Quality Health Research Articles

Two Side of the Same Coin: Accessibility and affordability for healthcare in Sabah

This article is to identify the level of accessibility and affordability of people in Sabah for quality healthcare. In-depth interviews were conducted with eight informants through qualitative research, and it is found that accessibility issue is very crucial which is due to more cost for travelling and ultimately related to affordability. Various initiatives require commitment from the government and community yet to be effective due to budget constraint, lack of awareness and community ability. All parties concern in healthcare needs to work as a team in ensuring that no one is left out from quality healthcare to achieve sustainable development goal of 2030.

Analysis of the National Formulary Drug Supply Chain with Its Availability in the Pharmacy Installation of the Government General Hospital (RSUD) Dr. Sitanala Tangerang City

This study explores the pharmaceutical supply chain management of the National Formulary at RSUP Dr. Sitanala in Tangerang City, aiming to identify obstacles to drug availability and formulate effective and efficient solutions. Acknowledging quality healthcare as a fundamental human right and a critical investment for a nation's future, this research emphasizes the importance of high-quality healthcare services. These services encompass not only treatment but also health promotion and disease prevention through the adoption of clean and healthy living habits. Drug availability is a major pillar in the provision of quality healthcare services. Effective and efficient management of the pharmaceutical supply chain, particularly regarding National Formulary drugs, is crucial in ensuring the availability of medications at healthcare facilities. This research employs a comprehensive analysis of the supply chain processes at RSUP Dr. Sitanala, examining stages such as drug selection, demand planning, procurement, receipt, storage, distribution, drug control, therapy monitoring, prescription preparation, drug dispensation, and medication administration. The study's methodology involves a case study approach, integrating theoretical management principles and interdisciplinary pharmacy management with compliance to regulations, as outlined in Permenkes No. 76 of 2016. Findings from RSUP Dr. Sitanala indicate that the hospital's pharmaceutical management practices align with contemporary health and pharmacy management theories, emphasizing structured systems, stringent verification, and effective interprofessional communication to ensure medication safety and efficacy. The study identifies challenges in information technology and interdisciplinary coordination as areas needing improvement. Nonetheless, a commitment to continuous improvement and adherence to regulatory standards reflects RSUP Dr. Sitanala's dedication to enhancing the quality of pharmaceutical management and healthcare services. The implications of this research extend beyond RSUP Dr. Sitanala, offering valuable recommendations for improving drug supply chain management in other healthcare institutions in Indonesia. By enhancing access to and the quality of healthcare services, this study contributes to the broader goal of achieving the highest possible level of health for individuals, reflecting the perspective of human rights and investment in the nation's future health.

Evaluation of the feasibility and acceptability of a home-based supervised exercise programme in individuals with spinal cord injuries: SCI-HOME-ACTIVE study protocol

Physical activity is essential to a healthy lifestyle for adults with spinal cord injuries (SCI). Although exercise is recognised as an important tool for improving the well-being and independence of...

Rare earth elements and warming: Implications for adult mussel health and sperm quality

The present study aimed to investigate the effects of europium (Eu) exposure (10 μg/L), warming (a 4 °C increase), and their combination on Mytilus galloprovincialis. Biochemical and histopathological changes in adult mussels were evaluated after a 28-day exposure period. Additionally, biochemical and physiological alterations in sperm were measured following a 30-min exposure period. The overall responses to each treatment were assessed using the Integrated Biological Response index version 2 (IBRv2). In adult mussels, warming elevated metabolism and activated glutathione S-transferases (GSTs), leading to redox imbalance and cellular damage. Europium exposure alone slightly enhanced metabolism and GSTs activity, resulting in cellular damage and histopathological injuries in digestive tubules. The combined exposure to Eu and warming was the most detrimental treatment for adults, as indicated by the highest IBRv2 value. This treatment slightly increased metabolism and uniquely elevated the activity of antioxidant enzymes, as well as GSTs and carboxylesterases. Despite these responses, they were inadequate to prevent redox imbalance, cellular damage, and histopathological injuries in digestive tubules and gills. Regarding sperm, warming reduced reactive oxygen species (ROS) production but raised lipid peroxidation levels. Sperm exposed to this treatment also increased their oxygen consumption and exhibited reduced velocity. The IBRv2 indicated that Eu was the most harmful treatment for sperm, significantly increasing ROS production and notably decreasing sperm velocity. When combined with warming, Eu elevated superoxide anion (O2-) production, lowered sperm velocity, and increased oxygen consumption. This study underscores the importance of investigating the effects of rare earth elements and their interaction with climate change-related factors.

Quality-of-Care Outcomes in Vertical Relationships Between Physicians and Health Systems

Vertical relationships (ownership, affiliations, joint contracting) between physicians and health systems are increasing in the US. Many proponents of vertical relationships argue that increased spending associated with consolidation is accompanied by improvements in quality of care. To assess the association of vertical relationships between primary care physicians (PCPs) and large health systems and quality of care. This stacked difference-in-differences study compared outcomes for patients whose attributed PCP entered a vertical relationship with a large system in 2015 or 2017 to patients whose PCP was either never or always in a vertical relationship with a large system from 2013 to 2017. Models account for differences between PCPs, patient characteristics, market concentration, and secular trends. Data were derived from the 2013 to 2017 Massachusetts All-Payer Claims Database. The study population included commercially insured individuals attributed to a PCP in the Massachusetts Health Quality Partners' Massachusetts Provider Database in 2013, 2015, or 2017. Analyses were conducted between January 2021 and January 2024. PCPs attributed to patients in the study entering a vertical relationship with a large health system in 2015 or 2017. Low-value care utilization, posthospitalization follow-up, utilization among patients with ambulatory care-sensitive conditions, practice site visit fragmentation, and timeliness of specialty care. The study population included 4 603 172 patient-year observations from 2013 to 2017. Among all patients in the study, 53.5% were female, 35.3% had any chronic condition, and the mean (SD) age was 38.9 (20.3) years. There was no association between vertical relationships and low-value care or ambulatory care-sensitive conditions utilization. A patient's PCP entering a vertical relationship had no association with the probability of follow-up within 90 days of cancer diagnosis with any oncologist but was associated with a 7.34-percentage point (pp) (95% CI, 2.28-12.40; P = .01) increase in the probability of follow-up with an oncologist in the health system. Vertical relationships were associated with increased posthospitalization follow-up with a physician in the health system by 7.51 pp (95% CI, 2.96-12.06: P = .001) in the 2015 subgroup. PCP-health system vertical relationships were associated with a significant decrease in fragmentation of practice site visits of -1.05 pp (95% CI, -2.05 to 0.05; P = .04). In this study, vertical relationships between PCPs and large health systems were associated with patient steering and changes in care delivery processes, but not necessarily improvements in patient outcomes.

Mobile Application for Improving the Quality of Life and Elderly Health Care

Mobile Application for Improving the Quality of Life and Elderly Health Care

The impact of a curriculum-based research training program on medical students’ research productivity and future research interests: a longitudinal study

BackgroundIncorporating scientific research into undergraduate medical education is necessary for the quality of future health care. However, providing rigorous research training to a large number of medical students at one institution remains one of the major challenges. The authors studied the impact of a curriculum-based Research Training Program (RTP) for all undergraduate students at Zhejiang University School of Medicine (ZUSM) on research productivity and future research interests.MethodsMedical students (n = 2,213) from ZUSM who completed the course of RTP between 2013 and 2020 were studied. The authors measured the academic performance, research publications, and research projects of students across years, and evaluated potential factors that contribute to student research productivity and increased interest in future research.ResultsAcross the years, there was an increase in the number of student publications, a greater proportion of students with publications, and a greater proportion of projects involving three or more students (P < .01 for all). The academic performance of the course was associated with increased publications (P = .014), whereas overall satisfaction of the course (OR 2.07, 95% CI [1.39, 3.10], P < .001), Skill Composite Score (SCS) (OR 1.70, 95% CI [1.16, 2.50], P = .007), and male gender (OR 1.50, 95% CI [1.06, 2.12], P = .022) were associated with increased future research interests.ConclusionsThe findings suggest that the curriculum-based RTP improved students’ research productivity, and that overall program satisfaction and self-assessed performance were associated with increased students’ intent to participate in future research.

Time to treatment of first-episode psychosis: the role of early intervention teams

Background/Aims Psychosis can affect a person's functioning, quality of life and physical health. Early intervention for service users presenting with psychosis has been implemented via early intervention teams, but there are inconsistencies in assessment and treatment. The aim of this study was to examine time to treatment (defined as the commencement of antipsychotic medication) for service users experiencing first-episode psychosis, the impact of this and engagement with teams. The authors explored the effect of patient characteristics (eg gender, deprivation, ethnicity, age) and early intervention teams on time to treatment for psychosis. Methods A retrospective cohort study was undertaken using routine data of service users accessing three early intervention teams from 2018–19. The care records of 457 service users were examined, including patient characteristics, assessments, time to first contact, treatment and time to discharge. Data were analysed using the Statistical Package for Social Sciences. Results Use of the Positive and Negative Syndrome Scale assessment tool differed across the three early intervention teams. Engagement with all teams varied by gender. Men were particularly slow to access treatment in one team (118 of 163 service users, 72.4%). Conclusions Increased emphasis on engaging male patients may improve service delivery. Improved communication between early intervention teams could increase standardisation of assessment and treatment.

The psychosocial impacts of skin-neglected tropical diseases (SNTDs) as perceived by the affected persons: A systematic review.

Neglected Tropical Diseases (NTDs) disproportionately affect marginalised groups within impoverished communities, conferring devastating physical, financial and psychosocial effects. Skin-NTDs (SNTDs) are uniquely stigmatising due to their visible nature, rendering affected individuals vulnerable to psychosocial risk and the associated decline in social participation, quality of life and mental health. In response to knowledge gaps identified by current global efforts for integrated control of SNTDs this review gathers existing evidence on the psychosocial effects of SNTDs, with consideration given to the influence of gender. The study protocol is registered with PROSPERO (CRD42022336676). Data was collected from Embase, Global Health, Medline and Web of Science, with additional articles identified through Google Scholar and bibliography tracking. Qualitative studies published in English between 2005 and 2024 reporting men's and women's experiences with SNTDs were searched. Appropriate data from each included study were inputted into NVivo software to facilitate thematic synthesis. Descriptive and analytic themes were generated through line-by-line coding using an inductive approach. 27 articles of high and moderate quality were included. They pertained to buruli ulcer, cutaneous leishmaniasis, leprosy, lymphatic filariasis, tungiasis, onchocerciasis, schistosomiasis and podoconiosis. Men and women across SNTDs and contexts reported debilitating physical symptoms which impaired their ability to work, socialise and carry out usual daily activities. Some felt (at least initially) well supported by partners and relatives, whereas most experienced avoidance, abandonment and even violence, with women incurring worse SNTD-related social consequences. Many men and most women experienced stigma, with discriminatory behaviours largely attributed to fear of infection, decreased ability to perform gender-specific daily activities, and the perceived association between SNTDs and sinfulness. Self-reported impacts of SNTDs on men's and women's mental wellbeing included low mood, anxiety, low self-esteem, and suicidal ideation. Disease-specific knowledge, early treatment, social support, and disease acceptance were mentioned as protective factors. SNTDs cause significant psychosocial harms, particularly for women. Implementing myth-busting and contact-based educational campaigns and improving access to treatment and to livelihood opportunities and social protection schemes for men and women with a SNTD will help prevent and mitigate these.

Moral courage level of nurses: a systematic review and meta-analysis

BackgroundMoral distress occurs in daily nursing work and plagues nurses. Improving the level of moral courage is one of the main strategies to reduce moral distress, and low levels of moral courage may lead to nurse burnout, increased turnover, and reduced quality of care.MethodsNine electronic databases in Chinese and English were searched for the level of moral courage among nurses, including PubMed, Web of Science, EMBASE, CINAHL, CNKI, Wan fang, Wei pu, CBM and Cochrane Library, for the period from the date of database creation to April 5, 2023. The Agency for Healthcare Research and Quality (AHRQ) was used to assess the methodological quality of the included studies, followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the Meta-analysis and Systematic Reviews of Observational Studies guidelines, and data from the included studies were meta-analyzed in STATA version 15 using a fixed-effects model.ResultsSeventeen cross-sectional studies of moderate or high quality met the eligibility criteria and involved 7718 nurses, and the Nurses’ Moral Courage Scale (NMCS) was used to measure the self-assessed moral courage level of nurses. Eleven of these studies reported total scores for nurses’ moral courage, and the meta-analysis results showed a pooled mean score of 78.94 (95% CI: 72.17, 85.72); Fourteen studies reported mean entry scores for nurses’ moral courage, and the meta-analysis results showed a pooled mean score of 3.93 (95% CI: 3.64, 4.23).ConclusionThe results of the meta-analysis showed that nurses’ moral courage levels were in the medium to high range, among the nurses who seemed to be male, non-nursing managers, high school education, had not experienced ethical issues, and considering resignation had lower levels of moral courage. The results of the meta-analysis may provide some reference for nursing managers and even hospital administrators to develop strategies to optimize nursing quality.

Impact of Anxiety, Depression, and Coping Strategies on Health-Related Quality of Life in Patients with Cystic Fibrosis.

With the significant increase in the life expectancy of cystic fibrosis (CF) patients, many individuals now reach adulthood and develop specific coping strategies to maintain their physical and mental well-being. This study aims to evaluate coping styles and their relationship with mental health and Health-Related Quality of Life (H-RQoL) in adult CF patients. Thirty adult CF patients completed the Hospital Anxiety and Depression Scale to assess anxiety and depression, the Cystic Fibrosis Questionnaire-Revised to evaluate quality of life, and the Brief Coping Orientation to Problems Experienced questionnaire to assess coping strategies. Twelve individuals (40%) met the diagnostic criteria for being at risk of experiencing anxiety and/or depression. Anxiety risk group exhibited lower life quality scores in the domains of vitality, emotional functioning, and role limitations (P = .027, P = .001, and P = .001, respectively). Patients reporting depressive symptoms had lower scores in emotional functioning and role limitations domains of quality of life (P = .005 and P = .018, respectively). Multivariate analysis indicated that depression and anxiety scores were significant predictors of emotional quality of life. In terms of coping strategies, "acceptance" was the most commonly preferred, while "substance use" was the least preferred strategy among all participants. Patients at risk of anxiety and/or depression often chose "avoidance" as their coping strategy. Anxiety and depressive symptoms are prevalent and associated with poorer H-RQoL in adult CF patients. These patients preferred to employ giving up strategy when dealing with the disease. Therefore, it is essential to screen adult CF patients for mental health risks and to work on improving their coping strategies.

Flavor and taste recognition impairments in people with type 1 diabetes

Background/objectivesAdherence to dietary recommendations is a critical component in the management of type 1 diabetes (T1D). Taste and flavor significantly influence food choices. The aim of this study was to investigate taste sensitivity and flavor recognition ability in adults with T1D compared to healthy individuals.Subjects/methodsSeventy-two people with T1D and 72 matched healthy controls participated in the study. Participants underwent the gustometry test for sweet, sour, salty, and bitter tastes and the flavor test, which consisted of oral administration of aqueous aromatic solutions identifying 21 different compounds.ResultsParticipants with T1D had significantly lower flavor scores and gustometry scores than controls (p < 0.0001 and p = 0.0063, respectively). T1D individuals showed a lower perception of sour, bitter and salty tastes than controls, while the perception of sweet taste was similar. The sex differences and age-related decline in flavor perception observed in controls were not present in the participants with T1D. Neither BMI nor disease-related parameters such as fasting blood glucose on the day of the study, glycosylated hemoglobin, age at onset of diabetes, duration of diabetes, or type of insulin treatment (insulin pump or multiple daily injections) correlated with flavor and taste perception in the T1D participants.ConclusionsFlavor and taste perception are impaired in adults with T1D, potentially affecting dietary adherence and food choices. This highlights the need for further research into the mechanisms underlying sensory changes in T1D and emphasizes the importance of targeted dietary interventions to improve health outcomes and quality of life in this population.

Chemical characterization and influencing factors of gaseous and particulate components in cooking oil fume (COF) from traditional Chinese dishes: Insights from high-resolution mass spectrometry

Cooking oil fumes (COF) are known to emit a wide range of organic compounds with significant impacts on human health and urban air quality. This study used HPLC-QToF-MS and Vocus PTR-TOF to explore the chemical constituents and influencing factors of the COF generated from eight typical Chinese dishes representing different areas in a laboratory kitchen. The results revealed that both CHO and CHON compounds exhibited strong reducibility and saturability, with CHO compounds being the dominant and CHON compounds showing greater diversity. 24 among 168 CHO compounds were identical with those generated from heating soybean oil, representing 72.4%–92.3% in abundance and 22.2%–29.2% in quantity. That was 5 among 113 CHON compounds, accounting for 7.8%–10% in abundance and 4.7%–6.7% in quantity. These findings suggest that the major CHO compounds from heating soybean oil continued to dominate the abundances in dishes. The diversity of CHO compounds and the presence of CHON compounds were influenced by the food ingredients. The VOC analysis indicated that oxygen-containing organics were the major components. 6 identical VOC species between cooking dishes and heating soybean oil were identified, comprising 36.02%–67.84% of the total VOCs mass. Notably, poor ventilation could result in even higher COF concentrations in the connected room compared to the kitchen itself.

Diabetes treatment satisfaction among a multi-ethnic Aotearoa New Zealand population with uncontrolled type 2 diabetes mellitus

aims: To assess whether diabetes treatment satisfaction differs by ethnicity among participants with insufficient glycaemic control of type 2 diabetes mellitus in a clinical trial involving additional oral diabetes medications. Patient satisfaction is used as an indicator of healthcare quality. However, data on patients’ diabetes treatment satisfaction in the context of insufficient glycaemic control is limited. methods: Individuals with type 2 diabetes and an HbA1c of 58–110mmol/mol (7.5–12.5%) were recruited across Aotearoa New Zealand to participate in an 8-month randomised crossover study of vildagliptin and pioglitazone as add-on therapy to metformin and/or sulfonylurea. Participants completed the Diabetes Treatment Satisfaction Questionnaire (DTSQ) at baseline pre-randomisation. Treatment satisfaction scores were compared between ethnic groups and other characteristics using the analysis of variance and linear regression. Perceived hyper- and hypoglycaemia were summarised separately. results: Between February 2019 and March 2020, 346 participants (41% women, 32% Pacific peoples, 23% Māori, 26% European) completed the DTSQ. Mean (SD) age was 57.5 (10.9) years, diabetes duration was 9 (6.3) years and HbA1c was 75 (12)mmol/mol (9.0[3.2]%). At study entry, 40% were receiving monotherapy for diabetes. Treatment satisfaction was rated highly, with a score of 29(6) (interquartile range 25–33). Pacific peoples and older people reported greater treatment satisfaction than other groups (p &lt;0.001). conclusions: Diabetes treatment satisfaction was high, particularly among Pacific peoples, despite suboptimal glycaemic control and insufficient glucose-lowering therapy.

Supplementing Systematic Review Findings with Healthcare System Data: Pilot Projects from the Agency for Healthcare Research and Quality Evidence-based Practice Center Program

ObjectivesThe US Agency for Healthcare Research and Quality (AHRQ), through the Evidence-based Practice Center (EPC) Program, aims to provide health system decision makers with the highest-quality evidence to inform clinical decisions. However, limitations in the literature may lead to inconclusive findings in EPC systematic reviews (SRs). The EPC Program conducted pilot projects to understand the feasibility, benefits, and challenges of utilizing health system data to augment SR findings to support confidence in healthcare decision-making based on real-world experiences. Study Design and SettingThree contractors (each an EPC located at a different health system) selected a recently completed systematic review conducted by their center and identified an evidence gap that electronic health record (EHR) data might address. All pilot project topics addressed clinical questions as opposed to care delivery, care organization, or care disparities topics that are common in EPC reports. Topic areas addressed by each EPC included infantile epilepsy, migraine, and hip fracture. EPCs also tracked additional resources needed to conduct supplemental analyses. The workgroup met monthly in 2022-2023 to discuss challenges and lessons learned from the pilot projects. ResultsTwo supplemental data analyses filled an evidence gap identified in the systematic reviews (raised certainty of evidence, improved applicability) and the third filled a health system knowledge gap. Project challenges fell under three themes: regulatory and logistical issues, data collection and analysis, and interpretation and presentation of findings. Limited ability to capture key clinical variables given inconsistent or missing data within the EHR was a major limitation. The workgroup found that conducting supplemental data analysis alongside an SR was feasible but adds considerable time and resources to the review process (estimated total hours to complete pilot projects ranged from 283-595 across EPCs), and that the increased effort and resources added limited incremental value. ConclusionSupplementing existing systematic reviews with analyses of EHR data is resource intensive and requires specialized skillsets throughout the process. While using EHR data for research has immense potential to generate real-world evidence and fill knowledge gaps, these data may not yet be ready for routine use alongside systematic reviews.

Assessing the English Language Needs of Nursing Students: A Systematic Review

Previous studies that conducted needs analyses on English for nursing students only concentrated on the target needs at a particular university. This study investigated nursing students' English language needs through a systematic review in order to improve methods of teaching and curriculum development. 14 studies published between 2015 and 2024 were reviewed to highlight the critical role of English proficiency in nursing education and professional practice. This review identified some themes, such as the importance of English for academic and career purposes, the need for developing core language skills, a preference for interactive and practical learning methods, and the requirement for support in online learning environments. The findings suggest the necessity of designing English for Specific Purposes (ESP) and English for Nursing Purposes (ENP) courses tailored to the needs of nursing students. To increase professional and healthcare quality, evidence-based recommendations for curriculum developers, educators, and policymakers are nedded to improve the English language training of nursing students.

Effect of high plant protein/peptide nutrition supplementation on knee osteoarthritis in older adults with sarcopenia: A randomized, double-blind, placebo-controlled trial

Background & AimsSkeletal muscle is an important contributor to joint health. Previous studies have shown that age-related muscle mass and strength loss are closely associated with the development of knee osteoarthritis. The objective of this study is to investigate whether a high plant protein/peptide nutrition supplementation can alleviate knee osteoarthritis by improving muscle mass and strength. MethodsThis randomized, double-blind, placebo-controlled trial that included participants aged 50–70 years diagnosed with knee osteoarthritis and sarcopenia was conducted in China from February 2022 to September 2022 (ChiCTR2200056415). Participants were randomized to receive a 12-week high plant protein/peptide nutrition supplementation or a placebo twice daily, with one serving each after breakfast and lunch, respectively. The primary outcome analyzed using intention-to-treat analysis was difference in Short Physical Performance Battery (SPPB) from baseline to week 12 between the two groups. The secondary outcomes included changes in muscle mass, strength, symptom and imaging of knee osteoarthritis, body composition, biochemical parameters, and health quality scores. ResultsAfter 12 weeks, a total of 124 participants (38.7% male) completed the trial and were included in the final analysis. Over the 12-week follow-up, the experimental group showed a significant improvement in the SPPB total score (1.03, 95% CI, 0.69 to 1.38, P < 0.0001) compared with the placebo group. Grip strength (2.83 kg, 95% CI, 2.13–3.53, P < 0.0001) and skeletal muscle mass index (0.66 kg/m2, 95% CI, 0.45–0.86, P < 0.0001) were also significantly increased in the experimental group compared with the placebo group. The mean change in Western Ontario and McMaster Universities Osteoarthritis Index total score was −3.95 points (95% CI, −5.02 to −2.89, P < 0.0001) in the experimental group and 0.23 points (95% CI, −0.17 to 0.63, P = 0.253) in the placebo group. Additionally, within the experimental group, nine participants experienced an improvement in osteophyte magnetic resonance imaging results, while no improvement was observed in the placebo group. The experimental group also exhibited significant improvements in health quality compared with the placebo group as assessed by Short Form 36, the World Health Organization Quality of Life Brief Scale, and the Chalder Fatigue Scale. No serious adverse event was reported during the trial. ConclusionOral supplementation with high levels of plant protein/peptides can alleviate symptoms of osteoarthritis in elderly individuals with minor and mild knee osteoarthritis and sarcopenia. The improvement may be attributed to the enhancement of muscle mass, strength, and physical performance.

Assessing patient satisfaction and healthcare delivery amidst the COVID-19 pandemic: insights from Jammu and Kashmir, India

IntroductionAmidst the challenges posed by Covid-19, assessing healthcare quality in India is crucial, particularly through patient satisfaction levels.MethodologyA cross-sectional survey of 277 participants in Jammu and Kashmir was conducted, utilizing a semi-structured questionnaire and PSQ-18. Data analysis was performed using SPSS (v25) including Chi-Square tests and Descriptive analysis.ResultsOut of 277 participants, 70.8% expressed high satisfaction with medical care. Majority (70%) agreed that doctors explained medical tests well. Additionally, 70% strongly agreed that their doctor’s office was well-equipped. Dissatisfaction factors were notably low. Significant associations were found between age and alcohol use (p = 0.041), gender and alcohol use (p = 0.007), gender and tobacco use (p = 0.032), and education level and vaccination (p = 0.001).ConclusionThe study highlights high patient satisfaction during the pandemic. Improving accessibility and quality of primary healthcare and community centres is essential to meet patient needs effectively.

Over Three Decades of Growth Hormone Treatment in Children With Chronic Kidney Disease-Associated Growth Failure Before and After Kidney Transplantation.

Growth retardation and short final height is a common complication of chronic kidney disease (CKD) beginning in childhood, with profound deleterious effects on quality of life, mental health, and social achievement. Despite optimal treatments of causative factors for growth retardation in children with CKD, more than 50% of patients reach end-stage renal failure with a height >2 SD below the mean, and most do not demonstrate "catch-up" growth after receiving a kidney transplant. Four decades ago, recombinant human growth hormone (rhGH) treatment was introduced after studies showed increased growth velocity and improved height SDS in uremic subjects. Since then, an abundance of published data showed significant improvements in health-related quality of life, and most studies revealed no significant adverse effects. Clinical practice guidelines recommended rhGH treatment in CKD Stages 3-5D and after transplantation. Despite these guidelines, this therapy remained underutilized. Most commonly cited barriers to the implementation of rhGH treatment were the need for daily injections, financial challenges, physicians' unfamiliarity with guidelines, and fear of adverse events. rhGH has been shown to improve growth and final height in short children with CKD, with minimal adverse effects. Despite data of its successful use generated over 3 decades, this treatment is underutilized. More judicious utilization of the treatment should emphasize educating patients, their care givers, and members of the multidisciplinary treating team. Additional studies are needed to assess the longer-term rhGH treatment in larger cohorts of patients, leading to additional supportive data and clearer recommendations.

Association between vision-related quality of life and mental health status in myopia children using various optical correction aids

PurposeTo evaluate the relationship between vision-related quality of life and mental health in myopia children with various optical aids. MethodsThis cross-sectional study enrolled children aged 8–13 years, exhibiting myopia ranging from −4.50 to −0.75 D, and utilizing various optical aids for correction. Full ocular examinations and completion of two questionnaires were performed. Vision-related quality of life was evaluated using the Paediatric Refractive Error Profile (PREP), and mental health status was assessed utilising the Screen for Child Anxiety Related Emotional Disorders (SCARED). Univariate and multivariate analyses were conducted to evaluate the association between vision-related quality of life and mental health status. ResultsThe study sample comprised 209 children with corrected myopia using single vision spectacles (100 [47.8 %]), soft contact lenses (66 [31.6 %]), and orthokeratology lenses (43 [20.6 %]). The mean age was 10.31 ± 1.65 y, and males accounted for 50.7 % of the sample. The distribution of demographic characteristics showed no significant difference among all correction types, except that the myopia duration was longer for orthokeratology lens wearers than those using spectacles (P=0.03). Contact lens showed clear benefits in almost all dimensions of vision-related quality of life, especially in appearance, satisfaction, activity and peer perceptions dimensions. The prevalence of anxiety disorders among spectacle wearers was 25.0 %, the highest among all groups. For myopia children with optical corrections, not being in the top 30 percent of their class rank, reporting lower PREP scores on symptoms, handling and peer perceptions dimensions were related with a higher prevalence of anxiety disorders. ConclusionsLower vision-related quality of life was associated with worse mental health status of myopia children with optical corrections. Identifying this association is crucial for protecting the mental health of myopia children and enhancing corrective measures.