptom scores and nasal hyperreactivity (52). Another argument to use quality of life instruments lies in the headstart with respect to the knowledge of their validation, reliability and responsiveness compared to the common symptom scores or visual analogue scores (VAS) scales used at clinical trials. In the field of nasal allergy, validation or standardization of symptom scores has rarely been the subject of research. In asthma, even quite recently introduced measures, such as the number of symptom-free days, merit more attention in terms of standardization and validation (53). Other reasons to assess quality of life are conceivable. Measurement of quality of life can also be useful for screening purposes or for evaluation of therapy. Quality of life may be a determinant of effectiveness or efficacy of treatment. Moreover, its assessment might be relevant to striving for optimal decision-making. As the perception of patients is clearly important in the management of disease and patient compliance (Fig. 1), measurement of this 'dimension' by HRQL questionnaires in clinical trials may be justified. The emphasis on quality of life has sometimes resulted in a routine inclusion of HRQL questionnaires in clinical trials. The inclusion of such an instrument is valuable only if the changes can be interpreted by clinicians and contributes to optimal medical decision-making. In an editorial, criticism has been directed to the routine inclusion of such instruments when the structure of the evaluation and its rationale appears ill-defined (54). A model representing the relationships between clinical aspects of therapy, HRQL and factors influencing HRQL (adapted from Cramer and Spilker (17)). Generally in clinical trials the effect of treatment or intervention on HRQL runs parallel with the effect on conventional medical outcome measures. However, in some studies differences can be found. In a study evaluating the combined effect of steroids and antihistamines no differences were demonstrated between patients treated with antihistamine and steroids vs steroids alone in terms of quality of life, whereas for some patient-rated symptoms the combination turned out to be superior (55). In a large multicenter study comparing budesonide and fluticasone it was found that both drugs were equally effective in suppressing symptoms (56), although budesonide had a better effect on general quality of life (57). This might indicate that patients perceive differences not captured by conventional symptom scores. The reverse situation, i.e. significant effects on classical outcomes (symptom scores, medication use, peak flow or FEV1) without important change in two generic and two specific HRQL measures has been described in a study on the effect of formoterol, a long-acting α2-agonist, in mild to moderate asthmatic patients (58). The latter discrepancies can be explained by a limited performance of HRQL measures in mild asthmatic patients. Alternatively, it is possible that the minor changes in symptom scores and lung function due to the intervention are not perceived by patients as relevant. Moreover, patients with a chronic condition may adapt themselves to their disease. The strength of HRQL questionnaires, that is the patient-centred approach, is also one of its weaknesses. Perceptions of quality of life experienced by persons may shift in time. It is easy to understand that a dramatic personal accident or a serious disease will not only cause deterioration in quality of life but will eventually also influence the patient's values and internal standards. For instance, in a study of quality of life after radiotherapy for laryngeal cancer, a temporary deterioration of physical functioning and symptoms was reported, mostly caused by side-effects of treatment. Despite physical deterioration, there was an improvement of emotional functioning and mood after treatment, probably as a result of psychological adaptation and coping processes (59). It is possible also that in less dramatic circumstances, disease and treatments will induce shifts in perception due to changes in the patient's values. Such subjective changes in patients' perception are known as response shift. Socioeconomic status is an additional important independent factor influencing HRQL. In a recent study with asthmatic patients it was shown that socioeconomic status attributes to HRQL. More importantly, in this study it was difficult to separate out the unique effects of socioeconomic status and race/ethnicity (60). Recently, a significant relationship between the mental health of children with asthma and family functioning has been shown (61). These findings suggest that the domains comprising the HRQL of children with asthma are related to both disease and non-disease factors. Psychological functioning influences the burden of a specific disease. A study designed to assess the effects of depressive symptoms on asthma patients' reports of functional status and health-related quality of life revealed that asthma patients with more depressive symptoms reported worse health-related quality of life than asthma patients with similar disease activity, but fewer depressive symptoms (62). Interestingly, these findings were seen not only in generic (SF-36) but also in specific (AQLQ) instruments. This means that a disease-specific instrument may be also influenced by phenomena such as fear and depression. Finally, patients may either intentionally or unconsciously mask their symptoms or trivialize their diseases. They may tend to ignore or discount those problems which they believe are unrelated to their illness. Others may tend to give socially desirable answers. Response shifts and illusory mental health (63) are not easily captured with HRQL instruments, but they will certainly influence the outcome of a clinical trial, when HRQL is chosen as the primary endpoint. In summary, one has to realize that the translation of clinical effects of treatment into perceived and reported changes in quality of life finds a place at the integration level of the patient and this is, in a way, a black box which is not easy to assess (Fig. 1). For these reasons it is strongly recommended to use HRQL outcome measures in parallel with conventional physiological outcome measures. Asthma, allergic rhinitis and AEDS often coexist. The question to what extent concomitant allergic disease affects quality of life has infrequently been addressed. In a recent study the SF-36 questionnaire from 850 subjects recruited in two French centers participating in the European Community Respiratory Health Survey was evaluated. Both asthma and allergic rhinitis were associated with impairment in quality of life. However, 78% of asthmatics also had allergic rhinitis. Subjects with allergic rhinitis but not asthma were more likely to report problems with social activities, difficulties with daily activities as a result of emotional problems, and low mental well-being than subjects with neither asthma nor rhinitis. Patients with both asthma and allergic rhinitis experienced more physical limitations than patients with allergic rhinitis alone, but no difference was found between these two groups for concepts related to social/mental health (64). In another study focusing on asthma, rhinitis and AEDS, comprising 325 subjects allergic to house dust mites, it was found that patients did show impaired quality of life compared to irrespective of the of the atopic Patients with the of asthma did out in terms of physical In addition, asthma symptoms with a visual had a major effect on social functioning, emotional functioning and disorders, in patients with AEDS, appeared to be associated with physical functioning, social functioning, mental health and general health It is not only concomitant atopic disease that has an impact on quality of life. such as and and nasal may patients with rhinitis and asthma. the SF-36 and a quality of life measure it has been shown that HRQL is impaired and that may improve quality of life for patients that is a other specific instruments such as the Index and the have been The impact of on social life in children during the four of life is not easily can be by use of a specific which measures the quality of life is a chronic disease of the respiratory which is frequently associated with respiratory compared the HRQL in patients with nasal with those of patients with perennial rhinitis and healthy It appeared that nasal impaired HRQL more than perennial allergic rhinitis The impairment of HRQL was greater when nasal was associated with asthma In addition, of nasal symptoms, and pulmonary function were after the evaluation in patients with nasal These demonstrated that nasal treatment either with nasal steroids or significantly improved both nasal symptoms and QOL without significant changes in pulmonary may a if the or is in one particular disease. A recent study the effects of on the of QOL measures an analysis of data from clinical trials with asthma, and The study suggest that conditions significantly and patients' scores on generic QOL measures and of treatment whereas their influence on disease-specific QOL scores and of treatment effect is although not These findings have significant practical for the of true treatment control of and the of QOL trials. The that atopic disease may have an effect on daily functioning has been by studies focused on school and in children with asthma may school and as as work by In a study it was shown that of children with recent symptoms of asthma, reported school absence for at one during the 12 compared with in children without respiratory absence of respiratory illness was reported for and use for respiratory problems for of the children with recent symptoms of asthma In another study reported in their activities and reported of work and school of asthma or nasal symptoms are not in patients with allergic rhinitis they may to problems during school either by direct or of sleep and allergic rhinitis may be associated with reduced to with will these problems, whereas treatment with nonsedating will only partially reverse the limitations in Recently, in a study out over in children with allergic perennial rhinitis and children with perennial rhinitis, it was shown that or the from on school on school and sleep In of the of a large it has been demonstrated that in asthma with increasing disease severity The of the effect of asthma on work the effect of work on asthma. The of asthma and of asthma is increasing It has been that of asthma can be to of asthma at work more on the of of underlying asthma than on the of possible asthma. It can be that patients with asthma may have a more severe impairment in quality of life of the between work and disease. In a study designed to address this question a statistically significant difference was seen in the scores of the AQLQ from a group of patients with asthma and a control group of subjects with asthma of The mean difference in the score was on a of limitation or of the to limitation or all the at the of the patient with asthma The difference between both groups was other more generic instruments focused on detect more showed that both asthma and rhinitis work with asthma are less likely to be at those rhinitis is a more determinant of work effectiveness In the allergic rhinitis in school days, and reduced activity per These data are derived from persons allergic rhinitis in with persons medical treatment. These data indicate that allergic rhinitis may have an important impact on and Patients are bothered by with performance and at and and may and only disease but also may influence work It has been that of treated their allergic rhinitis with antihistamines at for per Patients these antihistamines are more likely to The of include and With the antihistamines these problems have been significantly reduced studies have the for treatment of allergic rhinitis, asthma and associated In asthma in the for an A comparison of asthma in developed suggested an burden from to per of the asthma were to direct medical For the it has been that the when allergic was the primary were in The when allergic was a to other disorders such as asthma and was at The of allergic asthma and rhinitis and concerns about health care the increasing interest for only does the efficacy of treatment have to be but also its In these studies measures must be in to across patient populations and for different It is, however, difficult to the generic SF-36 or disease-specific HRQL scores into For this utilities such as the have been which measure the value that patients themselves place on their health some utilities measure the value that on health are the and Health An advantage of utilities is their to life associated with different medical can easily be into instruments are mostly A recent rhinitis specific the has been developed as a patient outcome for clinical trials and for studies comparing medical treatments for rhinitis The same group introduced an asthma specific the Asthma Index Also, disease-specific versions of the and have been developed for patients with asthma The interest in quality of life for patients with allergy that allergy is by a significant socioeconomic the introduction of HRQL outcome measures physicians were that patients cannot be by physiological measures. In a way, HRQL outcome measures of the from the with which clinicians are in their day-to-day The of these in the HRQL questionnaires it possible to include the patient in clinical trials and the in this field will improve medical decision-making and management of disease. of these outcome measures in the evaluation and management of patients be the However, HRQL questionnaires are in the of being in terms of and introduction of of instruments of QOL data is based on the that there are no measurement in the of is an technique for and which measurement into An important of is that it of whether a model fits the observed With this it has been shown that some changes in the of the SF-36 are when it is applied to evaluation of QOL for patients with or disease and with experienced criticism has been the of instruments and the to the measurement of quality of life It has been that attention has to be to better for of and of measures, these instruments will be for use in clinical practice and for use as primary in clinical trials Also, in the field of allergy the number of outcome measures is growing. For the and it will be difficult to select the of questionnaires. A a clinical is in of an disease-specific questionnaire with a whereas a at the level of health a generic instrument differences between subjects at a point in and utilities to assess of In not to patients with outcome measures research is to between In research to be focused on the selection and of a limited number of and instruments in to better understand the patient with allergy and better the of clinical trials. from the of Medical and for of the and

This paper has the purpose of assessing quality of life of migrants of Chennai city using 14 variables measured with Likert-type of scaling in a factor analysis.As many as 305 randomly chosen migrant-respondents from across the city have been interviewed using a custom-designed, structured questionnaire in 2012.The analysis has yielded two very neat and significant factor dimensions, labeled as 'Quality of Life Dimension' and 'Well-being in Life and Work Dimension'.The two factors, retained in the analysis using the eigenvalue criterion, explain a cumulative variance of 49.434 per cent.The rotated factor scores have shown that 47.4 per cent of the migrants of Chennai are on the better side of quality of life whereas 45.6 per cent of them are on the higher side of well-being in their life and work.In their revealed perceptions of quality of life and well-being in life and work, there is yet much to be accomplished and there are challenges in city life they could face up to.

Purpose The purpose of this paper is to investigate the impact of the hardiness of university business students. Overall hardiness, and its individual components of commitment, control and challenge, were all explored in relation to students’ quality of university life, quality of life and learning performance. Design/methodology/approach A sample of 722 Vietnamese business students was surveyed to collect the data. Structural equation modeling (SEM) was used to determine whether hardiness and/or its components enhanced students’ quality of university life, quality of life and learning performance. Necessary condition analysis (NCA) was then employed to explore the levels of hardiness and its components necessary for each of the key areas. Findings SEM results revealed that overall hardiness had a positive effect on all three key areas. In terms of individual components, commitment, control and challenge were found to have positive impacts on learning performance; however, control did not affect quality of university life, and challenge had no effect on quality of life. NCA results show that these components of hardiness had varying degrees necessary for students to experience success in these areas. Practical implications Findings suggest that university administers should consider the role which student hardiness, and its individual components, can play in relation to student success at university. Specifically, universities should practice hardiness training and assessment programs to equip their students with hardy attitudes and skills. Originality/value This study is one of the first to examine of the levels of the components of hardiness (i.e. commitment, control and challenge) necessary for students to achieve success in the quality of university life, quality of life and learning performance.

The Effect of Rural Guidance Plan on the Subjective Quality of Life among Rural Communities (Case Study: Fariman County)

Quality of life research responds to the growth of urbanization in the world by increasing the focus on the quality of urban life; however, the dominant applied research tends to be without conceptualization of the quality of urban life. The aim of this paper is to answer the question whether the quality of urban life exists as an original, separate part of the concept of quality of life, or whether only the quality of life or the well-being of a certain city exists. The authors argue that the quality of urban life exists as an original category of quality of life and their beliefs are based on the fact that it can be measured separately. The quality of urban life is holistic, co-existing with the quality of life. The city from the point of view of quality of life research is a place, and the quality of urban life is the satisfaction with life in a city and the quality of place in it. This approach is applied to the quality of urban life and its measurement in the city of Liberec. The results are implications for policy-makers and urbanists.

The Analysis of the Impacts of Tourism on the Quality of Rural Life (Case Study: Uraman District of Sarvabad County

Survival and quality of life: Comparing end points in oncology

BACKGROUND Several factors affect the quality of sexual life. Vaginitis may impair the quality of life and lowers the self-esteem of a woman by distorting the mental image of her body. So far, no study has been done on the effectiveness of vaginitis treatment on the quality of sexual life. Therefore, considering the importance of quality of sexual life in family relationships, the present study was designed and conducted to determine the effects of vulvovaginitis treatment on women’s quality of sexual life. METHODS This experimental study was conducted on patients visiting Imam Sajjad Hospital in Shahriyar from 2017 to 2018. The Inclusion criteria in the study were as follows: having one of the vaginal infections, i.e., Candidiasis, Gardnerella, or mixed infection (both Candidiasis and Gardnerella) diagnosed by a specialist. The subjects filled in the quality of sexual life questionnaires before treatment and 2 months after the treatment. Data analysis was done by SPSS version 16 with paired t - test, univariate analysis of covariance (ANCOVA), analysis of variance, and multiple regression test. The P - value < 0.05 was considered significant. RESULTS In each of the three groups (candidiasis, Gardnerella, and mixed infection), the quality of sexual life differed before and after treatment, therefore the treatment improved the patients’ quality of life significantly. Mean and standard deviation of the quality of sexual life in Candidiasis group before and after treatments were 68.97 ± 19.59 and 75.82 ± 8.46 respectively; in Gardnerella group: 69.28 ± 19.04, 14.14 ± 72.15, and in the mixed group, they were 66.59 ± 18.91, 71.61 ± 13.47 respectively. In all three groups, the components of personal feelings and sexual life before and after treatment were different (P < 0.001). The regression test proved the effects of such variables as education, body mass index (BMI) and duration of infection on the quality of sexual life (P < 0.05), and the greatest effect was related to the duration of infection with a coefficient of - 0.342. CONCLUSIONS After treating the vaginal infections, these women's quality of sexual life improved. As a result, it can be concluded that the diagnosis and treatment of the disease can enhance the quality of sexual life. KEY WORDS Quality of Life, Quality of Sexual Life, Vaginitis, Treatment

Objective: This study aims to comparatively evaluate the quality of daily life and quality of work life among employees working in environments with different noise exposure levels to explore the potential impact of occupational noise on overall well-being. Methods: This cross-sectional study was conducted in the audiology department at Trakya University between April and July 2024. The study included 86 employees who worked in an industrial estate, street market, hospital laboratory, and office. Noise levels in the environments were measured with a sound level meter, and participants were asked to complete the Short-Form 12 Questionnaire (SF-12) and the Quality of Work Life (QWL). Results: Average noise levels were highest in the street market (73.63 dBA) and lowest in the office (55.80 dBA). A significant difference was found between laboratory employees and street market workers in the physical component of the SF-12 and between industrial estate workers and office employees in the mental component (P < .05). The QWL scores did not differ significantly by group. Regression analyses revealed that age significantly predicted Physical Component Score-12 scores, while both age and work environment were significant predictors of Mental Component Score-12; however, no predictors were associated with QWL. Conclusion: Even when below legal limits, noise exposure in various work environments has negative impacts on employees’ quality of daily life. It is important that occupational health and safety policies address not only loud noises but also common “noisy” working conditions. Regular noise measurements, encouraging the use of protective equipment, and awareness training could play a critical role in improving employees’ quality of daily and work life. Cite this article as: Avcı NB, Ali C, Nterntiman A, Ferat OM, Taşdemir Gürşen İ, Bulut E. Impact of varied noise exposure on workers’ quality of life and work: A multienvironment study. Arch Health Sci Res. 2026, 13, 0189, doi: 10.5152/ArcHealthSciRes.2026.25189.

This paper is focused on the urban-rural dichotomy as one of the dichotomies of quality of life (QOL). The first objective is to find out whether the quality of urban life, or the quality of rural life, is higher in Czechia. The hypothesis assumes that the quality of urban life is higher. The second objective is to identify predictors of QOL and compare values for the residents of cities and villages. In the Theoretical Background section, we discuss cities and urban life, plus villages and rural life. In the QOL section, we explore the quality of urban and rural life in Czechia, and give examples of QOL measurements in Czech municipalities. In the Measurement and Findings section we measure QOL with a subjective indicator on the Cantril scale, and derive findings from these measurements. The correlations between QOL and other variables yield very strong predictors of both urban and rural quality of life. The measurements also yielded two “by products”: The first was the finding that women’s measured values are, except for women’s quality of city life, higher than the measured values of men. The second was the finding that the combination of quality of place and quality of the environment, which we named ‘geographical matter’, was rated higher by the respondents than the combination of QOL and happiness, which we named ‘psychological matter’.

The aim of the present study was to determine the effects of perceived pain on quality of sleep and life in patients hospitalized in a pain clinic. Population of the present descriptive study composed of patients (>18 years old) treated as inpatients in the algology clinic of a university located at the city center of Sivas, who consented to participate in the study (122 patients). Data were collected through Personal Information Form, Visual Analog Scale (VAS), Pittsburg Sleep Quality Index (PSQI) and Short Form 36. Data were analyzed using independent t-test, Mann Whitney U test, Kruskal Wallis test and Pearson correlation test. Statistical significance level was set at p<0.05. A moderate negative correlation was found between VAS and three dimensions of SF-36, namely Physical Functioning, Role-Physical and Role-Emotional. VAS was weakly and negatively correlated to Vitality and Mental Health. There was a good linear correlation between VAS and quality of life (QoL), pain score while there was a moderate linear correlation between VAS and the total sleep score. It was found that quality of life was not statistically significantly correlated to General Health and Social Functioning. There is a relationship between pain, sleep quality and quality of life. Quality of sleep and life was found to decrease as the level of pain increased, and quality of life was affected negatively when the quality of sleep was poor. Applications towards resolving pain would have a positive effect on the quality of sleep and life.