Negative Quality Of Life Research Articles

Quality of life and psychological distress in end-stage renal disease patients undergoing hemodialysis and transplantation.

Among diverse profound impacts on patients' quality of life (QoL), end-stage renal disease (ESRD) frequently results in increased levels of depression, anxiety, and stress. Renal replacement therapies such as hemodialysis (HD) and transplantation (TX) are intended to enhance QoL, although their ability to alleviate psychological distress remains uncertain. This research posits the existence of a significant correlation between negative emotional states and QoL among ESRD patients, with varying effects observed in HD and TX patients. To examine the relationship between QoL and negative emotional states (depression, anxiety, and stress) and predicted QoL in various end-stage renal replacement therapy patients with ESRD. This cross-sectional study included HD or TX patients in the Eastern Region of Saudi Arabia. The 36-item Short Form Survey and Depression Anxiety Stress Scale (DASS) was used for data collection, and correlation and regression analyses were performed. The HD and TX transplantation groups showed statistically significant inverse relationships between QoL and DASS scores. HD patients with high anxiety levels and less education scored low on the physical component summary (PCS). In addition, the results of the mental component summary (MCS) were associated with reduced depression. Compared with older transplant patients, TX patients' PCS scores were lower, and depression, stress, and negative working conditions were highly correlated with MCS scores. The findings of this study revealed notable connections between well-being and mental turmoil experienced by individuals undergoing HD and TX. The PCS of HD patients is affected by heightened levels of anxiety and lower educational attainment, while the MCS of transplant patients is influenced by advancing age and elevated stress levels. These insights will contribute to a more comprehensive understanding of patient support.

Quality-of-Life Outcomes Following Endoscopic Resection of Sinonasal Inverted Papilloma.

There is growing interest in assessing patient quality of life (QOL) following treatment of sinonasal tumors, including inverted papilloma (IP). We aimed to elucidate the natural history of postoperative QOL outcomes in IP patients treated with surgery. Cases of sinonasal IP treated surgically at 4 tertiary academic rhinology centers were retrospectively reviewed. SNOT-22 scores were used to evaluate QOL preoperatively and postoperatively (1, 3, 6, 12 months). Repeated-measures ANOVA assessed for differences in mean scores over time. Linear regression identified factors associated with QOL longitudinally. 373 patients were analyzed. Mean preoperative SNOT-22 score was 20.6 ± 20.4, which decreased to 16.3 ± 18.8 (p = 0.041) and 11.8 ± 15.0 (p < 0.001) at 1 and 3 months postoperatively, respectively. No further changes in SNOT-22 scores occurred beyond 3 months postoperatively (p > 0.05). When analyzed by SNOT-22 subdomains, nasal, sleep, and otologic/facial subdomain scores (all p < 0.05) demonstrated improvement at 12-month follow-up compared with preoperative scores; this was not observed for the emotional subdomain score (p = 0.800). Recurrent cases were associated with higher long-term SNOT-22 scores (β = 7.08; p = 0.017). Age, sex, degree of dysplasia, prior surgery, primary site, and smoking history did not correlate with symptoms (all p > 0.05). QOL outcomes related to IP resection are largely driven by nasal, sleep, and otologic/facial subdomains, though patients appear to experience enduring improvement as early as 3 months postoperatively. Recurrent disease is a major driver of negative QOL. 4 Laryngoscope, 2024.

Effects of Music Therapy in the Context of Positive Emotions, Engagement, Relationships, Meaning and Accomplishment (PERMA) on Negative Emotions in Patients with Mild-to-Moderate Depression.

This study explores the effects of music therapy under the framework of positive emotions, engagement, relationships, meaning, and accomplishment (PERMA) on the negative emotions and quality of life (QOL) in patients with digestive diseases and mild-to-moderate depression in a general hospital. From January 2020 to December 2021, 192 digestive diseases patients with mild-to-moderate depression who met the inclusion criteria were retrospectively analyzed and divided into the control group (routine nursing, n = 90) and the observation group (music therapy under PERMA, n = 102). Hamilton Depression Scale (HAMD-17), Hamilton Anxiety Scale (HAMA), General Well-being Scale, and a 36-item short-form health survey were used to evaluate the negative emotions and QOL of patients. SPSS 25.0 was used for statistical analysis. At baseline, the general data and the type of digestive disease of the two groups were similar, and no significant difference was noted in the HAMA and HAMD-17 scores (P > 0.05). After 2 weeks of treatment, the HAMA and HAMD-17 scores of the observation group were significantly lower than those of the control group (P < 0.05). In terms of subjective well-being and QOL, the scores of the four dimensions of "satisfaction and interest in life," "melancholy and cheerful mood," "control of emotional behavior" and "relaxation and tension" in the observation group were significantly higher than those in the control group (P < 0.05). In the dimension of "body pain" of QOL, the score of the observation group was significantly higher than that of the control group (P < 0.05). Among patients in a general hospital with digestive diseases and mild-to-moderate depression, music therapy under the framework of PERMA shows significant positive effects in reducing anxiety and depression symptoms and improving subjective well-being and specific QOL dimensions.

Abstract PO2-12-01: Five-year quality of life (QOL) trajectories among young breast cancer (BC) survivors

Abstract Background: Young BC survivors are at risk for impaired QOL in part due to issues that are unique to their life stage. We sought to characterize trajectories of QOL in the 5 years following diagnosis among young BC survivors as well as evaluate patient and clinical characteristics associated with poorer or deteriorating QOL trajectories over time. Methods: Women diagnosed with stage I-III BC at age ≤40 enrolled in the Young Women’s BC Study, a prospective cohort in North America, who completed ≥2 study surveys through 5 years of post-diagnosis follow-up. QOL was evaluated with the Cancer Rehabilitation Evaluation System (CARES) physical, psychosocial, and sexual subscale scores. Demographic, treatment, and clinical characteristics were ascertained through surveys and chart review. Longitudinal trajectories for each CARES subscale were defined using group-based trajectory modeling; associations between patient/clinical characteristics and trajectory group membership were estimated for each subscale using multivariable multinomial logistic regression. Results: Among 900 women, median age at diagnosis was 36 (range: 17-40) 89% were white, 2% Black, and 4% Hispanic. At baseline, 73% were partnered, 61% parous and 49% perceived themselves as financially comfortable. Most had hormone-receptor positive (74%), HER2-negative (70%) BC, and most received chemotherapy (82%); 36% underwent mastectomy with radiation. Physical and psychosocial scores each clustered into 4 trajectories, with &amp;gt;75% of participants clustering in groups reflecting excellent or good QOL that was stable over time and few (6% for physical and 4% for psychosocial) clustering into groups that reflected poorer QOL at baseline that did not improve over time. Sexual health trajectories were more variable, clustering into 5 trajectories, with over half of participants clustered into groups reflecting good (35%) or excellent (20%) QOL that remained relatively stable over time, 22% clustered into a trajectory that was poor at baseline but moderately improved over follow-up, 13% in a group that reflected deteriorating from moderate-to-poor QOL and 11% in a group with poor QOL at baseline that did not improve over time. In multivariable regression analyses (Table), factors associated with clustering in a poorer trajectory (vs. clustering in an excellent trajectory), in multiple QOL domains included baseline financial discomfort (associated with poorer QOL across all 3 domains), mastectomy+radiation (vs. lumpectomy, associated with poorer QOL across all 3 domains); chemotherapy receipt (associated with poorer physical and sexual health trajectories); and baseline BMI &amp;gt;25 (vs. 18.5-24.9, associated with poorer physical and poorer/deteriorating sexual health trajectories). Conclusions: Young BC survivors follow distinct QOL trajectories in survivorship. While most will not experience substantial QOL impairment through the first 5 years following diagnosis, a substantial minority report persistently poor or deteriorating QOL. The association between more extensive local therapy and poorer physical/psychosocial/sexual health trajectories underscores the importance of communicating the potential for negative QOL outcomes when women are making surgical decisions. Additionally, the pervasive impact of financial wellbeing on multiple QOL domains supports the potential value of systematic screening for and addressing of financial distress to prevent or mitigate financial toxicity in survivorship Factors associated with clustering in poorer/deteriorating (vs. excellent) QOL trajectories *Reference trajectory=excellent QOL Citation Format: Tal Sella, Zheng Yue, Kathryn Ruddy, Shari Gelber, Rulla Tamimi, Jeffrey Peppercorn, Lidia Schapira, Virginia Borges, Steven Come, Eric Winer, Ann Partridge, Shoshana Rosenberg. Five-year quality of life (QOL) trajectories among young breast cancer (BC) survivors [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-12-01.

Assessing Quality of Life, Economic Burden, and Independence Across the Alzheimer's Disease Continuum Using Patient-Caregiver Dyad Surveys.

Alzheimer's disease (AD) and mild cognitive impairment (MCI) have negative quality of life (QoL) and economic impacts on patients and their caregivers and may increase along the disease continuum from MCI to mild, moderate, and severe AD. To assess how patient and caregiver QoL, indirect and intangible costs are associated with MCI and AD severity. An on-line survey of physician-identified patient-caregiver dyads living in the United States was conducted from June-October 2022 and included questions to both patients and their caregivers. Dementia Quality of Life Proxy, the Care-related Quality of Life, Work Productivity and Activity Impairment, and Dependence scale were incorporated into the survey. Regression analyses investigated the association between disease severity and QoL and cost outcomes with adjustment for baseline characteristics. One-hundred patient-caregiver dyads were assessed with the survey (MCI, n = 27; mild AD, n = 27; moderate AD, n = 25; severe AD, n = 21). Decreased QoL was found with worsening severity in patients (p < 0.01) and in unpaid (informal) caregivers (n = 79; p = 0.02). Dependence increased with disease severity (p < 0.01). Advanced disease severity was associated with higher costs to employers (p = 0.04), but not with indirect costs to caregivers. Patient and unpaid caregiver intangible costs increased with disease severity (p < 0.01). A significant trend of higher summed costs (indirect costs to caregivers, costs to employers, intangible costs to patients and caregivers) in more severe AD was observed (p < 0.01). Patient QoL and functional independence and unpaid caregiver QoL decrease as AD severity increases. Intangible costs to patients and summed costs increase with disease severity and are highest in severe AD.

Understanding the quality-of-life experiences of older or frail adults following a new dens fracture: Nonsurgical management in a hard collar versus early removal of collar.

In the United Kingdom, fractures of the cervical dens process in older and/or frail patients are usually managed nonsurgically in a hard collar. However, hard collars can lead to complications and this management approach is now being questioned, with growing interest in maximising patients' short-term quality-of-life. It is vital that patients' perspectives are considered; yet, there is a dearth of literature examining the aspect. To help inform wider decision-making about use of collar/no collar management of dens fractures in older/frail people, we explored older/frail people's experience of the two management approaches and how they affected their perceived quality-of-life. We interviewed older and/or frail adults with a recent dens fracture (aged ≥65 years or with a clinical frailty score of ≥5) or their caregiver. Participants were recruited from both arms of a clinical trial comparing management using a hard collar for 12 weeks (SM) with early removal of the collar (ERC) and were interviewed following randomisation and again, 12-16 weeks later. Data were analysed using a framework approach. Both participant groups (SM/ERC) reported substantial, negative quality-of-life (QoL) experiences, with the fall itself and lack of access to care services and information being frequent major contributory factors. Many negative experiences cut across both participant groups, including pain, fatigue, diminished autonomy and reduced involvement in personally meaningful activities. However, we identified some subtle, yet discernible, ways in which using SM/ERC reinforced or alleviated (negative) QoL impacts, with the perceived benefits/burdens to using SM/ERC varying between different individuals. Study findings can be used to support informed decision-making about SM/ERC management of dens fractures in older/frail patients. Public and patient involvement contributors were involved in the study design, development of interview topic guides and interpretation of study findings.

The Impact of bilateral endoscopic thoracic sympathectomy on hyperhidrosis patients’ quality of life and its link to psychiatric disorders

Background and Aims: To measure the Quality of Life (QOL) of patients with hyperhidrosis after undergoing Bilateral en¬doscopic thoracic sympathectomy (BETS), and its association with psychiatric disorders, that were diagnosed using MINI psychiatric interview, and compensatory hyperhidrosis (CH). Methods: A retrospective cross-sectional study was carried out on patients with primary hyperhidrosis after undergoing BETS. 50 Patients were recruited from King Saud University Medical City database and contacted via phone calls. The interview contained a hyperhidrosis-specific QOL questionnaire, and a diagnostic psychiatric questionnaire MINI. The QOL results were classified into 5 categories and used to study QOL and its associated factors. Results: The reported QOL before the operation has 52% of the patients showing negative QOL. Alternately, the reported QOL after the operation improved with 96% patients showing positive QOL. Among this sample, 76% reported suffering from CH post procedure, 28% were diagnosed with one or more mood disorders, and 20% were diagnosed with one or more anxiety disorders. No statistical relationship was found linking the QOL of the sample to the occurrence of CH or the presence of any common psychiatric disorder. Conclusions: In conclusion, there was a significant improvement in the patients’ QOL after BETS. The improvement in QOL was unaffected by the surgeries most notable complication, compensatory hyperhidro¬sis, or the presence of any common psychiatric disorder that they were diagnosed with post-surgery. Further research is needed to explore factors that may affect the QOL of these patients.

도시재생 지역 내 공동체 의식과 삶의 질의 관계에서 갈등대처의 조절효과

The purpose of this study was to explore the preferred parking solution model for residents of Yeonmu-dong, Suwon-si, Gyeonggi-do, in order to address conflicts arising from parking problems and to develop parking relief systems tailored to local characteristics. Yeonmu-dong is situated in an urban regeneration area within the old city center, characterized by low-rise residential density, a high percentage of elderly residents, and a significant number of long-term residents who have lived there for more than a decade. Our primary objective was to investigate whether conflict resolution strategies have a moderating impact on the relationship between residents' sense of community and their quality of life.&#x0D; To achieve our research objectives, we gathered academic literature related to urban regeneration, analyzed statistical data from public institutions, and conducted a survey of local residents. We then conducted statistical analysis, including descriptive statistics, group difference analysis, and hierarchical regression analysis, to analyze the survey data using SPSS 27 statistical techniques.&#x0D; The analysis revealed several key findings. Firstly, residents expressed a preference for parking solutions falling under the categories of 'citizen participation type' and 'existing facility utilization type' to alleviate parking space shortages. Some of the suggested alternatives included 'developing parking lots by purchasing old houses,' 'having parking facilities at home,' 'utilizing public facilities such as school playgrounds,' and 'making use of vacant land.' Secondly, although local residents exhibited a relatively high sense of community and employed positive conflict resolution methods, their overall quality of life was somewhat low. Lastly, the relationship between a positive sense of community and a negative quality of life was found to be influenced by the type of conflict resolution strategies employed.&#x0D; In conclusion, while the presence of a significant elderly population in the region can be advantageous, it is important to address the declining number of young residents, which can hinder regional development. Therefore, policies aimed at attracting younger individuals should be considered, along with initiatives to promote privately-led community councils. Furthermore, it was observed that a higher sense of community among local residents positively affects their quality of life. To enhance this effect, policy efforts should include providing conflict management education for local residents.

Time without Transfusion Reliance or Anemia Worsening: A Novel Method for Integrating Transfusion Dependence, Anemia, and Survival with Myelofibrosis Therapies Based on the Phase 3 Simplify-1 and Simplify-2 Trials

Introduction: While approved Janus kinase inhibitors (JAKi) have improved overall survival (OS) in myelofibrosis (MF), traditional survival analyses do not consider individual patient (pt) experience, which may be negatively impacted by factors such as persistent symptoms, adverse events (AEs), and red blood cell (RBC) transfusion dependence. In particular, RBC transfusions, an important component of anemia management in MF with currently approved JAKi, are associated with negative quality of life (QOL), increased healthcare resource utilization, and poor prognosis. Momelotinib (MMB), a JAK1/JAK2/activin A receptor type 1 inhibitor, has demonstrated consistent anemia benefits, including increased transfusion independence and reduced transfusion burden, as well as spleen and symptom improvements across 3 phase 3 trials in MF. In the SIMPLIFY-1 (NCT01969838) and SIMPLIFY-2 (NCT02101268) trials, achieving transfusion independence with MMB was associated with prolonged OS (Mesa R, et al. Leukemia. 2022). Here we apply time without transfusion reliance (TWiTR) analyses, integrating transfusion-dependent (TD) status and OS, to further characterize the benefits of MMB on survival quality. Methods: Analyses were performed in the safety populations, by treatment arm, over the randomized 24-wk treatment period of SIMPLIFY-1 (n/N=430/432; MMB vs ruxolitinib [RUX], JAKi naive) and SIMPLIFY-2 (N=156; MMB vs best available therapy [BAT; 88.5% RUX], JAKi experienced). TWiTR (Zeidner JF, et al. Haematologica. 2023) was based on the established time without symptoms and toxicity (TWiST) analysis, replacing toxicity with TD status. The analysis partitioned survival duration into 3 health states: (1) TD, defined as the number of days on which pts were TD (defined per protocol in the SIMPLIFY studies as requiring ≥4 units of RBC transfusions or having a hemoglobin level &amp;lt;8 g/dL in the previous 8 weeks) before experiencing a leukemia-free survival (LFS) event (leukemic transformation or death); (2) Post-LFS, defined as the number of days from an LFS event to death or censoring (OS; Post-LFS = OS − LFS); and (3) TWiTR, defined as the number of days without Post-LFS or TD (TWiTR = LFS − TD). An additional analysis incorporated the number of days on which pts had any-grade anemia events in the TD state (TD-Anemia [TD-An]) to define time without transfusion reliance or anemia worsening (TWiTR-An). Health state durations were estimated via Kaplan-Meier curves of the survival distribution function, with mean duration in each state calculated as the area under the curve. Results: In SIMPLIFY-1, pts in the MMB arm spent less time in the TD state and more time in the TWiTR state vs pts in the RUX arm (Figure 1). Mean duration in the TD state was 28.3 vs 62.7 days (difference with MMB, −34.4 days), while mean duration in the TWiTR state was 163.4 vs 131.1 days with MMB vs RUX (difference with MMB, 32.3 days). Fewer pts in the MMB arm had treatment-emergent anemia AEs, and incorporation of anemia events into the analysis increased the mean time spent in the TD-An state compared with the TD state in both treatment arms, although this increase was smaller in the MMB arm, at 32.0 vs 74.8 days in the RUX arm (difference with MMB, −42.8 days). Mean duration in the TWiTR-An state was 159.7 vs 119.0 days with MMB vs RUX (difference with MMB, 40.7 days). Similar results were observed in SIMPLIFY-2, although incorporating anemia events had less impact. Mean duration in the TD state was slightly shorter with MMB vs BAT, at 69.4 vs 89.9 days (difference with MMB, −20.5 days); mean duration in the TD-An state was 69.6 vs 89.9 days (difference with MMB, −20.3 days). Consistently, mean duration in the TWiTR state was slightly longer with MMB vs BAT, at 118.3 vs 95.9 days (difference with MMB, 22.4 days); mean duration in the TWiTR-An state was 118.0 vs 95.9 days (difference with MMB, 22.1 days). Conclusions: Pts treated with MMB spent less time reliant on RBC transfusions and more time free from transfusions and anemia events, without the cost of increased AEs, compared with those treated with RUX or BAT. Given the negative QOL and prognostic impact of RBC transfusion dependence, these analyses suggest that the anemia benefits of MMB lead to improved quality of survival for pts with MF.

How patients experience thyroid eye disease.

To determine the impact of thyroid eye disease (TED) on patients in various stages of the disease. TED is a debilitating and potentially sight-threatening inflammatory autoimmune disease that is frequently misdiagnosed. Challenging quality-of-life (QoL) issues can persist long after the active phase of disease has subsided. A 62-question survey was designed as a hypothesis-generating instrument to identify key issues confronting patients ≥18 years old with physician-diagnosed TED. Questions focused primarily on physical and emotional status, and QoL experiences in the 2 months prior to the survey. Data for individual questions are presented as summary statistics. Correlations between questions were determined using χ2 analyses. The 443 respondents were 18 to >80 years old; >90% female, and >80% from the United States. Time since TED diagnosis ranged from <1 year to >10 years. Participants provided >500 free-form responses describing experiences of living with TED. Physical signs/symptoms were experienced by 307/443 (69%) patients. Of those responding to the QoL questions (N = 394), 53 (13%) reported symptoms improving, 73 (19%) reported symptoms worsening, and 255 (65%) reported no change in the 2 months prior to the survey. The most bothersome signs/symptoms were dry/gritty eyes, light sensitivity, bulging eyes, and pressure or pain behind the eyes. Respondents <60 years were significantly (p < 0.0001) more likely to report symptomatic TED than older patients. Of 394 respondents, 179 (45%) reported feeling depressed and/or anxious, 174 (44%) reported concern about their appearance, and 73 (19%) avoided public situations; 192 (49%) reported declines in confidence or feelings of general well-being, and 78 (20%) reported an inability to achieve goals. Activities limited by TED included reading, driving, and socializing. The proportion of respondents experiencing these negative QoL measures was higher when patients reported experiencing >5 symptoms, had been diagnosed within the last 5 years, or were <60 years of age. Physical manifestations of TED impact QoL for patients through all phases of the disease. It is essential that physicians and healthcare professionals become more familiar with patient experiences such as those described here to better help patients manage their disease.

Quality of Life of Patients Who Have Suffered from Acute Cerebrovascular Accident (Investigation Based on EQ-5D-5L).

Acute cerebrovascular accident is known to be one of the main causes of morbidity, mortality, long-term disability, and disability in society. To investigate the quality of life of patients who have suffered from acute cerebrovascular accident (hereinafter ACVA) in stratified groups by age, gender, diagnosis, type (primary or secondary), and severity of a stroke, as well as undergoing rehabilitation. This research is a cross-sectional descriptive-analytical study. The main research method is a survey. Data collection was carried out in 2020 in Almaty of the Republic of Kazakhstan by inpatient doctors (City Clinical Hospital No. 5 of the Public Health Department of Almaty), engaged in the rehabilitation treatment of patients with acute cerebrovascular accident. The standardized questionnaire EQ-5D-5L was used to assess the quality of life due to health conditions. Data on the state of "mobility", "self-care", "daily activities", "pain", "anxiety", as well as data on self-assessment of health status (according to the EQ VAS scale) were analyzed using the Level Sum Scores (hereinafter LSS). The study involved 258 respondents who had a stroke. The survey was conducted 2 months after the respondents were discharged from the hospital. The average LSS index of patients who underwent ACVA was 10.2 (9.7±10.7). Significant differences in LSS levels ( P ≤ 0.001) were revealed by the severity of stroke and by the fact of rehabilitation. Differences in LSS levels by age, gender, diagnosis, and type of ACVA are insignificant (P > 0.05). The difference in health indicators of patients with primary and repeated strokes indicates the fact of deterioration in the quality of life with each subsequent stroke. The quality of life of patients with ACVA is associated with the fact of rehabilitation: low values of EQ VAS in the group of patients who did not undergo rehabilitation and high values of EQ VAS in those who underwent rehabilitation. After a stroke, the majority of patients tend to have a negative quality of life, mostly due to violations of the component "daily activities". The identified significant disparities in LSS and EQ VAS indicators further show that the quality of life varies among stratified groups. The kind (primary or secondary) and severity of the stroke, as well as the existence of rehabilitation, are indicators that impact the quality of life of patients who have had ACVA.

Relationship Between Sleep Quality and Quality of Life in Diabetic Ulcer Patients

Background: Diabetes mellitus (DM) is a significant prevalence that occurs making Indonesia ranked sixth in the world. Diabetes mellitus can totally affect the quality of life of diabetic patients with complications, ulcers are complications that affect the quality of life of DM patients. One of the factors that can affect the quality of life of DM patients is sleep quality. Purpose: Knowing the relationship between sleep quality and quality of life in patients with diabetic ulcers. Methods: This type of research is analytic research with a correlational design with a cross-sectional approach. The sampling technique in this study was total sampling with a sample size of 36 respondents. Data analysis using the Chi-square test. Results: It was found that there were 32 respondents (88.9%) experiencing moderate sleep quality and there were 30 respondents (83.3%) who had a negative quality of life. Results: statistical test of the relationship between sleep quality and quality of life showed a statistical test p value = 0.662 or a significance value&gt; a = 0.05, which means that there is no significant relationship between sleep quality and the quality of life of patients with diabetic ulcers. Conclusion: There is no relationship between sleep quality and the quality of life of patients with diabetic ulcers at the Griya puspa wound care clinic, Sleman Regency. Researchers suggest that respondents who have poor sleep quality are expected to improve their quality of life by improving physical health, leisure time, independence, managing emotions and performing good ulcer care.

Onychomycosis Treatment Prescribed at Only Twenty Percent of Visits: A Cross-Sectional Analysis of the National Ambulatory Medical Care Survey 2007 to 2016.

Onychomycosis represents the highest proportion of nail disorders seen in clinical practice. Onychomycosis management may differ amongst specialties, with impact on patient outcomes and quality of life (QoL). We aimed to characterize onychomycosis treatment across specialties, accounting for patient demographics, to assess for potential onychomycosis practice gaps. We conducted a population based cross-sectional analysis using the National Ambulatory Medical Care Survey (NAMCS) 2007 to 2016 (the most recent years available). Overall, 71.6% of onychomycosis visits were with general practitioners (GPs), 25.8% with dermatologists, and 2.58% with pediatricians. No onychomycosis treatment was prescribed at 82.0% of dermatology visits and 78.9% of GP visits. Dermatologists (Odds Ratio (OR):2.27 [95% Confidence Interval (CI):[2.14-2.41]; P&lt;0.0001) and GPs (OR:2.32 [2.21-2.44]; P&lt;0.0001) were more likely than pediatricians to prescribe treatment vs no treatment. Dermatologists were more likely than GPs to prescribe both no treatment vs treatment and topical vs oral antifungals (OR:1.33 [1.16-1.52]; P&lt;0.0001 and OR:4.20 [3.80-4.65]; P&lt;0.0001), respectively. Our study showed that there is a low treatment rate for onychomycosis, with treatment prescribed at only 20% of visits. Untreated onychomycosis might result in secondary infection, pain, and negative QoL impact.1 Although dermatologists are specialists in nail disease management, they saw only about 25% of onychomycosis visits. Future efforts should be directed towards promoting onychomycosis therapy, and educating both patients and referring physicians that dermatologists are primary resources for nail disorder treatment.J Drugs Dermatol. 2023;22(10):1040-1045 doi:10.36849/JDD.6770.

Discriminatory episodes negatively impact the quality of life of Brazilian dental students: A cross-sectional study.

This study aimed to evaluate whether discriminatory episodes occurring in the university environment were associated with dental students' self-perceived overall quality of life and assess the cumulative effect of perceived discriminatory experiences on the overall quality of life. In this cross-sectional study, all students enrolled in three Brazilian dental schools were invited to participate in a survey between August and October 2019. The outcome was students' self-perceived quality of life, measured through the overall quality of life item of the World Health Organization-Quality of Life Abbreviated Version (WHOQOL-BREF). Descriptive, bivariate, and multivariable logistic regression analyses (95% confidence intervals and α of 5%) were conducted using RStudio software. The sample was composed of 732 students (70.2% response rate). The great part was female (66.9%), white or yellow skin color (67.9%), and were children of highly educated mothers. About 68% of the students reported having experienced at least one of the seven discriminatory experiences presented in the questionnaire and 18.1% reported neutral or negative quality of life. In multivariable analyses, it was estimated that students who experienced at least one episode of discrimination were 2.54 times (95% CI: 1.47-4.34) more likely to report worse quality of life than their counterparts who reported no experience of discrimination. There was also a 25% (95% CI: 1.10-1.42) increase in the odds of reporting poorer quality of life for each additional discriminatory experience reported. Reporting at least one discriminatory situation in the academic environment was associated with worse quality of life among dental students, and a cumulative effect was also noted.

Effect of Dialectic Behavior Therapy on Self-conscious Emotions and Family Quality of Life in Mothers of Children with Intellectual Disability

Background and Aims having children with intellectual disability can cause psychological, emotional and social problems for the parents, especially mothers. The present study aims to examine the effect of dialectic behavior therapy (DBT) on self-conscious emotions and family quality of life (QoL) in mothers of children with intellectual disability. Methods This is a quasi-experimental study with a pre-test/post-test/ follow-up design. The study population consists of all mothers of children with intellectual disability in Ardebil, Iran in 2021. Of these, 37 were selected using a purposive sampling method and randomly divided into intervention and control groups. The mothers in the intervention group received eight sessions of DBT for two months. Tangney et al.’s test of self-conscious affect and the beach center family QoL scale were used in this study. The data were analyzed using mixed ANOVA. Results The DBT had a significant effect on positive self-conscious affect (F=75.20; Eta squared=0.68; P=0001), negative self-conscious affect (F=45.19; Eta squared =0.56; P=0001) and family QoL (F=71.74; Eta squared=0.67; P=0001) in mothers. Conclusion The DBT can improve self-conscious emotions and family QoL in mothers of children with intellectual disability by employing techniques such as distress tolerance, mindfulness, and emotional regulation.

Cancer-related fatigue and functional impairment: Retrospective study in patients with newly diagnosed solid-tumor cancer.

e24143 Background: Functional impairment (FI) and debilitating cancer-related fatigue (CRF) occur across all cancers with negative impact on quality of life (QoL). The nature of the association between CRF and FIs is unknown. We conducted a retrospective, single institutional study to investigate the association between CRF and FIs prior to treatment in newly diagnosed solid tumors within Levine Cancer Institute (LCI), a regional, multi-site cancer system. Methods: Electronic Distress Screening (EDS) and Cancer Registry databases from Jan 2017 to Jan 2022 were sourced. CRF was defined as fatigue (0-10 scale) ≥4. FIs were assessed using three EDS questions with a two-week recall: (1) how well have you been able to manage your day-to-day life? (PM); (2) has your physical health kept you from doing things like household chores or climbing stairs? (PHL); and (3) do you have limited movement (LM) in any of the following [body parts]? These are proxies for activities of daily living and instrumental activities of daily living. LCI patients aged ≥18 years with one cancer diagnosis within 10 years, completed EDS ±2 weeks of diagnosis, and before treatment were included. Proportions were compared using Fisher’s Exact test; multivariable logistic regression models evaluated the prognostic value of FIs on CRF. Results: 3439 unique patients were identified with strong associations between CRF and FIs. Median age was 62 years (18 to 97); 68% female and 78% White. The largest diagnostic groups were breast (30%), upper GI (17%), and gynecologic (16%); and 21% had stage IV disease. High CRF was reported by 57% (N = 1946) patients. FIs included: poor PM of day-to-day life, PHL, and ≥1 one body area of LM which were reported by 18% (N = 613), 19% (N = 648), and 29% (N = 982) respectively. More patients with FIs indicated CRF: PM 92% v. no PM 49% (P &lt; .01), PHL 92% v. no PHL 48% (P &lt; .01), and LM 75% v. no LM 49% (P &lt; .01). In multivariable modeling, all FIs were significantly associated with CRF. The Table outlines that all lower bounds of estimated 95% confidence intervals ratios associated with odds ratios were greater than 1.66 when adjusted for age at diagnosis, sex, race, diagnostic group, and advanced disease, highlighting that all are independently associated with CRF. Conclusions: FIs are highly associated with CRF prior to treatment for solid tumors in a large cohort of patients. Pre-diagnosis FI screening identifies patients at risk for significant CRF. Early CRF management is essential to reduce negative QoL impacts.[Table: see text]

Characterization of a chronic cough in cerebellar ataxia, neuropathy, vestibular areflexia syndrome.

Cerebellar ataxia with neuropathy and vestibular areflexia syndrome (CANVAS) is a common cause of late-onset ataxia that often presents with chronic cough. This study is the first to characterize the CANVAS cough both objectively and subjectively. A cross-sectional study of 13 patients was conducted. Medical records and available esophagram, modified barium swallow study, esophageal manometry, and video laryngostroboscopy data were reviewed. Leicester cough questionnaire (LCQ) and Eating Assessment Tool-10 were administered to evaluate quality of life (QoL) impairments and dysphagia symptoms, respectively. CANVAS history questionnaire was developed to characterize the clinical course. 92% of patients endorsed chronic cough that preceded gait instability by a median of 16 years. Cough was dry (67%), disturbed sleep (75%), triggered by various factors, including talking, eating, and dry/spicy foods, did not respond to standard reflux therapy, and inconsistently responded to neuromodulators and superior laryngeal nerve injections. Despite perceived cough severity worsening or remaining constant in most patients, no correlation was found between cough duration and total LCQ scores. Patients reported significantly more negative social QoL impacts compared to physical QoL impacts. Ataxia duration and years of cough before ataxia symptoms were directly and inversely correlated with total LCQ scores, respectively. Imaging data revealed esophageal dysmotility (71%), vestibular penetration (57%), vestibular aspiration (14%), supraglottic compression (63%), vocal fold lesions/atrophy (50%), and arytenoid erythema (38%). Chronic cough is a hallmark presenting symptom in CANVAS with predominantly psychosocial QoL effects and unrecognized laryngeal alterations. In cases of idiopathic, refractory chronic cough, genetic testing for CANVAS should be considered, especially in association with sensory, cerebellar, and/or vestibular involvement. VI.

Evaluation of quality of life (QOL) of young patients with primary hyperhidrosis (PH) before and after endoscopic thoracic sympathectomy (ETS)

Primary hyperhidrosis (PH) affects young patients and may cause emotional distress and a negative quality of life (QOL). We sought to evaluate the QOL of children and adolescents with PH treated by endoscopic thoracic sympathectomy. A study of 220 patients was performed, based on submitted QOL questionnaires from their first consultation. Patients were evaluated within 1week and 24months after surgery. Before endoscopic thoracic sympathectomy, the QOL in relation to PH was declared very poor by 141 patients, and poor by the remaining 79 (P=.552). Postoperative cure was reported in 100% of palmar and axillary PH cases, and in 91.7% of facial PH. After 24months, the QOL was described as much better by 212 patients, a little better by 6 patients, and 2 patients reported no change. Convenience sampling was used and patients were taken from private practice only, raising the possibility of bias in gathering the data. Onset of PH symptoms was mainly before the age of 10years and substantially affected daily activities. Endoscopic thoracic sympathectomy cured PH and promoted significant improvement in the QOL of these young patients.

Impact of (recurrent) bacterial vaginosis on quality of life and the need for accessible alternative treatments

BackgroundBacterial vaginosis (BV) is one of the most common vaginal dysbiosis in women aged 15–44 years old.MethodsWe administered a cross-sectional, single timepoint survey to women ages 18 years or older and who have had bacterial vaginosis (BV). Women completed an anonymous online survey evaluating the impact of BV on their quality of life, how effective different types of treatments were and the amount of self-diagnosed vs. provider diagnosed BV episodes they had.Results62 participants completed the anonymous online survey. With a self-reported median number of BV episodes in the past year was 4 (IQR 1–7). Among these women 69.8% reported BV had a negative impact on their sexual health, 67.7% on their physical health, 74.6% on their mental health. More than half of the respondents had used probiotics with oral Lactobacillus sp. (53.2%), mainly by oral route, and over a third had used vaginal boric acid (37.1%). Most women were unaware of Lactobacillus crispatus. Lactobacillus probiotics were more likely to be tried by women who were negatively impacted by BV for overall quality of life (p = 0.033), sexual health (p = 0.002), and mental health (p = 0.006) while boric acid use was more likely to be used by women who were negatively impacted by BV for their sexual health (p = 0.008).ConclusionsBV is associated with negative quality of life and the women most impacted are seeking alternative treatments such as probiotics (Lactobacillus) and boric acid. There needs to be improvements in BV treatment that include alternative therapy options that have demonstrated efficacy with standardized composition, formulation and dosage.

Navigating the Unforeseen: Perceptions of Quality of Life While Working from Home in the United States During the COVID-19 Pandemic

&lt;i&gt;Social distancing requirements resulted in many people working from home in the United States during the COVID-19 pandemic. The topic of working from home was often discussed in the media and online during the pandemic, but little was known about how quality of life (QOL) and remote working interfaced. The purpose of this study was to describe QOL while working from home during the COVID-19 pandemic. The novel topic, unique methodological approach of the General Online Qualitative Study (D’Abundo &amp;amp; Franco, 2022a), and the strategic Social Distancing Sampling (D’Abundo &amp;amp; Franco, 2022c) resulted in significant participation throughout the world (n = 709). The United States subset of participants (n = 169) is the focus of this article. This big qual (Brower et al., 2019), large qualitative study (n &amp;gt;100) included the principal investigator-developed open-ended, online questionnaire entitled the “Quality of Life Home Workplace Questionnaire (QOLHWQ),” and demographic questions. Data were collected from July to September 2020 (during the height of the COVID-19 pandemic). Data analysis included open coding and categorical analysis resulting in the categories of positive, negative, both positive and negative, and neutral experiences with QOL while working from home. More participants cited increased QOL due to having more free time, less stress, and less commuting to work. The most cited issue associated with negative QOL was social isolation. As the post-peak era of the COVID-19 pandemic continues and the potential for future public health emergencies requiring social distancing exists, the findings from this study provide an important baseline understanding of remote working in the United States during the COVID-19 pandemic. As working from home either full-time or part-time becomes more common, implications of this research are likely applicable beyond the era of the COVID-19 pandemic. To promote QOL and work-life balance for employees working remotely in the United States, stakeholders may want to develop social support networks and create effective planning initiatives to prevent social isolation and maximize the benefits of remote working experiences for both employees and organizations.&lt;/i&gt;