Loss In Quality Of Life Research Articles

A Systematic Review of Traumatic Brain Injury in Modern Rodent Models: Current Status and Future Prospects.

According to the Centers for Disease Control and Prevention (CDC), the national public health agency of the United States, traumatic brain injury is among the leading causes of mortality and disability worldwide. The consequences of TBI include diffuse brain atrophy, local post-traumatic atrophy, arachnoiditis, pachymeningitis, meningocerebral cicatrices, cranial nerve lesions, and cranial defects. In 2019, the economic cost of injuries in the USA alone was USD 4.2 trillion, which included USD 327 billion for medical care, USD 69 billion for work loss, and USD 3.8 trillion for the value of statistical life and quality of life losses. More than half of this cost (USD 2.4 trillion) was among working-age adults (25-64 years old). Currently, the development of new diagnostic approaches and the improvement of treatment techniques require further experimental studies focused on modeling TBI of varying severity.

Quality of life, disease burden and healthcare need of patients with vitiligo

With aprevalence of 0.5-2%, vitiligo is one of the most common skin disorders worldwide with loss of pigment. The skin disease has adisfiguring, often stigmatising character and is often associated with psychosocial distress. To provide an overview of the psychosocial impairment, disease burden and resulting health care needs of patients with vitiligo. Narrative review based on aliterature search in PubMed for the years 1996-2022 on disease burden, quality of life and stigmatization is provided. The search yielded 175 relevant original papers including clinical studies, meta-analyses and systematic reviews (n = 65) for the search period. Alarge number of studies document that vitiligo is associated with considerable psychosocial stress and relevant losses in quality of life. Problem areas particularly concern stigmatisation, sexual dysfunction, anxiety, reduced self-esteem and problems at work. The observed increased levels of anxiety and depression correlate with the severity and activity of vitiligo. Often, comorbidity also contributes to reduced self-esteem and social isolation. These factors determine ahigh need for care in arelevant proportion of those affected. Vitiligo is not primarily acosmetic problem, but adisease requiring treatment according to the World Health Organisation's definition of health as physical, mental and social well-being. The benefits of treatment options are to be measured by their effects on patient-reported outcomes.

Surgical site infection after trochanteric and subtrochanteric fractures: a single centre retrospective analysis

Surgical site infection (SSI) following osteosynthesis of trochanteric or subtrochanteric fractures is a rare but serious complication with incidence rate ranging from 1 to 3%. SSIs are associated with higher mortality and increased length of hospital stay resulting in higher healthcare costs and loss of life quality. In this retrospective analysis all patients with SSI following osteosynthesis of trochanteric or subtrochanteric fractures at the Department of Trauma Surgery were identified. We included all surgical procedures performed from 1992 to 2018, using data from electronic health records and SSI-Trauma-Registry. The aim was to describe epidemiological data, as well as to identify parameters correlating with the occurrence of SSI and mortality. Of 2753 patients, 53 (1.9%) developed SSI. Longer operative time was demonstrated among patients with SSI (P = 0.008). Mortality during the first postoperative year was significantly higher in the SSI group (32.1% vs. 19.1%; P = 0.018), with detection of methicillin-sensitive (MSSA) and methicillin-resistant Staphylococcus aureus (MRSA; HR 4.13, CI 95% 1.24–13.80; P = 0.021) or Enterococcus spp. (HR 5.58, CI 95% 1.67–18.65; P = 0.005) being independent risk factors. Male sex (HR 2.25, 95% CI 1.86–2.73; P < 0.001) and higher mean age (HR 1.05, 95% CI 1.04–1.06; P < 0.001) were found to be predictors for 1-year mortality in non-infected patients. SSI rate was low with 1.9% and longer duration of surgery was associated with infection. Patients with SSI had a higher 1-year mortality, with detection of MSSA, MRSA and enterococci significantly increasing the risk of dying. Male sex and higher age were risk factors for one-year mortality in patients without SSI.

COL11A1 is associated with developmental dysplasia of the hip and secondary osteoarthritis in the HUNT study

ObjectiveDevelopmental dysplasia of the hip (DDH) is a congenital condition affecting 2–3% of all infants. DDH increases the risk of osteoarthritis, is the cause of 30 ​% of all total hip arthroplasties (THAs) in adults <40 years of age and can result in loss of life quality. Our aim was to explore the genetic background of DDH in order to improve diagnosis, management and longterm outcome. DesignWe used the large, ongoing, longitudinal Trøndelag Health Study (HUNT) database. Case definition was based on ICD-9/-10 diagnoses of DDH, or osteoarthritis secondary to DDH. Analyses were performed using SAIGE software, with covariates including sex, batch, birth year and principal components. We included only single nucleotide polymorphisms (SNPs) with minor allele frequency (MAF) ≥ 0.01, R2≥ 0.8 and Hardy-Weinberg equilibrium (HWE) P-value ≥ 0.0001. Significance level was set at p ​< ​5 ​× ​10−8. Meta-analysis using data from DDH and primary osteoarthritis genome-wide association studies (GWASs) was done using METAL software. The study was approved by the regional ethical committee. ResultsAnalysis included 69,500 individuals, of which 408 cases, and 8,531,386 SNPs. Two SNPs near COL11A1 were significantly associated with DDH; rs713162 (β ​= ​−0.43, SE ​= ​0.07, p ​= ​8.4 ​× ​10−9) and rs6577334 (β ​= ​−0.43, SE ​= ​0.08, p ​= ​8.9 ​× ​10−9). COL11A1 has previously been associated with acetabular dysplasia and osteoarthritis. Meta-analysis supported previous GWAS findings of both DDH and primary osteoarthritis. ConclusionsThis large, genome-wide case-control study indicates an association between COL11A1 and DDH and is an important contribution to investigating the etiology of DDH, with further research needed.

Subjective burden of government-imposed Covid-19 restrictions in Switzerland: Evidence from the 2022 LINK Covid-19 survey.

While a large literature has quantified the health and economic impact of COVID-19, estimates on the subjective losses in quality of life due to government imposed restrictions remain scarce. We conducted a nationally representative online survey in Switzerland in February 2022 to measure average self-reported quality of life with government restrictions. We used a discrete choice experiment to compute average willingness to pay for avoiding specific restrictions and time-trade-off questions to quantify the relative quality of life under restrictions. A total of 1299 Swiss residents completed the online survey between February 9th and 15th, 2022. On average, respondents valued life under severe restrictions at 39% of their usual life (estimated relative utility 0.39 [0.37, 0.42]). Willingness to pay for avoiding restrictions was lowest for masks (CHF 663 [319, 1007]), and highest for schools and daycares (CHF 4123 [3443, 4803]) as well as private parties (CHF 4520 [3811, 5229]). We estimate that between March 2020 and February 2022 a total of 5.7 Million QALYs were lost due to light, moderate and severe restrictions imposed by the governments. The quality of life losses due to government restrictions are substantial, particularly when it comes to the closure of schools and daycares, as well as the prohibition of private gatherings. Future policies should weigh these costs against the health benefits achievable with specific measures.

Cost–utility analysis of tapering strategies of biologicals in rheumatoid arthritis patients in the Netherlands

ObjectivesCurrent guidelines recommend tapering biological disease-modifying antirheumatoid drugs (bDMARDs) in rheumatoid arthritis (RA) if the disease is under control. However, guidelines on tapering are lacking. Assessing cost-effectiveness of different tapering...

DETECT: DEveloping and testing a model to identify preventive vision loss among older paTients in gEneral praCTice – protocol for a complex intervention in Denmark

IntroductionThe number of people living with visual impairment is increasing. Visual impairment causes loss in quality of life and reduce self-care abilities. The burden of disease is heavy for people...

Foodborne disease outbreaks in flour and flour‐based food products from microbial pathogens in the United States, and their health economic burden

The most comprehensive and inclusive estimates for the economic burden of foodborne illness yield values as high as $97.4 billion USD annually. However, broad incidence and cost estimates have limited use if they cannot be attributed to specific foods, for the purposes of food safety control. In this study, we estimated the economic burden of foodborne illnesses resulting from flour and flour-based food products in the United States from the years 2001 to 2021. The outbreak, illness burden, and health economic data are combined to generate these estimates. Our model combined outbreak data with published Centers for Disease Control and Prevention multipliers to estimate the annual number of illnesses associated with flour-borne pathogens. We then integrated illness severity data with an updated economic model that accounts for costs related to medical care, productivity loss, loss of life, along with the quality of life loss that entails pain and suffering. In total, 752 cases and 223 hospitalizations from flour-related illnesses were reported from 2001 to 2021, with an average of 37.6 cases of reported cases annually. However, the actual number of cases, accounting for underreporting and underdiagnosis, can be as high as 19,440 annually. Pathogens involved in these outbreaks are Salmonella, E. coli O157:H7, and E. coli O121. Our estimates suggest average annual economic losses, including healthy years of life lost, of $108 and $258 million using two alternative models.

Cost-effectiveness of the implementation of [68Ga]Ga-PSMA-11 PET/CT at initial prostate cancer staging

BackgroundDespite its high specificity, PSMA PET/CT has a moderate to low sensitivity of 40–50% for pelvic lymph node detection, implicating that a negative PSMA PET/CT cannot rule out lymph node metastases. This study investigates a strategy of implementing PSMA PET/CT for initial prostate cancer staging and treatment planning compared to conventional diagnostics. In this PSMA PET/CT strategy, a bilateral extended pelvic lymph node dissection (ePLND) is only performed in case of a negative PSMA PET/CT; in case of a positive scan treatment planning is solely based on PSMA PET/CT results.MethodA decision table and lifetime state transition model were created. Quality-adjusted life years and health care costs were modelled over lifetime.ResultsThe PSMA PET/CT strategy of treatment planning based on initial staging with [68Ga]Ga-PSMA-11 PET/CT results in cost-savings of €674 and a small loss in quality of life (QoL), 0.011 QALY per patient. The positive effect of [68Ga]Ga-PSMA-11 PET/CT was caused by abandoning both an ePLND and unnecessary treatment in iM1 patients, saving costs and resulting in higher QoL. The negative effect was caused by lower QoL and high costs in the false palliative state, due to pN1lim patients (≤ 4 pelvic lymph node metastases) being falsely diagnosed as iN1ext (> 4 pelvic lymph node metastases). These patients received subsequently palliative treatment instead of potentially curative therapy.ConclusionInitial staging and treatment planning based on [68Ga]Ga-PSMA-11 PET/CT saves cost but results in small QALY loss due to the rate of false positive findings.

COVID-19 Pandemic Impact on US Childhood Caries and Potential Mitigation

Non-Hispanic Black (NHB) and Hispanic and low-income US children have a higher prevalence of untreated caries than their higher-income and non-Hispanic White (NHW) counterparts. Due to the COVID-19 pandemic, many dental offices and school sealant programs closed beginning March 2020. We examine the effect of reduced access to restorative care and sealants on the oral health of children from low-income households overall and by race/ethnicity and how increased sealant delivery in September 2022 could mitigate these effects. We used Markov chain Monte Carlo simulation to model COVID-19’s impact on first permanent molar (1M) caries incidence and loss in quality of life (disability-adjusted life years [DALYs]) due to time lived with 1M untreated caries. Our model followed a cohort of children aged 7 y in March 2020 until February 2024. Model inputs were primarily obtained from published studies and nationally representative data. Excess DALYs per 1,000 children attributable to reduced access to care during the pandemic were 1.48 overall and greater for Hispanic (2.07) and NHB (1.75) children than for NHW children (0.94). Excess incidence of 1M caries over 4 y was 2.28 percentage points overall and greater for Hispanic (2.63) and NHB (2.40) children than for NHW (1.96) children. Delivering sealants to 50% of eligible 1Ms in September 2022 would not completely mitigate COVID-19’s health access impact: overall excess DALYs would decrease to 1.05, and absolute disparities in excess DALYs between NHW children and Hispanic and NHB children would remain but decrease by 0.38 and 0.33, respectively. Sealing 40% of eligible 1Ms, however, would bring overall 4-y caries incidence down to pre–COVID-19 levels and eliminate the differential effect of the pandemic on children from minority groups. The pandemic’s negative impact on the oral health of children from low-income households and increased disparities could be partially mitigated with increased sealant delivery.

Sleep-disordered breathing-Update 2021

HintergrundSchlafbezogene Atmungsstörungen (SBAS) und andere Schlafstörungen sind sehr häufige Erkrankungen, die zu erheblichen Einbußen hinsichtlich der Lebensqualität, Arbeitsfähigkeit und Prognose beitragen können.FragestellungWelche neuen Erkenntnisse gab es in der Schlaf- und Beatmungsmedizin zwischen November 2019 und Oktober 2021, die die Versorgung von Patienten mit SBAS maßgeblich beeinflussen?Material und MethodenEs wurde eine systematische Literaturrecherche im Zeitraum November 2019 bis Oktober 2021 und eine Auswahl der relevantesten Artikel durchgeführt.ErgebnisseDie für die Versorgung von Patienten mit SBAS relevantesten Ergebnisse waren: 1) Eine Therapie mit Continuous Positive Airway Pressure (CPAP) kann zwar bei Patienten mit SBAS den arteriellen Blutdruck senken, führt aber bei a‑ oder oligosymptomatischen Patienten und SBAS zu keiner Reduktion des Risikos für Myokardinfarkt oder Schlaganfall. 2) Nachdem in den letzten Jahren die Wirksamkeit der Unterkieferprotrusionsschienen (UKPS) bei ausgewählten Patienten mit obstruktiver Schlafapnoe (OSA) gezeigt wurde, sind UKPS seit 2021 als Secondline-Therapie nach CPAP auch erstattungsfähig. 3) Solriamfetol und Pitolisant wurden durch die Europäische Arzneimittelbehörde (EMA) für die Indikation der residualen Tagesschläfrigkeit bei Patienten mit OSA zugelassen. 4) Telemedizinische Verfahren können in der Langzeitbetreuung von Patienten mit SBAS hilfreich sein.SchlussfolgerungenDie diskutierten Studien liefern für die Versorgung von Patienten mit SBAS relevante Ergebnisse.

Development of a decision analytical framework to prioritise operating room capacity: lessons learnt from an empirical example on delayed elective surgeries during the COVID-19 pandemic in a hospital in the Netherlands

ObjectiveTo develop a prioritisation framework to support priority setting for elective surgeries after COVID-19 based on the impact on patient well-being and cost.DesignWe developed decision analytical models to estimate the...

Health care cost of crusted scabies in Aboriginal communities in the Northern Territory, Australia.

BackgroundCrusted scabies is a debilitating dermatological condition. Although still relatively rare in the urban areas of Australia, rates of crusted scabies in remote Aboriginal communities in the Northern Territory (NT) are reported to be among the highest in the world.ObjectiveTo estimate the health system costs associated with diagnosing, treating and managing crusted scabies.MethodsA disease pathway model was developed to identify the major phases of managing crusted scabies. In recognition of the higher resource use required to treat more severe cases, the pathway differentiates between crusted scabies severity grades. The disease pathway model was populated with data from a clinical audit of 42 crusted scabies patients diagnosed in the Top-End of Australia’s Northern Territory between July 1, 2016 and May 1, 2018. These data were combined with standard Australian unit costs to calculate the expected costs per patient over a 12-month period, as well as the overall population cost for treating crusted scabies.FindingsThe expected health care cost per patient diagnosed with crusted scabies is $35,418 Australian dollars (AUD) (95% CI: $27,000 to $43,800), resulting in an overall cost of $1,558,392AUD (95% CI: $1,188,000 to $1,927,200) for managing all patients diagnosed in the Northern Territory in a given year (2018). By far, the biggest component of the health care costs falls on the hospital system.DiscussionThis is the first cost-of-illness analysis for treating crusted scabies. Such analysis will be of value to policy makers and researchers by informing future evaluations of crusted scabies prevention programs and resource allocation decisions. Further research is needed on the wider costs of crusted scabies including non-financial impacts such as the loss in quality of life as well as the burden of care and loss of well-being for patients, families and communities.

Costs of common perinatal mental health problems in South Africa

Perinatal mental health problems, defined as mental health problems occurring from the start of pregnancy to one year after birth, substantially affect women's and children's quality of life in low- and middle-income countries. In South Africa, despite high prevalence and documented negative impacts, most women do not receive any care. A modelling study examined the costs of perinatal mental health problems, namely depression and anxiety, for a hypothetical cohort of women and their children in South Africa over part of their life course (10 years for women, 40 years for children). In sensitivity analysis, additional impacts of post-traumatic stress disorder (PTSD) and completed suicide were included. Data sources were published findings from cohort studies, as well as epidemiological and economic data from South Africa. Data from international studies were considered where no data from South Africa were available. Lifetime costs of perinatal depression and anxiety in South Africa amount to USD 2.8 billion per annual cohort of births. If the impacts of PTSD and suicide are included, costs increase to USD 2.9 billion. This includes costs linked to losses in quality of life (USD 1.8 billion), losses in income (USD 1.1 billion) and public sector costs (USD 3.5 million). Whilst important progress has been made in South Africa with regards to mental health policies and interventions that include assessment and management of perinatal mental health problems, substantial underinvestment prevents progress. Findings from this study strengthen the economic case for investing in perinatal mental health care.

RF Coil Setup for 31P MRSI in Tongue Cancer in vivo at 7 T.

Surgery for tongue cancer often results in a major loss in quality of life. While MRI may be used to minimise the volume of excised tissue, often the full tumour extent is missed. This tumour extent may be detected with metabolic imaging. One of the main reasons for the lack of metabolic information on tongue cancer would be the absence of an x-nuclear coil with the tongue as a focus target. Metabolic MRI through 31P MRSI is known as a powerful tool to non-invasively study elevated cell proliferation and disturbed energy metabolism in tumours. Severe magnetic field non-uniformities are inherently caused by the substantial difference in magnetic susceptibilities of tissue and air in the mouth and its environs. Despite this, the wide chemical shift dispersion of 31P could still facilitate precise detection of the cell proliferation biomarkers, phospomonoesters and diesters, as well as energy metabolites ATP, inorganic phosphate, and phosphocreatine potentially mapped over the tongue or tumour in vivo. In this study, we present the first 31P MRSI data of the human tongue in vivo from healthy volunteers and a patient with a tongue tumour at 7 T MRI using a 1H 8-channel transceiver setup placed inside a body 31P transmitter, which is able to get a uniform excitation from the tongue while providing comfortable access to the patient. In addition, a user-friendly external 31P receiver array is used to provide high sensitivity (80%) comparable to an uncomfortable inner mouth loop coil positioned on the tongue. The primary aim is the demonstration of 31P metabolite profiles in the tongue and the differences between healthy and malignant tissue. Indeed, clear elevated cell proliferation expressed as enhanced phosphomonoesters is observed in the tumour vs. the healthy part of the tongue. This can be performed within a total scan duration of 30 min, comparable to clinical scans, with a spatial resolution of 1.5 cm for the 10-min 31P MRSI scan.

Effects of Antimomium crudum 30cH and 200cH on the macrophage – Leishmania (L) amazonensis relation in vitro

Background: Leishmaniasis is a chronic skin and systemic disease, whose treatment is related to important side effects and loss of life quality. In previous results [1], mice treated with Antimonium crudum (AC) 30cH presented reduction in local inflammatory process and modulation of B1 cell-phagocyte differentiation and migration, but also increase of free amastigotes number among the surrounding tissue. Aims: To know the mechanisms involved, a series of in vitro studies was done, using co-cultures of macrophages (RAW 264.7) and Leishmania (L.) amazonensis treated with AC 30cH and 200cH, in different times. Methodology: The morpho-functional features of macrophages (spreading, phagocytosis and oxidative activity), the number of free promastigotes in the supernatant and the cytokines measurement were evaluated. The spreading and phagocytosis assays were performed in quadruplicate, in three experiments, resulting in 12 datapoints for each dilution/time. Kruskal Wallis (for no parametric variables) and two-way ANOVA test (for parametric variables) were used to verify time to time differences and the interaction between treatment and time respectively, being p≤0.05 considered significant. Animals were not used in this study. Results: The treatment with AC 30cH and AC 200cH resulted in significant but transitory increase in spreading and phagocytosis activity after 2 to 24 hours of incubation, followed by increase in the number of free promastigotes in the supernatant (in AC 30cH treatment) and decrease in CD86 expression (in AC 200cH treatment). GMCSF, alpha-INF, IL1, IL6, IL10 and IL12 were reduced after 48 to 72 hours and CCL4 and RANTES were reduced after 120H, for both potencies. Two peaks of CCL2 were seen in Leishmania sp infected macrophages, at 24 and 120 hours, but only AC30cH inhibited them. A peak of VEGF was observed after 120 hours following the treatment with AC 200cH, together with the increase in the number of multinucleated cells. The morphology of macrophages at fluorescence microscopy after the staining with acridine orange in fresh unfixed cells showed severe reduction of acid vacuoles in AC 30CH treated cells at 2 hours of parasite-macrophage interaction, revealing possible macrophage anergy. No difference in peroxide / NO production and in apoptosis percentage of free promastigotes was seen among groups, in all evaluated times. Conclusions: Both potencies were able to decrease most of cytokines production, specially CCL2 in AC 30cH treated cells, which explains the inhibition of monocyte migration seen in vivo [1]. The late peak of VEGF observed in AC 200cH treated cells suggests a M1 - M2 polarization, whose biological meaning is still under discussion.&#x0D; &#x0D; Acknowledgements: CAPES, UNIP, FAPESP (2014/00967-1)&#x0D;  &#x0D; References&#x0D; Rodrigues de Santana F, de Paula Coelho C, Cardoso TN, Perez Hurtado EC, Roberti Benites N, Dalastra Laurenti M, Villano Bonamin L. Modulation of inflammation response to murine cutaneous Leishmaniasis by homeopathic medicines: Antimonium crudum 30cH. Homeopathy, 2014;103(4):264-74. doi: 10.1016/j.homp.2014.08.006.

Cardiorespiratory Fitness And Risk Of Brain Cancer

PURPOSE: Brain cancer although uncommon, leads to significant loss in quality of life due to disability and has a high mortality. While prior studies have revealed the cardiorespiratory fitness (CRF) as a risk factor to cancer incidence, such studies specific to brain cancer does not exist due to its rarity. Since CRF is an objective marker of recent physical activity habits and less prone to misclassification, we aimed to assess the relationship between CRF and risk of brain cancer across age groups in a large (N = 580,559) retrospective study. METHODS: Male (N = 542,104) and female (N = 38,455) US Veterans (age 61.3 ± 9.5) completed a symptom-limited exercise treadmill test (ETT) between 1999-2020. None had a history of brain cancer prior to ETT. We established four CRF categories based on age-specific quartiles of peak metabolic equivalents achieved: Least-Fit (n = 122,905); Low-Fit (n = 202,774); Moderate-Fit (n = 116,390); and High-Fit (n = 138,490). Multivariable Cox models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for brain cancer events across CRF categories. RESULTS: During the follow-up period (median = 8.8 years), 813 individuals (age: 63.3 ± 8.3) developed brain cancer (15 events/100,000 person years of observation) at least one-year post-ETT. After adjustment for age, gender, race, body mass index and smoking, the risk of brain cancer was inversely related to CRF. Brain cancer risk was 7% lower for each 1-MET increase in exercise capacity. When CRF categories were considered, comparisons to the Least-Fit category (referent) revealed that Low-Fit individuals had a 30% lower risk of developing brain cancer (HR 0.70; 95% CI: 0.58-0.83). For Moderate-fit, and High-fit individuals the risk was lower by 33% (HR 0.67; 95% CI: 0.55-0.83); and 38% (HR 0.62; 95% CI: 0.50-0.75), respectively. CONCLUSIONS: We observed an inverse and graded association between CRF and brain cancer incidence. These findings suggest that increased physical activity may provide protection against brain cancer and underscore the importance of promoting physical activity for the public.

Adherence to Guideline-Oriented Preventive Measures in Patients with Atopic Dermatitis in Germany

Background: Atopic dermatitis (AD) is a chronic inflammatory skin disease that is often associated with comorbidities and quality of life losses. The implementation of evidence-based preventive measures strengthens patient participation and offers the potential to improve quality of care for AD. Objectives: To assess adherence to guideline-oriented preventive measures in adult patients with AD in dermatological routine care in Germany. Methods: The self-responsible application of preventive measures, clinical features, pruritus, disease severity, and duration of disease as well as skin disease-related quality of life were assessed in two independent cross-sectional studies in 2010 and 2017–2019. Results: Between 2017 and 2019, 706 patients (55.8% female, mean age 41 years) were recruited in a comparable way to the survey in 2010 with 1,678 patients (60.5% female, mean age 38 years). Regular skin care was applied by 99.5% (2010: 94.9%), 90.9% avoided skin irritants (2010: 84.6%), and 80.2% (2010: 61.6%) did not smoke at home. Relaxation techniques were applied by 44.4% (2010: 29.9%). Advice on self-help measures was taken by 36.4% (2010: 27.1%) and 29.2% (2010: 15.4%) attended AD patient education courses. All six preventive measures categorized as obligatory were performed by 13.9% of the patients (2010: 6.7%). Predictors for the number of obligatory preventive measures applied were a high level of education, a longer disease duration, and a lower quality of life. Conclusions: Although the self-reported use of evidence-based preventive measures in the 2017–2019 study appears to be more frequent than in 2010, important measures are still insufficiently established. Hence, more implementation, including education, is needed to increase the use of guideline-oriented preventive measures.

Quality of life in enuretic children.

ABSTRACTIntroduction:Nocturnal enuresis is a highly incident chronic disorder that generates countless problems to the child and their parents. Bed-wetting has significant negative impacts on self-esteem and the performance of children. The aim of the current study is to assess the quality of life of enuretic children, as well as its association to sex and age.Patients and Methods:Thirty-nine enuretic children (23 boys) and 49 healthy children (27 boys) without any history of previous treatment for enuresis or voiding dysfunction were included. Age ranged between 6 and 11 years old. The “AUQEI” questionnaire was applied in a private environment to all children by the same researcher (psychologist) to evaluate quality of life.Results:Enuretic children displayed loss in quality of life when compared to non-enuretic (35.9% of enuretic x 16.3% of non-enuretic, p=0.035). They were mostly affected in their daily activities (p=0.02). No significant differences were found in the association of sex and gender with quality of life. These results suggest that, children with nocturnal enuresis have 2.87 times more chances of having loss in quality of life compared to non-enuretic.Conclusions:Enuresis has a great impact in quality of life of children. This impact is not related to the age or sex of the child.

Does Submandibular Gland Sacrificing Neck Dissection Decrease Salivary Output and Quality of Life?

Purpose: Our study aimed to quantify the impact of submandibular gland (SMG) resection during Level I neck dissection (ND) on stimulated salivary output (SSO) and xerostomia-related quality of life in patients with head and neck cancer (HNC). Methods: A retrospective cohort was formed from 32 patients that underwent unilateral or bilateral Level I ND and a control group of 23 patients that had level II–IV ND. SSO (Saxon test) and University of Washington Quality of Life survey results for both groups were compared. Results: Mean SSO was 3.41 g in the SMG resection group and 3.86 g in the control group, with no significant statistical difference. There was no difference in mean SSO between patients with 2 SMGs, a single remaining SMG, or no glands. The mean SSO of SMG resection cases with a history of adjuvant RT was 2.61 g which was below the xerostomia threshold for the Saxon test (2.75 g) and control group patients with RT had a significantly higher mean SSO (4.07 g). The lowest UW-QoL saliva domain score average (53.8) was in the SMG-resected, RT-positive group. Conclusion: Results indicate unilateral or bilateral resection of SMG does not reduce SSO to a significant extent. Adjuvant radiotherapy and SMG resection are additive risk factors for xerostomia and the related loss in quality of life. SMG sparing may be necessary in HNC patients with higher risk for the need of adjuvant radiation.