Better Quality Of Life Research Articles

LGG-20. SELUMETINIB IN PEDIATRIC PATIENTS WITH RELAPSED/REFRACTORY OPTIC PATHWAY/HYPOTALAMIC LOW GRADE GLIOMA: A MONOINSTITUTIONAL EXPERIENCE

Abstract BACKGROUND Pediatric low-grade gliomas (pLGG) are the most common central nervous system tumors in children. The optic pathway and hypothalamic (OPH) frequent localizations are correlated with multiply relapses due to inoperability, thus emphasizing the need for alternative treatments. The results of activation of the BRAF oncogene through a tandem duplication resulting in a KIAA1549–BRAF fusion is the most common genetic aberration. Selumetinib is an oral mitogen-activated protein kinase (MEK) 1/2 inhibitor with promising efficacy and good tolerability on relapsed/refractory pLGG. METHODS From January 2021 to January 2024 three patients with refractory OPH-pLGG with KIIA1549-BRAF fusion were treated with Selumetinib 25 mg/sqm/day (compassionate use) all after two lines of chemotherapy. They were males, mean age at diagnosis 8 months, at starting Selumetinib 74 months. All had partial surgery at diagnosis and two of them other debulking surgeries during the treatment. All patients had numerous events of hydrocefalous with need of shunt revision. RESULTS Two patients experienced grade-3 stomatitis, one grade 3 nausea-vomiting, one grade 3 gastritis, one grade 1 increased level of CPK (CTCAE-V5.0). For grade 3 toxicity Selumetinib had to be stopped for a maximum of 7 days with clinical benefit. Two of them have completed treatment with Selumetinib, one is ongoing after 20 months, all with radiological stable disease at MRI. Median time of treatment is 26 months (range 20-30 months). All three experienced a trend in reduction of emergency room admission for ventricular-shunt problems. Median PFS at starting Selumetinib was 62 months, median OS is 97 months. CONCLUSIONS Selumetinib has a good profile of toxicity, allowing a good quality of life procrastinating radiotherapy and reducing surgery events in a context of heavily pretreated relapsed/refractory patients. Further data are needed on both visual and auxological parameters and late side effects.

QOL-33. CANCER WORRY AND PSYCHOPATHOLOGICAL SYMPTOMS IN ADOLESCENTS AND YOUNG ADULTS SURVIVORS OF PEDIATRIC BRAIN TUMORS

Abstract BACKGROUND Adolescent and young adult (AYA) survivors of pediatric brain tumors may experience cancer-related worries, defined as concerns about relapse and late effects of treatment. Late psychological effects include psychological distress, depression, immaturity, and poor development of social skills. Furthermore, pediatric brain tumor survivors (PBTS) are more vulnerable to developing long-term neurocognitive and psychosocial consequences compared both to the general population and survivors of other types of childhood cancer. The purpose of the study was to identify the presence of cancer worry and psychopathological symptoms in AYA survivors of pediatric brain tumors. METHODS AYA survivors were assessed using the Cancer Worry Scale and Child Behavior Checklist questionnaires. Neurocognitive evaluation was performed using the age-appropriate Wechsler Scale. RESULTS Among 22 AYA survivors (M =14; F=8), the diagnosed tumor types were: germ cell tumor (10/22), low-grade glioma (4/22), embryonal tumor (3/22), high-grade glioma (2/22), craniopharyngioma (2/22), and mesenchymal tumor of the meninges (1/22). Survivors received the assessment at a median age of 20.2 years (range 13.6-28.7), with a median of 92 months after diagnosis. Cancer worry was reported in 50% of patients. The psychological evaluation showed clinical levels of internalizing problems in 17% and externalizing problems in 8%. Depressive and anxiety problems were reported in 25% of our cohort. Neurocognitive assessment demonstrated an average tIQ of 104. CONCLUSIONS As reported in the literature, cancer worry can influence the psychosocial adjustment process, alter self-image, and influence lifestyle decisions in PBTS. These concerns can affect their life prospects and their ability to successfully complete developmental tasks. Therefore, these issues must be early identified to prevent, through targeted psychosocial interventions, the onset of troubles in having romantic relationships, finishing school, entering the job market, and obtaining a good quality of life.

Efficacy and safety of once daily oral administration of sodium-glucose cotransporter-2 inhibitor velagliflozin compared with twice daily insulin injection in diabetic cats.

Options for treatment of diabetes mellitus in cats are limited to insulin injections and monitoring for hypoglycemia. Once daily sodium-glucose cotransporter-2 inhibitor velagliflozin PO is noninferior to insulin injections. Client-owned diabetic cats (127 safety; 116 efficacy assessment). Prospective, randomized (1 mg/kg velagliflozin), positive controlled (titrated Caninsulin), open label, noninferiority field trial, comparing number of cats with treatment success in ≥1 clinical variable and ≥1 glycemic variable (margin Δ: 15%) on Day 45; secondary endpoints included glycemic and clinical assessments during 91 days. On Day 45, 29/54 (54%) velagliflozin-treated cats and 26/62 (42%) Caninsulin-treated cats showed treatment success, demonstrating noninferiority (difference -11.8%; upper 1-sided 97.5% confidence interval, -∞ to 6.3%). By Day 91, quality of life (QoL), polyuria, and polydipsia had improved in 81%, 54% and 61% (velagliflozin); on blood glucose (BG) curves, mean BG was <252 mg/dL in 42/54 (78%; velagliflozin) and 37/62 (60%; Caninsulin); minimum BG was <162 mg/dL in 41/54 (76%; velagliflozin) and 41/62 (66%; Caninsulin); serum fructosamine was <450 μmol/L in 41/54 (76%; velagliflozin) and 38/62 (61%; Caninsulin). Velagliflozin's most frequent adverse events were loose feces/diarrhea (n = 23/61, 38%), positive urine culture (n = 19/61, 31%), and nonclinical hypoglycemia (BG <63 mg/dL; n = 8/61, 13%); Caninsulin's: clinical and nonclinical hypoglycemia (n = 35/66, 53%), positive urine culture (n = 18/66, 27%), and loose feces/diarrhea (n = 10/66, 15%). Diabetic ketoacidosis occurred in 4/61 (7%; velagliflozin) and 0/66 (Caninsulin). Once daily oral administration of velagliflozin was noninferior to insulin injections, showed good QoL and glycemia without clinical hypoglycemia.

Health-Related Quality of Life in Danish Cancer Survivors Referred to a Late Effects Clinic: A Prospective Cohort Study.

The Region of Southern Denmark has recently established four late effects clinics to help cancer survivors suffering from complex and severe late effects. This study aimed to capture and analyze the full range of physical, mental, and psychosocial issues using patient-reported outcomes. Moreover, we aimed to describe demographic data and the type and severity of the late effects. A prospective cohort study was conducted among cancer survivors referred to a late effects clinic. Before their first appointment, patients completed the European Organization for Research and Treatment of Cancer Quality of Life cancer survivorship core questionnaire (EORTC QLQ-SURV100). We compared mean scores of the EORTC QLQ-SURV100 scales that were comparable to the scales/items from the EORTC QLQ-C30 questionnaire with norm data for the Danish population and EORTC reference values. All patients referred to the clinic within its first 2 years were included (n = 247). The mean age was 57 [23-85] years and 74% were females. The most common cancer diagnoses was breast cancer (39%). The five most commonly reported late effects were fatigue (66%), pain (51%), cognitive impairment (53%), sleep problems (42%), and neuropathy (40%). A total of 236 of the patients entering the clinic completed QLQ-SURV100. They reported significantly worse mean scores on all scales compared to the Danish norm population and EORTC reference values for pretreatment cancer patients, p < 0.001. Effect sizes were moderate or large for all scales. In this study, we collected demographic data and described the late effects presented by the patents referred to the clinic. Moreover, we captured and analyzed the full range of physical, mental, and psychosocial issues using QLQ-SURV100. Patients referred to the Late Effects Clinic (LEC) had a number of late effects and reported a significantly lower health-related quality of life compared to the general Danish population and patients who have just been diagnosed with cancer, suggesting the aim of helping patients suffering from late effects gain a better quality of life is in dire need.

Effectiveness of a phone-based support program on self-care self-efficacy, psychological distress, and quality of life among women newly diagnosed with breast cancer: A randomized controlled trial

PurposeThis study aimed to determine the effectiveness of a Phone-Based Support Program (PBSP) for newly diagnosed women with breast cancer. MethodsA two-group repeated measures randomized controlled trial was designed. Participants included 94 patients aged 18–60 years who were newly diagnosed with breast cancer and undergoing chemotherapy in a tertiary hospital in China. They were randomly assigned to the intervention and the control groups. Participants in the intervention group were enrolled in a four-session PBSP, consisting of four interactive sections: learning, discussion, ask-the-expert, and personal stories, plus the routine care. Outcomes included patients’ self-care self-efficacy, psychological distress (including symptom distress, anxiety, and depression), and quality of life. These were assessed at three time points: pre-intervention (T1), post-intervention (T2), and follow-up (T3) by using the self-care self-efficacy scale, the M.D. Anderson Symptom Inventory, the hospital anxiety and depression scale, and the global health status scale. ResultsAfter completion of the intervention, participants in the intervention group had significantly (p < .001) higher self-care self-efficacy (T2: Mdiff = 11.49, T3: Mdiff = 22.33), better quality of life (T2: Mdiff = 8.18, T3: Mdiff = 17.19), lower symptom distress (T2: Mdiff =−26.68, T3: Mdiff = −54.76), less anxiety (T2: Mdiff = −2.52, T3: Mdiff = −5.11), and less depression (T2: Mdiff = −3.61, T3: Mdiff = −6.71) than those in the control group. ConclusionThese findings indicate that the PBSP is effective. Healthcare professionals, especially nurses, could utilize it to enhance self-care self-efficacy and quality of life, as well as decrease psychological distress among women newly diagnosed breast cancer. RegistrationThe Thai Clinical Trial Registry #TCTR20230321010.

Barriers and Enablers for Green Concrete Adoption: A Scientometric Aided Literature Review Approach

Green concrete is a concept of concrete that uses waste materials to reduce its environmental impact and has various benefits for the environment, economy, and society, such as lower construction cost, less landfill waste, new waste markets, and better quality of life. This study aims to investigate and analyze the barriers and enablers for green concrete development and implementation, based on a mixed-method approach that combines a scientometric analysis and a literature review. The Scopus database was explored first and then these data were used to investigate and capture six categories of barriers and enablers: awareness, technical, economic and market, implementation, support/promotion, and social. Results reveal that the technical and operational aspects are the main challenges for green concrete, while the awareness and social acceptance are not major issues. The current study surpasses the mere popularization of green concrete. Instead, it delves into its multifaceted dimensions, that is, technical, economic, social, and institutional. By meticulously analyzing a diverse group of research articles, key challenges and opportunities associated with green concrete are pinpointed. The findings not only deepen our understanding of the barriers impeding the widespread adoption of green concrete, but also shed light on potential solutions. In summary, this work bridges theory and practice, providing invaluable insights for future researchers, practitioners, and policymakers in the sustainable construction domain.

Moving Beyond Morphometrics and Alignment: Prospective Longitudinal Study on Cognition, Quality of Life, and Diffusion Metrics in Congenital Craniovertebral Junction Anomalies.

Chiari type I malformation (CMI) has been implicated to cause cognitive impairment. Unusual for a craniovertebral junction (CVJ) anomaly, this phenomenon is postulated to be related to microstructural changes across the brain. However, this has not been confirmed in a longitudinal study, in bony CVJ anomalies, or in the context of quality of life (QOL). This study aimed to analyze cognition, QOL, and diffusion tensor imaging (DTI) metrics before and after surgery for congenital CVJ anomalies and evaluate their correlations with conventional clinico-radiological factors. Fifty-seven patients with congenital CVJ anomalies-CMI, atlantoaxial dislocation (AAD), and basilar invagination (BI)-were evaluated in this prospective longitudinal study over 3 years with a neuropsychological battery, QOL and functional scores, and DTI metrics. A total of 43 patients (23 with CMI; 20 with AAD or BI) with 1-year postsurgical data were included in the final analysis. Cognitive dysfunction in one or more domains was noted in 15 (65%) of the patients with CMI and 16 (80%) of the patients with AAD/BI. Memory and visual motor perception were the most-affected domains in both the cohorts. At the 1-year follow-up, the proportion of patients demonstrating an overall cognitive dysfunction did not change significantly (P > .05). All patients demonstrated significant postoperative improvement in functional and QOL scores at follow-up. DTI metrics improved in many regions postoperatively, but did not correlate with functional or cognitive changes (P > .05). Cognition is affected in a majority of patients with CMI, AAD, or BI. These patients experience good functional and QOL outcomes after surgery but most of them continue to exhibit cognitive impairment. DTI metrics improve after surgery, but do not correlate with cognitive changes. These findings underline the multidimensional nature of the pathology of these anomalies that complicate achieving the concept of a "successful" surgery.

Celiac Disease, Gluten Sensitivity, and Diet Management.

Celiac disease is a common chronic inflammatory condition of the small bowel triggered by gluten in wheat, rye and barley in the diet. Non-celiac gluten sensitivity presents with symptoms similar to celiac disease with the ingestion of gluten or other components of wheat. In this article, we review challenges presented by a gluten free diet for the treatment of both disorders. Wheat is ubiquitous in the diet and medications/products. A registered dietitian is mandatory for patient education on the gluten free diet. Naturally gluten free foods provide a healthy diet for those with celiac disease. Whole grains labelled gluten free, including oats, are encouraged in the diet as refined grains may be deficient in fiber, protein, and micronutrients, particularly folate. Gluten contamination is the most common cause of persistent symptoms in celiac disease though shared equipment of food preparation may not be as large a problem as suspected. Most with celiac disease on a gluten free diet will fully recover and gain weight that poses a problem for those overweight to start. The gluten free diet may have a negative impact on quality of life for both celiac patients and their families. Those with hypervigilance of the gluten free diet and avoidance of dining out have the lowest quality of life. The gluten free diet is currently the only effective treatment for celiac disease. A registered dietitian is needed to educate patients on the complexity of the gluten free diet with a goal of healthy eating, maintaining a healthy weight, and avoiding disordered eating or diet hypervigilance; key to a good quality of life.

Predictors of concerned others' mental health and quality of life over 12 months following adults' entry into treatment for an alcohol use disorder

IntroductionPeople in treatment for alcohol use disorders (AUDs) can negatively impact their Concerned Others (COs). This longitudinal study examined patient and CO characteristics associated with CO outcomes. MethodParticipants were 279 dyads of patients entering residential treatment and their CO. Outcomes were COs' mental health and quality of life. The study collected patient and CO predictors and CO outcomes at baseline and 3-, 6-, and 12-month follow-ups as part of a randomized controlled trial. In the first set of models, the analytic approach identified baseline patient predictors associated with COs' outcomes measured at baseline and follow-ups. In the second set of models, we examined whether those effects remained after adding baseline CO characteristics. ResultsIn the first set of models, COs of older age and whose patient reported less CO-patient relationship stress had better mental health. Also, married COs and those with higher income and whose patient reported no violence in the CO-patient relationship had better quality of life. In the second set of models, COs whose patient entered treatment due to criminal justice involvement, with more social support, less reported stigma, and less use of avoidance coping had better mental health. Also, married COs, those with higher income, and less reported discrimination stigma had better quality of life. ConclusionsUnderstanding patient and CO characteristics that are associated with COs' outcomes may inform AUD treatment programs' efforts to help COs. Identifying modifiable determinants of CO outcomes is important to clinical practice regardless of whether the patient chooses to obtain treatment.

Urban Planning and Accessibility: A Priority Right to Ensure The Well-Being of People in Urbanized Spaces

Objective: The objective of this study is to reflect on the implications of accessibility in the urban planning of cities, since this is a legal issue ensured by the various legislation in force considering that accessibility is relevant not only for people with reduced mobility or wheelchair users, but also for those with temporary disabilities, the elderly, pregnant women, obese people among others. Method: The research is based on a qualitative approach using bibliographic review and documentary research procedures. Data interpretation is anchored in categorical content analysis. Results and Discussion: The results obtained provide an understanding of how legislation seeks to promote a better quality of life for everyone within a city, through the implementation of various laws and decrees, including those related to urban planning and city development. Therefore, urban planning presents itself as an indispensable element for the organization of a city in all its aspects, contributing to its development and orderly growth. This is because, without this planning, it becomes difficult to guarantee quality education, access to healthcare, adequate housing, leisure opportunities and employment for all citizens. Originality/Value: This study contributes to the literature by considering the importance of urban planning in achieving accessibility in cities, in this context, the importance of legislation in ensuring the well-being of all inhabitants of a city is perceived, by guaranteeing accessibility, along with other mechanisms, such as urban planning and related decrees. A change in lifestyles has been observed in relation to the rural exodus, with a greater number of people living precariously in cities, which has resulted in significant changes in their urban spaces

Validation of the carolinas comfort scale (CCS) in Brazil: a hernia-specific quality of life questionnaire.

Ventral hernia surgery (VHS) has the intent to promote a better quality of life (QoL). VHS results were evaluated by recurrence incidence in the past, however the concept of Patient-Reported Outcomes Measures has changed this scenario. SF-36 is a generic questionnaire with some limitations on the hernioplasty postoperative evaluation. Disease-specific surveys such Hernia-Related Quality of Life Survey (HerQLes) and Carolinas Comfort Scale (CCS) were developed to improve specificity. The aim of this study was to validate a Brazilian version of the CCS as a QoL questionnaire for patients undergoing VHS in Brazil. The study consists of a retrospective cohort that reviewed the medical records of patients who underwent ventral hernia surgery for incisional hernias in the Hospital de Clínicas de Porto Alegre between January 2019 to December 2020. Participants answered both the HerQles questionnaire and the CCS, then we compared the patients' scores between scales. In-personal evaluations or surveys applied by telemedicine were performed. Intraclass correlation coefficient was utilized to assess the consistency of the agreement between the HerQLes and CCS scales. A sample of 80 patients were evaluated. Most were male (70%), mean age 61.11 years and BMI 28.4. The most common comorbidity was systemic arterial hypertension, one third were smokers and 77.5% of cases were ASA 2. The average HerQLes score was 30.40 and the CCS was 15.46 (SD: 21.81), with an intraclass coefficient of 0.68. This study suggests that CCS is a good and robust tool for assessing ventral hernia. Tools to measure QoL are increasingly used in the literature, as QoL seems to be important data to assess surgical success, since it shows the perception of the patient about the results of their surgery. Further studies with larger sample sizes should be performed to confirm our findings.

Resultados comunicados por el paciente, adherencia y satisfacción en pacientes con psoriasis

BackgroundPatient-reported outcomes (PROs) are outcomes evaluated by patients based on their perception of their disease and treatment. ObjectivesDetermine antipsoriatic treatment-related adherence, quality of life (QoL) and satisfaction. Materials and MethodsWe conducted an observational cross-sectional, prospective, and single-center study in which PROs surveys were conducted on adherence (Morisky-Green [MG] test), treatment satisfaction (Spanish Questionnaire of Treatment Satisfaction in Psoriasis [CESTEP]) and QoL (Skindex-29 and DLQI). Additional variables include: PASI, BSA. Statistical analysis: Jamovi®2.3.26. ResultsA total of 100 surveys were conducted. Based on the MG questionnaire, we found that 75% (75/100) of patients were adherent vs 94% (94/100) from the dispensation records. Regarding CESTEP, a mean score of 7.4±7.7 (close to maximum satisfaction 0) was obtained, while DLQI yielded a score of 2.6±4.6 (indicating a small effect on QoL), and SKINDEX-29 a score of 14.6±15.4 (68% indicating mild (< 5) or very mild (6-17) impact according to Nijsten et al.).Based on CESTEP a p.Rho Spearman value of 0.338 (p=0.004) was obtained in relation to PASI when the study was conducted with a BSA of 0.255 (p=0.050), DLQI results of 0.508 (p <0.001) and Skindex-29 results of 0.397(p <0.001). At the time of the study, the correlation matrix between DLQI result and PASI was 0.365 (p=0.002) with a BSA of 0.347 (p=0.007). Skindex-29 results with PASI were 0.380 (p=0.001) and with BSA, 0.295 (p=0.022). ConclusionsPatients on therapy exhibit a good QoL, high adherence and satisfaction with their treatment. A significant correlation was seen among satisfaction, QoL, and PASI-BSA at the time of the study.

Comparing the quality of life of patients with epilepsy receiving conventional and newer antiepileptics in a tertiary care hospital, Northern India

Objectives: Both conventional and newer antiepileptic drugs (AEDs) are being used as initial monotherapy in epileptic patients. However, differences in their quality of life (QoL) scores have not been researched considerably. The objective of this study was to determine the overall QoL employing the QoL in Epilepsy Inventory (QOLIE-31) questionnaire Materials and Methods: This prospective comparative research was conducted on 126 patients with epilepsy. Two equal groups, A and B, consisting of 63 patients each, were allocated conventional and newer AEDs, respectively. The allotment of the AED was as per the decision of the treating physician based on patient and drug characteristics. QoL was assessed at 0 and 12 weeks using questionnaire QOLIE-31. Results: The QoL showed significant improvement with newer AEDs, while conventional AEDs worsened it. The subscales of QOLIE-31 showing the statistical difference in the mean percentage change were worry related to seizure, energy/fatigue, cognitive function, and medication effects. QoL did show a statistically significant difference in young and more educated patients. The patients who had generalised tonic-clonic seizures (GTCS) demonstrated a better QoL than patients with partial seizures, as per the questionnaire. Conclusion: The findings of our study suggest that QoL is better with newer AEDs. There seemed to be no effect of gender, age, or education on QoL; however, subjects with GTCS displayed a better QoL. Therefore, newer AEDs can be helpful in improving QoL in epileptic patients. Newer Antiepileptics as monotherapy may offer a better quality of life to epileptic patients.

Au-doped Fe3O4 nanoparticle as an effective nanocarrier for delivery of 5-fluorouracil anti-liver cancer drug

5-Fluorouracil (5-FU) is an important chemotherapy that is classified as an antimetabolite and is widely used in cancer treatment, particularly for liver cancer. Yet, administering high doses of 5-FU for liver cancer can result in a range of adverse effects. Therefore, employing a suitable delivery system for this important drug can greatly enhance its safety and effectiveness, leading to improved treatment outcomes and better quality of life for patients. Au-doped Fe3O4 nanoparticles have attracted significant interest in scientific research due to their unique physical and chemical properties. This study presents a straightforward and cost-effective method for synthesizing Au-doped Fe3O4 nanoparticles by using a natural reducing agent. The study involved a comprehensive analysis of the Au-doped Fe3O4 nanoparticles using various techniques such as FT-IR, XRD, XPS, FE-SEM, TEM, UV–Vis, EDS, VSM, and DLS. The delivery experiments indicated a loading capacity of approximately 78 %. The release profile showed slow release profile, dependent on pH. Therefore, 41 % release was detected under physiological pH 7.4, while a much faster release was observed at pH 5.7 (84 %) within 48 h. Moreover, the high crystallinity degree of approximately 84 % was attained for Au-doped Fe3O4, confirming this nanoparticle as an efficient drug delivery system. In another attempt, PDI and hydrated particle size distribution analyses on Au-doped Fe3O4 showed no significant change in size after 72 h. Therefore, it can be concluded that drug loaded Au-doped Fe3O4 is stable enough and maintained its efficacy after a long time of 3 days. Finally, an in vitro assessment of cellular cytotoxicity was performed on a liver cancer cell line (HepG2) to assess the safety and efficacy of the Au-doped Fe3O4 nanoparticles. The results from the MTT assay confirmed the potential of these nanoparticles as a promising vehicle for delivering 5-Fluorouracil.

Integrated home dialysis model: facilitating home-to-home transition

ABSTRACT Peritoneal dialysis (PD) and home hemodialysis (HHD) are the two home dialysis modalities offered to patients. They promote patient autonomy, enhance independence, and are generally associated with better quality of life compared to facility hemodialysis. PD offers some advantages (enhanced flexibility, ability to travel, preservation of residual kidney function, and vascular access sites) but few patients remain on PD indefinitely due to peritonitis and other complications. By contrast, HHD incurs longer and more intensive training combined with increased upfront health costs compared to PD, but is easier to sustain in the long term. As a result, the integrated home dialysis model was proposed to combine the advantages of both home-based dialysis modalities. In this paradigm, patients are encouraged to initiate dialysis on PD and transfer to HHD after PD termination. Available evidence demonstrates the feasibility and safety of this approach and some observational studies have shown that patients who undergo the PD-to-HHD transition have clinical outcomes comparable to patients who initiate dialysis directly on HHD. Nevertheless, the prevalence of PD-to-HHD transfers remains low, reflecting the multiple barriers that prevent the full uptake of home-to-home transitions, notably a lack of awareness about the model, home-care “burnout,” clinical inertia after a transfer to facility HD, suboptimal integration of PD and HHD centers, and insufficient funding for home dialysis programs. In this review, we will examine the conceptual advantages and disadvantages of integrated home dialysis, present the evidence that underlies it, identify challenges that prevent its success and finally, propose solutions to increase its adoption.

Penyuluhan dan Pelatihan Pemeliharaan Kesehatan Gigi dan Mulut Kader PKK dan Posyandu Kelurahan Grogol, Kecamatan Grogol Petamburan, Jakarta

The prevalence of oral health problems in the Jakarta Special Capital Region (DKI Jakarta) according to the Basic Health Research (Riskesdas) results in 2018 was 59.1%. Pericoronitis and periodontal disease are common oral cavity issues. Knowledge about maintaining oral health is a key factor in achieving a good quality of life. To increase public understanding of the importance of dental and oral care, this knowledge program is designed to provide holistic and practical information. Therefore, education in the form of counseling and training is needed by directly engaging with the community to emphasize the importance of dental and oral health care, targeting mothers from the Family Welfare Movement (PKK) and Integrated Health Service Post (Posyandu) cadres in the Grogol sub-district. The results show a significant difference between pre-test and post-test (p &lt; 0.0001). In conclusion, the knowledge of participants improves after receiving counseling and training.

Evaluation of health literacy and its association with medication adherence and quality of life in childhood-onset systemic lupus erythematosus.

Little is known about health literacy in childhood-onset systemic lupus erythematosus (cSLE) and how health literacy relates to medication adherence and psychosocial outcomes in this high-risk population. The objective of this study was to evaluate health literacy in adolescents and young adults with cSLE and its association with medication adherence and quality of life. Youth 10-24years with cSLE (n = 48) completed the Brief Healthy Literacy Screen (BHLS) and the Newest Vital Sign (NVS) to assess health literacy. Participants also completed validated measures of medication adherence and quality of life. Descriptive analyses were used to determine levels of health literacy. Bivariate correlations were used to evaluate associations between measures of health literacy with adherence and quality of life. A multivariable regression analyses was used to determine if health literacy was a significant predictor of adherence or quality of life, after adjusting for age, sex, race, and household income. Inadequate health literacy was common in this population, with 67% of youth categorized as having inadequate health literacy by the BHLS and 42% by the NVS. Higher medication adherence was associated with a higher BHLS score (r=.36, p = .017). BHLS was also significantly associated with better quality of life (r = 0.31, p = .034). Inadequate health literacy is prevalent among youth with cSLE. Higher health literacy is associated with higher medication adherence and better quality of life, suggesting that attention to health literacy could improve outcomes for this vulnerable population.

Does Free Fibular Flap Reconstruction Affect the Quality of Life in Pediatric Patients With Various Extend of Mandible Defects?

The long-term outcomes in pediatric patients with various extents of mandible defects have not been well-documented. A retrospective case series in which this study looked at pediatric patients under the age of 13 who had mandibular reconstruction with free fibular flap and had not received another operation in the previous 6 months. The eating, swallowing, speech function, and quality of life are evaluated with EORTC QLQ-H&N35 after the mandible growth spurt has occurred. A total of 7 patients were included in this study with operation ages ranging from 6 years 1 month to 12 years 2 months. The etiology of malignant tumors was found in 2 patients and benign tumors in 5 patients. The mandibular defect distribution consists of 1 class Ic, 1 class II, 2 class IIc, 2 class III, and 1 class IVc. All patients reported no swallowing or speech difficulties. However, transient eating trouble was seen in 1 patient due to the extensive defect size that causes tooth loss. Only 1 patient received dental rehabilitation. The patients displayed an overall good quality of life with an average score of 2.857. Free fibular flap for mandibular reconstruction in children who have not reached their mandibular growth peak have a satisfying outcome, both in their function and quality of life.

Shoulder Arthroplasty: A Bibliometric Analysis Using the Scopus Database.

Primary joint replacements are performed increasingly often worldwide, driven by an aging population, improvement in surgical techniques, and advancements in implant designs. While more attention has traditionally been focused on weight-bearing joints such as the hip and knee, shoulder replacement surgeries have gained increasing attention in recent years due to the population's demand for a better quality of life. Thus far, a comprehensive bibliometric analysis of shoulder arthroplasty-related publications using the Scopus database has not yet been conducted. This bibliometric analysis aims to fill this gap by reviewing the Scopus database from its inception until 2023 to examine the literature on shoulder arthroplasty. A total of 5300 publications meeting the selection criteria were included in this analysis. The turn of the century marked a significant turning point for the field of shoulder arthroplasty, with an increasing number of publications produced annually. This trend can be attributed to the improvement of implant designs, which have become more consistent and reliable over time. While the majority of articles were authored by researchers and clinicians from the United States of America (USA), publications by French authors had a higher scholarly impact in the field. There is a noticeable gap in research on shoulder arthroplasty in developing countries, possibly due to the prohibitively high cost of implants and the prioritization of other healthcare sectors. This bibliometric analysis, utilizing Scopus data, serves as a guiding light for researchers, clinicians, and policymakers, potentially fostering collaborative projects and guiding the development of future studies to further advance the field of shoulder arthroplasty, particularly in developing countries.

Delivering care to women with congenital heart disease: the role of clinical nurse specialist

Congenital heart disease is now the most common reason for women to attend a high-risk joint cardiac–obstetric clinic. With advances in medical care and surgical techniques, most children born with congenital heart disease reach childbearing age and have a good prognosis for long-term survival with a good quality of life. Pregnancy remains a major life event for these women, posing additional risks with the potential for severe morbidity and mortality. The hemodynamic changes induced by pregnancy can unmask undiagnosed congenital heart disease or exacerbate pre-existing conditions. Therefore, specialist care is essential for a successful pregnancy outcome. Women with complex congenital heart disease embarking on pregnancy need the support of a multidisciplinary team, including cardiologists, obstetricians, anaesthetists, midwives and adult congenital heart disease clinical nurse specialists. Clinical nurse specialists in particular play a crucial role in coordinating, supporting, educating and advocating for the mother and fetus through preconception, pregnancy, the puerperium and beyond.