Environmental Health Domain Research Articles

Health-Related Quality of Life Among Heart Failure Patients Attending an Outpatient Clinic in the University of Gondar Comprehensive Specialized Hospital Northwest, Ethiopia, 2020: Using Structural Equation Modeling Approach.

BackgroundChronic heart failure is one of the most important public health concerns in the industrialized and developing world having increasing prevalence. Measuring quality of life using rigorous statistical methods may be helpful to provide input for decision-makers and the development of guidelines. This study aimed to assess health-related quality of life and associated factors among heart failure patients attending the University of Gondar Specialized Hospital.MethodsA cross-sectional study was employed to select 469 heart failure patients who have follow-up at the University of Gondar Specialized Hospital consecutively from March 01 to 30, 2020. Data were entered to Epi Info 7 and exported to STATA version 15 for further statistical analysis. The quality-of-life domains were measured with World Health Organization Quality of Life BREF. Structural equation modeling was employed to estimate the relationships among exogenous, mediating, and endogenous variables simultaneously.ResultsChronic heart failure patients had a significantly lower mean score in physical health domain (31.70 mean score), environmental health domain (38.35 mean score), and in overall quality of life domain (41.61 mean score) moderate in social relation domain (46.22 mean score), and in psychological health domain (50.21 mean score) of health-related quality of life (p-value <0.0001). Age had a direct positive effect on health-related quality of life. Residency also had a direct negative effect on both physical and environmental health-related quality of life domain. Duration of heart failure had a direct negative effect on psychological health.ConclusionThe finding of this study indicated that poor health-related quality of life in the physical health domain, moderately poor in overall health-related quality of life, and moderate health-related quality of life in the psychological health domain among Chronic heart failure patients. Age, residence, marital status, income, and duration of HF were significantly associated factors for quality of life among HF patients.

Health-Related Quality of Life Among Myocardial Infarction Survivors: Structural Equation Modeling Approach.

BackgroundMyocardial infarction is the fifth leading causes of disability-adjusted life years in low-income countries including Ethiopia. The aim of this study was to construct a hypothetical model to determine the factors affecting the health-related quality of life of myocardial infarction survivors at the cardiac center Ethiopia.MethodsA cross-sectional study design was employed, and 421 myocardial infarction patients were enrolled through consecutive sampling technique from the outpatient clinic at the cardiac center of Ethiopia. The World Health Organization Quality of Life-BREF-26 tool was used to assess the problem. It consists of four domains such as physical, psychological, social relationships, and environmental health domains. The structural equation modeling (SEM) analysis was employed using STATA-14 software to examine the relationship between various exogenous and endogenous or mediating variables with overall quality of life.ResultsPsychological, physical, environmental health domains and sex had significant association with health-related quality of life (β=0.708, p<0.001, β= 0.237, p=0.046, β=0.242, p=0.020, and β=0.189, p=0.017, respectively), whereas age had direct, negative association with health-related quality of life (β=−0.007, p=0.026). Residence and level of education were not directly associated with health-related quality of life. Residence indirectly, negatively influenced health-related quality of life (β= −0.379, p<0.001). On the other hand, level of education indirectly, positively affects health-related quality of life (β=i0.133, p<0.001).ConclusionPsychological health factors had the most substantial causal effect on health-related quality of life, which was larger than the causal effects of physical and environmental health-related factors. Developing and providing comprehensive interventions are necessary to assess and manage psychological, physical, and environmental health factors and to improve the quality of life in myocardial infarction patients.

Quality of life of obstetrics fistula patients before and after surgical repair in the Jimma University Medical Center, Southwest Ethiopia

BackgroundThe consequences of obstetric fistula on affected women are more than the medical condition. It has extensive physical, psychological, social, and economic consequences on them. Obstetric fistula affects the entire health and entire life of women. Women suffering from obstetric fistula are often abandoned by her partner, relatives, and the community. This study aimed to determine the quality of life of obstetrics fistula patients before and after surgical repair.MethodsInstitutional-based prospective, before and after study design was conducted in the Jimma University Medical Center from November 1, 2019–October 30, 2020. A face-to-face interview was conducted with fistula patients who visited Jimma University Medical center, fistula clinic during the study period. All fistula patients were included in the study. Accordingly, 78 women who underwent surgical repair were interviewed. The means and the standard deviation were computed using conventional statistics formulas. The unpaired t-test was used to compare two independent means, and one-way analysis of variance (ANOVA) was used to compare the quality of life before repair and after a successful repair. Linear regression analysis was done for identifying determinants of quality of life. A P value of 0.05 will be considered statistical significance.ResultThe overall quality of life of women was 58.17 ± 7.2 before the surgical repair and 71.20 ± 10.79 after surgical repair. The result indicates there is a significant difference in the mean value of pre and post-operative (P < 0.001). The overall satisfaction of women with their health status before the surgical repair was 22.5 ± 1.30and it has increased to 53.0 ± .90after surgical repair. The physical health dimension score was 16.51 ± 5.27 before the surgical repair while it has increased to 21.77 ± 5.38 after the surgical repair. The score of the social domain before the surgical repair was 5.19 ± 1.34 and it has increased to 7.13 ± 3.67 after the surgical repair. The score of the environmental health domain was 17.41 ± 2.89 before the surgery while it also increased to 21.65 ± 4.04 after the surgical repair. The results have shown there was a significant difference in the mean values of pre and post-operatives in both social and environmental scores (P < 0.001). The score of the psychological health domain before the surgery was 19.06 ± 1.46 and it was increased to 19.84 ± 3.21 after the surgical repair. The result showed there is a significant difference in mean value pre and post-operative (P = 0.048), though it is a slight improvement compared to other domains.ConclusionThe overall quality of life of the patient with fistula was improved after successful surgical repair. Although all domains of quality of life had shown significant improvement after successful surgical repair, the psychological domain showed slight improvement.

Quality of Life Assessment in Pre-Hospital and Hospital Emergency Healthcare Workers: A Pilot Study

Introduction Quality of life (QoL) is an important index of general and mental health. Several studies have demonstrated healthcare staff can provide higher quality services to patients when they have a better QoL. Working in emergency care services has a heavy workload therefore poor QoL can lead to poor quality of service to patients. We aimed to assess the QoL in pre-hospital and hospital emergency healthcare workers in Isfahan province in Iran via the WHOQOL-BREF (World Health Organization Quality of Life) questionnaire. Methods A total of 891 pre-hospital and hospital emergency personnel were selected via the census method. The WHOQOL-BREF questionnaire was filled out by the participants over a period of 1 year. Results A total of 891 subjects participated. About 33.7% of the participants were pre-hospital emergency staff, 59.1% emergency department nurses, 5.3% emergency department physicians, and 1.6% emergency medicine specialists. Approximately 412 participants (48.8%) were women and 469 (53.2%) were men (mean age 37.72 ± 11.02 years). QoL in pre-hospital and hospital emergency personnel had the highest mean score in the general health domain (61.43 ± 21.38) and the lowest mean score in the environmental health domain (48.54 ± 17.62). Social relationships with a mean score of 53.30 ± 23.56 were not significantly different to the average (p&gt;0.05). Workplace and work experience had a significant effect on all domains of QoL. Conclusion Pre-hospital and hospital emergency personnel in Isfahan province had an optimal QoL, except in environmental health. Therefore, to increase the QoL in this area the periodical evaluation of environmental health is recommended. Appropriate training to create workplace adjustment and work experience can also improve QoL.

Health-Related Quality of Life of People with Physical Disability in South-South, Nigeria

Background: The global increase in non-communicable diseases and increased aging of most populations is projected to have a profound effect on the overall prevalence of disability. Quality of life is a concept that has become fundamental to assessing life and living of all individuals more so for people with disabilities. In this study, we focused on assessing the quality of life of persons with mobility disabilities in Rivers State, Nigeria, identifying factors that influence their quality of life from their perspective. Materials and Methods: A descriptive, cross-sectional design was used in conducting this study among 179 subjects with a physical disability, specifically mobility impairment. The inclusion criterion was all persons with a physical disability. Exclusion criteria were children (0-17 years) with any form of disability, persons with intellectual, visual and hearing impairments. We used a Two-Stage sampling process using a computerized random number generator. The study tool was the (7) WHOQOL - BREF questionnaire which was both self and interviewer-administered. Data were analyzed using both descriptive and inferential statistics. Significance was set at P≤0.05. Results: The lowest and the highest mean scores of WHOQOL-BREF domains were found for the social relationships domain (Mean = 10.58) and the environmental health domain (Mean = 23.52), respectively. The mean age of respondents was 38.49 ± 10.89years. Respondents ≤34 years of age had a higher mean overall QoL scores (2.71 ± 1.04) than those above 34 years (2.57 ± 1.10). A significance was observed between age and physical health. Education years was significantly associated with two domains (psychological and environment), Employment status was associated with two domains (psychological and social relationships), and the onset of disability associated with the psychological domain (p&lt;0.05). Conclusion: Quality of life was relatively low across the four health-related domains, with the social relationship domain recording the lowest mean QoL scores. The factors that had significant positive relationships with various domains of quality of life were level of education, gender, age, occupation and activities of daily living. In Nigeria, disability status is still largely absent from routine data collection. This study adds to bridging the gap in evidence-based research on disability.

Health-Related Quality of Life and Associated Factors Among Type Two Diabetic Patients on Follow-Up in Dessie Comprehensive Specialized Hospital, Dessie, North East Ethiopia, 2020.

BackgroundDiabetes mellitus is a disorder of carbohydrate metabolism and it is highly related with diminished HRQOL in Ethiopia; diabetic related complications especially bring major negative impacts on HRQOL.ObjectiveTo assess HRQOL and associated factors among type two diabetic patients in Dessie Comprehensive Specialized Hospital, north east Ethiopia, 2020.MethodsInstitutional-based cross-sectional study design was conducted on 417 patients through systematic random sampling technique from February 08 to April 08, 2020. WHO HRQOL 26 items were used to measure outcome variable. Face-to-face interview, document review and measurement were implemented to collect data. The data were analyzed by IBM SPSS Statistics version 25 and summarized by using tables. Simple linear regression analysis was done and forwarded to multivariable linear regression analysis at p-value <0.25. Next multivariable linear regression analysis was done and variables whose p-value less than 0.05 with unstandardized B-coefficient were declared significant predictor variables.ResultsThe mean scores of physical domain, psychological domain, environmental domain and social domain were 48±6.7 (47–49), 52±4.2 (50–52.3), 48.9±3.4 (48–50.4) and 49±4 (48–50), respectively. As age increased by one year, patients’ physical HRQOL decreased by 0.031 factor, keeping effect of other variables constant [−0.031, 95% CI (−0.050 to-0.013)]. As duration of diabetes increased by one year, patients’ physical HRQOL increased by 0.034 factor, keeping effect of other variables constant [0.034, 95% CI (0.004 to 0.065)]. In general, age, depression, perceived social stigma, self-employed, having two complications, widowed, insulin and oral anti-diabetic medication affected HRQOL negatively and duration of diabetes in physical domain and university level of education in environmental domain affected HRQOL positively.Conclusion and RecommendationThe mean score of health-related quality of life in physical health domain, psychological health domain, social health domain and environmental health domain was recorded nearly half score point out of a hundred. Health professionals should follow a holistic approach to management to address negatively associated predictor variables with HRQOL.

Health-Related Quality of Life and Associated Factors Among Adult HIV Mono-Infected and TB/HIV Co-Infected Patients in Public Health Facilities in Northeast Ethiopia: A Comparative Cross-Sectional Study.

PurposeThis study was conducted to assess the health-related quality of life and associated factors among adult human immunodeficiency virus (HIV) mono-infected and tuberculosis (TB) and HIV co-infected patients in the public health facilities of northeast Ethiopia.MethodsA comparative facility-based cross-sectional study was conducted from February 01 to May 30, 2019. A total of 434 HIV mono-infected and 143 TB/ HIV co-infected patients were randomly selected for the study. The data were collected using an interviewer-administered structured questionnaire. The health-related quality of life of patients was measured using the World Health Organization quality of life HIV instrument which contains physical, psychological, social relationships, environmental, level of independence, and spiritual domains. The validated version of the Kessler scale was used to assess depressive symptoms. Linear regression analysis was performed to identify factors associated with the outcome variables, and a p-value < 0.05 with 95% CI was used to measure the degree of association between health-related quality of life and independent variables.ResultsThe mean scores of health-related quality of life among HIV mono-infected patients in terms of thephysical, psychological, level of independence, social relationships, environmental, and spiritual health domains were 63.9, 65.0, 60.5, 59.0, 56.4, and 63.9, respectively; whereas the mean scores among TB/HIV co-infected patients were 46.6, 48.5, 42.7, 43.5, 39.3, and 51.3, respectively. Among HIV mono-infected patients, being married improved the quality of social relationships by 6.7 compared with unmarried patients (β = 6.7, 95% CI = 3.24, 10.11); whereas among the TB/HIV co-infected patients, being educated increased the quality of social relationships by 10.6 compared with being uneducated (β=10.6, 95% CI=3.70, 17.51).ConclusionThe study revealed that the TB/HIV co-infected patients had poor health-related quality of life in all domains compared with HIV mono-infected patients. Besides, depression and stigma were more prevalent among co-infected patients. Therefore, designing and implementing specific management that focuses on psychiatric centers for TB/HIV co-infected patients will be necessary as their quality of life is lowered.

Quality of Life among Caregivers of Psychiatric Patients: Educational Qualification and Gender Differences

Families of psychiatric patients experience challenges to maintain personal well-being. The present study aimed to compare the quality of life among caregivers of psychiatric patients against the general public. A cross-sectional study was carried out on sub-samples of caregivers (n = 123) and the general public (n = 146) belonging to middle socioeconomic status in districts Haripur and Abbottabad. Participants responded to the Urdu version of the World Health Organization Quality of Life Questionnaire (WHOQOL-BRIEF). They also provided information about gender (men = 48%, women = 52%), age (18-40 years), marital status, and educational level. The findings of the Mann-Whitney U test showed caregivers had a poor quality of life in physical, psychological, social relations, and environmental health domains. The Kruskal-Wallis test revealed significant differences in the quality of life of participants across six levels of education, and caregivers with graduate degrees had a better quality of life than those with elementary, middle, or matric certifications. However, gender differences were absent, as hypothesized. Findings highlight the significance of the personal well-being of caregivers by providing them with counseling and psychoeducation to cope with the caregiving stressors.

A cross-sectional study on caregivers\u2019 perspective of the quality of life and adherence of paediatric HIV patients to highly active antiretroviral therapy

BackgroundPoor compliance to highly active antiretroviral therapy (HAART) can result in the poor quality of life in children living with Human immunodeficiency virus/Acquired immunodeficiency syndrome (HIV/AIDS) because of low plasma drug concentration and the possibility of drug resistance. This study evaluates the response of caregivers for determination of adherence and the four quality of life domains in children (aged 14 years and under) on HAART.MethodsWe conducted a cross-sectional study of 188 children, each accompanied by their caregivers at Ola During Children’s Hospital and Makeni Government Hospital between September and November 2016. Adherence to HAART and Quality of life was assessed using the WHO Quality of life summary questionnaire (WHOQOL-BREF). We obtained ethical approval from the Sierra Leone Ethics and Scientific Review Committee.ResultsThe study revealed 5.9% adherence amongst paediatric patients, and a strong association of adherent patients(p = 0.019*) to the physical health domain (mean = 64.61 SD = 8.1). Caregiver HIV status showed a strong association with the physical (mean = 58.3, SD = 11.7 and p = 0.024*), and psychological health domains (mean = 68.2, SD = 14.7 and p = 0.001). Caregiver type (mother/father/sibling) accompanying child to hospital also showed strong associated with the physical (mean = 58.0, SD = 10.6, p < 0.001), psychological (mean 68.2 SD = 14.81 p < 0.001) and environmental health domains (mean = 59.7, SD = 13.47, p < 0.001). Further regression analysis showed a strong association with physical health domain for HIV positive caregivers (p = 0.014) and adherent paediatric patients (p = 0.005). Nuclear family also showed a strong association with psychological (p < 0.001) and environmental (p = 0.001) health domains.ConclusionThis study showed a strong association between the quality of life domains and the involvement of nuclear family caregiver, HIV-positive caregiver and adherence to HAART. Our study suggests that the involvement of any member of the nuclear family, HIV positive parents and patient adherence to therapy can improve the quality of life of paediatric HIV/AIDS patients on highly active antiretroviral therapy in the two hospitals.

Quality of Life and Self-care Behavior Among People Living with Diabetes- A Study from Coastal South India.

Diabetes mellitus is a serious chronic condition affecting millions of people globally. The focus of our future health care providers should not lie primarily on increasing the "quantity" of life but also on improving the Quality of Life of the patient. There is a serious lack of awareness and adherence regarding self-care for Diabetes in countries like India. To determine the Quality of Life and self-care behavior among people living with Diabetes. A cross-sectional study was carried out among 190 of all patients diagnosed with Diabetes mellitus type II of the duration of one year and more who came to Government Wenlock Hospital, Mangalore. The Quality of Life was assessed using the WHO BREF questionnaire. Data was entered and analyzed using the Statistical Package for Social Sciences. Amongst 190 participants, 151 (79.5%) of them had a good physical and psychological QOL. In a social relationship and environmental health domain, good quality of life was observed among 81.6% (n=155) and 89.5% (n=170) of study participants, respectively. It was noted that out of 190 people with Diabetes, only 24 (12.6%) participants inspected their feet daily. The Quality of Life was found to be good amongst the majority of the study participants. Results of the study point that the majority of the patients enjoy a good quality of life but also reinstate the importance of self-care activities for the betterment of health.

Removal of Organic Micro-Pollutants by Conventional Membrane Bioreactors and High-Retention Membrane Bioreactors

The ubiquitous presence of organic micropollutants (OMPs) in the environment as a result of continuous discharge from wastewater treatment plants (WWTPs) into water matrices—even at trace concentrations (ng/L)—is of great concern, both in the public and environmental health domains. This fact essentially warrants developing and implementing energy-efficient, economical, sustainable and easy to handle technologies to meet stringent legislative requirements. Membrane-based processes—both stand-alone or integration of membrane processes—are an attractive option for the removal of OMPs because of their high reliability compared with conventional process, least chemical consumption and smaller footprint. This review summarizes recent research (mainly 2015–present) on the application of conventional aerobic and anaerobic membrane bioreactors used for the removal of organic micropollutants (OMP) from wastewater. Integration and hybridization of membrane processes with other physicochemical processes are becoming promising options for OMP removal. Recent studies on high retention membrane bioreactors (HRMBRs) such as osmotic membrane bioreactor (OMBRs) and membrane distillation bioreactors (MDBRs) are discussed. Future prospects of membrane bioreactors (MBRs) and HRMBRs for improving OMP removal from wastewater are also proposed.

Quality of life and the related factors in early postnatal women in Malawi

ObjectiveTo explore the quality of life (QOL) and related factors in early postnatal women. DesignA descriptive, cross-sectional study. SettingLiwonde, Malawi. ParticipantsWomen who underwent a normal vaginal birth (N = 173) were included from August to September 2018. MeasurementsThe QOL of participants was assessed using a World Health Organization QOL instrument. Demographic, obstetric, and health variables were collected using a structured questionnaire. Childbirth fear and depression were respectively assessed using the Wijma Delivery Experience Questionnaire and the Edinburgh Postnatal Depression Scale. A multiple linear regression was used to examine factors associated with the QOL. ResultsThe mean age of participants was 29 (standard deviation 6.7) years. The overall QOL and health were satisfactory. The mean score of the QOL was highest in the psychological health and social relationships domains, followed by the environmental and physical health domains. A higher educational level was negatively related to the physical health of QOL (p ≤ 0.01), with physician care positively related (p = 0.01). The employment status was positively related to psychological health and the environmental QOL (p ≤ 0.01). Furthermore, a higher income, and physician care were positively related to the environmental QOL (p ≤ 0.05). High levels of childbirth fear and depressive symptoms were negatively related to all domains of the QOL (p ≤ 0.05), except for the social relationships domain. Conclusion and implications for practiceThe physical health QOL was lower in postnatal mothers in Malawi. Measures to improve physical health aspects and address women's fears and depressive symptoms during postpartum care are warranted. The findings should alert the health providers of the importance of assessing and improving women's physical health and psychological well-being during postpartum care.

Quality of life and its predictors among Pakistani head of household in district Abbottabad, Pakistan

This study aimed to measure the quality of life (QOL) and its predictors among male and female heads of household in Pakistan. A population-based cross-sectional study in all 52 Union Councils of District Abbottabad, Pakistan was conducted from March 2015 to August 2015. Multi-stage cluster sampling technique was used to enroll 747 head of household from the study sample. Quality of life was assessed through standardized and validated Urdu version of World Health Organization’s quality of life instrument (WHOQOL-BREF) and Social capital was assessed through World Bank Social Capital Questionnaire (SC-IQ). Descriptive and inferential analyses were done to measure the levels of QOL domains. Univariate and multivariate logistic regression models were developed to explore the association between the presence of a better QOL domain and other socio-demographic factors among heads of household in Pakistan. Mean scores (± standard deviation) for physical, psychological, social relationship and environmental health domain were 64.21 ± 15.37, 67.75 ± 14.76, 72.37 ± 16.74 and 55.50 ± 14.56 respectively among the Pakistani heads of households. Overall QOL score for all domains was 64.96 ± 12.07. Males had higher score in psychological, social and environmental domains than female heads (p < 0.05). In multivariate analysis, we found that urban residence, married, absence of diseases, employed and better social capital were significantly associated with one or more domains of QOL. Our study was first of its kind which assessed the QOL among heads of household and laid the foundation for further research in this grey area.

Relation of quality of life with clinical and demographic features in patients with obsessive-compulsive disorder: the effect of insight and suicidality

Objective: Obsessive-compulsive disorder (OCD) may affect the quality of life (QOL), family relations, professional performance, and relationships of the individual in many other areas. The evidence has emphasized the relevance of examining QOL as a critical outcome in mental health studies. This study aimed to examine possible effects of clinical and demographic features including insight and suicidality on the QOL in patients with OCD. Method: The sample of this study consists of 80 patients diagnosed with OCD according to DSM-IV and 80 healthy volunteers. A sociodemographic and clinical data form and the World Health Organization Quality of Life brief form-Turkish version (WHOQOOL-BREF-TR) were administered to the participants. In addition, the patient group was assessed with the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and the Hamilton Depression Rating Scale (HAM-D). Insight was evaluated by using the insight item of Y-BOCS and the Overvalued Ideas Scale (OVIS). Results: The average scores for the physical health, psychological health, and social relationship domains of WHOQOOL-BREF-TR were lower in the patient group; however, there was no significant difference in the environmental health domain between the two groups. Negative correlations were found between the severity of the disease, age at illness onset and QOL subdomains. Besides, a history of suicide attempt had a statistically significant effect on all subscales of quality of life. Insight had no significant effect on any QOL subscale. Conclusion: This study shows that the quality of life is affected in OCD and this is partly related to the severity of the disease and suicidality but not to insight. Considering the effects of quality of life in both the treatment and follow-up of this patient group, the importance of identifying the factors affecting the quality of life will be better understood in OCD patients. Further large-scale longitudinal studies are needed to clarify this issue.

Health-related quality of life among undergraduate dentistry students in Ho Chi Minh, Vietnam: A cross-sectional WHOQOL‑BREF study

Context: Dentistry is one of the most stressful and difficult programs in Vietnam. The quality of life (QoL) of dentistry students strongly affects their learning ability and is an issue that causes anxiety among educators. Aims: To assess the QoL of dentistry students using the World Health Organization Quality of Life Instrument - Short Form (WHOQOL-BREF) and to explore the relationship between questionnaire scores and participant characteristics. Methods: A cross-sectional survey was administered directly in February to May 2019 with the participation of 201 dentistry students from three universities in southern Vietnam. Results: The mean scores of the students in the four WHOQOL-BREF domains were 57.20 ± 11.93 (physical health), 53.75 ± 14.78 (psychological health), 59.70 ± 15.68 (social relationships), and 55.79 ± 13.25 (environment). Their QoL scores were lower than those of their counterparts in the US and Pakistan. The female students had lower psychological, environmental, and physical health domain scores than those acquired by the male students (p&lt;0.01). The frequency of physical exercise and average sleep duration was significantly associated with all the QoL domains (p&lt;0.05). Conclusions: The WHOQOL-BREF is a suitable questionnaire for evaluating the QoL of Vietnamese dentistry students. To improve the health and well-being of this population, medical universities should innovate dentistry education programs and provide essential support, especially to female and fourth year students. Such institutions should also encourage students to participate in sport activities outside learning time and obtain enough sleep for a healthy body and satisfactory academic performance.

Communication and Community Involvement to Support Risk Governance.

In past years, communication activities have become increasingly important in the environment and health domain, considering the concurrent developments of social media and scientific citizenship that contributed changes in legislation and culture. Communication is particularly crucial where an environmental hazard is present, as in the case of high risk environmental and health risk areas. The project “International Center of Advanced Study in Environment, Ecosystem and Human Health” (CISAS), carried out by the Italian National Research Council, covers multiple research activities, from ecology to biology and medical sciences, from epidemiology to social sciences and communication. Three different studies based on human biomonitoring and a birth cohort study are currently in progress in the project locations, together with studies on the environmental fate of pollutants. A clear, accurate and respectful communication of study protocols and results represents a priority to produce comprehensible information available for policy makers, citizens, and stakeholders. This paper describes the multiple external and internal communication activities planned in the framework of the CISAS project as an example of promotion of knowledge in the society at large and improvement of risk management in the environmental health domain.

The role of information in multilateral governance of environmental health risk: lessons from the Equatorial Asian haze case

A multilateral approach to the governance of environmental health risk could be regarded as a possible response to the complexity of current risk problems. Such multilateral governance is deemed advisable in consideration of the need to achieve an adaptive risk management approach and establish a dialogue among the stakeholders involved in or affected by a specific risk. However, whereas the benefits of multilateral risk governance are clear in theory, in practice – and specifically for the environmental health domain – there seems to be a shortage of successful cases where this multilateral approach has been actually applied. In particular, this article targets the necessity to understand ‘multilateral’ in a broad sense, thus also including the international community and civil society actors, both organized in collectives (e.g. NGOs) and wider civil society (e.g. on-the-ground citizens). The case of the Equatorial Asian haze is investigated to respond to a theoretical question, namely whether and how processes of deviating dynamics can trigger an improvement in risk governance, especially stimulating alternative information production and pushing for the release of key information held by the government. Access to information results in being a necessary step to achieve multilateral risk governance.

The Effects of Acceptance and Commitment Therapy and Biofeedback on Chronic Psychosomatic Low Back Pain

Background: Mental processes can make the pain and quality of life of women with chronic psychosomatic low back pain better or worse. acceptance and commitment therapy (ACT) and biofeedback have on some psychosomatic disorder. Objectives: The aim of this study was to investigate the effects of ACT and biofeedback on severity and duration of pain and quality of life among women with chronic psychosomatic low back pain. Materials &amp; Methods: This three-group Pre-test and post-test controlled quasi-experimental study was conducted from September 2016 to June 2017. Thirty women with chronic psychosomatic low back pain were conveniently recruited from Rasht pain clinic, Rasht, Iran, and randomly allocated to three ten-person groups including ACT, biofeedback, and control groups. Data were collected before and after the study intervention using the McGill Pain Questionnaire and the short version of the World Health Organization quality of life (QOL) survey. Data analysis was performed using the one-way analysis of variance as well as the Chi-square, the paired-sample Test, and post-hoc Scheffe Tests. Results: Both ACT and biofeedback interventions significantly and similarly reduce severity and duration of pain and improve the quality of life. ACT had significant effects on the psychological, social, and environmental health domains of quality of life, while biofeedback had significant effects only on the physical health domain. Conclusion: ACT and biofeedback are effective on psychosomatic low back pain. Unlike the ACT, biofeedback has significant effect on the physical health aspect of QOL and it has no effects on the other aspects of QOL.

Measuring Health related Quality of life and its determinants among physically disabled adults in Bangladesh

The prime purpose of the study was to assess the quality of life of physically disabled adults attending at rehabilitation center in Dhaka city, Bangladesh and to determine the relationship of the type of disability, educational level and relationship with the family with quality of life.Participants were 500 adults with physical disabilities. Thestructured questionnaire consist of WHOQOL-BREF were used as research instruments. When dividing the participants into three groups according to the level of total QOL score, in physical domain majority (96.2%) had fair level QOL score. In psychological domain veryfew(5.4%) had poor level and more than half (53.2%) had fair level QOL score and rest of them had good QOL score (41.4%). more than one third (37.2%) and nearly half(47.0%) had fair and good level respectively whereas rest of them (15.8%) had poor level of QOL in Social domain. In environmental domain a minimum number(3.8%) had poor QOL score but almost half (43.6%) and more than half (52.6%) had fair and good level of QOL score. The Cronbach’s alpha coefficient of WHOQOL-BREF was adequate (0.914) for all 26 questions and for each domain the values are: Physical health domain (0.812), Psychological health domain (0.831), Social relationship domain (0.68) and Environmental health domain (0.78). Statistically significant correlations present between all domains. Mean and percentage of satisfaction rating in DOM1, DOM2 and DOM3 and DOM4 was higher in males than females. There were significant differences found in WHOQOL-BREF score between different education level group, different marital statusgroup,different employment statusgroup, differentincome level group, relationship with family, utilization of primary rehabilitation in four domains and total of WHOQOL-BREF (P &lt; 0.05). multiple linear regression observed that education level and utilization of primary rehabilitation center is most important factor that affects QOL of study population in total and four domains of WHOQOL.The findings from this study confirm that the WHOQOL-BREF questionnaire is a reliable instrument to measure quality of life in disable adults. From the data, it appears that Bangladeshi disable adults have WHOQOL-BREF scores that might be considered to indicate a fair level of quality of life.&#x0D; Bangladesh Journal of Medical Science Vol.18(3) 2019 p.607-614

Assessment of Health-Related Quality of Life among Tuberculosis Patients in a Public Primary Care Facility in Indonesia.

Background and Objectives:Evaluation of health-related quality of life (HRQoL) among tuberculosis (TB) patients could improve understanding about the burden associated with the diseases. There is a paucity of research regarding evaluation of HRQoL among TB population in Indonesia. This study aimed to investigate HRQoL among TB patients in Ciamis, Indonesia.Methods:This was a cross-sectional study conducted at one primary health-care facility in Ciamis, Indonesia. HRQoL was measured using the World Health Organization (WHO) QoL-BREF instrument which covers assessment on physical, psychological, social relationship, and environmental health domains. Multiple regression analysis was used to investigate the association between domain scores with demographic factors of the participants such as age, sex, education years, and types of treatment. Statistical analysis was conducted using SPSS software version 21.Results:Eighty-one participants were recruited in the present study. The total mean score for all domains was 45.35 (±23.3). The mean scores for physical, physiological, social relationship, and environmental health domains were 20.5 (±9.9), 76.4 (±11.9), 36.9 (±9.2), and 46.9 (±10.4), respectively. Education years were significantly associated with improved HRQoL in environmental health domain (P < 0.05).Conclusion:TB had remarkable negative impacts on patients HRQoL, with physical domain was the most affected. This finding calls upon strategies addressing HRQoL problems in the management of TB patients.