Environmental Health Domain Research Articles

Impact of Oral Submucous Fibrosis on Quality of Life: A Cross-Sectional Study.

Oral submucous fibrosis (OSMF) is a chronic disease of the oral cavity which presents clinically with burning sensation, leathery consistency of oral mucosa with palpable fibrous bands leading to reduced mouth opening. Though the evaluation of quality of life (QOL) in health care is gaining importance, researches regarding the evaluation of QOL in OSMF individuals are very sparse. The aim of the present study is to evaluate the QOL assessment in OSMF patients through WHOQOL-BREF questionnaire. The study includes a total of 300 participants recruited from the outpatient department. The quality of life was assessed using the WHOQOL-BREF questionnaire. The raw scores for the physical health, psychological health, social relationships and environmental health domains were done on 4-20 scale suggested by the WHOQOL procedural manual. The analysis of variance (ANOVA) was used for the simultaneous comparison of mean scores for the four domains, and independent t test was used for the comparison of two means of domain scores. The participants with OSMF have a significant negative impact on the quality of life when compared with the participants without OSMF (P = 0.002). The environmental factors in the WHOQOL-BREF have shown a significant difference in the QOL of participants with OSMF than without OSMF (P = 0.001). The oral submucous fibrosis has a negative impact on the quality of life in participants with OSMF specifically in social and environmental domains of the WHOQOL-BREF questionnaire.

Fatigue as a mediator of the relationship between quality of life and mental health problems in hospital nurses

The aims of this study were to investigate the relationships among quality of life (QoL), mental health problems and fatigue among hospital nurses, and to test whether fatigue and its multiple dimensions would mediate the effect of QoL on mental health problems. Data were collected using questionnaires (including the World Health Organization Quality of Life-BREF [WHOQOL-BREF], General Health Questionnaire [GHQ-12] and Multidimensional Fatigue Inventory [MFI-20] for evaluation of QoL, mental health problems and fatigue, respectively) from 990 Iranian hospital nurses, and analysed by generalized structural equation modelling (GSEM). The results indicated that QoL, mental health problems and fatigue were interrelated, and supported the direct and indirect (through fatigue) effects of QoL on mental health problems. All domains of the WHOQOL-BREF, and particularly physical (sleep problems), psychological (negative feelings) and environmental health (leisure activities) domains, were strongly related to the mental health status of the studied nurses. Fatigue and its multiple dimensions partially mediated the relationship between QoL and mental health problems. The results highlighted the importance of physical, psychological and environmental aspects of QoL and suggested the need for potential interventions to improve fatigue (particularly physical fatigue along with mental fatigue) and consequently mental health status of this working population. The findings have possible implications for nurses' health and patient safety outcomes.

Quality of life and social support in patients with multiple sclerosis.

Quality of life and needforsocial support in persons diagnosed with multiple sclerosis (MS) are to a large extent determined by the degree of their disability. The aim of the study was to analyze an association between specific forms of MS, subjectively perceived quality of life and social support. The study included subjects with established diagnosis of MS, treated at rehabilitation centers, hospitals and in a home setting, as well as the members of patient organizations. After being informed about objectives of the study, type of included tasks and way to complete them, each participant was handed out a set of questionnaires: Berlin Social Support Scales (Łuszczyńska, Kowalska, Schwarzer, Schulz), Quality of Life Questionnaire (WHOQOLBREF), as well as a survey developed specifically for the purposes of this project. The results were subjected to statistical analysis with STATA 12 package. The study included a total of 110 persons (67 women and 43 men). Quality of life overall, as well in physical, psychological, social relationships and environmental health domains, turned out to be particularly important in patients with primary-progressive MS. Irrespective of MS type, social support overall did not play a significant role on univariate analysis. However, subgroup analysis according to sex demonstrated that men with MS received social support four times less often than women. Quality of life in individuals with primary-progressive MS is significantly lower than in patients presenting with other types of this disease. Men with MS are more likely to present with worse scores for social support overall. They are less likely both to acknowledge the need for support and to realize the availability of support they actually need.

Quality of life of schizophrenic patients in a tertiary care hospital in Bangladesh

Schizophrenia is one of the major mental disorders which affect individual’s thinking ability, social interaction or attention. It affects person’s entire quality of life. The purpose of the study was to find out the quality of life of schizophrenic patient in Bangladesh. Cross sectional study design was used to conduct this study. The convenient sampling procedure was used throughout the process of participant’s selection and the numbers of respondents were 83. The study was carried out at National Institute of Mental Health and Hospital (NIMH), Dhaka. Data was collected by using face to face interview with a structured questionnaire WHOQOL-BREF (The World Health Organization Quality of Life- BREF) scale. It was found that most of the participants lead poor to moderate quality of life in four domains of the WHOQOL-BREF scale. Results showed that mean scores were for physical health (mean 2.7, SD+0.106); psychological health (mean 2.108, SD +0.0787); social relationship (mean 2.226; SD+0.116) and environmental health (mean 2.47; SD+0.077).This study indicated that, quality of life poor on psychological domain. It was also found statistically significance with age and social relationship domain (p value 0.005< 0.05); marital status and physical health domain (p value 0.004<0.05); educational level and physical health domain (p value 0.005<0.05) and environmental health domain (p value 0.025<0.05). There were no statistically significant difference between gender and other variables. Schizophrenia affects all aspects of person’s life such as physically, psychologically, socially and economically. Schizophrenic patients as well as their family members led very poor quality of life.Bang J Psychiatry June 2015; 29(1): 30-34

Quality of life of patients with obsessive compulsive disorder

Obsessive-Compulsive Disorder (OCD) is a severe and debilitating anxiety disorder which causes severely impaired quality of life. The objective of the study was to assess the quality of life of the patients suffering from OCD. It was a cross-sectional study conducted from January 2011 to June 2011 among 46 patients who attended the out-patient department of the National Institute of Mental Health Sher-E-Bangla Nagar, Dhaka, Bangladesh and Holy Family Red Crescent Medical College and Hospital, Dhaka, Bangladesh by using purposive sampling technique. A Semi-structured questionnaire, Dhaka University Obsessive Compulsive Scale (DUOCS), World Health Organization Quality of Life-Scale Brief Version (WHOQOL-BREF), Diagnostic and Statistical Manual for Mental Disorder, 4th edition (DSM-IV) were used in each case for this assessment. Results showed that mean age of the patients was (29.07±6.11) years, majority of the respondents (71.7%) were male, 63.0% were unmarried and 34.8% were students. Patients were least satisfied with social domain and patients having only obsession had lower mean score (23.54±1.80) in environmental domain than in patients having both obsession and compulsion (25.15±3.70). OCD patients having major conflict (52.2%) were least satisfied with environmental health domain and patients suffering from OCD for more than ten years (78.3%) had low score than those suffering for less than ten years (21.7%) in overall quality of life domain. Patients having strained family relationship (34.8%) were less satisfied to psychological health domain and patients getting medication (91.3%) had better quality of life in all domains than those getting no medication (8.7%).Bang J Psychiatry June 2015; 29(1): 18-22

Characterising bias in regulatory risk and decision analysis: An analysis of heuristics applied in health technology appraisal, chemicals regulation, and climate change governance

In many environmental and public health domains, heuristic methods of risk and decision analysis must be relied upon, either because problem structures are ambiguous, reliable data is lacking, or decisions are urgent. This introduces an additional source of uncertainty beyond model and measurement error – uncertainty stemming from relying on inexact inference rules. Here we identify and analyse heuristics used to prioritise risk objects, to discriminate between signal and noise, to weight evidence, to construct models, to extrapolate beyond datasets, and to make policy. Some of these heuristics are based on causal generalisations, yet can misfire when these relationships are presumed rather than tested (e.g. surrogates in clinical trials). Others are conventions designed to confer stability to decision analysis, yet which may introduce serious error when applied ritualistically (e.g. significance testing). Some heuristics can be traced back to formal justifications, but only subject to strong assumptions that are often violated in practical applications. Heuristic decision rules (e.g. feasibility rules) in principle act as surrogates for utility maximisation or distributional concerns, yet in practice may neglect costs and benefits, be based on arbitrary thresholds, and be prone to gaming. We highlight the problem of rule-entrenchment, where analytical choices that are in principle contestable are arbitrarily fixed in practice, masking uncertainty and potentially introducing bias. Strategies for making risk and decision analysis more rigorous include: formalising the assumptions and scope conditions under which heuristics should be applied; testing rather than presuming their underlying empirical or theoretical justifications; using sensitivity analysis, simulations, multiple bias analysis, and deductive systems of inference (e.g. directed acyclic graphs) to characterise rule uncertainty and refine heuristics; adopting “recovery schemes” to correct for known biases; and basing decision rules on clearly articulated values and evidence, rather than convention.

Mental health status after living donor hepatectomy.

Donor safety and preservation of donor health after living liver donation are of paramount importance. In addition, the preoperative mental state of a donor is an important factor in determining the psychological impact of donor hepatectomy. Thus, we aimed to explore the mental health status of living liver donors after hepatectomy. We enrolled 60 donors who were scheduled to undergo living donor hepatectomy during the period January 2014 to March 2015 at a single medical center. Mental health status was measured before and 3 months after surgery using 3 self-report questionnaires, namely the Center for Epidemiologic Studies Depression Scale (CES-D) to assess depressive symptoms, the World Health Organization Quality of Life (WHOQOL-BREF) questionnaire to measure quality of life, and the Chinese Health Questionnaire (CHQ) to screen for minor psychiatric disorders. A comparison of the pre- and postdonation CES-D scores revealed a significant reduction in depressive symptoms after surgery (P = .031). There were significant improvements in the physical health domain (P = .031), the psychological health domain (P = .005), the social relationships domain (P = .005), and the environmental health domain (P = .010) of the WHOQOL-BREF. There were no significant changes in CHQ scores after donor hepatectomy (P = .136). All donors reported that they would donate again if required. Approximately one-third (33.3%) of donors experienced more pain than they had anticipated in the immediate postoperative period, and 20.0% of donors had complications after donor hepatectomy. Donor mental health status tended to improve as donors regained physical function during the 1st 3 months of recovery. Long-term monitoring of living donors’ mental health is needed to minimize the adverse psychological outcomes of living liver donation.

Coping Strategies among Parents of Children with Acute Lymphoblastic Leukemia

Background: Having a child with acute lymphoblastic leukemia represents challenges to the family which may impact their quality of life. In such circumstances, parents use various coping strategies to face this stressful situation, and understanding the relation of coping strategies on quality of life among parents of children with acute lymphoblastic leukemia may provide professionals with ideas about how to support them which in turn may improve their quality of life. Aim: The aim of the present study was to assess the correlation between coping strategies and the health related quality of life of parents whose children are suffering from acute lymphoblastic leukemia. Study design: A cross-sectional design using guided self-administered questionnaire by a single researcher was used. Methods: A universal sample consisted of 299 parents of children with acute lymphoblastic leukemia (ALL) was recruited from Hospital Universiti Kebangsaan Malaysia and Kuala Lumpur Institute Pediatrics. The response rate was 98%. The data collection tools were WHOQOL BREF which is the World Health Organization Quality of Life shorter version and Brief COPE questionnaires. Results: The results revealed that half of the parents perceived their health related quality of life as good. The highest scores for parents were reported on the social relationship domain meanwhile the lowest were reported on the environmental health domain. In regard to the coping strategies, it was found that religion was most frequently used while humor was the least to be used. Moreover, there was a significant positive relationship between quality of life of the parents and problem-focused coping style and a significant negative relationship with emotion-focused coping style. Conclusion: On the basis of the finding of present study, an appropriate intervention could be design to include program that promote the use of problem-focused copings such as active coping and planning and discourage the use of emotion-focused copings such as self-blaming to enhance parents’ health related quality of life.

Assessment of physical, psychological, social, and environmental health domains of quality of life in female students living in dormitories of Qom University of Medical Sciences

Aims: Considering significant number of students, especially female students consisting young stratum of the society, there is the increased possibility of mental damages and the direct effect it can have on their quality of life (QOL). The present study aimed to investigate the QOL in female students living in dormitories of the University of Medical Sciences in Qom University of Medical Sciences. Materials and Methods: This study is a cross-sectional study conducted in 2016 on 300 students of the Qom University of Medical Sciences selected using quota sampling. Data gathering tool was the World Health Organization QOL-BREF questionnaire containing 26 items. Statistical data were analyzed using descriptive and inferential statistics of SPSS software. Results: In general, the mean score of students in the four domains of QOL was respectively related to physical health (14.42 ± 2.42), social health (13.30 ± 3.33), environmental health (13.11 ± 2.95), and psychological health (13 ± 2.81), and also, there was a significant relationship between QOL and age (P < 0.0001), discipline (P < 0.04), economic status (P < 0.0001), and interest in discipline (P < 0.001). Conclusion: This study showed that the lowest area of QOL was associated with psychological health; therefore, to increase the QOL in this dimension; the periodical evaluation of the mental health is recommended. Appropriate training to create psychological adjustment in student dormitories can also improve the QOL.

Low Quality of Life and its Associated Risk Factors in Parents of Children with Cerebral Palsy in the Northwest of Iran; A Case Control Study

Aim: Parenting a child with cerebral palsy (CP) presents multiple challenges. In this study we aim to compare the quality of life in parents of children with CP and parents of healthy children and its correlations with possible risk factors. Material and Method: Sixty-four parents of children with CP and 64 parents of healthy children matched for age and gender were recruited. Families were visited by researchers to administer the World Health Organization Quality of Life – short version (WHOQOL-BREF) and Duke University Religion Index (DUREL) questionnaires to parents. Also the motor function of the children with CP was evaluated according to the Gross Motor Function Classification System (GMFCS). Results: Compared to parents of healthy children, parents of children with CP had significantly stronger religious beliefs and a lower score in overall quality of life and all its domains, except for the social subscale. There was a significant negative correlation between parents’ age and psychological domain, social domain, and overall quality of life. There was also a significant negative correlation between GMFCS level and the social and environmental health domains of quality of life. Families with higher income had a significantly higher score in social, environmental health, and overall quality of life, and environmental health was significantly higher in parents with higher education. Discussion: Parents of children with CP have lower quality of life than parents of healthy children; their quality of life was negatively correlated with their children’s disability, their education level, and family income. Although these parents had stronger religious beliefs, this was not correlated with the domains of quality of life.

Development of Occupational Health Measures for the National Health Security Preparedness Index.

Development of Occupational Health Measures for the National Health Security Preparedness Index.

Quality of Life Among Thalassemia Children Patients in the Gaza Strip

This study aimed to assess the quality of life of children (3-12 years) diagnosed with Thalassemia in Gaza Strip. A descriptive, analytical, cross-sectional design was used. All children 3-12 years old who were diagnosed with thalassemia and live in GS were included in the study (75 cases) with response rate (81.3%). Participants were interviewed by the researcher and completed the questionnaire which focused on quality of life of chronic diseases and included five domains. These domains are physical health, psychological health, social relationships, environment health and personal safety. Validity and reliability of the instrument were tested and the total instrument reliability test (Cronbach's Alpha) was 0.767. The scores for the study domains ranged between 2.81 for personal security domain and 3.66 for environmental health domain. Moreover, the study domains did not show statistically significant difference when compared by sex, living places, monthly income the relationship between parents and recurrent hospitalization. The findings of this study suggest the need of children diagnosed with thalassemia for support in all study domains. Health professionals need to work to minimize the disease's burdens. The current study calls the attention of health policy makers for new policies and new roles for the community health nurses and social workers. The study also revealed that there is a bad need to pay more attention when caring and dealing with thalassemia patients. Special food supplementation should be available in order to improve their physical health, more psychological support from their families and the society is needed. In addition, there is a need to provide safe environment and to enhance personal safety of these children.

A comparison of quality of life before and after successful repair of genitourinary fistula: Is there improvement across all the domains of WHOQOL-BREF questionnaire?

ObjectiveTo compare preoperative quality of life (QoL) scores using World Health Organization WHOQOL-BREF quality of life assessment with postoperative QoL scores following successful repair of genitourinary fistula. Patients and methodsThe WHOQOL-BREF questionnaire was used as a tool to evaluate the quality of life before and after surgical repair. All patients, who underwent genitourinary fistula repair between January 2011 and December 2013 were included. Women with complaints of continuous leakage of urine per vagina following obstetric or gynaecological procedures were included in this study. Women with rectovaginal fistula, malignant fistula or radiation induced fistula were excluded from this study. Patients with co-morbidities affecting QoL and those who did not give consent to participate were excluded. Patients whose questionnaire was incomplete were also excluded. ResultsOf the 106 women admitted for treatment of genitourinary fistula during the time period; 101 were included. The preoperative score of physical, psychological, social and environmental health domains were 15.04±2.56, 16.42±4.4, 51.75±11.91 and 34.81±6.89 respectively. The postoperative scores in physical, psychological, social and environmental health domains were 83.61±5.09, 75.79±6.33, 76.17±8.53 and 33.88±6.13 respectively. On comparison between the preoperative and postoperative QoL scores; there was significant improvement in physical, psychological and social health domains in the postoperative period (p<0.01) but the environmental health domain scores remained static. ConclusionThere is marked improvement in the overall quality of life, especially the physical, psychological and social health domains of WHOQOL-BREF questionnaire after successful surgical repair of genitourinary fistula. The environmental health domain remained unchanged even after successful repair.

Stress, Coping Strategies, and Quality of Life among Jordanian Parents of Children with Autistic Disorder

Background: Parents in different cultures show different psychological functioning when caring for a child with chronic disability such as Autistic Disorder. Arabs are united in a shared culture that is considered substantially different from their western counterparts. Nevertheless, no investigations regarding the experience of parenting a child with Autistic Disorder have been made in the Arab world yet. Therefore, the purpose of this study was to investigate the psychosocial impacts of raising children with Autistic Disorder in a sample from the Arab world. The study examined the levels of parenting stress, the coping strategies, and the levels of quality of life reported by Arab parents. Methods: Using a descriptive cross-sectional design, the convenience sample of the study consisted of 184 parents of children with Autistic Disorder. Data were collected using self-administered questionnaires on parenting stress, coping strategies, and quality of life. Results: The results revealed that parents of children with Autistic Disorder experience significant high levels of parenting stress. Positive reappraisal was the most frequently used coping strategy among those parents. Meanwhile, confrontive coping was the least frequently used strategy. In regard to parents’ quality of life, parents reported poor physical, psychological, social, and environmental health scores, with mothers reporting relatively lower scores. The lowest scores for parents were reported on the environmental health domain. Conclusion: The findings from this study indicate that Jordanian parents of children with Autistic Disorder suffer significant impairments in their psychosocial health. Thus, those parents are in need for a wide range of support and educational programs that offer broad information about Autistic Disorder alongside with therapeutic and effective strategies to address their stressors and improve their quality of life.

Assessment of health-related quality of life in Turkish patients with facial prostheses

BackgroundFacial prostheses are intended to provide a non-operative rehabilitation for patients with acquired facial defects. By improving aesthetics and quality of life (QOL), this treatment involves reintegration of the patient into family and social life. The aim of this study was to evaluate the perception of QOL in adult patients with facial prostheses and to compare this perception with that of a control group.MethodsThe study participants consisted of 72 patients, who were divided into three equal-sized groups according to the type of prosthesis (OP- orbital prosthesis, AP- auricular prosthesis, NP - nasal prosthesis) and 24 healthy control participants without any congenital or acquired deformity of face or body. Clinical and socio-demographic data were gathered from each person’s medical chart. Participants completed the Turkish version of the World Health Organization Quality of Life Instrument, Short Form (WHOQOL-BREF). Descriptive statistics, independent sample t-tests, Pearson's chi-square test, ANOVA, ANCOVA, and Pearson correlation were used to analyse the data.ResultsCompared with the control participants, patients with NP scored lower on the all domains of QOL and all three patient groups had lower scores on overall QOL and its domains of physical and environmental health. Patients with OP reported significantly lower physical health scores than those with AP, while patients with NP reported significantly lower overall QOL and psychological health scores than those with AP. Female patients had lower environmental domain scores than did male patients. The patient’s age and income correlated with social relationships QOL, while the patient’s income and the age of facial prosthesis were correlated with environmental QOL.ConclusionPatients with facial prostheses had lower scores in overall QOL, physical and environmental health domains than the control participants. Socio-demographic and clinical characteristics such as age, gender, income, localization of the defect, and age of facial prosthesis were associated with patients’ QOL. These findings may provide valuable information about the specific health needs of these patients that may affect their well-being. Further studies are needed to confirm these results. Use of the WHOQOL-BREF may provide valuable information for determining patients’ needs and priorities as well as for planning and developing comprehensive prosthetic rehabilitation programs.

The relationship between computer games and quality of life in adolescents

Background:Term of doing computer games among teenagers is growing rapidly. This popular phenomenon can cause physical and psychosocial issues in them. Therefore, this study examined the relationship between computer games and quality of life domains in adolescents aging 12-15 years.Materials and Methods:In a cross-sectional study using the 2-stage stratified cluster sampling method, 444 male and female students in Borkhar were selected. The data collection tool consisted of 1) World Health Organization Quality Of Life – BREF questionnaire and 2) personal information questionnaire. The data were analyzed by Pearson correlation, Spearman correlation, chi-square, independent t-tests and analysis of covariance.Findings:The total mean score of quality of life in students was 67.11±13.34. The results showed a significant relationship between the age of starting to play games and the overall quality of life score and its fourdomains (range r=–0.13 to –0.18). The mean of overall quality of life score in computer game users was 68.27±13.03 while it was 64.81±13.69 among those who did not play computer games and the difference was significant (P=0.01). There were significant differences in environmental and mental health domains between the two groups (P<0.05). However, there was no significant relationship between BMI with the time spent and the type of computer games.Conclusion:Playing computer games for a short time under parental supervision can have positive effects on quality of life in adolescents. However, spending long hours for playing computer games may have negative long-term effects.

Étude des paramètres toxicocinétiques du plomb sanguin chez les ex-salariés d’une fonderie de plomb et de zinc, après arrêt de l’exposition professionnelle au plomb

Data generated by the rapidly evolving human biomonitoring (HBM) programmes are providing invaluable opportunities to support and advance regulatory risk assessment and management of chemicals in occupational and environmental health domains. However, heterogeneity across studies, in terms of design, terminology, biomarker nomenclature, and data formats, limits our capacity to compare and integrate data sets retrospectively (reuse). Registration of HBM studies is common for clinical trials; however, the study designs and resulting data collections cannot be traced easily. We argue that an HBM Global Registry Framework (HBM GRF) could be the solution to several of challenges hampering the (re)use of HBM (meta)data. The aim is to develop a global, host-independent HBM registry framework based on the use of harmonised open-access protocol templates from designing, undertaking of an HBM study to the use and possible reuse of the resulting HBM (meta)data. This framework should apply FAIR (Findable, Accessible, Interoperable and Reusable) principles as a core data management strategy to enable the (re)use of HBM (meta)data to its full potential through the data value chain. Moreover, we believe that implementation of FAIR principles is a fundamental enabler for digital transformation within environmental health.The HBM GRF would encompass internationally harmonised and agreed open access templates for HBM study protocols, structured web-based functionalities to deposit, find, and access harmonised protocols of HBM studies. Registration of HBM studies using the HBM GRF is anticipated to increase FAIRness of the resulting (meta)data. It is also considered that harmonisation of existing data sets could be performed retrospectively. As a consequence, data wrangling activities to make data ready for analysis will be minimised. In addition, this framework would enable the HBM (inter)national community to trace new HBM studies already in the planning phase and their results once finalised. The HBM GRF could also serve as a platform enhancing communication between scientists, risk assessors, and risk managers/policy makers. The planned European Partnership for the Assessment of Risk from Chemicals (PARC) work along these lines, based on the experience obtained in previous joint European initiatives. Therefore, PARC could very well bring a first demonstration of first essential functionalities within the development of the HBM GRF.

P2-S7.05 Assessing the quality of life of HIV/AIDS patients on ARV therapy and their caregivers at the National Hospital Abuja

The study assessed the quality of life of HIV/AIDS patients on Antiretroviral (ARV) Therapy and their caregivers at the National Hospital, Abuja. A sample of 200 participants comprising 150 patients...