Broad Definition Research Articles

A statewide population-based approach to examining Long COVID symptom prevalence and predictors in Michigan

ObjectiveThe current broad definition of Long COVID, and an overreliance on clinical and convenience samples, is leading to a wide array of Long COVID estimates with limited generalizability. Our objective was to examine Long COVID symptoms using a statewide population-based probability sample. MethodsAmong 8000 sampled adults with polymerase-chain-reaction-confirmed SARS-CoV-2 between June 2020 and July 2021 in the Michigan Disease Surveillance System, 2533 completed our survey (response rate 32.2%). Using modified Poisson regression, we examined sociodemographic, behavioral, and clinical predictors of eight Long COVID symptom clusters, defined as at least one applicable symptom lasting 90 or more days post COVID-19 onset. ResultsNeuropsychiatric Long COVID symptoms, including brain fog, were most prevalent (23.7%), followed by systemic symptoms (17.1%), including fatigue, musculoskeletal (11.4%), pulmonary (10.4%), dermatologic (6.7%), cardiovascular (6.1%), gastrointestinal (5.4%), and ear, nose, and throat symptoms (5.3%). In adjusted analyses, female sex, a pre-existing psychological condition, and intensive care unit admission were strong predictors of most Long COVID symptom clusters. Older age was not associated with a higher prevalence of all symptoms – cardiovascular and dermatologic symptoms were most prevalent among middle-aged adults and age was not associated with neuropsychiatric or gastrointestinal symptoms. Additionally, there were fewer associations between pre-existing conditions and cardiovascular, neuropsychiatric, and dermatologic symptoms compared to other symptom clusters. ConclusionsWhile many predictors of Long COVID symptom clusters were similar, the relationship with age and pre-existing conditions varied across clusters. Cardiovascular, neuropsychiatric, and dermatologic symptoms require further study as potentially distinct from other Long COVID symptoms.

The intensity and duration of occupational noise exposure and cardiovascular disease in the United States: a nationally representative study, 2015 to 2020.

Occupational noise exposure may be associated with an increased risk of cardiovascular disease (CVD). Yet the findings are inconclusive. This study aimed to examine the association between self-reported occupational noise exposure and CVD (using a broad composite case definition and by each condition) and identify how these associations vary with the intensity and duration of noise exposure, and combinations thereof. This cross-sectional study included a nationally representative sample (n = 6,266) from the National Health and Nutrition Examination Survey (2015 to 2020), aged 20 and greater, in the United States. Survey-weighted logistic regression models were constructed from multiple imputed datasets. Relative to the unexposed, the adjusted odds ratio (95% confidence interval) of composite CVD was 1.33 (1.05 to 1.67) among the noise-exposed population, and ranged from 1.23 to 1.56 when examining CVD conditions separately. The odds ratios of composite CVD were 1.43 (1.06 to 1.93), 1.43 (1.04 to 1.95), and 1.51 (1.03 to 2.21) among those who had noise exposure with very loud intensity of any duration, with duration ≥10 years at any intensity, and with a combination of very loud noise ≥10 years, respectively, compared to those unexposed. Increased risk of CVD is associated with occupational noise exposure, particularly at higher intensities and longer durations. Policies and interventions for noise mitigation at workplaces are warranted, targeting individuals with chronic exposure to high-level noise.

The challenge of defining news literacy: Perceptions from the UK news literacy sector

Recent research has lamented a lack of theoretical clarity around the term news literacy, calling on the academy to produce tighter, more nuanced definitions. Vraga, described news literacy as a “bloated” term, warning in another paper that the movement was at a tipping point. If scholars want to do their bit by offering concrete guidelines to those delivering initiatives, they argued, agreement as to what news literacy actually is, and how it should be evaluated, must be reached. This paper seeks to aid this process by providing insights about how news literacy is conceived and operationalised by those delivering such education to UK. Drawn from in-depth interviews with practitioners linked to five news literacy projects in the UK conducted in summer 2021, it finds that far from there being agreement in the sector as to what news literacy is, or indeed what it could be, the term as deployed by UK practitioners is equally ‘bloated’ and lacking in clear definition. This has implications for the ability of the sector to promote itself, champion its priorities or conduct evaluation work against clear and relevant metrics. By highlighting this lack of clarity around definitions in the UK context, this study adds international weight to existing work stemming primarily from the US. It also demonstrates the need for greater clarity of terminology so that news literacy concepts including critical thinking are not lost within increasingly broad and instrumental skills-focussed definitions of a wider media literacy.

OASES project: promoting evidence-based reforms on medical deserts

Abstract The OASES project aims to strengthen the capacity of public health authorities to reform their health systems and address all the key issues to successfully deal with the challenges posed by medical deserts. The project has adopted a broad definition of “medical desert”: it encompasses any situation in which critical issues arise in the meeting of health needs, demand and supply of health care, i.e. not only the simple shortage of health professionals and services, but also poor quality and low accessibility of health care. The project has developed: • a set of indicators to assess medical desertification, in terms of availability, quality and accessibility of health workers and services; • an analysis of the main causes of the phenomena and possible solutions or mitigation actions, through the literature review; • pilot studies in seven European countries consisting in measuring medical deserts and discussing the antecedents and possible solutions with local stakeholders (consensus building exercise). So far, the project has completed the activities related to the measurement methodology. Currently, pilot studies have been launched, with the aim to: • provide a national overview of medical deserts in the participating countries (Cyprus, Finland, France, Hungary, Italy, Republic of Moldova and Romania); • assess and characterise the medical desert at national and/or regional level, and the mitigation strategies in place and/or planned; • facilitate consensus on medical deserts mitigation strategies among national/local stakeholders; • provide evidence-based recommendations to mitigate medical deserts in the seven participating countries. The results of the project will provide a proposal for policy actions and solutions against medical desertification for all the EU Member States.

Judicial search for a legal definition of religion

A prerequisite for the proper application of the law is a certain definition of the terms used in the law. A variable definition of a concept undermines the requirement of legal certainty, and an overly narrow or broad definition of a concept (compared with the general idea of its content) may lead to doubts about the fairness of legal regulation. Although the legal system uses the term “religion” relatively frequently, it does not generally define it explicitly. In most cases, this does not cause problems because there is no reasonable doubt as to whether we are dealing with a religious element. In hard cases, however, there is no choice but to decide where to draw the line between religion and other types of beliefs. The alternative is to stop distinguishing between them, thus depriving the religious element of its special legal status. The social sciences distinguish four basic approaches to the definition of a religious phenomenon. The substantive definition seeks to capture the content that a particular belief must satisfy in order to be labelled religious. The essentialist approach emphasises the experience of the believer. The functionalist definition notes the function that religion serves in the life of the believer. The analogical approach does not seek to capture the essence of religion but rather notes its manifestations and what different religions have in common. This article offers examples of the application of these theoretical approaches in jurisprudential practice. It also highlights the fact that courts work flexibly with the concept of religion and often give it a different content depending on the context under consideration.

Digital Platform Reporting (DAC7): Fundamental Considerations Regarding the Notion of “Relevant Activity” – A Belgian Case Study

The digital platform economy has been subject to various legislative interventions. In the context of taxation, the European Union has introduced obligations for digital platforms by Amending Directive to the 2011 Directive on Administrative Cooperation (2021/514) (DAC7). Despite the guidance of the Belgian legislator, certain notions remain unclear. This article focuses on the challenges related to the Belgian interpretation of the notion of “relevant activity”. It demonstrates that the broad definition of this notion gives rise to Belgian interpretations that could cause friction with the intention of the European legislator and with the fundamental rights and freedoms of the reporting platforms.

The implementation of infection prevention and control measures and health care utilisation in ACF-supported health facilities during the COVID-19 pandemic in Kinshasa, Democratic Republic of the Congo, 2020

ABSTRACT Background Infection prevention and control (IPC) was a central component of the Democratic Republic of the Congo’s COVID-19 response in 2020, aiming to prevent infections and ensure safe health service provision. Objectives We aimed to assess the evolution of IPC capacity in 65 health facilities supported by Action Contre la Faim in three health zones in Kinshasa (Binza Meteo (BM), Binza Ozone (BO), and Gombe), investigate how triage and alert validation were implemented, and estimate how health service utilisation changed in these facilities (April–December 2020). Methods We used three datasets: IPC Scorecard data assessing health facilities’ IPC capacity at baseline, monthly and weekly triage data, and monthly routine data on eight health services. We examined factors associated with triage and isolation capacity with a mixed-effects negative binomial model and estimated changes in health service utilisation with a mixed-model with random intercept and long-term trend for each health facility. We reported incidence rate ratios (IRRs) for level change when the pandemic began, for trend change, and for lockdown and post-lockdown periods (Gombe). We estimated cumulative and monthly percent differences with expected consultations. Results IPC capacity reached an average score of 90% by the end of the programme. A one-point increase in the IPC score was associated with +6% and +5% increases in triage capacity in BO and Gombe, respectively, and with +21% and +10% increases in isolation capacity in the same zones. When the pandemic began, decreases were seen in outpatient consultations (IRR: 0.67, 95% confidence interval (CI) [0.48–0.95] BM&BO-combined; IRR: 0.29, 95%CI [0.16–0.53] Gombe), consultations for respiratory tract infections (IRR: 0.48, 95%CI [0.28–0.87] BM&BO-combined), malaria (IRR: 0.60, 95%CI [0.43–0.84] BM&BO-combined, IRR: 0.33, 95%CI [0.18–0.58] Gombe), and vaccinations (IRR: 0.27, 95%CI [0.10–0.71] Gombe). Maternal health services decreased in Gombe (ANC1: IRR: 0.42, 95%CI [0.21–0.85]). Conclusions The effectiveness of the triage and alert validation process was affected by the complexity of implementing a broad clinical definition in limited-resource settings with a pre-pandemic epidemiological profile characterised by infectious diseases with symptoms like COVID-19. Readily available testing capacity remains key for future pandemic response to improve the disease understanding and maintain health services.

Quality Management in GIS

This paper centers on the crucial elements of quality control (QC) and quality assurance (QA) in the domain of geographic information systems (GIS). A dependable and resilient GIS database is at the core of any spatial system, and it is of utmost significance across a wide range of fields, including Hajj, Umrah, tourism, real estate, and natural resource management. Given the inherent intricacy of spatial databases and their requirement for specialized technical upkeep, applications that depend on them also necessitate specialized technical expertise. To address inconsistencies within the database, best practices for database maintenance are implemented. This paper presents a systematic approach to the updating of comprehensive spatial databases and provides an overview of the quality procedures that are essential to this process. It also discusses the various safeguard mechanisms that are employed to enhance data consistency, completeness, integrity, and other qualitative aspects. The primary objective is to establish a customer-focused quality standard for spatial databases. Considering the broad definition of quality as "the extent to which project deliverables meet requirements," GIS projects face the challenge of precisely defining specifications and relevant quality standards that are tailored to specific project types and deliverables. The increasing demand for digital maps and GIS applications in Egypt emphasizes the urgent need for quality control and quality assurance procedures. This paper describes the implementation of these procedures in the creation of ten geological maps of Egypt at a scale of 1:500,000. This collaborative effort involves Cairo University and the Ministry of Water Resources and Irrigation in Egypt. Additionally, this project provides an internship opportunity for students in the College of Engineering, Civil Department, enabling them to gain practical experience in the field.

Leisure and Human Rights … or Social Justice?

This paper notes the recent increased interest of leisure researchers in the concepts of human rights and social justice, with social justice being particularly favored by North America researchers. Since both concepts concern the just treatment and well-being of individuals and social groups in contemporary society, the paper aims to establish whether they represent distinctly different approaches to analysis or are overlapping in meaning and possibly complementary. It is found that, while some proponents of social justice down-play the significance of human rights, it is widely accepted that human rights are a component of social justice and that broad inclusive definitions of human rights encompass most of the concerns of social justice. It is therefore concluded that the two approaches to leisure analysis are complementary and each would benefit from incorporation of elements of the other in its conceptual framework and from more extensive engagement key generic social theory and policy frameworks.

Making It Magical

Making It Magical

Unmet need: definitions, literature evidence and implications for HTA

The present paper illustrates the definition of unmet need provided by the peer-reviewed literature and the Health Technology Assessment (HTA) authorities across Europe in the assessment and appraisal process and within the early access schemes for medicines. The analysis relied on a descriptive review of the peer-reviewed literature and HTA documents on the definition of need (disease severity) and the way it is satisfied (existence and validity of alternatives). HTA agencies were found using (i) a narrow definition of need, focused on the clinical impact and the impact on health-related quality of life of the disease and (ii) a broad definition of comparators, including treatments used off-label in the clinical practice. Most of the contributions of the literature advocated for a broader definition of need, including additional dimensions (for example, the socio-economic impact of the disease) and the effects of existing treatments beyond their risk-benefit profile (for example, acceptability to patients). On the one hand, these contributions should be considered by HTA agencies, considering its multi-disciplinary and multi-stakeholder nature. On the other one, the explicit inclusion of the unmet need domains, at present disregarded, should depend on the decisions taken on the ground of the assessment.

Susceptibility of nursery teachers to measles, rubella, varicella and mumps in Japan

BackgroundA guideline published in 2018 by the Ministry of Health, Labour and Welfare stipulated confirmation of the vaccine history of nursery staff members. ObjectThis study was conducted to elucidate nursery teachers' vaccine and infection histories for measles, mumps, rubella, and varicella through survey responses. MethodAfter sending questionnaires through the mail to 5000 nursery teachers in November 2022, we received responses through December 2022. We measured the proportion of susceptibility in three ways. Additionally, we compared the proportions of susceptibility by disease by age class. ResultsAfter receiving 1620 responses in all, the data of 1229 respondents under 50 years old were analyzed. Under the broad definition by which “no answer” was also regarded as unvaccinated or uinfected as well as “unknown,” the proportions of susceptibility for measles, rubella, and varicella were higher: 22–23%. For mumps, the proportion was 42%. For varicella, they were 31% for respondents in their 30 s, and 14% for respondents in their 40 s. For mumps, the respective values were 58% and 26%. DiscussionRespondents assessed for this study were less susceptible and unknown in comparison with earlier studies investigating health care workers, school teachers, university students, and pregnant women. ConclusionThe survey revealed that measles and rubella susceptibility was higher among respondents in their 30 s. However, it was higher for varicella and mumps among respondents in their 20 s.

ROLE OF PHARMA DIGITALIZATION IN HEALTHCARE DEVELOPMENTS

Healthcare development is a revolutionary sector where digital technologies drive success, with exponential growth seen in a computing system involving advancements in medical devices. Due to social distancing norms, widespread lockdowns, and an emphasis on individualized healthcare, the Covid-19 pandemic has inevitably increased the usage of digital technologies. “Digital” has become the most essential part of day-to-day existence, and all sectors are adapting more swiftly to the digital world. The healthcare system is more complicated, as its culture and structure are not ready to accept innovation, since development in healthcare involves decision on a person’s life or death. The use of digital health tools has the potential to significantly improve individual patient care by enhancing the accuracy diagnosis and treatment of diseases. For the clinical adoption of any digital healthcare technology, evidence is required first, and their effects must be assessed before integrating them into healthcare systems such as Electronic Health Records (EHRs). The broad definition of digital health encompasses fields like wearable technology, telehealth and telemedicine, personalized medicine, the Internet of Things (Internet of things (IoT)), virtual reality (VR), Artificial Intelligence (AI), and mobile health (mHealth). Pharmaceutical digitalization is still in a testing phase regarding offering advanced administrations beyond conventional products. In this paper, digitalization from the perspective of diverse case studies was carried out to collect data from several companies, and a literature study was conducted to complement the data on healthcare development. The digitalization of health care is a game changer for developing health care.

Old world assessment of new world provenance cues: An Italian perspective

Discussion of terroir emerged from “Old World” producers explaining their wines’ provenance and special nature and consumers wondering why one wine’s flavor differs from another’s despite no apparent difference in winemaking. European markets have entertained the concept far longer than their New World counterparts, applying it to a range of agricultural and place-based products. This paper asks how European consumers evaluate a New World wine’s terroir, studying results from a large Discrete Choice Experiment of Italian consumers considering Californian wine. We find a generally negative perception of the legal designation of terroir, expressed through the US American Viticultural Area label, and preference for a relatively broad definition of the wine’s geographic provenance. However, a terroir story focused on the specific site is most popular. Evidence of utility increasing with price suggests the price-quality heuristic. Three latent classes depicting preference models emerge which in turn have implications for producers of place-based products.

Professional Misconduct & Feeble Underpinning of Government Departments in India

This work tries to explore how government agencies' shoddy foundations contribute to professional misconduct. Because it is the only profession in which the general public either benefits from or suffers because of an employee's actions, working for the government is regarded as one of the most prestigious jobs in any nation. The government department is seen as a crucial component of the nation's administrative structure since the entire department is tasked with carrying out the policies and programs designed to serve the needs of the general populace. Therefore, it is only normal to have expectations that these agencies would function properly and that public officials won't misuse the authority granted to them by behaving in an ethical, sensible, and appropriate manner. Having a government department that runs smoothly is a fantasy, though, since every department has a weak base that encourages employee malfeasance that in turn leads to harassment of the general public. The word "professional misconduct" in connection to a government agency has a broad definition and refers to a variety of behaviors, including inappropriate conduct, unethical behavior, public harassment caused by excessive delays, the use of illegal tactics, etc.

Hate Speech in the Equality Act Following the Constitutional Court Judgment in Qwelane v SAHRC

In its judgment in Qwelane v South African Human Rights Commission 2022 2 BCLR 129 (CC), the Constitutional Court declared section 10(1) of the Equality Act unconstitutional and invalid to the narrow extent that section 10(1)(a) refers to the intention to be "hurtful". The prohibition on hate speech passed constitutional muster in all other respects. In addition, the court purposively interpreted aspects of the application of section 10(1) so as to limit its impact on the right to freedom of expression. This contribution firstly welcomes the court's reliance on the transformative goals of the Constitution and the Equality Act as its primary framework in interpreting section 10(1). The severance of section 10(1)(a) and the conjunctive reading of sections 10(1)(b) and (c) ("be harmful or to incite harm" and ʺpromote or propagate hatred" respectively) also seem sensible considering the court's broad definition of "harm". The article further emphasises that the terms of section 10 call for a proper consideration of context. In this regard, the court rightly considered the extreme homophobia in the society addressed by Mr Qwelane, the particular vulnerability of the target group and the real threat of devastating imminent consequences to conclude that Qwelane's words were clearly intended to "incite harm" and "propagate hatred". Yet the court's view that the speaker's subjective intention is irrelevant in performing the requisite objective reasonableness assessment from the ambit of section 10(1) is arguably less judicious, as is the categorical exclusion of expression in private. Ultimately, the objective case-by-case reasonableness inquiry under section 10(1) should be whether a reasonable person in the speaker's position should have refrained from making the impugned harmful discriminatory utterances. This inquiry involves a determination of wrongfulness based on the constitutional duty not to discriminate unfairly. It invokes all the aspects of the Equality Act's definition of discrimination as well as all the elements of fairness analysis set out in section 14 of the Equality Act. Factors to be considered include the value of the particular expression, and the extent of the (potential) harm to individual members of a protected group and to society as a whole, as well as justification considerations such as the respondent's legitimate and bona fide exercise of the right to freedom of expression and to privacy.

New progress in an old debate? Applying the DSM-5 criteria to assess traumatic events and stressor-related disorders in cancer survivors.

The rather broad definition of medical trauma within DSM-IV has contributed to long-lasting debates on the applicability of Posttraumatic Stress Disorder (PTSD) in oncological patients and its differentiation from Adjustment Disorder (AjD) which results from non-traumatic critical life events. The DSM-5 criteria have introduced a narrower definition of medical traumatization. However, studies on updated prevalence rates in cancer patients are missing. Within a cross-sectional study, we assessed hematological cancer survivors using the Structured Clinical Interview for DSM-5. We investigated (i) the frequency and type of cancer-related stressors, (ii) the proportion of stressors qualifying as traumatic according to DSM-5 (i.e., an event of sudden and catastrophic character) and (iii) the prevalence of PTSD, AjD and cancer-related PTSD according to DSM-5. 291 patients participated (response rate: 58%). Mean age was 54years, 60% were male. 168 patients (59%) reported cancer-related stressors, with the most frequent being cancer diagnosis disclosure (n=58, 27%). Eight percent of reported stressors qualified as traumatic events according to DSM-5. Five (1.8%), 15 (5.3%) and 20 (7.0%) cancer survivors met DSM-5 criteria for current PTSD, lifetime PTSD and AjD, respectively. Among all PTSD cases, three were cancer-related (1.1%). In addition, seven patients (2.5%) metall symptoms for cancer-related PTSD, but not the DSM-5 criterion for medical trauma. Considering receiving the cancer diagnosis as traumatic event, which is debatable according to DSM-5, 38% of stressors qualified as traumatic and six patients (2.1%) met criteria for cancer-related PTSD. DSM-5 criteria enable a clear identification of traumatic events in the context of cancer. This change may inform discussions on the appropriateness of PTSD in cancer patients and facilitates its differentiation from AjD. Larger studies need to validate our findings.

‘It's not really Michael who wears me out, it's the system’: The hidden work of coordinating care for a disabled child

The parents, especially mothers, of disabled children play a crucial role in coordinating care for their children. This article investigates families’ coordination work using qualitative accounts of the parents of disabled children in Norway. The theoretical concepts of the third shift, hidden work and a broad definition of care are applied. We present a typology of coordination work, consisting of writing, meetings, administration of services, learning, monitoring and emotional work. We describe three cases to show the nature and consequences of having to coordinate the everyday lives of disabled children. The findings show that coordination work is gendered, individualised and taken for granted in service provision. We argue that coordination work should be better recognised in social policy design for these families to provide adequate services and avoid reproducing social inequality.

Will AI ever become spiritual? A Hospital Chaplaincy perspective

ABSTRACT With humanity’s ever-increasing reliance on, and closer integration with Artificial Intelligence (AI), the questions of AI’s agency as both potential spiritual-being and spiritual care-giver are pressing. This paper reviews these from an acute Hospital Chaplaincy perspective, utilising that sector’s broad definitions of spirituality, and case studies. The structure is provided by two broad questions: ‘Does AI need chaplaincy?’ and ‘Could AI provide chaplaincy?’ Focusing on Boden’s (2018) definition of AI as being humans and computers in symbiosis, this article argues that Chaplaincy may be deeply necessary for the human components of AI, especially with the lax ethical landscape around AI development and usage. Further, recognising that AI already provides quasi-Chaplaincy through apps, this article raises concerns around whether it can provide the same level of care as a human Chaplain, especially around questions of embodiment, free-will, veracity, professionalism, charity, and humanity. Although this paper has a specific focus on Hospital Chaplaincy and its arguments sit within those parameters (which the author recognises is more person-centred and limited than broader parish-based pastoral care), there are important implications for all in public ministry, whatever their setting.

Health-related Quality of Life among Type 2 Diabetes Patients in Southern Province of Saudi Arabia using WHOQOL-BREF: A Cross-section Study.

Quality of life has become a more important health outcome with advancements in medical therapies and disease management, leading to better lives for people in general, particularly those living with chronic diseases. Diabetes has a direct impact on the physical, psychological, and social aspects of personal health. This study aimed to determine healthrelated quality of life (HRQOL) and its predictors in patients with type 2 diabetes. A cross-sectional study was carried out on 420 patients with type 2 diabetes who presented to primary healthcare centers in Samtah Town, Saudi Arabia, from March 2017 to February 2018. The HRQOL of the study participants was determined using the World Health Organization Quality of Life-BREF. Multi-level linear regression was employed to ascertain the factors associated with HRQOL among patients with type 2 diabetes. Female sex was significantly associated with higher HbA1c, anxiety, depression, and stress scores and a lower HRQL in the physical, psychological, and environmental health subscales than males (P<0.001). All subscales of HRQOL were significantly lower in the > 50 years age group. When compared to those with low levels of education (illiterate, primary, or elementary school), patients with secondary and bachelor's degrees had significantly higher HRQOL in all subscales (P<0.001). In addition, there were significant differences in glycemic control and HRQL with a longer duration of diabetes, the presence of one or more diabetes complications, and the presence of comorbid hypertension (P<0.001). However, no significant differences in the Depression Anxiety and Stress Scale (DASS) index were observed with a longer duration of diabetes and the presence of comorbid hypertension. Patients with diabetes on combined therapy and healthy diet and exercise showed significantly higher HRQOL on physical functioning (P<0.001). Type 2 diabetes was significantly associated with impaired health-related quality of life and mental health among study participants. Females appeared to have worse quality of life and mental health than males. Age, duration of diabetes, comorbid hypertension, diabetes complications, and level of education were significantly associated with lower HRQOL and mental health scores. Healthy diet and exercise, when combined with hypoglycemic and insulin therapy, were found to improve HRQOL and mental health among patients with diabetes. Scales based on a broad definition of health, such as the WHOQOL-BREF, are appropriate for use in primary care settings and can enhance patient management and care.