Impact of urinary incontinence on the quality of life of individuals undergoing radical prostatectomy.

OBJECTIVE: to assess the level of urinary incontinence and its impact on the quality of life of patients undergoing radical prostatectomy. METHOD: cross-sectional study carried out with prostatectomized patients. The data were collected from the following instruments: sociodemographic questionnaire, Pad Test, International Consultation on Incontinence Questionnaire - Short Form and King Health Questionnaire. Data were submitted to descriptive and bivariate statistical analysis. The level of significance was set at 0.05. RESULTS: a total of 152 patients participated, with a mean age of 67 years. Among incontinent patients, there was a predominance of mild urinary incontinence. Urinary incontinence had a very severe impact on the general assessment of quality of life in the first months and severe impact after six months of surgery. The greater the urinary loss, the greater the impact on the quality of life domains Physical Limitations, Social Limitations, Impact of Urinary Incontinence and Severity Measures. Most participants reported no erection after surgery and therefore did not respond to the question of the presence of urinary incontinence during sexual intercourse. CONCLUSION: the present study evidenced the occurrence of urinary incontinence after radical prostatectomy at different levels and its significant impact on the quality of life of men, which reveals the need of interventions for controlling it.

Patient-Reported Measures for Person-Centered Coordinated Care: A Comparative Domain Map and Web-Based Compendium for Supporting Policy Development and Implementation.

BACKGROUND: Patient-reported measure (PRM) questionnaires were originally used in research to measure outcomes of intervention studies. They have now evolved into a diverse family of tools measuring a range of constructs including quality of life and experiences of care. Current health and social care policy increasingly advocates their use for embedding the patient voice into service redesign through new models of care such as person-centered coordinated care (P3C). If chosen carefully and used efficiently, these tools can help improve care delivery through a variety of novel ways, including system-level feedback for health care management and commissioning. Support and guidance on how to use these tools would be critical to achieve these goals. OBJECTIVE: The objective of this study was to develop evidence-based guidance and support for the use of P3C-PRMs in health and social care policy through identification of PRMs that can be used to enhance the development of P3C, mapping P3C-PRMs against an existing model of domains of P3C, and integration and organization of the information in a user-friendly Web-based database. METHODS: A pragmatic approach was used for the systematic identification of candidate P3C-PRMs, which aimed at balancing comprehensiveness and feasibility. This utilized a number of resources, including existing compendiums, peer-reviewed and gray literature (using a flexible search strategy), and stakeholder engagement (which included guidance for relevant clinical areas). A subset of those candidate measures (meeting prespecified eligibility criteria) was then mapped against a theoretical model of P3C, facilitating classification of the construct being measured and the subsequent generation of shortlists for generic P3C measures, specific aspects of P3C (eg, communication or decision making), and condition-specific measures (eg, diabetes, cancer) in priority areas, as highlighted by stakeholders. RESULTS: In total, 328 P3C-PRMs were identified, which were used to populate a freely available Web-based database. Of these, 63 P3C-PRMs met the eligibility criteria for shortlisting and were classified according to their measurement constructs and mapped against the theoretical P3C model. We identified tools with the best coverage of P3C, thereby providing evidence of their content validity as outcome measures for new models of care. Transitions and medications were 2 areas currently poorly covered by existing measures. All the information is currently available at a user-friendly web-based portal (p3c.org.uk), which includes all relevant information on each measure, such as the constructs targeted and links to relevant literature, in addition to shortlists according to relevant constructs. CONCLUSIONS: A detailed compendium of P3C-PRMs has been developed using a pragmatic systematic approach supported by stakeholder engagement. Our user-friendly suite of tools is designed to act as a portal to the world of PRMs for P3C, and have utility for a broad audience, including (but not limited to) health care commissioners, managers, and researchers.

Hacinamiento en menores de 5 años como factor de riesgo para infecciones respiratorias agudas en una comunidad rural de Honduras / Overcrowding as a risk factor for acute respiratory infections in children under 5 years in a rural community from Honduras

Antecedentes: Mundialmente las infecciones respiratorias agudas (IRA) ocupan los primeros lugares como causa de morbimortalidad, principalmente, en los países en vías de desarrollo y en menores de 5 años. Existen varios factores de riesgo relacionados con la aparición, evolución y pronóstico de las mismascomo son la desnutrición,privación de lactancia materna, hacinamiento entre otros. Objetivo: Buscando mejorar el conocimiento regional de estas enfermedades que son el principal motivo de consulta en nuestro país. Métodos: El estudio fue de tipo descriptivo, transversal y cuantitativo durante febrero - abril 2016, se usaron las variables: tipos de IRA, edad, sexo, peso, talla, estado nutricional, manifestaciones clínicas, lactancia materna y hacinamiento, fue realizado en una población rural de 105 niños y niñas menores de 5 años en el departamento de Atlántida, Honduras. Resultados y discusión: El factor de riesgo más frecuentemente presentado fue el hacinamiento; 72/105 niños (68.5%) viviendo en hacinamiento, se observó una prevalencia de desnutrición de 14.2%; de estos el 26.6% presentaron más de 6 episodios de IRA al año en contraste con 16.2% en menores de 5 años con estado nutricional normal, se encontró que aquellos niños que recibieron menos de 6 meses o ninguna lactancia materna presentaban más episodios de IRA al año. En conclusión, estos datos indican el aumento en la incidencia de IRAS en niños desnutridos y que viven en hacinamiento, se observó el importante papel de la lactancia materna como factor protector contra infecciones. Resulta necesario desarrollar políticas públicas y estrategias para la prevención y reducción de factores que predisponen a padecer IRA en menores de 5 años...(AU)

Associations of prognostic awareness/acceptance with psychological distress, existential suffering, and quality of life in terminally ill cancer patients' last year of life.

PURPOSE: Whether prognostic awareness benefits terminally ill cancer patients' psychological-existential well-being and quality of life (QOL) is unclear because of lack of well-controlled longitudinal studies. This study longitudinally evaluated the associations of accurate prognostic awareness and prognostic acceptance with psychological distress, existential suffering, and QOL while comprehensively controlling for confounders in Taiwanese terminally ill cancer patients' last year of life. PATIENTS AND METHODS: A convenience sample of 325 cancer patients was followed until death. Psychological distress and existential suffering were assessed by severe anxiety and depressive symptoms and high self-perceived sense of burden to others, respectively. Dichotomized and continuous (QOL) outcome variables were evaluated by multivariate logistic and linear regression modeling with the generalized estimating equation, respectively. RESULTS: Accurate prognostic awareness was not associated with the likelihood of severe anxiety or depressive symptoms but significantly increased the likelihood of high self-perceived sense of burden to others and was associated with poorer QOL in participants' last year of life. Participants who knew and highly accepted their prognosis were significantly less likely to experience severe anxiety symptoms than those who were unaware of or knew their prognosis but had difficulty accepting it. CONCLUSION: Knowing one's poor prognosis and confronting one's impending death without full acceptance and adequate professional psycho-spiritual support may harm more than benefit terminally ill cancer patients' psychological state, existential well-being, and QOL. These findings highlight the importance of tailoring psycho-spiritual support to cancer patients' psychological and existential needs when prognostic information is disclosed.

Child euthanasia: should we just not talk about it?

Belgium has recently extended its euthanasia legislation to minors, making it the first legislation in the world that does not specify any age limit. I consider two strands in the opposition to this legislation. First, I identify five arguments in the public debate to the effect that euthanasia for minors is somehow worse than euthanasia for adults--viz, arguments from weightiness, capability of discernment, pressure, sensitivity and sufficient palliative care--and show that these arguments are wanting. Second, there is another position in the public debate that wishes to keep the current age restriction on the books and have ethics boards exercise discretion in euthanasia decisions for minors. I interpret this position on the background of Velleman's 'Against the Right to Die' and show that, although costs remain substantial, it actually can provide some qualified support against extending euthanasia legislation to minors.

[The significance of quality of life from a socio-legal perspective]. / Die Bedeutung von Lebensqualität--aus sozialrechtlicher Perspektive.

Only rarely is the term quality of life explicitly mentioned in the Social Security Code (Sozialgesetzbuch, SGB). In the statutory health insurance law (Book V of the Social Security Code, SGB V), the term is explicitly regulated within the context of the entitlement to pharmaceuticals. While there are pharmaceuticals that have the priority to increase the quality of life but are excluded from the provision of healthcare (Section 34 (1) Sentence 7 SGB V), the improvement of the quality of life has to be taken into account for the cost-benefit assessment (Section 35b SGB V) as well as for the early pharmaceutical benefit assessment (Section 35a SGB V) and for the formation of reference price groups (Section 35 SGB V) for and in the case of an entitlement to benefits in the event of illness.

Chronic pain following inguinal hernia repair: assessment of quality of life and medico-legal aspects.

The aim of our study was to evaluate the quality of life (QoL) of a group of patients who underwent tension-free inguinal hernia repair in light of the possible medicolegal implications. We conducted a retrospective study on the QoL of patients who underwent inguinal hernioplasty. One hundred and fifty patients who answered the SF-36 questionnaire were included in the study. Twenty-six (17.3%) had chronic pain, 18 (12%), sensory deficits, and 106 (70.6%) did not complain of any symptoms. There was no a significant deterioration in QoL compared to the reference population. In the group with chronic pain, 10 patients (38.4%) reported being very limited in performing "physically demanding activities"; 18 (69.2%) reported a deficit of performance in activities of daily living; 8 (30.7%) complained of a reduction of time spent at work because of emotional disorders. In one case the pain was particularly severe and required surgical treatment. The answers obtained through the questionnaire show that tension-free hernioplasty does not degrade patients'QoL. However in the group of patients with chronic pain examined one year after surgery, QoL had deteriorated so much that it affected the employment sphere and the social and relational sphere. Although there is a relatively low incidence and frequency of problems relating to chronic pain following inguinal hernioplasty, chronic pain can sometimes have serious effects on QoL and socio-economic and legal implications.

La vulnerabilidad femenina frente al VIH en América Latina / Women's vulnerability to HIV in Latin America, HIV/AIDS in women

Este artículo tiene como objetivo analizar las condiciones, en el contexto de América Latina, que incrementan la vulnerabilidad de las mujeres al VIH y que impactan gravemente en su bienestar. La revisión sobre la evidencia disponible y la reflexión de las autoras fue centrada en las experiencias de América Latina incluyendo la experiencia personal de las autoras de México y El Salvador en el seguimiento y atención de mujeres con VIH. Las mujeres de la región de América Latina se encuentran en una posición de enorme vulnerabilidad y con pocos recursos de protección. Los factores relacionados a dicha vulnerabilidad las impulsan hoy al centro de la epidemia teniendo como resultado un crecimiento acelerado de la epidemia entre ellas. El daño producido por el VIH a las mujeres no se limita exclusivamente a ellas sino se ve extendido a su familia acrecentando así el dolor y el sufrimiento de las afectadas

This manuscript is intended to analyze the conditions that contribute to increase women's vulnerability to HIV in the Latin American region and affects and impacts on its wellbeing. The review and reflection of the authors is center in the evidence available and in their experience in Latin America with particular emphasis in the experience in Mexico and El Salvador where they have being involved in the care of HIV infected women. Women in the Latin-American region are placed in a position of great vulnerability, with scarcely preventive resources. The factors related to this vulnerability are impelling them to the center of this epidemic with an accelerated HIV epidemic among women in the region. The damage produced by HIV in women is not exclusively limited to them but is being extended to their families increasing the pain and suffering of those affected

[Psychosocial care assistants caring for residents with dementia according to section 87b SGB XI. Emotional and cognitive effects]. / Betreuung dementer Bewohner durch Alltagshelfer nach [symbol: see text] 87b SGB XI. Psychische und kognitive Effekte.

PROBLEM: Since 2008 nursing homes may receive resources for assistance in additional low threshold psychosocial care for residents with dementia. By now, most institutions make use of this. However, the effects of this additional psychosocial care on the emotional and cognitive state of mind of persons with dementia have not yet been investigated systematically. METHOD: Using a longitudinal control group design the effects of additional low threshold psychosocial assistance were recorded and analysed for ten months. FINDINGS: There appears to be a positive relation between the work of the psychosocial care assistants and the emotional state of mind (Geriatric Depression Scale) and the cognitive performance (Mini-Mental State Test) of residents with dementia. In addition, other employees appraised the additional psychosocial care and experienced some relief of strain. CONCLUSIONS: More investigation is needed, but it seems worthwhile to intensify low threshold psychosocial care.

La calidad de vida: Análisis multidimensional / The quality of life: Multidimensional analysis

Objetivo: Analizar el concepto de calidad de vida. Su estudio se amplió considerablemente a partir del siglo XX. El concepto se considera multidimensional dentro de una perspectiva formativa, debido a que éste cambia con las diferentes culturas, épocas y grupos sociales. Se realiza una revisión por diferentes autores.

Objective: To analyze the concept of quality of life. His study was expanded considerably in the twentieth century. The concept is considered multidimensional in a formative perspective due to be changed with the different cultures, ages and social groups. A review by different authors.

Prospects of future measures for persons with dementia in Japan.

In May 2008, the Japanese government launched the 'Emergency Project for Improvement of Medical Care and Quality of Life for People with Dementia' under the idea that it is necessary to build a society, without delay, where people can live life safely without anxiety even after being affected by dementia, where they can be supported by appropriate and integrated services of medical care, long-term care and community care. We would like to introduce our future dementia policy standing on the outcome of this project, which was published as a report on 10 July 2008. The measures for people with dementia in Japan have gradually achieved good results. For example, public understanding and awareness of dementia has increased through renaming the term for dementia in Japanese from 'Chiho' to 'Ninchi-sho' in 2004, and the comprehensive care system was founded focusing on the importance of providing community based long-term care while maintaining the person's familiar human relationships and residential circumstances. However, case reports show that there are yet some cases that fail to deliver appropriate treatment or long-term care service as a result of a lack of timely definite diagnosis in an early stage or a lack of coordination between medical care and long-term care. Therefore, the future dementia policy should be designed by envisaging the flow of the measures that would support the life of the person and his/her family, and improve their quality of life; starting with measures that link early notice of the patient, his/her family or neighbor to early diagnosis, and then measures to develop well-designed comprehensive care planning that provides appropriate medical and long-term care services through good coordination, while promoting research and development of diagnosis/treatment technology. In addition, in regard to early-onset dementia, comprehensive self-support measures including employment assistance should be promoted.

[Limitation of medical treatment and ethics in chronic recurrent Clivus chordoma]. / Therapiebegrenzung und ethische Aspekte bei chronisch rezidivierendem Clivuschordom. alexandraegger@scheibbs.lknoe.at

In this paper ethical questions concerning the limitation and termination of medical treatment of comatose patients will be discussed on the basis of a case study. The team is confronted with extremely high communicative and ethical demands, since every person engaged in the treatment and care of the patient should take part in this decision making process. The final responsibility regarding the medical decisions, however, lies with the doctor in charge. In such cases advance directives or living wills are important and should be taken into consideration.