Related Quality Research Articles

Recovery from severe cardio-respiratory failure: the trajectory of muscle mass, strength, function and health related quality of life

Abstract Background The impact of intensive care unit acquired weakness (ICUAW) is associated with reduced muscle mass, strength, function and health related quality of life (HRQoL). Patients suffering from severe cardio-respiratory failure are known to lose considerable muscle mass and strength in the first 7 days of admission to the intensive care unit (ICU). Furthermore, patients surviving critical illness have a considerable less HRQoL and physical function with long term outcomes such as inability to return to work being reported. However, more information regarding muscle loss and recovery is required when patients leave hospital. Currently there are no treatments for ICUAW as once the process is established management is supportive, such as physical therapy. Purpose We Sought to investigate the effects of severe cardio-respiratory failure, in patients receiving extra corporeal membrane oxygenation (ECMO), on ICUAW (including muscle mass, strength, function and HRQoL). Researching a real life model of ICUAW allows the observation of the loss of muscle mass and strength in the first stages of critical illness and severe cardio-respiratory failure. Methods Adults receiving ECMO for severe cardiorespiratory failure were included. Muscle mass was measured using ultrasound of the rectus femoris cross sectional area (RFcsa). Muscle strength was measured using hand held dynamometry for both hand held grip strength and isometric leg extension. HRQoL was measured using the EQ-5D-5L. Function was measured using the short physical performance battery (SPPB). Measurements were taken on day 0, day 7, ICU discharge, hospital discharge and at out-patient follow up. Results 17 patients were recruited with 10 patients completing follow up. Patients lost 24% muscle mass in the first 7 days of ICU admission and ECMO initiation, with muscle loss continuing up until ICU discharge. Contrary to the hypothesis only 50% of the patients were seen to recover muscle mass at follow up. Strength and function all considerably improved between ICU discharge and out patient follow up. The EQ5D crosswalk index supported this suggesting considerable functional improvement. Conclusion Patients in severe cardio-respiratory failure lose considerable muscle mass in the first 7 days of admission, with only 50% of these patients recovering the initial muscle loss at follow up. However, strength, function and HRQoL all improve following ICU discharge suggesting an element of functional recovery. Strength and function have shown to improve regardless of the status of the muscle mass. Therefore, given the advantages of the real-life model and novel findings, this could serve as a platform to assess muscle loss and recovery over a longer time frame continuing to build the understanding of the patients recovery trajectory from critical illness.Rectus Femoris Muscle MassHand-Held Grip Strength

Autonomic dysfunction is prevalent in PASC of Covid-19 [PASC

Abstract Background Post-acute sequelae of COVID-19 [PASC] is thought to occur in 10% of all COVID infections and has previously been associated with autonomic dysfunction including postural orthostatic tachycardia syndrome [POTS].[1,2] Purpose To assess prevalence of autonomic disorders in those with PASC. Methods Consecutive patients reporting unexplained symptoms persisting for ≥3 months after SARS-CoV-2 infection were recruited through social media platforms. Beat to beat plethysmography was used to determine autonomic haemodynamic response to 10-minute active stand test, Valsalva maneuverer and deep breathing. International criteria were used to diagnose POTS, initial orthostatic hypotension (IOH), and classical orthostatic hypotension (COH). Validated patient reported outcome measures were used to determine symptom severity and health related quality of life (HrQoL) including, composite autonomic symptom score [COMPASS-31], Euroquol 5-Dimension [EQ-5D] and fatigue severity score (FSS). Results Institutional ethics was granted from our university. A total of 150 PASC participants (79% female, 93% Caucasian) with a mean age of 40.7 ± 11.5 years and BMI 25.8 ± 6.7 were prospectively consented and enrolled. In total 86% were vaccinated with at least 2 vaccines at the time of acute SARS-CoV-2 infection. The mean time to onset of PASC symptoms after acute infection was 18.3 ± 35.3 days and duration of symptoms at time of testing was 306.9 ± 188.1 days. In total 75% of participants met the criteria for an autonomic disorder with the most common diagnoses being POTS (55%), initial orthostatic hypotension (38%), and classic orthostatic hypotension (5%) respectively. Valsalva ratio was within normal limits for the majority (90%) of participants however it was statistically higher in those with POTS compared to those without (1.9±.6 versus 1.7±.8: p=.014). Total composite autonomic symptoms were more severe in women than men (42.6±13.1 vs. 35.4±19.9; p = .018) and those with a COMPASS-31 score >40 (49%) had worse fatigue severity (57.9±6.9 vs. 50.3±14.3: p<.001) and poorer EQ-5D utility health scores (0.611±0.247 vs 0.701±0.237: p =.008) on a scale from 0-1 where ‘1’ = ‘full health’. The mean FSS score was 53.9±11.8 out of a maximum score of 63 and fatigue was universally problematic with 92% experiencing FSS score >36. Participants reported only being a mean of 40.5%±21.2% of their previous health status and the mean self-reported ‘health today’ [100 = ‘full health’] was 40.5 ± 14.2. A significant 91.3% reported missing work due to symptoms in the last month and 50.3% had been unable to return to work due to PASC symptoms. Conclusion Autonomic disorders are prevalent in PASC and greatly impact on working capacity and health related quality of life. We call for routine autonomic testing in PASC and further research to explore efficacy of autonomic treatment modalities in this cohort.

Exercise-based cardiac rehabilitation effects on severity of angina, HRQoL and exercise capacity in patients with microvascular angina: systematic review and meta-analysis

Abstract Background Microvascular angina (MVA) is a clinical syndrome caused by coronary microvascular dysfunction in patients with angina symptoms and no flow limiting blockages in their main coronary arteries. Patients experience recurrent angina, low health related quality of life (HRQoL) and limited exercise tolerance, making them more likely to repeatedly present to healthcare services. Aim To establish the effects of exercise-based cardiac rehabilitation (CR) on the severity of angina, HRQoL and exercise capacity among adults with a diagnosis of MVA compared to a no-exercise group. Methods Searches were performed in 14 online databases. We included randomised controlled trials (RCTs) that assessed the independent effect of CR versus a no-exercise group in adults with a probable or definite diagnosis of MVA according to the COVADIS criteria. Risk of bias was assessed via the Cochrane RoB2 tool at outcome level and the quality of the evidence using the Grading of Recommendations, Assessment, Development and Evaluations framework. Meta-analysis using random effects models were used to estimate mean difference (MD) or standardised mean difference (SMD) with 95% confidence intervals (CI). Results Of the 15,873 reports identified, five studies (n=222) were included. Reasons for RoB judgements varied between studies and outcomes, however all were scored at either ‘high risk’ or ‘some concerns’. Participants were mostly female (97%), average ages ranged from 51 to 64 years. The CR programmes utilised aerobic exercise and resistance training. Meta-analysis of the effect of CR on severity of angina (2 RCTs; n=85) was not possible due to the limited data presented in one of the reports. The narrative synthesis concluded that there is no evidence of an effect of CR on severity of angina symptoms. Meta-analysis of the effects of CR versus no-exercise on HRQoL were conducted at domain level of the Short Form-36 (SF-36) questionnaire (2 RCTs; n=75), and exercise capacity as measured by peak VO2 (3 RCTs; n=101). The evidence of the effect of CR versus no-exercise intervention of the SF-36 domains from the meta-analyses was classified as ‘very low certainty’, meaning we have very little confidence in the effect estimates calculated. CR versus no-exercise intervention was estimated to result in a SMD of 1.06 (95% CI -0.7 to 2.19, low certainty of evidence) for measurements of peak VO2 in favour of CR. A SMD of 1.06 is estimated to be equivalent to a 4.42 ml/kg/min change in peak VO2, which is believed to represent a clinically meaningful difference. Conclusions CR may improve exercise capacity outcomes in patients with MVA compared to controls, however our confidence in the effect estimate is limited. We remain uncertain as to the effect of CR on the severity of angina symptoms and HRQoL. High-quality, well-reported RCTs are needed to more rigorously assess the benefits and harms of exercise-based CR for adults with MVA.

Confidence as a Buffer Against Covid-19 Stigma: Enhancing Employee Engagement Among Recovered Individuals

Quality of work life (QWL) is important for individual and organizational success. Post-pandemic times have brought the challenge of declined, yet continued Covid-19 cases among the working Pakistani population. Stigma due to Covid-19 and thus deteriorated QWL in such individuals is plausible. Hence, elucidating factors that enhance the possible damaged quality of work life among Covid-19 stigmatized individuals remains an essential question for managers and practitioners. Drawing on the Social Identity theory, we hypothesize that QWL is damaged in Covid-19 recovered, stigmatized working individuals through deterioration in self-esteem as such individuals are prone to influences from the societal groups that they psychologically identify with. We also argue that self-efficacy buffers this negative effect. Albeit several researches have probed into relations of QWL with stigma-related antecedents and moderation and mediation mechanisms that underlie these effect, but this study investigates self-esteem and self-efficacy as mediator and moderator, respectively, of the Covid-19 related stigma and quality of work life relationship through the lens of the Social Identity Theory. Employing a correlational framework using purposive sampling, we obtained data from 133 working individuals who had been tested positive with Covid-19 in public and private hospitals and health centers of Pakistan during November 2022 – November 2023, had completely recovered and joined their professional lives. Results confirmed study hypotheses, suggesting that stigma related to Covid-19 damages QWL, this relationship is mediated by self-esteem, while self-efficacy buffers the relationship between Covid-19 related stigma and self-esteem. Such individuals and their managers need to collaboratively work in order to reduce effects of this stigma, and undo its damaging effects on self-esteem and QWL. In this regard, boosting self-efficacy plays a supporting role as it acts as a coping mechanism in the inter-play between Covid-19 stigma, self-esteem, and QWL.

Responsiveness and minimal important change of specific and generic patient-reported outcome measures for back patients: the Norwegian Neck and Back Register

PurposeTo evaluate responsiveness and minimal important change (MIC) of Oswestry Disability Index (ODI), pain during activity on a numeric rating scale (NRSa) and health related quality of life (EQ-5D) based on data from the Norwegian neck and back registry (NNRR).MethodsA total of 1617 patients who responded to NNRR follow-up after both 6 and 12 months were included in this study. Responsiveness was calculated using standardized response mean and area under the receiver operating characteristic (ROC) curve. We calculated MIC with both an anchor-based and distribution-based method.ResultsThe condition specific ODI had best responsiveness, the more generic NRSa and EQ-5D had lower responsiveness. We found that the MIC for ODI varied from 3.0 to 9.5, from 0.4 to 2.5 for NRSa while the EQ5D varied from 0.05 to 0.12 depending on the method for calculation.ConclusionIn a register based back pain population, the condition specific ODI was more responsive to change than the more generic tools NRSa and EQ5D. The variations in responsiveness and MIC estimates also indicate that they should be regarded as indicative, rather than fixed estimates.

Study on the Drying Characteristics and Physicochemical Properties of Alfalfa under High-Voltage Discharge Plasma

High-voltage discharge plasma drying (HVDPD) is a non-thermal and efficient drying technique. In this study, we compared the drying characteristics and physicochemical properties of alfalfa dried via HVDPD, hot-air drying (HAD), and natural air-drying (AD) and analyzed the experimental results using infrared spectroscopy, scanning electron microscopy, colorimetry, and other detection techniques. The results showed that HVDPD had a higher drying rate than AD and saved more energy than HAD. Alfalfa dried via HVDPD had the most intact internal structure, the highest rehydration ratio (RR), the best color quality, and the best nutrient retention, resulting in the highest relative quality and feeding value. Therefore, HVDPD is an excellent drying technique for alfalfa, providing a new and effective way to improve the storage, transportation, and drying quality of alfalfa.

Promoting Gender Equity through Teacher Education: A Comparison of Turkish and American Preservice Teachers’ Perspectives

Gender perception and beliefs of teachers constitute a significant dimension of gender inequities in education. Even in societies that have made significant progress in achieving gender equity, the structure and content of teacher education remains insufficient to create gender awareness among teacher trainees and to develop an egalitarian understanding of education. Utilizing a multiple case study design, the present study examines the extent to which the teacher education programs in two different countries, Türkiye and the USA, prepare pre-service teachers to be gender sensitive in their practices as teachers. Data were collected through semi-structured interviews with 22 student teachers from two countries. Student teachers talked about their experiences inside the teacher education programs and their views regarding how issues surrounding gender were embedded into the teacher education curriculum. Interviews revealed the nature and quality of teacher education, social mechanisms and relations within the teacher education programs in shaping the gender norms of prospective teachers. The study has important implications for educational policies, school practices, and teacher education programs.

Dyskinetic Cerebral Palsy in Children: Clinical Perspectives on Common Comorbidities and Health-Related Quality of Life.

The data on specific comorbidities in children with dyskinetic cerebral palsy (DCP) is limited. We evaluated the pattern of comorbidities and health related quality of life (HRQOL) in these children and compared them between etiological and motor impairment subgroups. This cross-sectional study was conducted over 18 months in children with DCP of both sex, and age between one and 14 years. Comorbidities were assessed using standardized scales such as gross motor functioning scale (GMFCS), developmental profile-3 (DP-3), developmental behaviour checklist, sleep behaviour questionnaire (SBQ), and caregiver questionnaire. Sixty-five children with DCP were evaluated (hyperbilirubinemia n = 43, 66% and perinatal asphyxia n = 19, 29%). The majority of children were severely affected in gross motor functioning (level IV 29.2% and level V 53.8%). Epilepsy was seen in 21.5% of cases (19% in hyperbilirubinemia and 32% in asphyxia, p = 0.4). The mean age of onset of seizures was 15.4 + 20.6 months (range 2-72). Visual problems were seen in 54% of cases and included upgaze palsy, squint, refractive error, optic atrophy and cortical blindness. A significant proportion of children with hyperbilirubinemia had upgaze palsy as compared to those with perinatal asphyxia (70% vs. 32%, p 0.01). Rest of the visual problems were not significantly different between the two etiological subgroups. Drooling (87.6%), protein-energy malnutrition (66.6%), and reflux (57%) were the most common gastrointestinal problems in children with DCP. Children with DCP showed problems in social relating (33.8%), anxiety (26.2%), and self-absorbed behaviour (7.7%). However, there were no statistically significant differences between the etiological, motor impairment and age-based subgroups. Children with DCP had high scores on SBQ, suggesting sleep problems. Sleep scores were similar in the hyperbilirubinemia and perinatal asphyxia subgroups. Greater sleep problems were noted in children aged < 4y (70.6 + 10.1 vs. 56.5 + 11.3, p < 0.05 as compared to children above 4y of age) and severe motor impairments (68.2 + 11.3 vs. 57.2 + 13.1, p 0.008 as compared to mild-moderate motor impairment). Poor overall developmental scores were seen in 61.5% children and were significantly associated with GMFCS (p 0.04). The majority of children showed impairments in physical (58.5%), adaptive behaviour (58.5%), social-emotional (50.8%), cognitive (60%) and communication (52%) subscales of DP-3. Cognitive impairment was similar in the etiological (hyperbilirubinemia vs. perinatal asphyxia, p = 0.3), and motor impairment (mild-moderate vs. severe, p = 0.9) subgroups. HRQOL was significantly affected by motor impairment in positioning-transfer (p value 0.0001), and interaction-communication domains (p value 0.0001), however, there was no difference based on the etiology of hyperbilirubinemia and asphyxia. Children with DCP demonstrate several comorbidities and impaired quality of life. These are similar in hyperbilirubinemia and perinatal asphyxia cohorts, expect for significant proportion of upgaze palsy in DCP secondary to hyperbilirubinemia. Younger children have more problematic behaviour and impaired sleep quality. Severe motor disability influences the developmental outcomes, cognition, sleep and HRQOL in children with DCP.

Exploring the integration of dentistry within a multidisciplinary palliative care team: does bedside dental care improve quality of life and symptom burden in inpatient palliative care patients?

BackgroundDespite the significant impact of oral problems on the quality of life of palliative care patients, comprehensive studies are lacking. This study is the first of its kind to address this gap by including both a dental examination and an intervention and assessing quality of life using the EORTC QLQ OH 15 questionnaire.ObjectivesThe objective of this study is to explore the impact of incorporating dentists into inpatient palliative care, with a focus on enhancing quality of life and alleviating symptom burden.MethodsIn this monocentric study, data were gathered from a palliative care unit over an 8-month period. At the beginning of the multidisciplinary treatment, T0, patients underwent both a dental examination and interviews utilizing established questionnaires, the EORTC QLQ-C30 (core, general) and OH 15 (oral health). A week later, at T1, patients underwent a follow-up examination and interview. The QLQ-C30 and OH15 are widely recognized instruments developed by the European Organisation for Research and Treatment of Cancer (EORTC) for evaluating health related quality of life in cancer patients.ResultsA total of n = 103 patients (48.5% women) were enrolled in the study. The median duration since their last dental visit was 1 year, and the dental condition at T0 was desolate. At T1, statistically and clinically significant changes in oral quality of life and symptom burden were observed. Noteworthy changes were noted in the OH-QoL score (median 63 vs. 92, p < 0.001), sticky saliva (median 33 vs. 0, p < 0.001), sensitivity to food and drink (median 33 vs. 0, p < 0.001), sore mouth (median 33 vs. 0, p > 0.001), and poorly fitting dentures (median 33 vs. 0 p < 0.001). Additionally, improvements were observed in xerostomia candidiasis and mucositis.ConclusionThe study highlights the powerful contribution of integrating a dentist in inpatient palliative care. With very little dental effort and simple ward and bedside treatments, significant improvements in the oral symptom burden of critically ill palliative patients can be achieved. This contributes to improved care status, relief of distressing symptoms, and ultimately improved quality of life. The results strongly support the consideration of dental support as an integral part of palliative care units.

Valuation of customers’ service quality, affective, sensory experience and entertainment to behavioral intention

This study explores the impact of distinct characteristics of theme restaurants on service quality and behavioral intentions. As the unique attributes of themed restaurants continue to gain in popularity, this study gathered data from a face-to-face survey of 776 diners who visited various themed restaurants across different regions of Taiwan. The study validated the evaluation of customers’ service quality, affective experience, sensory experience, and entertainment in relation to behavioral intention within a proposed conceptual model, which was then tested using covariance-based structural equation modeling (CB-SEM) analysis. The findings reveal that affective experiences, the perception of entertainment and the sensory experience mediate between service quality and behavioral intention. Furthermore, the study underscores that the perception of a servicescape acts as a moderating factor influencing the associations between service quality and sensory experience, thereby reinforcing the links between affective experience and behavioral intentions. The study's robustness is confirmed by implementing alternative models. The final section of the study discusses both theoretical and managerial implications derived from these outcomes.

Incidence of Peri-implantitis and oral health related quality of life in patients rehabilitated with implants: A retrospective Study

Background: Peri-implantitits, periodontal disease and bone loss are main complications of dental implant treatment that can impact the quality of life . Aim: This study aimed to determine incidence of Peri-implantitis and oral health related quality of life in patients rehabilitated with Implants by means of a shortened 14-item questionnaire of Oral Health Impact Profile Index (OHIP-14). Materials and Methods: Sixty number of patients was included in this study who were diagnosed with peri implantitis. The participants were assessed on the basis of response received in Oral Health Impact Profile Index(OHIP-14) questionnaire. OHIP-14 is a Likert-type questionnaire that uses a 5- point rating scale (0 = never, 1 = rarely, 2 = sometimes, 3 = frequently and 4 = very often). Results: A statistically significant correlation was noted between the Functional limitation domain with the psychological limitation and social limitation (p&lt;0.0001). Conclusions: Within the limitations of this study, it was observed that quality of life has been compromised due to peri implantitis. Results also indicated that patients should take action to improve their oral health. Further longitudinal studies are needed to support our results and should include control groups that use conventional removable dentures.

P-029 Genome-wide microRNA expression profiling in human spermatozoa and its relation to sperm quality

Abstract Study question Does the microRNA (miRNA) expression profile in human spermatozoa change with their morphological appearance? Summary answer This study revealed miRNA expression associated with good-quality sperm classified based on their morphology. These miRNAs could represent efficient biomarkers to evaluate male fertility status. What is known already We previously published a scoring scale where the spermatozoa with a Score 6 (Good spermatozoon) display normal head shape with symmetrical nuclear no extrusion and/or no invagination of the nuclear membrane, without any vacuole and normal base. The spermatozoa with a Score 0, display a nuclear-shape disorder with an abnormal base and at least one large vacuole (Bad spermatozoon). Despite the great magnitude of studies investigating the miRNA role in spermatogenesis, limited work has been done to evaluate it as a potential biomarker for sperm quality in relation to their morphology. Study design, size, duration In a prospective study from March 2023 to May 2023, twenty semen samples were collected. The samples were categorized according to their scoring morphology into Score 6 and Score 0. Ten samples (five with a Score 6 and five with a Score 0) were used for the analysis by microarray and ten (five with a Score 6, and five with a Score 0) for the miRNA expression analysis by RT-qPCR. Participants/materials, setting, methods Semen samples were scored according to their high-magnification morphology and stored at -80 °C. We used miRNA microarray chip to analyze miRNA profile. Statistical significance was evaluated by Significance Analysis of Microarrays, screened by Fold change&amp;gt;2 and p-values ≤ 0.05. The correlation between miRNAs and their corresponding mRNA targets was analyzed using in silico prediction algorithms. The methylome was studied using the DNA sequencing method. TaqMan miRNA assays were used to confirm the miRNA results. Main results and the role of chance We perform a robust transcriptomic analysis to define unique miRNA signatures able to identify the spermatozoa that have high scores regardless of morphological appearance at high magnification. There were 86 significantly overexpressed in Score 6 and 21 miRNAs in Score 0. Score 6-spermatozoa had significantly higher levels of hsa-miR-132 (FCx41, p=1.68E-8), hsa-miR-1973 (FCx32, p=6.19E-8), hsa-miR-34 (FCx30, p=8.43E-8), hsa-miR-25 (FCx27, p=1.30E-6), hsa-miR-342 (FCx24, p=1.57E-5), hsa-miR-15 (FCx14, p=8.56E-6), hsa-miR-125 (FCx13, p=6E-4), hsa-miR-30 (FCx12, p = 3.75E-6), than Score 0. The miRNAs overexpressed in Score 6 are predicted to target 910 messenger RNA involved in biological functions of the spermatozoa and several signaling pathways, such as mTOR, p53, and MAPK signaling pathways, as well as cell Intrinsic pathway for apoptosis, cellular senescence, and oxidative stress. Whereas genes targeted by score 0-miRNAs were implicated in the regulation of cellular growth and proliferation. Our data indicate a difference in methylation of the promoter region of miRNAs, and their validated target genes were observed between score 6 and score 0. Aberrant expression of the Score 6-miRs or their targets could be due to the methylation status of the promoter region and indicative of a defect in spermatogenesis. Limitations, reasons for caution This work provides a foundation for the interpretation of miRNA changes associated with spermatozoa morphological appearance. The data must be validated by TaqMan miRNA assays in a higher number of semen samples. Moreover, the molecular network of miRNA-targeted gene pathways also merits investigation. These experiments are currently ongoing. Wider implications of the findings The profiling of miRNAs repertoire in scored spermatozoa morphology opens new perspectives to explore male fertility status and provides a biomarker panel for sperm analysis during the ART procedure. Larger well-controlled investigations employing microRNAome approaches are needed to validate these conclusions. Trial registration number not applicable

Evaluation of Child Oral Health Related Quality of Life in Bleeding Disorders

Abstract Background Oral bleeding is a common symptom for many inherited and acquired bleeding disorders in children. Understanding oral health and treatment needs of patients with bleeding disorders is necessary for patients' primary oral health prevention. Aim of the Work To evaluate the oral health problems in children with bleeding disorders both clinically and with child oral health related quality of life questionnaire score. To assess the effect of intervention (education and any necessary dental procedure) on the child oral health related quality of life questionnaire score. Patients and Methods This cross-sectional study was conducted on 70 patients aged from (2-18 years), males represent n = 47 (67.1%), females n = 23 (32.9%). Inherited bleeding disorders represent n = 37 (52.9%) and acquired bleeding disorders represent n = 33 (47.1%). ITP n = 33 (47.1%), hemophilia A n = 27 (38.6%), Von Willebrand’s disease n = 7 (10%) and Glanzmann n = 3 (4.3%) and all subjected to full history taking, examination, dental health estimation, oral health education, dental management and replacement therapy as needed at baseline and after 6 months of follow up from October 2021 to April 2022. ITP bleeding score (ISTH SSC bleeding assessment tool) used to assess severity of ITP patients. Child oral health related quality of life and child oral health impact profile questionnaires were filled by patients/parents at base line and after 6 months follow up. Results The current study revealed that (57.1%) of patients have dental caries. Regarding oral hygiene status, (10%) of patients have poor oral hygiene. Regarding gingival health, (50%) of patients have moderate gingivitis and (11.4%) have severe gingivitis. Oral symptomatology, Psychological domain for child, Psychological domain for family, Social domain for child and Total oral health score were significantly affected more with long duration of disease (p-value =0.0005, 0.0015, 0.010, 0.022 and 0.0045 respectively). There was statistically significant improvement in oral health related quality of life questionnaire score after 6 months of follow up with total oral health score (p-value = 0.000). Conclusion Oral health was significantly affected among patients with acquired and inherited bleeding disorders. Oral health education and management had significant impact on oral health related quality of life scores after 6 months of follow up.

Health Related Quality of Life of Children with Pediatric Mental Disorders and Their Caregivers

Abstract Background Studies have shown that the presence of pediatric mental disorders causes great impairment in academic, social, and professional activities as well as in the quality of life (QoL) of the patients as well as their caregivers. Aim of the Work Compare the health related quality of life (HRQoL) scores of children with pediatric mental disorders and their caregivers to those of apparently healthy children of comparable sex and age. Patients and Methods This was an observational study that included seventy-five (75) children with various pediatric mental disorders of different diagnoses (25 cases ASD, 25 cases nocturnal enuresis, 25 cases ADHD) represented the patient group (1). They were 25 females and 50 males. Their ages ranged between 4–15 years with mean ± SD of 9.32 ± 4.72 years. Another 25 healthy children matched in age and sex with the patients’ group (1) were selected as a control group (2). Results Caregivers of children with ASD, nocturnal enuresis and ADHD had an elevated risk of experiencing mental health problems. Children with ASD, enuresis and ADHD have a higher risk for additional behavioral problems tested by Pediatric Symptom Checklist, Child Behavior Checklist and DSM-V. Female cases, in all subgroups, had lower scores than male cases in the three subgroups regarding PSC and CBCL of attention, internalizing and externalizing subscales; however, results didn’t reach level of significance Conclusion Children with ASD, enuresis and ADHD and their caregivers have a higher risk for additional behavioral problems than children without mental disorders.

The Influence of Service Quality and Price on Purchasing Decisions at the Azalea Pharmacy, Sukabumi City

This study took place in Sukabumi City at the Azalea Pharmacy. The study's objective is to find out how customers in Sukabumi City's Azalea Pharmacy feel about the store's pricing and service quality in relation to their final purchase choice. The study methodologies employed included both descriptive and associative analysis. One hundred individuals were selected using a non-probability, purposive selection technique to represent the demographic of customers who frequently purchase goods and services at the Azalea Pharmacy in Sukabumi City. You may put the tool through its paces by doing tests for validity, reliability, and classical assumption. After that, we may go on to multiple linear analysis, partial t-test, simultaneous f-test, study of the coefficient of determination, and effects of multiple correlation. According to the results of the correlation analysis, there is a strong correlation between service quality and purchasing decisions (r=0.723, or 72.3%), which falls within the range of 0.600-0.799. Similarly, there is a strong correlation between price and purchasing decisions (r=0.755, or 75.5%), once again falling within the range of 0.600-0.799. The determination analysis reveals that service quality and price significantly impact purchase decisions (Rsquared = 0.623, or 62.3%). Other variables, not included in this study, account for the remaining 37.7%

Mediating effects of predictability between caregiving demands and caregiving consequences for persons living with dementia: A longitudinal study

ObjectivesThe purpose of this study was to examine the role of predictability in the relationship between caregiving demands and caregiving consequences. Design. This 2-year longitudinal survey study collected from self-report questionnaires. A convenience sample of family caregivers of older persons living with dementia were recruited from a neurology clinic. ResultsA total of 200 family caregivers were recruited to participate. Analysis indicated predictability was a partial mediator between caregiving demand and caregiver consequences of role strain, depressive symptoms and both physical and mental components of health-related quality of life at the 2-year follow. Predictability accounted for 25 %, 28.8 %, 15.3 % and 46.5 % of the relationship between caregiving demand and caregiving consequences of role strain, depressive symptoms, physical- and mental-health related quality of life, respectively. ConclusionsThe contributions of caregiving demand to outcomes of caregiver consequences were in part due family caregivers perceived predictability for caregiving.

Malnutrition contribution to the functional status and health related quality of life after COVID-19, a correlational follow-up study

To assess malnutrition contribution to the functional status and health related quality of life after hospitalization due to COVID-19 pneumonia, 66 selected adults referred for physical rehabilitation accepted to participate in the study; none of them required oxygen supply or had history of lung/musculoskeletal/neurological/immune/rheumatic disease or trauma, or contraindication for respiratory-function tests. At three evaluations, with 3 months in-between, assessments included: self-report of functional status, the St. George’s Respiratory Questionnaire, spirometry, the 6-min-walk-test, the MRC-scale, the 30-s sit-to-stand-test, the timed-up-and-go-test, nutritional status, and ultrasound imaging (vastus medialis and diaphragm). At referral, patients had nutritional deficits with protein deficiency, which gradually improved; while muscle thickness (of both vastus medialis and diaphragm) increased, along with muscle strength and mobility (ANOVA, p < 0.05). Contrarywise, the distance covered during the 6-min-walk-test decreased (ANOVA, p < 0.05), with a negative influence from excess body mass. During rehabilitation, health-related quality of life and functional status improved, with negative influence from a history of tobacco use and referral delay, respectively. After hospitalization due to COVID-19, early diagnosis of both protein deficiency and decrease of skeletal muscle thickness could be relevant for rehabilitation, while pondering the negative impact of excess body mass on submaximal exercise performance.

Oral Health-Related Quality of Life, Locus of Control, Self-Reported Oral Health and Oral Health Status among Nursing Students in Moradabad.

Oral health related quality of life (OHRQoL), locus of control, dental health as assessed by oneself and oral health situation have all been the subject of several research, but none of them have yet been investigated in combination. This cross-sectional study was carried out on 525 nursing students to investigate these ideas. The Oral Health Impact Profile-14 (OHIP-14) scale was employed to evaluate the standard of living associated with oral health. Both chance participants and group internals reported having good OHRQoL. Nursing students in the internals group accurately assessed the deteriorated aspect of their self-reported oral health. However, it was found that participants from the chance locus and powerful others were unable to accurately rate the decayed component (P < 0.05). Internal nursing students had the highest OHRQoL, followed by random and influential students. Individuals from locus internals and random gave accurate ratings of their dental deterioration.

Post-COVID syndrome: Clinical pattern and impact on health related quality of life

Background COVID-19 management has changed from just dealing with a novel respiratory viral illness to unraveling the mystery of a systemic disease. This study aimed to assess clinical pattern for post-COVID survivors and impact on quality of life. Methods 115 Patients suffering from COVID-19 affection were recruited in this study. The assessment included clinical history with special attention to symptoms attributable to post-COVID manifestations. Evaluation for presence of insomnia, anxiety and depression were done using insomnia severity index (ISI), Hamilton’s anxiety (HAM-A) and depression rating scales (HAM-D), respectively. Laboratory investigations included complete blood count (CBC), kidney function test, liver function test, C-reactive protein (CRP), and inflammatory markers including ESR, CRP and Ferritin level. EQ-5D-5L and EQ visual analogue scale (EQ-VAS) were used to assess participants’ overall health status and quality of life. Results COVID-19 patients suffered from cough (76%), fever (72.9%), fatigue (72.9%), dyspnea (69.8%) and muscle/joint pain (66.1%) as the most distressing symptoms during period of acute infection. Regarding post-COVID syndrome (PCS); Dyspnea (32.2%), fatigue (26.1%), muscle/joint pain (22.6%), loss of taste (16.5%) and loss of smell (15.7%) were the most prevalent at 3 month evaluation. 46.9% patients developed manifestations attributable to post-COVID syndrome. Fever, cough, loss of smell and taste, fatigue, anxiety and insomnia persisted significantly for longer periods among severe cases (Group 2). EQ-5D-5L domains were significantly impaired among severe COVID patients. Significant positive correlation noticed between age and increased duration of dyspnea, muscle/joint pains and depression. Also, CT chest severity scores showed significant correlation with dyspnea, fatigue, muscle/joint pains (P=0.023, 0.012 and &lt;0.001; respectively). Conclusion High prevalence of Post-COVID syndrome is a challenge to health care resources. PCS directly impacts mobility, self-care, usual activities, pain perception and anxiety and therefore is associated with lower quality of life among post-COVID patients.

Class 3 Obesity and Oral Health in Adults: A Scoping Review of the Challenges for Oral Healthcare Services.

Background: Obesity is one of the most neglected public health problems affecting both developed and developing countries. The most clinically severe obesity (Class 3 obesity) has both clinical and service delivery implications on dental services. However, associations between Class 3 obesity and oral health are minimally explored in the literature and thus poorly understood. Aims: This scoping review aimed to explore the existing evidence on Class 3 obesity and oral health. Methods: A literature search was performed via Medline, Scopus, Google scholar and Embase research databases. Results: A total of 375 papers were sourced from the database search. Twenty seven full-text papers were included in the final literature review. Results revealed findings from both quantitative and qualitative studies. Papers included results pertaining to associations with dental disease, oral health and associated behaviours, oral health-related quality of life and the barriers experienced by adults with Class 3 obesity in accessing dental services. Conclusions: While mixed findings were identified, this scoping review reports associations between Class 3 obesity and poor oral health across various domains including clinical parameters and oral health related quality of life. The literature has also highlighted important barriers to dental care in those with the most severe Class 3 obesity. Based upon our findings, we have summarised current oral health management implications and directions for future research.