General Health Scores Research Articles

The Role of Blood Groups in Health Anxiety, Marital Adjustment, and Quality of Life in Nurses

Background: This study aimed to determine the effect of blood groups on dyadic adjustment, quality of life, and health anxiety in nurses. Methods: In this causal-comparative research, 200 married nurses working in the health care centers of Iranshahr City were selected by simple random sampling using Cochran's sample size formula in 2019. Data were collected using Spinner's marital adjustment questionnaire, War and Sherborn's quality of life questionnaire, and Salkovskis' health anxiety inventory. Results: To investigate the difference among the groups, SPSS was applied, and multivariate and one-way analyses of variance were run. Among the subscales of dyadic adjustment, only the mean score of dyadic cohesion was higher in blood group A than in groups B and AB. Among the subscales of life quality, the mean score of affective role play was higher in blood group A than in groups B and AB, the mean score of social function was lower in blood group B than in blood group O, and the mean score of general health was higher in blood group A than in group B. However, the mean score of health anxiety was lower in blood group A than in blood group B. Conclusions: Given the relationship between health anxiety, marital compatibility, and quality of life with blood types among married nurses, the present study results can help increase people's awareness about at-risk blood types. As a result, vulnerable groups can be screened and trained to improve their lifestyles, healthy behavior, and environment to live a better life.

Investigating the relationship between religious orientation and spiritual intelligence with general health dimensions in women with breast cancer.

Breast cancer is the most common type of cancer and the second leading cause of death among women. Religion and spiritual behaviors are effective strategies for maintaining human health. The aim of this study was to determine the relationship between religious orientation and spiritual intelligence with general health dimensions in women with breast cancer. The present study is a correlational study that was performed on 50 women with breast cancer referred to medical centers affiliated to Isfahan University of Medical Sciences in 2020. Data were collected through questionnaires of religious orientation, spiritual intelligence, and general health. Data were analyzed by Spearman and regression tests. The results showed that religious orientation had a significant positive relationship with the overall score of general health, but the components of religious orientation had a significant negative relationship with the number of components of public health (p < 0.05). Spiritual intelligence also had a significant positive relationship with general health. However, the number of components of spiritual intelligence has a significant negative relationship with the number of components of general health (p < 0.05). Considering the relationship between religious orientation and spiritual intelligence with public health and considering educational programs based on spiritual intelligence and religious orientation in this group of people can be an important step in promoting their general health.

The impact of inhibitors on the quality of life in patients with hemophilia.

To investigate the association of health-related quality of life in hemophilia patients with inhibitor and clinical and demographic characteristics. In this multi-center cross-sectional study, 41 male patients with hemophilia A were investigated from May to October 2021. All patients were registered at the Hemophilia Clinic affiliated with Shiraz and Zahedan Universities of Medical Sciences in Iran. Health-related quality of life of the patients was evaluated by the Short Form-36 questionnaire. The patients' mean ± SD of age was 36.9 ± 13.2 (range: 18-76) years. Eleven patients (26.8%) were inhibitor positive. In univariate analysis, physical function, mental health dimension, and total Short Form-36 scores were significantly lower in the inhibitor-positive patients (p < 0.001, p = 0.045, and p = 0.035, respectively). Moreover, patients with severe disease showed significantly lower scores in physical function (p < 0.001), physical health dimension (p = 0.018), and total Short Form-36 (p = 0.031) than those with mild and moderate hemophilia. Also, blood-borne infections showed a significant association with lower score in physical health dimension (p = 0.038). In addition, annual bleeding rate showed significant negative correlations with physical health dimension (rs = -0.609, p < 0.001), mental health dimension (r = -0.317, p = 0.044), and total Short Form-36 (r = -0.455, p = 0.003) scores. In multiple linear regression analysis, disease severity revealed a significant negative relationship with scores in physical function (p = 0.001), role physical (RP) (p = 0.015), general health (GH) (p = 0.006), physical health dimension (p = 0.006), and marginally in total Short Form-36 score (p = 0.054). Also, age of the patients showed a significant negative association with physical function and GH scores (p < 0.001 and p = 0.015, respectively). Disease severity and age were shown as independent factors affecting health-related quality of life, but inhibitor alone was not an independent influencing factor. Reduced health-related quality of life was also observed in hemophilia patients with higher annual bleeding rate and blood-borne infections. Therefore, it is necessary to pay more attention to these subgroups. Further studies with larger sample size are needed for more accurate results.

Evaluating the impact of proximity to reported toxic release facilities and flood events on chronic health outcomes in the city of Galena Park, Texas

Evidence has conclusively revealed that environmental justice communities experience poor environmental conditions compared to more affluent majority communities. However, there has been little research evaluating the health impacts of immediate proximity to industrial pursuits and flood events on a population compared to others living within the same community who are only marginally removed from these locations. This cross-sectional study (N = 130) utilized three approaches to assess health outcomes (1) the 12 item Short Form Health Survey, which creates a general physical component score, (2) self-reported noncancerous chronic conditions, and (3) self-reported diagnosis of twelve different cancers. Three risk levels were spatially created using a 5-scale ordinal score for each residential parcel based on the corresponding flood probability level and proximity to facilities which report to the United States Environmental Protection Agencies Toxic Release Inventory. Analysis revealed that general physical health scores were significantly lower (P-value < 0.001) in the medium and high-risk locations, Similarly chronic conditions witnessed a non-significant twofold increased risk in the highest-risk locations compared to the lowest (POR 1.91; 95 % CI 0.82–4.39) and a non-significant increased risk of cancer diagnosis (POR 1.51; 95 % CI 0.38–5.99). This research underscores the importance of place and health outcomes even within relatively geographically compact communities. Public health and urban planning interventions and designs should take into account fine grain approaches to respond to community needs while still being mindful of limited resources.

Effect of physical activity level on pain, functionality, and quality of life in migraine patients.

This study aimed to determine the physical activity (PA) level of individuals with migraine and examine its effects on pain intensity (PI), disability, and quality of life (QoL). Individuals diagnosed with migraine between the ages of 18 and 55 were included in the study. PA levels are assessed by the International PA Questionnaire Short Form (IPAQ-SF), PI with the McGill Melzack Pain Questionnaire, disability with the Migraine Disability Assessment Scale (MIDAS), and QoL with the World Health Organization QoL Scale Short Form (WHOQOL-BREF). A total of 88 individuals, with a mean age of 34.11±10.51 years, were included in the study; 53.41% were low active (LA), 30.68% were moderate active (MA), and 15.91% were high active (HA). The physical health of LAs (p=0.047) was lower than that of MAs. General (p<0.001), physical (p<0.001), and psychological (p=0.003) health scores were lower than HAs. LAs had a higher disability (p=0.042) and PI (p=0.001) than HAs. There was a weak negative correlation between PA and PI (p=0.001) and disability (p=0.005), and a weak positive correlation between PA levels and social (p=0.007) and environmental (p=0.013) scores, and moderate positive correlations with physical (p=0.000), general (p=0.000), and psychological (p=0.000) scores. It was observed that as PA levels increased, PI decreased, and functionality and QoL increased in patients with migraine. Ensuring exercise continuity seems to be effective for improving the negative effects of migraine.

Prospektivna studija kvaliteta života kod pacijenata sa miotoničnom distrofijom tipa 2

Introduction/aim: Although myotonic dystrophy type 2 (DM2) is generally milder than DM1, quality of life (QoL) seems to be similarly impaired in these two disorders. There are no studies that assessed QoL during DM2. Our aim was to assess QoL and disease outcome in patients with DM2 after a five-year follow-up period. Material and Methods: Study originally comprised 49 DM2 patients at baseline. During the five-year period, seven patients died, eight were lost to follow-up, one patient moved, and one refused testing. The Short Form (36) Health Survey (SF-36) and Individualized Neuromuscular Quality of Life (INQoL) questionnaires were administered in 30 patients at baseline and at follow-up (47% males, 54±10 years old). Results: Patients who were retested had better Role Physical (RP) and General Health (GH) scores of the SF-36 and better weakness score of the INQoL compared to non-retested (p&gt;0.05). After the five-year follow-up, none of the SF-36 and INQoL scores differed compared to baseline (p&gt;0.05). Conclusion: QoL did not change in DM2 patients during a five-year period, as measured by both SF-36 and INQoL.

HRQOL after endoscopic transaxillary gasless hemithyroidectomy.

Endoscopic transaxillary gasless hemithyroidectomy (TAH) is one of several different hemithyroidectomy approaches. TAH has the advantage of better cosmesis compared to open surgery, although we have a lack of information about patient health-related quality of life (HRQOL) after TAH. To evaluate HRQOL after TAH. The prospective clinical study involved 40 patients who underwent TAH. Patient demographic and clinical data were collected. Patients completed the Short-Form 36 Health Survey (SF-36) before surgery, and at 1 and 6 months after surgery. Patients were followed up at an outpatient clinic for a check-up and postoperative evaluation. Patient HRQOL preoperative scores were compared with the general population. All patients were female, with a median age of 32 years and median body mass index of 23 kg/m2. The overall complication rate was 12.5%. According to the SF-36, patient HRQOL 1 month after TAH decreased in role physical (RP) and bodily pain (BP) scores (p < 0.05). RP and BP scores reached the preoperative level 6 months after surgery. Patients' role emotional score 6 months after surgery was higher than before surgery (78.94 ±34.16 vs. 93.38 ±19.24; p < 0.05). Role physical, general health, physical functioning and vitality scores were changed (p < 0.05) 1 month after surgery in patients with different pathological examination results, lobe weight, lobe volume and postoperative complications. Patient HRQOL scores are higher 6 months after TAH than before surgery. Thyroiditis in pathological examination, resected lobe weight and volume, postoperative complications have significance to postoperative HRQOL scores.

Vision-Related Quality of Life in Primary Angle-Closure Glaucoma Patients with or without Visual Field Dysfunction.

To evaluate the association between visual-related quality of life (VRQoL) and visual field (VF) loss in patients with primary angle-closure glaucoma (PACG). In this case-control study, a total of 79 patients with PACG (with or without VF detects) and 35 healthy controls were included. The patients underwent the 25-item National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25), clinical examination, and VF testing. VF defects were identified by simplified Hodapp's classification. NEI VFQ-25 scores were compared between the three groups. No significant differences were found in gender, VFQ rating for "composite score" and "color vision" between the three groups. PACG patients with VF loss were most likely to be older and had lower best corrected visual acuity (BCVA), spherical equivalent (SE), mean deviation (MD), and visual field index (VFI), but higher pattern standard deviation (PSD) (all P < 0.05). Furthermore, patients with VF loss had significantly lower NVE-VFQ-25 subscale scores for general health, general vision, ocular pain, near activities, distance activities, social functioning, mental health, role difficulties, dependency, driving, and peripheral vision than PACG patients without VF loss and healthy controls (all P < 0.05). VFI (β = 1.498, P=0.003) and MD (β = -3.891, P=0.016) were significantly correlated with Role Difficulties scores. Additionally, PSD was significantly correlated with Peripheral Vision scores (β = -1.346, P=0.003). PACG patients with VF loss reported lower NEI VFQ-25 composite and subscale scores. VF indices including VFI, MD, and PSD were strongly correlated with VRQoL as assessed by NEI VFQ-25; thus, VRQoL may be significantly impacted by glaucomatous VF defects.

Treatment of Infected Tibial Metaphyseal Nonunions Using the Ilizarov Method: Protocol for a Prospective Nonrandomized Study

The management of infected metaphyseal nonunion of the tibia is devastating, especially when associated with significant bone loss, poor soft tissues, draining sinuses, axial deformity, knee or ankle joint stiffness, limb discrepancy, and multiresisted pathogens. A systematic review, performed recently by the primary investigators but not yet published, yielded the lack of studies in the field and the huge heterogeneity of the presented results. We found several bias and controversies such as no clear definition of the exact part of the tibia where the nonunion was located, the pathogen causing the fracture-related infection, the number of previous interventions and time to presentation, and the exact type of treatment methods including the use of muscle flaps or bone grafting. Time to final union as a functional score is another important but missing data. The proposed study is designed to evaluate a sufficient number of patients with infected metaphyseal tibial nonunions using various general health, functional, and bone scores. This prospective clinical trial study, with a minimum follow-up period of 36 months, focuses on the effectiveness of the Ilizarov method after radical nonunion debridement and targeted antibiotic therapy in patients with infected metaphyseal tibial nonunions. The primary outcomes would be the definite healing of nonunion and infection-free results. Secondary outcomes would be limb alignment and discrepancy, alteration in the patient's quality of life, and functional results. A power analysis calculated a minimum of 11 patients to obtain statistical power, but we aim to include at least 25 patients. Limb discrepancy, clinical validation of infection eradication and fracture healing, radiographic validation, and patient-reported outcome measures will be highlighted and correlated. Statistical analysis of the results will offer data missing from the literature so far. Measurements are scheduled at specific times for each patient: preoperatively, 3 and 6 months postoperatively, 1 month after Ilizarov frame removal, and once per semester afterward until the end of the follow-up period (minimum 36 months). Laboratory evaluation will be assessed once per month. Any complication will be reported and treated when it occurs. The trial has already started. It was funded in June 2020. As of May 2022, 19 participants have been recruited and no major complications have been noticed yet. Data analysis will be performed after data collection ends, and results will be published afterward. An infected metaphyseal tibial nonunion is a rare condition with limited treatment options and many controversies. There is no consensus in the literature about the best treatment strategy, and this lack of evidence should be fulfilled. International Standard Randomized Controlled Trial Number (ISRCTN) 30905788; https://www.isrctn.com/ISRCTN30905788. DERR1-10.2196/39319.

EVALUATION OF FALL RISK PREVENTION EDUCATION THROUGH AGE-FRIENDLY PARTNERSHIPS

Abstract Falls in the home and community environments are the leading cause of injuries and long-term disabilities for the aging population. This study examines the outcomes of a partnership among an academic institution, government agency, community nonprofit, and emergency services organization to expand access to a fall prevention training program by targeting delivery in postal codes identified as underserved with high rates of falls emergencies (hot spots) and non-high rates (non-hot spots). A total of 354 adults aged 50 and older participated in a fall prevention education program, with 188 (53%) participants completing at least five sessions (completers), of which 35% resided in hot spot areas. Descriptive statistics for frequency, percentage, mean, and standard deviations values were calculated for demographic variables. A paired t-test analysis was conducted to compare initial and final scores for self-assessed general health and fall efficacy programs. The paired sample t-test statistics revealed significant improvements in fall efficacy for completers in hot spots (t= -6.23; p &amp;lt; 0.001) and non-hot spots areas (t= - 11.17; p &amp;lt; 0.001). No statistical differences (p &amp;gt; 0.05) were observed between the initial and final scores of the self-assessed general health for completers in hot spots and non-hot spot areas. Cross-sector collaboration to deliver targeted falls prevention training at various community locations can effectively reach underserved, at-risk older adults, although additional retention strategies must be considered. In conclusion, identifying at-risk older adults to mobilize partnerships, limited resources can be allocated towards improving retention and program outcomes of community-based fall prevention education.

Analysis of the quality of life of patients with prostate cancer on hormone therapy using information technology

Malignant neoplasms of the prostate gland are the second most common malignant disease in the male population after lung cancer. Prostate cancer is the type of diseases, which can only be controlled, but not completely cured. The purpose of this article is to study the quality of life of patients with prostate cancer on hormonal therapy with the drug buserelin, which depends on the frequency of injection and combination with the drug bicalutamide. Methods: the results of analyses 70 questionnaires of patients with prostate cancer, diagnosed with locally advanced prostate cancer, aged 68 to 75 years. There were analyzed using data processing programs: Statistica 10.0. and MS Excel. Results: according to the data obtained, the treatment regimen consisting of buserelin and bicalutamide received the highest score for general health and emotional state. Most often, patients suffer from symptoms: «fatigue», «shortness of breath», «insomnia», which increase as the duration of the injection therapy of Buserelin increases. Conclusion: the results of the study showed the need to develop organizational technologies for optimizing drug supply for oncourological patients by introducing mechanisms for recording data on the quality of life on various types of therapy in medical records.

Assessment of the general condition and quality of life of women of post-reproductive age after asymptomatic COVID-19 and 12 months after moderate COVID-19

The aim. To assess the general condition, laboratory parameters, quality of life of women of post-reproductive age after asymptomatic COVID-19 and 12 months after moderate COVID-19. Material and methods. We examined 47 women (45–69 years old), divided into 3 groups: those who did not have COVID-19, not vaccinated (group 1 – control; n = 15); women 12 months after moderate COVID-19, accompanied by pneumonia (group 2; n = 19); women with IgG in their blood who deny any symptoms of COVID-19 (group 3; n = 13). Results and discussion. An assessment of the general condition of women in post-reproductive age was carried out. In women 12 months after COVID-19 we found a lower level of total bilirubin compared to the group with asymptomatic COVID-19 (p = 0.004). An increase in thrombin time was determined in the groups of patients with symptomatic (p = 0.014) and asymptomatic (p = 0.025) COVID-19 course compared with the control group. Patients with asymptomatic COVID-19 course had a higher level of high-density lipoprotein cholesterol compared with the control group (p = 0.016) and the group 2 (p = 0.006). Compared with the control group, the group 2 had lower scores for general health (p = 0.006), vital activity (p = 0.013), general physical well-being (p = 0.039), physical functioning (p = 0.046); and the group 3 had higher scores in role functioning due to physical condition (p = 0.049). When comparing groups 2 and 3, lower scores in the group of women who recovered from the moderate COVID-19 were found in physical functioning (p = 0.002), pain intensity (p = 0.034), role functioning due to physical condition (p = 0.049), general health (p = 0.003), vital activity (p = 0.018), general physical well-being (p = 0.001). Conclusion. 12 months after moderate COVID-19, there is a pronounced deterioration in physical and emotional health; and in asymptomatic patients, better protective functions of an organism can be assumed.

Comparison of quality of life and psychological distress in patients with tongue cancer undergoing a total/subtotal glossectomy or extended hemiglossectomy and free flap transfer: a prospective evaluation

The aim of this study was to assess changes in the quality of life and psychological distress of patients with tongue cancer undergoing total/subtotal glossectomy (TG) or extended hemiglossectomy (HG) and free flap transfer. Differences between the two groups were compared using the Short Form 8-Item Health Survey (SF-8) and Hospital Anxiety and Depression Scale (HADS). Of the 43 patients with tongue cancer, 24 (56%) underwent TG and 19 (44%) underwent HG. The general health and social functioning scores in the SF-8 and depression in the HADS were significantly worse in the TG group than in the HG group at 12 months after surgery, indicating that patients in the TG group may experience social isolation and psychological distress, and have difficulty in employability even 12 months after surgery. In contrast, all items of the SF-8 in the HG group were nearly equal to those in the general population. Due to the extensive psychological impact on patients with tongue cancer who are planned for an extended resection, curative surgery with free flap transfer and multidisciplinary psychiatric support are essential to improve quality of life and manage psychological distress.

Anxiety state impact on recovery of runners with lower extremity injuries.

This prospective cohort study examined the impact of high anxiety levels on psychological state and gait performance during recovery in runners with lower body injuries. Recreational runners diagnosed with lower body injuries who had reduced running volume (N = 41) were stratified into groups using State Trait Anxiety Inventory (STAI) scores: high anxiety (H-Anx; STAI ≥40 points) and low anxiety (L-Anx; STAI <40 points). Runners were followed through rehabilitation to return-to-run using monthly surveys. Main outcome measures included kinesiophobia (Tampa Scale of Kinesiophobia, TSK-11), Positive and Negative Affect Schedule (PANAS; Positive and negative scores), Lower Extremity Function Scale (LEFS), running recovery (University of Wisconsin Running Injury and Recovery Index [UWRI]) and CDC Healthy Days modules for general health, days of anxiety/tension, disrupted sleep and work/usual activities. Running biomechanics were assessed at baseline and the final visit using 3D motion capture and a force-plated treadmill. The time to return-to-running for was 5.0±3.1 and 7.9±4.1 months for L-Anx and H-Anx, respectively and participants who withdrew (n = 15) did so at 7.7±6.2 months. L-Anx maintained low anxiety and H-Anx reduced anxiety from baseline to final visit (STAI = 31.5 to 28.4 points, 50.4 to 37.8 points, respectively), whereas the withdrawn runners remained clinically anxious at their final survey (41.5 to 40.3 points; p < .05). Group by time interactions were found for PANAS positive, LEFS UWRI, general health scores, and days feeling worry, tension and anxiety (all p < .05). Final running performance in L-Anx compared to H-Anx was most improved with cadence (8.6% vs 3.5%; p = .044), impact loading rate [-1.9% vs +8.9%] and lower body stiffness [+14.1% vs +3.2%; all p < .05). High anxiety may identify runners who will experience a longer recovery process, health-related functional disruptions, and less optimization of gait biomechanics during rehabilitation after a lower extremity injury.

Associations among hearing loss, multiple co-occurring symptoms, and quality of life outcomes in cancer survivors.

Evaluate for differences in demographic and clinical characteristics, occurrence of common symptoms, symptom severity scores, and quality of life (QOL) outcomes in survivors with (n = 155) and without (n = 118) audiometrically confirmed hearing loss. Survivors, who were recruited from throughout the San Francisco Bay area, completed the self-report questionnaires to obtain the information of demographic and clinical characteristics; the occurrence and severity of depression, anxiety, fatigue, decrements in energy, sleep disturbance, pain, and cognitive impairment; and the general and cancer-specific QOL outcomes. Parametric and non-parametric tests were used to evaluate for differences between the two survivor groups. Survivors with audiometrically confirmed hearing loss were older, more likely to be male, were more likely to be unemployed, report a lower annual household income, and had a higher comorbidity burden. Except for the severity of worst pain, no between-group differences were found in the occurrence rates for or severity of any of the symptoms. Survivors with hearing loss reported worse physical function and general health scores. While no between-group differences in symptom occurrence rates and severity scores were found, across the total sample, a relatively high percentage of survivors who were over 6years from their cancer diagnosis reported clinically meaningful levels of depression (25%), anxiety (50%), fatigue (40%), decrements in energy (70%), sleep disturbance (58%), cognitive impairment (57%), and pain (60%). Clinicians need to perform routine assessments of hearing loss, as well as common co-occurring symptoms and initiate individualized symptom management interventions.

Is central pancreatectomy an effective alternative to distal pancreatectomy for low-grade pancreatic neck and body tumors: A 20-year single-center propensity score-matched case-control study.

Central pancreatectomy (CP) is associated with a higher rate of postoperative pancreatic fistula (POPF), and it is less preferred over distal pancreatectomy (DP). We compared the short- and long-term outcomes between CP and DP for low-grade pancreatic neck and body tumors. This was a propensity score-matched case-control study of patients who underwent either CP or DP for low-grade pancreatic neck and body tumors from 2003 to 2020 in a tertiary care unit in southern India. Patients with a tumor >10 cm or a distal residual stump length of < 4 cm were excluded. Demographics, clinical profile, intraoperative and postoperative parameters, and the long-term postoperative outcomes for exocrine and endocrine insufficiency, weight gain, and the 36-Item Short Form Survey (SF-36) quality of life questionnaire were compared. Eighty-eight patients (CP: n=37 [cases], DP: n=51 [control]) were included in the unmatched group after excluding 21 patients (meeting exclusion criteria). After matching, both groups had 37 patients. The clinical and demographic profiles were comparable between the two groups. Blood loss and POPF rates were significantly higher in the CP group. However, Clavien-Dindo grades of complications were similar between the two groups (p = 0.27). At a median follow-up of 38 months (range = 187 months), exocrine sufficiency was similar between the two groups. Endocrine sufficiency, weight gain, SF-36 pain control score, and general health score were significantly better in the CP group. Despite equivalent clinically significant morbidities, long-term outcomes are better after CP compared to DP in low-grade pancreatic body tumors.

A Matching-Adjusted Indirect Comparison of the Efficacy of Pegcetacoplan Using Prince Trial Data Versus Ravulizumab and Eculizumab in Complement Inhibitor-Naïve Patients with Paroxysmal Nocturnal Hemoglobinuria

Introduction Paroxysmal nocturnal hemoglobinuria (PNH) is a rare, chronic, and life-threatening disease characterized by anemia, thrombosis, and bone marrow failure. Currently available treatment options for PNH include the C5 inhibitors eculizumab (ECU) and ravulizumab (RAV), which have been shown to improve clinical outcomes and quality of life for patients with PNH. However, a substantial proportion of patients continue to develop clinical manifestations after initiating treatment with C5 inhibitors. Pegcetacoplan (PEG) is a novel C3 inhibitor approved in the US (2021) and Europe (2021) and has the potential to address this unmet need. However, there is no head-to-head study comparing PEG against either RAV or ECU in complement inhibitor-naïve patients with PNH. The objective of the study is to perform cross-trial comparisons of PEG against both RAV and ECU using unanchored matching-adjusted indirect comparison (MAIC) methods. Methods Individual patient data from the PRINCE trial (NCT04085601), a randomized, phase 3 study of PEG in complement inhibitor-naïve patients with PNH, were compared to aggregate data from the 301 study (NCT02946463; Lee 2019, PMID: 30510080), another phase 3 study that compared RAV and ECU in a patient cohort having similar eligibility criteria to the PRINCE study. Propensity score weighting was used to adjust for cross-study differences in demographics and baseline characteristics. Unanchored comparisons were assessed for the following outcomes at Week 26: percent change in LDH level from baseline, LDH normalization (LDH <1x ULN [246 U/L]), hemoglobin (Hb) stabilization (avoidance of ≥2 g/dL decrease in Hb level in the absence of transfusions), transfusion avoidance, transfusion requirements, Functional Assessment of Chronic Illness Therapy (FACIT) Fatigue scores, and European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) General Health scores from baseline. Weighted Wald tests and 95% confidence intervals (CIs) were computed for comparisons of binary and continuous outcomes. To quantify the extent of residual bias from unmeasured confounders, bias factor analysis was used to estimate the bias due to unmeasured confounders for the following binary variables: age≥65 years, overweight or obese, aplastic anemia, impaired renal function, bone marrow failure, and GPI-deficient granulocyte clone size >70%. Unanchored indirect comparisons were adjusted for each bias factor by subtracting the bias factor from the effect estimate and 95% CIs. Results The analysis included 34 patients treated with PEG from PRINCE, along with 125 and 121 patients treated with RAV and ECU, respectively. Weighting variables included Asian race, age at first infusion, female sex, and baseline EORTC QLQ-C30 general health score. PEG compared favorably to RAV and ECU in unanchored comparisons, with a greater percent reductions in LDH (RAV: mean [95% CI], -11.89 [-16.13, -7.65], p<0.0001; ECU: -12.42 [-16.03, -8.81], p<0.0001); higher percentages of patients achieving LDH normalization (RAV: 25.94 [6.40, 45.48], p=0.0093; ECU: 25.56 [5.07, 48.05], p=0.0154), Hb stabilization (RAV: 26.35 [14.83, 37.86], p<0.0001; ECU: 27.73 [13.93%, 41.53%], p=0.0001), and transfusion avoidance (RAV: 20.75 [9.55, 31.94], p=0.0001; ECU: 26.13 [12.39, 39.87], p=0.0002); as well as lower transfusion requirements, in PRBC units transfused (RAV: -4.07 [-5.69, -2.46], p<0.0001; ECU: -4.62 [-6.69, -2.55], p<0.0001). There were also significant improvements in EORTC QLQ-C30 General Health scores (RAV: 12.91 [3.27, 22.56], p=0.0087; ECU: 12.52 [2.60, 22.44], p=0.0133), but not FACIT-Fatigue scores for both RAV and ECU. Bias factor analysis showed that the results in the MAIC were robust to residual confounding. Conclusions Using individual patient data from the PRINCE trial and aggregate data from the comparator 301 study, MAIC methods allowed for the examination of the comparative effectiveness of PEG versus RAV and ECU in the absence of head-to-head trials. Results suggest that the use of PEG may lead to improvements in LDH levels, LDH normalization, Hb stabilization, transfusion avoidance, and transfusion requirements, compared to both RAV and ECU. These results were additionally robust to sensitivity analysis using bias factor adjustments. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Quality of life among health care workers in Arab countries 2 years after COVID-19 pandemic.

Assessment of the quality of life (QoL) among healthcare workers (HCWs) is vital for better healthcare and is an essential indicator for competent health service delivery. Since the coronavirus disease 2019 (COVID-19) pandemic strike, the frontline position of HCWs subjected them to tremendous mental and psychological burden with a high risk of virus acquisition. This study evaluated the QoL and its influencing factors among HCWs residing in the Arab countries. This was a cross-sectional study using a self-administered online questionnaire based on the World Health Organization QoL-BREF instrument with additional questions related to COVID-19. The study was conducted in three different languages (Arabic, English, and French) across 19 Arab countries between February 22 and March 24, 2022. A total of 3,170 HCWs were included in the survey. The majority were females (75.3%), aged 18-40 years (76.4%), urban residents (90.4%), married (54.5%), and were living in middle-income countries (72.0%). The mean scores of general health and general QoL were 3.7 ± 1.0 and 3.7 ± 0.9, respectively. Those who attained average physical, psychological, social, and environmental QoL were 40.8, 15.4, 26.2, and 22.3%, respectively. The income per capita and country income affected the mean scores of all QoL domains. Previous COVID-19 infection, having relatives who died of COVID-19, and being vaccinated against COVID-19 significantly affected the mean scores of different domains. A large proportion of the Arab HCWs evaluated in this study had an overall poor QoL. More attention should be directed to this vulnerable group to ensure their productivity and service provision.

Efficacy of Two Probiotic Products Fed Daily to Reduce Clostridium perfringens-Based Adverse Health and Performance Effects in Dairy Calves.

Clostridium perfringens is a spore-forming, anaerobic bacterium which produces toxins and exoenzymes that cause disease in calves, especially necro-hemorrhagic enteritis-associated diarrhea often resulting in death. Clostridium infections are currently being treated with antibiotics, but even with the prudent administration of antibiotics, there are significant rates of recurrence. Probiotics, an alternative to antibiotics, are commonly employed to prevent clostridial infections. The objectives of our study were to demonstrate that two commercially available products, when used as daily, direct-fed microbials, are effective in reducing adverse effects of an experimentally induced C. perfringens infection in dairy calves. We conducted a single site efficacy study with masking using a randomized design comprising 10 calves allocated to 3 treatment groups (probiotic 1, probiotic 2, and control). The procedures such as general health scores, body weight, blood samples, and fecal sample collections were done followed by experimental challenge of calves with C. perfringens. Daily feeding of L. animalis LA51 and P. freudenreichii PF24 without or with Bacillus lichenformis CH200 and Bacillus subtilis CH201, before, during and after an oral challenge of C. perfringens significantly reduced the incidence and severity of diarrhea while improving general impression and appearance scores of calves. Most notably, survival of calves in the two probiotic-fed groups was significantly higher than for control calves and further substantiates the potential economic and health benefits of feeding effective probiotics.

Low Vision Referral Patterns in Intermediate Age-Related Macular Degeneration

Purpose Sparse data exist regarding low vision (LV) services referral patterns. We retrospectively examined our institution’s intermediate age-related macular degeneration (iAMD) patients to determine factors influencing referral. Methods We compared visual acuity (VA) and Visual Function Questionnaire (VFQ-25) composite and subscale scores for referred and non-referred iAMD patients. VA was collected at time of referral or most recent visit, and VFQ-25 was taken upon enrollment into the registry. Results Thirty-six (15.5%) of the 232 iAMD patients were referred to LV. Referred patients were more likely to have older age, worse VA in both eyes, and lower VFQ-25 scores. Univariate analysis of VFQ-25 subscales demonstrated worse scores in general vision, near, distance, mental health, role limitations, dependency, and driving. Multivariable analysis revealed lower scores in general health, general vision, and driving. Forty-eight percent of non-referred patients had VA or VFQ-25 composite scores at least as poor as the median for referred patients. Two-thirds of patients who were not referred had no discernable obstacle to referral. Conclusions Our institution refers patients with worse objective and functioning vision, but more patients may benefit from referral. Future studies should identify metrics to prompt referral and evaluate this approach.