Steatotic liver disease is the most important somatic determinant of quality of life in patients with obesity: A cross-sectional study.

BACKGROUND AND AIMS: Patients with metabolic dysfunction-associated steatotic liver disease (MASLD) are often comorbid and stigmatized. This can negatively affect quality of life (QOL). Other studies have primarily used the Chronic Liver Disease Questionnaire (CLDQ), which focuses on liver-related symptoms, to characterize QOL, but most MASLD patients have only mild liver disease, and CLDQ might overlook QOL issues pertaining to them. We aimed to determine the impact of metabolic dysfunction-associated steatohepatitis (MASH) on QOL in obese patients using a 136-item generic QOL questionnaire. METHODS: We included participants with BMI ≥ 35 kg/m2 who all fully answered the sickness impact profile (SIP, range 0-100, normal = 3.4, 100 = worst) and had a liver biopsy to diagnose MASLD. Sociodemographics, comorbidity and biometric data were obtained from all participants. RESULTS: Of 176 (mean age 45.9 years, 70% female, 12.6 years of education), 132 had no-MASH and 44 MASH. On stepwise multivariable regression analysis, divorce (p = .011), unemployment (p < .003) and hepatic steatosis (p = .01) were associated with poor overall QOL. No other somatic comorbidity was associated. MASH patients more frequently than no-MASH reported physical discomfort (48% vs. 30%, p = .04), inability to do daily activities (29% vs. 54%, p = .006) and attention problems (32% vs. 57%, p = .003). CONCLUSION: MASLD severity was the only somatic determinant of QOL in patients with obesity in this cohort, and a large fraction reported debilitating symptoms. Patients and caregivers should consider the limitations this poses when planning interventions.

Calidad de vida relacionada con enfermedad periodontal en pacientes diabéticos del régimen subsidiado de Manizales

Introducción: la calidad de vida relacionada con la salud bucal es un tema relevante que involucra la relación de la odontología con las enfermedades crónicas no transmisibles como la diabetes, dada su relación bidireccional. En este trabajo se resalta la importancia de revisar el impacto que generan las alteraciones periodontales en la calidad de vida de pacientes diabéticos. El objetivo de este estudio fue establecer la calidad de vida relacionada con el estado periodontal en pacientes diabéticos pertenecientes al régimen subsidiado de Manizales. Métodos: se observaron 90 adultos diabéticos pertenecientes al programa de diabetes del régimen subsidiado mediante entrevista estructurada, aplicación del instrumento OHIP-14 (Perfil de Impacto de la Salud Oral en la Calidad de Vida) y observación directa del estado periodontal, con el fin establecer el índice de extensión y severidad periodontal, descripción del índice OHIP-14, establecer su relación con variables sociodemográficas y con el estado de salud periodontal. Resultados: se encontró una prevalencia de impacto según el OHIP-14 del 44,4%, extensión del impacto con un promedio de 1,58 (IC: 1,0-2,1) y una severidad del impacto de 6,7 (IC: 6,2-7,8). Al consolidar los resultados del OHIP-14 por dimensión, se observó que el mayor impacto correspondió a la dimensión de dolor físico, con un porcentaje del 81,1%. El menor porcentaje se presentó en las dimensiones de Incapacidad Social y Discapacidad o Minusvalía con un 34,4%. Conclusiones: aunque en la población estudiada, la presencia de enfermedad periodontal ejerció pobre impacto en calidad de vida, éste fue mayor en las dimensiones de impacto de dolor físico y malestar psicológico.

Introduction: quality of life related to oral health is a relevant topic that involves the relationship of dentistry with chronic noncommunicable diseases such as diabetes, given its bidirectional relationship. This study emphasizes the importance of reviewing the impact of periodontal alterations on the quality of life of diabetic patients. The objective of this study was to establish the quality of life related to periodontal status in diabetic patients belonging to the subsidized regime of Manizales. Methods: 90 diabetic adults belonging to the diabetes program of the subsidized regime were observed by means of a structured interview, application of the OHIP-14 instrument (Oral Health Impact Profile on Quality of Life) and direct observation of periodontal status, to establish the index of periodontal extension and severity, description of the OHIP-14 index, establish its relationship with sociodemographic variables and with periodontal health status. Results: we found a prevalence of impaction according to OHIP-14 of 44.4%, extent of impaction with an average of 1.58 (CI: 1.0-2.1) and severity of impaction of 6.7 (CI: 6.2-7.8). When consolidating the OHIP-14 results by dimension, it was observed that the greatest impact corresponded to the physical pain dimension, with a percentage of 81.1%. The lowest percentage was presented in the dimensions of Social Incapacity and Disability or Handicap with 34.4%. Conclusions: although in the population studied, the presence of periodontal disease had a poor impact on quality of life, this was greater in the dimensions of physical pain and psychological discomfort.

Improving the Understanding and Managing of the Quality of Life of Patients With Lung Cancer With Electronic Patient-Reported Outcome Measures: Scoping Review.

BACKGROUND: Electronic patient-reported outcome measures (ePROMs) are essential to clinical practice and research. The growth of eHealth technologies has provided unprecedented opportunities to collect information systematically through ePROMs. Although they are widely used in scientific research, more evidence is needed to determine their use and implementation in daily clinical practice. For example, when diagnosed, patients with lung cancer are at an advanced stage of the disease. This entails tremendous burden because of high mortality and losses in the different dimensions of the human being. In this case, monitoring symptoms and other outcomes help improve the patient's quality of life. OBJECTIVE: ePROMs offered unprecedented opportunities to collect information systematically. Our goal was to demonstrate that ePROMs are more useful in controlling patient symptoms, lung cancer, and overall survival than their alternatives, such as nonelectronic PROMs. METHODS: This exploratory review considered articles published between 2017 and 2022 identified through searches of PubMed, Scopus, Cochrane, CINAHL, and PsycINFO. We found 5097 articles; after removing the duplicates, we reduced them to 3315. After reading the summary, we were left with 56. Finally, after applying the exclusion criteria, we reviewed 12. The 5-step framework by Arksey and O'Malley was used to refine the initial search results with the following research questions: Do ePROMs help physician-patient communication? To what extent do they improve decision-making? Are institutions and their digitization policies barriers to or facilitators of this process? and What else is needed for routine implementation? RESULTS: This review included 12 articles. We found that ePROMs are an integrative and facilitative communication tool, highlighting their importance in the relationship between palliative care and medical oncology. ePROMs help assess patient symptoms and functionality more accurately and facilitate clinical decision-making. In addition, it allows for more precise predictions of overall patient survival and the adverse effects of their treatments. The main institutional obstacles are the initial investment, which can be costly, and the data protection policy. However, enablers included better funding through the development of telemedicine, support from institutional leaders to overcome resistance to change, and transparent policies to ensure the safe and secure use of ePROMs. CONCLUSIONS: Routine collection of remote ePROMs is an effective and valuable strategy for providing real-time clinical feedback. In addition, it provides satisfaction to patients and professionals. Optimizing ePROMs in patients with lung cancer leads to a more accurate view of health outcomes and ensures quality patient follow-up. It also allows us to stratify patients based on their morbidity, creating specific follow-ups for their needs. However, data privacy and security are concerns when using ePROMs to ensure compliance with local entities. At least four barriers were identified: cost, complex programming within health systems, safety, and social and health literacy.

Catquest-9SF questionnaire: validation of the Portuguese version using the Rasch analysis / Questionário Catquest-9SF: validação da versão em português utilizando análise Rasch

ABSTRACT Purpose: The aim of this study was to validate the Portuguese version of Catquest-9SF through its application in a native Brazilian population with cataracts and to determine the correlation of the questionnaire scores with preoperative visual acuity. Methods: A prospective study was conducted to validate the Catquest-9SF questionnaire, which was translated and back-translated, generating a final version in Portuguese. A total of 120 Brazilian patients awaiting cataract surgery were recruited to answer the questionnaire and to document their preoperative data and visual acuity. The Rasch analysis was used to assess the instrument's psychometric properties. Results: The Portuguese version of Catquest-9SF demonstrated an acceptable adjustment of the items (item fit statistics ranging from 0.7 to 1.3), unidimensionality (principal component analysis), and good organization in the item response categories (thresholds of the categories: -2.79, 0.57, and 2.22, respectively). The questionnaire contains items with stable relationships if considered at the same level of visual impairment in the comparison between the two groups (absence of differential item functioning). The separation of people (person separation index, 3.07) was adequate. The visual acuity in the logarithm of the minimum angle of resolution (logMAR) in the best eye with the best optical correction showed a statistically significant correlation with the Catquest-9SF logit score (r=0.282 and p=0.004). Conclusions: The Portuguese version of Catquest-9SF presents evidence of validity and reliability, in addition to being linguistically and culturally understandable for Portuguese-speaking patients born in Brazil. The questionnaire is easy to understand and quick to apply, as it could adequately estimate the subjective visual functioning in patients with cataracts. We found a significant correlation between visual acuity and the questionnaire score.

RESUMO Objetivos: Validar a versão em português do Catquest-9SF através de sua aplicação em uma população nativa do Brasil com catarata e determinar a correlação da pontuação obtida no questionário com a acuidade visual pré-operatória. Métodos: Realizou-se um estudo prospectivo para validação de questionário. O Catquest-9SF foi traduzido e retro traduzido gerando uma versão final em português. Um total de 120 pacientes brasileiros que aguardavam realização de cirurgia de catarata foram recrutados para responder ao questionário e para documentação de dados pré-operatórios e acuidade visual. Análise Rasch foi utilizada para acessar as propriedades psicométricas do instrumento. Resultados: A versão em português do Catquest-9SF demonstrou ajuste aceitável dos itens (item fit statistics variando entre 0,7 e 1,3), unidimensionalidade (Principal Component Analisis) e boa organização nas categorias de resposta dos itens (limiares das categorias: -2,79; 0,57; 2,22). O questionário contém itens com relação estável, se considerado um mesmo nível de deficiência visual, na comparação entre dois grupos (ausência de differential item functioning). Existe adequada separação de pessoas (Person Separation Index 3,07). A acuidade visual em LogMAR no melhor olho com melhor correção óptica mostrou correlação estatisticamente significativa com a pontuação em logit do Catquest-9SF (r=0,282 e p=0,004). Conclusões: A versão em português do Catquest-9SF apresenta evidência de validade e confiabilidade, além de ser linguística e culturalmente compreensível para pacientes de língua portuguesa naturais do Brasil. Trata-se de questionário de fácil entendimento e rápida aplicação, sendo capaz de estimar de maneira adequada o funcionamento visual subjetivo em pacientes com catarata. Existe correlação significativa com a acuidade visual e a pontuação obtida no questionário.

Correlation between levels of perceived stress and depressive symptoms in the functional disability of patients with fibromyalgia

SUMMARY OBJECTIVE: The aim of this study was to evaluate the factors that are most correlated with the levels of functional disability in patients with fibromyalgia. METHODS: This is a cross-sectional descriptive study in which 42 patients diagnosed with fibromyalgia according to the criteria of the American College of Rheumatology reported their status using the following questionnaires: the Beck Depression Inventory, the Perceived Stress Scale 14, the Revised Fibromyalgia Impact Questionnaire, the Visual Analog Pain Scale, and the Health Assessment Questionnaire. RESULTS: Moderate to severe levels of depression (Beck Depression Inventory: 22.35±10.39), moderate to severe functional disability (Health Assessment Questionnaire: 1.28±0.58), and high levels of stress (Perceived Stress Scale 14: 31.59±10.02) were found. The correlation adjusted by multiple regression as a function of the Health Assessment Questionnaire indicated a negligible to weak positive correlation with perceived stress (r=0.11), while a moderately strong positive correlation was observed with the Visual Analog Pain Scale (r=0.55). Regarding physical exercise, one of the pillars of the treatment, a moderate negative correlation was found with the Health Assessment Questionnaire (r=-0.4). CONCLUSION: The pain levels were moderately influenced by depression severity. The factors most linked to functional disability are due to the pain levels but not to the perception of stress.

Patient reported outcomes after definitive open tibial fracture management.

AIMS: Open tibial fractures are often life-changing injuries and patient outcomes remain poor despite the introduction of national management guidelines. The longer-term impact to the patient can be considerable but this is often overlooked in the literature. This study aims to establish the functional, physical, and psychosocial impact of sustaining an open tibial fracture. METHODS: We reviewed 69 consecutive Gustilo-Anderson grade IIIB and IIIC open tibial fractures that presented to our Major Trauma Centre (MTC) between September 2012 and April 2018. Each participant was interviewed and sent patient-reported outcome questionnaires, a minimum of 12 months following injury. Our primary outcome was the Lower Extremity Functional Scale (LEFS). Secondary outcomes included the Short-Form 36 Healthy Survey (SF-36), Sickness Impact Profile 128 (SIP) and return to occupation. Subgroups were analysed according to age, Injury Severity Score (ISS) and limb amputation. RESULTS: The mean follow up was 43 months. 96% were grade IIIB and 4% grade IIIC. The response rate for our study was 72%. The mean LEFS was 42 (IQR 21.5-58.5). All total and sub-domain scores within both the SF-36 and SIP questionnaires were reduced when compared to normative population data. Only 48% of patients returned to full time employment. Subgroup analysis revealed significantly reduced LEFS, SIP and SF-36 subdomain scores for those with a presenting ISS >14 and those undergoing limb amputation. CONCLUSION: Patients are at significant risk of longer-term functional, physical and psychosocial harm after suffering an open tibial fracture. Those sustaining major polytrauma or amputation demonstrated to have the greatest risk of poor outcome. Early identification of these individuals likely to suffer most from their injury would help direct appropriate resources to those with greatest need at the earliest opportunity.

Family functioning and health-related quality of life of inpatients with coronary heart disease: a cross-sectional study in Lanzhou city, China.

BACKGROUND: A key outcome in coronary heart disease (CHD) is Health Related Quality of Life (HRQoL), and family functioning is important in the management of CHD. But few studies have examined both together, and little is known about them among inpatients with CHD in less developed areas of China. Therefore, this study aimed to assess the HRQoL and family functioning status of inpatients with CHD in Lanzhou from Northwest China, and identify the factors that affect their HRQoL. METHODS: A cross­sectional study was conducted in 224 CHD inpatients at one major hospital. Sociodemographic data and disease information of CHD inpatients were collected by face-to-face using a structured questionnaire and data were also obtained from patient medical records. HRQoL was measured using the Sickness Impact Profile (SIP). Family functioning was measured using the family APGAR index. Multiple binary logistic regression analysis (MBLRA) was used to explore potential risk factors associated with HRQoL, and Pearson's correlations were used to assess the relationship between family functioning and HRQoL. RESULTS: The overall, physical and psychosocial SIP scores were 25.03 ± 8.52, 18.61 ± 9.90 and 28.08 ± 9.64, respectively. The total family APGAR score was 6.11 ± 2.45. MBLRA found older age, poorer cardiac function and more severe disease were associated with poorer HRQoL, while better family functioning, higher monthly income, and urban living were associated with better HRQoL. Family functioning was weakly to moderately correlated with total and psychosocial HRQoL. CONCLUSIONS: Older and less affluent inpatients with lower educational level, less family support and more severe CHD have poorest quality of life, and health care providers should consider interventions to support them.

Encephalopathy in Cirrhosis: Prevention and Management.

Hepatic encephalopathy (HE) is a major neuropsychiatric complication of cirrhosis. The clinical manifestations of HE ranges from mild confusion, disorientation to altered behaviour and coma in advanced stages. HE is an important cause of recurrent admissions in liver cirrhosis patients. HE is the most common cause of altered mentation in a patient of liver cirrhosis. Lactulose and rifaximin are approved treatment options for the treatment of HE. In patients who have localised neurological signs or are not improving with lactulose and rifaximin should be investigated for other causes of altered sensorium.

Climaterio y sueño: revisión narrativa / Climacteric and sleep: narrative revision

RESUMEN Introducción: El sueño es un proceso dinámico y complejo fundamental para mantener un adecuado estado de salud física y psicológica. Los trastornos del sueño se incrementan durante la transición menopáusica con efectos deletéreos sobre la salud, la calidad de vida, el uso de los recursos de salud y la productividad laboral. Aunque la relación sueño-climaterio es abordada con frecuencia no hay consenso sobre la asociación entre síntomas vasomotores, calidad del sueño y los tratamientos. En Cuba los estudios son escasos lo que dificulta comprender su impacto en la vida cotidiana de la mujer de edad mediana. Objetivo: Actualizar aspectos relacionados con la interrelación síndrome climatérico: calidad del sueño, factores asociados y sus opciones terapéuticas. Métodos: Se revisaron las bases de datos Google Scholar, PubMed Central y SciELO Regional, por intermedio del buscador web de Google. El artículo se estructuró como: características del sueño en el climaterio, factores biológicos y sociales de la relación síndrome climatérico - sueño y tratamientos de los trastornos del sueño. Conclusiones: Durante la transición a la menopausia se incrementan los autoreportes de trastornos del sueño relacionados con la intensidad de los síntomas vasomotores, los estados emocionales, enfermedades y factores sociales. Hay falta de uniformidad en los métodos clínicos para el diagnóstico de los problemas del sueño y en los enfoques psicoterapéuticos y farmacológicos. Debido a la escasez de estudios nacionales sería pertinente caracterizar los problemas de sueño en la mujer cubana de edad mediana.

ABSTRACT Introduction: Sleep is a dynamic and complex process, essential to maintain an adequate state of physical and psychological health. Sleep disorders increase during the menopausal transition with deleterious effects on health, quality of life, use of health resources, and work productivity. Although the sleep-climacteric relationship is frequently addressed, there is no consensus on the association between vasomotor symptoms, sleep quality, and treatments. In Cuba, studies are scarce, which makes it difficult to understand their impact on the daily life of middle-aged women. Objective: To update aspects related to the interrelation of climacteric syndrome: sleep quality, associated factors and their therapeutic options. Methods: Google Scolar, PubMed and SciELO Regional data bases were reviewed with Google web search engine. The article was structured: sleep characteristics in the climacteric, relationship between Climacteric Syndrome and sleep and treatment for sleep disorders. Conclusions: During the transition to menopause, self-reports of sleep disorders related to the intensity of vasomotor symptoms, emotional states, illnesses and social factors increased. There is a lack of uniformity in clinical methods for the diagnosis of sleep problems and in psychotherapeutic and pharmacological approaches. Due to the scarcity of national studies, it would be pertinent to characterize sleep problems in middle-aged Cuban women.

Tooth Loss, Sociodemographic Conditions and Oral Health-Related Quality of Life in the Elderly

Abstract Objective: To verify the association between impacts produced by tooth loss and sociodemographic variables in the oral health-related quality of life (OHRQoL) in the elderly. Material and Methods: This is an analytical cross-sectional study carried out in the municipality of Vitória/ES, Brazil, which sample was composed of 402 older adults. The Oral Health Impact Profile (OHIP-14) was used to measure the individuals' OHRQoL. For data analysis, descriptive and bivariate analyses were performed using the Fisher's exact test and the Mantel-Haenzsel test to assess the effects of combined dimensions. The significance level adopted was 5%. To assess the strength of association between independent variables and dimensions, Odds-Ratio (OR) with 95% confidence interval (CI) was calculated. Results: The prevalence of negative impact on OHRQoL in the elderly was 32.6%. The greatest impact perception was found in individuals with up to 10 years of schooling (p=0.021 and OR=1.602), with need for removable partial dentures (p=0.000 and OR=2.873) and those who did not accept the loss of dental elements (p=0.000 and OR=3.064). Conclusion: Older female adults with socioeconomic class C/D-E, with up to 10 years of schooling, who lost 11 or more teeth, who declared the need for removable partial dentures, suffered greater impacts caused by tooth loss on OHRQoL.

Perfil epidemiológico HIV/AIDS no estado do piauí em 2019 / Epidemiological Profile HIV/AIDS In The Piauí State In 2019 / Perfil Epidemiológico VIH/SIDA En El Estado Piauí En 2019

Introdução:O vírus da imunodeficiência Humana e a Síndrome daImunodeficiência Adquirida (HIV/Aids) ainda é expressivamente presente em grupos que sofrem de vulnerabilidades sociais, sendo umdesafio ainda não superado, principalmente no que diz respeito ao desempenho de ações de saúde e por parte dos gestores no sentidoda realização de prevenções amplas, baseadas nos contextos epidemiológicos das comunidades, cabendo também considerar os problemasde estrutura da rede de saúde para com o manejo diagnóstico, contextos de desigualdade e gênero que são as principais influencias para o desenvolvimento da doença.Objetivo:observar por meio de indicadores o panorama da situação do HIV/Aids no Piauí no ano de 2019. Metodologia:Estudo epidemiológico realizado através da plataforma do Departamento de informática do Sistema Único de Saúde. Foram consultadosdados referentes ao período de 2019do Estado do Piauí. Utilizou-se os indicadores de incidência, sexo, raça/cor, faixa etária, escolaridade e exposição, com foco nas taxas de incidência, óbitos e letalidade. Os dados foram agrupados e tabulados por meio dos programas Excel e Tabwin, utilizandoo método de análise a técnica de percentagem.Resultados:No período vigente, o Estado apresentou 207 novos casos. A incidência foi de 6,32/100.000 habitantes, tendo maior detecção parao público masculino (73,91%), faixa etária de 30-39 anos, maior predominância da população parda, escolaridade de ensino médio completo e heterossexuais. Quanto a mortalidade, foram notificados134 óbitos por HIV, predominante para o sexo masculino. A Letalidade mostrou que 65% foram realmente afetadas pela doença.Conclusões:O perfil epidemiológico dos casos de HIV/Aids no Piauí foi caracterizado pela prevalência emdeterminados grupos, demonstrando que apesar da existência de políticas públicas que buscam a prevenção da doença, essa realidade ainda é presente nos dias atuais. Ressalta-se a importância da realização de estudos epidemiológicos para comparação e analise situacionais futuras (AU).

Introduction:The Human Immunodeficiency Virus and the Acquired Immunodeficiency Syndrome (HIV/Aids) is still significantly present in groups that suffer from social vulnerabilities, being a challenge that has not yet been overcome, especially with regard to the performance of health actions and by the managers in the sense of carrying out comprehensive prevention, based on the epidemiological contexts of the communities, and it is also necessary to consider the problems of the structure of the health network in terms of diagnostic management, contexts of inequality and gender, which are the main influences on the development of the disease. Objective: observe through indicators the panorama of the situation of HIV/Aidsin Piauí in theyear 2019. Methodology:Epidemiological study carried out through the platform of the Information Technology Department of the Unified Health System. Data for the period 2019 in the State of Piauí were consulted. Indicators of incidence, sex, race/color, age, education and exposure were used, focusing on incidence rates, deaths and lethality. Data were grouped and tabulated using Excel and Tabwin programs, using the method of analysis and the percentage technique. Results: In the current period, the State presented 207 new cases. The incidence was 6.32/100,000 inhabitants, with greater detection for the male population (73.91%), age group 30-39 years, greater predominance of the brown population, complete high school education and heterosexuals. As for mortality, 134 deaths from HIV were reported, predominantly for males. Lethality showed that 65% were actually affected by the disease.Conclusions: The epidemiological profile of HIV/Aidscases in Piauí was characterized by the prevalence in certain groups, demonstrating that despite the existence of public policies that seek to prevent the disease, this reality is still present today. The importance of conducting epidemiological studies for future situational comparison and analysis is highlighted (AU).

Introducción: El Virus de la Inmunodeficiencia Humanael Síndrome de Inmunodeficiencia Adquirida (VIH/Sida) sigue estando presente de manera significativa en grupos que padecen vulnerabilidades sociales, siendo un desafío aún no superado, especialmente en lo que respecta al desempeño de las acciones de salud y por el gestores en el sentido de realizar una prevención integral, con base en los contextos epidemiológicos de las comunidades, y también es necesario considerar los problemas de la estructura de la red de salud en términos de gestión diagnóstica, contextos de desigualdad y género, que son los principales influencias en desarrollo deenfermedad. Objetivo: observar indicadores a través del panoramade situación del VIH/Sidaen Piauí en el año 2019. Metodología: Estudio epidemiológico realizado a través de la plataforma del Departamento de Tecnología de la Información del Sistema Único de Salud. Se consultó la fecha para el período 2019 enEstado de Piauí. Se utilizaron indicadores de incidencia, sexo, raza/color, edad, educación y exposición, centrándose en las tasas de incidencia, las muertes y letalidad. Los datos se agruparon, tabularon medianteprogramas Excel y Tabwin, utilizando método de análisis ytécnica de porcentaje. Resultados: Enperíodo actual, el Estado presentó 207 nuevos casos. La incidencia fue de 6,32/100.000 habitantes, con mayor detecciónpara población masculina (73,91%), grupo etario 30-39 años, mayor predominio de la población morena, bachillerato completo y heterosexuales. En cuantola mortalidad, se reportaron 134 muertes por VIH, predominantemente por males. La letalidad mostró que el 65% estaba realmente afectadopor enfermedad. Conclusiones: El perfil epidemiológico delos casos de VIH/Sida en Piauí se caracterizó porprevalencia de ciertos grupos, demostrando que a pesar de la existencia de políticas públicas que buscan prevenir la enfermedad, esta realidad sigue presenteen actualidad. Se destacaimportancia de realizar estudios epidemiológicos para futuros análisis y comparaciones situacionales (AU).

Repercussões do câncer na qualidade de vida de homens em tratamento quimioterápico / Cancer repercussions on the quality of life of men in chemotherapeutic treatment

Resumo Objetivo: Esse estudo objetivou avaliar o nível de qualidade de vida entre pacientes do sexo masculino em tratamento quimioterápico. Metodologia: Trata-se de estudo descritivo com abordagem quantitativa, realizado de abril a junho de 2019, no serviço de quimioterapia de um hospital escola da região norte do Ceará. A coleta de dados foi realizada através de questionário sociodemográfico e de instrumento para avaliação da qualidade de vida. Resultados: Participaram do estudo 61 pacientes, com média de idade de 60,29 anos, casados e com baixa escolaridade, cujos domínios de qualidade de vida que apresentaram menores médias de escores foram o físico e autoavaliação da qualidade de vida. Já os domínios melhores avaliados foram o psicológico, relações sociais e meio ambiente. Conclusão: A autoavaliação da qualidade de vida geral dos participantes obteve avaliação relativamente satisfatória, evidenciando-se que os impactos do câncer na qualidade de vida dos pacientes do sexo masculino em tratamento quimioterápico afetam principalmente os aspectos relacionados ao domínio físico, o que demanda a prestação de assistência multiprofissional e de enfermagem integral e holística, que busque mitigar as implicações dessa patologia e melhorar a qualidade de vida dos sujeitos.

Resumen Objetivo: Evaluar el nivel de calidad de vida de los pacientes masculinos sometidos a quimioterapia. Método: Se trata de un estudio descriptivo con abordaje cuantitativo, realizado de abril a junio de 2019, en el servicio de quimioterapia de un hospital universitario de la región norte de Ceará. La recolección de datos se realizó a través de un cuestionario sociodemográfico y un instrumento para evaluar la calidad de vida. Resultados: En el estudio participaron 61 pacientes, con una edad promedio de 60,29 años, casados ​​y con bajo nivel educativo. En los dominios de calidad de vida, las puntuaciones medias más bajas fueron la calidad de vida física y autoevaluada. Los dominios mejor evaluados fueron el psicológico, las relaciones sociales y el medio ambiente. Conclusión: La autoevaluación de la calidad de vida general de los participantes obtuvo una evaluación relativamente satisfactoria, mostrando que los impactos del cáncer en la calidad de vida de los pacientes masculinos sometidos a quimioterapia inciden principalmente en aspectos relacionados con el dominio físico, lo que demanda la prestación de asistencia multiprofesional y de enfermería integral y holística, la cual busca mitigar las implicaciones de esta patología y mejorar la calidad de vida de los sujetos.

ABSTRACT Objective: To assess the level of quality of life among male patients undergoing chemotherapy. Method: This a descriptive study with a quantitative approach carried out from April to June 2019, at the chemotherapy service of a teaching hospital in northern Ceará. The data collection was carried out using a sociodemographic questionnaire and an instrument to assess the quality of life. Results: 61 patients participated in the study; they were of an average age of 60.29 years old, married and with low education. The quality of life domains that had lower mean scores were physical and self-rated quality of life. The best assessed domains were psychological, social relationships and the environment. Conclusion: The self-assessment of the general quality of life of the participants obtained a relatively satisfactory evaluation showing that the impact of cancer on the quality of life of male patients undergoing chemotherapy mainly affected aspects related to the physical domain, which demands a multi-professional approach with comprehensive and holistic nursing to mitigate the implications of this pathology and to improve the quality of life of the subjects

Quality of life and unmet needs in patients with chronic liver disease: A mixed-method systematic review.

BACKGROUND & AIMS: In an attempt to uncover unmet patient needs, this review aims to synthesise quantitative and qualitative studies on patients' quality of life and their experience of having liver disease. METHODS: Three databases (CINAHL, Embase, and PubMed) were searched from January 2000 to October 2020. The methodological quality and data extraction of both quantitative and qualitative studies were screened and appraised using Joanna Briggs Institute instruments for mixed-method systematic reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A convergent, integrated approach to synthesis and integration was used. Studies including patients with autoimmune and cholestatic liver disease, chronic hepatitis B and C, non-alcoholic fatty liver disease and non-alcoholic steatohepatitis, cirrhosis, and hepatocellular carcinoma were considered. RESULTS: The searches produced 5,601 articles, of which 95 (79 quantitative and 16 qualitative) were included in the review. These represented studies from 26 countries and a sample of 37,283 patients. The studies showed that patients´ quality of life was reduced. Unmet needs for information and support and perceived stigmatisation severely affected patients' quality of life. CONCLUSIONS: Our study suggests changes to improve quality of life. According to patients, this could be achieved by providing better education and information, being aware of patients' need for support, and raising awareness of liver disease among the general population to reduce misconceptions and stigmatisation. REGISTRATION NUMBER: PROSPERO CRD42020173501. LAY SUMMARY: Regardless of aetiology, patients with liver diseases have impaired quality of life. This is associated with disease progression, the presence of symptoms, treatment response, and mental, physical, and social factors such as anxiety, confusion, comorbidities, and fatigue, as well as limitations in daily living, including loneliness, low income, stigmatisation, and treatment costs. Patients highlighted the need for information to understand and manage liver disease, and awareness and support from healthcare professionals to better cope with the disease. In addition, there is a need to raise awareness of liver diseases in the general population to reduce negative preconceptions and stigmatisation.

Liver Transplant Is Associated with Sustained Improvement in Tandem Gait and Risk of Falls.

BACKGROUND: Cirrhosis is associated with poor health-related quality of life (HRQOL), cognitive dysfunction (CD), and lack of coordination leading to falls. Tandem gait (TG; heel-toe) can be used to assess coordination. The impact and relationship between CD, TG and falls pre-/post-liver transplant (LT) is unclear. We aimed to determine the impact of LT on CD, abnormal TG, and HRQOL in cirrhosis. METHODS: We analyzed patients who underwent complete neurological examination, cognitive testing by psychometric hepatic encephalopathy score (PHES), and HRQOL assessment using sickness impact profile (SIP). All patients were followed for 1 post-LT visit at 6 or 12 months post-LT for clinical course and falls. Change in CD, TD, and falls pre-/post-LT were compared. RESULTS: Off 131 recruited, 61 patients completed all visits. Majority were men (84%), with HCV etiology (34%). Pre-LT: Abnormal TG trended towards increased falls (OR 3.3, P = 0.08). Forty-nine % had abnormal TG, 61% had CD, 32.7% had CD + abnormal TG, 62% had prior OHE, and 14.7% had falls. Abnormal and normal TG patients had similar ages, BMI, sex, education level, and MELD scores. Abnormal TG group had higher prior overt HE (P = 0.03) and worse physical SIP score (P = 0.008). Post-LT: There was sustained improvement in CD, HRQOL, falls, and TG post-LT more at 12 than 6 months in all patients. Patients who had abnormal TG pre-LT continued to have a worse PHES (P = 0.0064) and physical SIP score (P = 0.008) compared to normal pre-LT TG patients. CONCLUSION: After LT, there is a sustained improvement in coordination measured via tandem gait, accompanied by a lower rate of falls.

A survey on quality of life and its influencing factors among patients with non-melanoma skin cancers / 中华皮肤科杂志

Objective:To investigate quality of life and its influencing factors among patients with non-melanoma skin cancers (NMSC) .Methods:From June 2017 to January 2020, demographic, clinical and behavioral data were collected from 153 inpatients with NMSC, who received surgeries in Department of Plastic Surgery, Hospital of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, by using a self-made questionnaire and the dermatology life quality index (DLQI) scale, and DLQI score was calculated to evaluate the quality of life of the patients. Chi-square test, Kruskal-Wallis H test, and multivariate logistic regression model were used to analyze factors influencing the quality of life of NMSC patients. Results:A total of 146 (95.4%) valid questionnaires were collected. The 146 patients were 31-92 years old, and 101 (69.2%) of them were over 60 years old, and 59 (40.4%) had a history of long-term ultraviolet exposure. There were 66 cases (45.2%) of basal cell carcinoma (BCC) , 57 (39.0%) of invasive squamous cell carcinoma (SCC) , 16 (11.0%) of extramammary Paget disease and 7 (4.8%) of Bowen disease. The median DLQI score ( M[ P25, P75]) was 3 (1, 7) . The quality of life were affected in 99 (67.8%) patients, including 52 (35.6%) mildly affected, and 47 (32.2%) moderately to extremely severely affected. Multivariate logistic regression analysis showed that the skin cancer type, long-term ultraviolet exposure history, and having 3 or more children affected the quality of life of the patients with NMSC. Conclusion:NMSC decrease the quality of life of the patients, and the type of skin cancers, history of long-term ultraviolet exposure and number of children are the factors influencing the quality of life of patients with NMSC.

Impacto da doença valvar nas atividades cotidianas de pacientes no período pré-operatório / Impact of valvular heart disease on activities of daily living during the preoperative period

Objetivo: avaliar o impacto da valvopatia no cotidiano dos pacientes em pré-operatório de cirurgia cardíaca. Métodos: estudo transversal, observacional, descritivo, com amostra de conveniência. Utilizado o instrumento "Impacto da Doença no Cotidiano do Valvopata", composto por uma questão geral e 14 itens, distribuídos em quatro domínios: "Impacto físico da doença", "Impacto da doença nas atividades cotidianas", "Impacto social e emocional da doença" e "Adaptação à doença". Obtém-se um escore para cada domínio e um escore total, por meio da soma de todos os escores (14 a 350), quanto maior o valor, maior a percepção negativa do impacto. Resultados: participaram do estudo 73 pacientes. O domínio "Impacto da doença nas atividades cotidianas" apresentou a maior média (82,79; DP=21,35), seguido pelo "Impacto social e emocional da doença" (61,24; DP=22,7). A média do escore total foi 210,55 (DP=51,7). Conclusão: os pacientes avaliaram o impacto da valvopatia como negativo no pré-operatório de cirurgia cardíaca.

Objective: to assess the impact of valvular heart disease on the daily life of patients in the preoperative period of heart surgery. Methods: we conducted a descriptive cross-sectional study using consecutive sampling. We used the assessment instrument "Impact of Valvular Heart Disease on the Daily Life of Patients", consisting of 14 items divided into four domains: "Physical impact - symptoms", "Impact on activities of daily living", "Social and emotional impact" and "Adaptation to the disease". Each domain is scored and an overall score is calculated based on the sum of all items, ranging from 14 to 350. The higher the score, the more negative the perceived impact. Results: 73 patients participated in the study. The domain that obtained the highest mean score was "Impact on activities of daily living" (82.79; SD = 21.35), followed by "Social and emotional impact" (61.24; SD = 22.7). The mean overall score was 210.55 (SD = 51.7). Conclusion: the patients rated the impact of valvular heart disease during the preoperative period of heart surgery as negative.

Bem-estar e comprometimento motor facial em pacientes com paralisia facial periférica: um estudo transversal / Well-being and facial motor impairment in patients with peripheral facial paralysis: a cross-sectional study

A Paralisia Facial Periférica (PFP) é resultante da disfunção do nervo facial. A incapacidade de mover o rosto tem consequências sociais e funcionais para o paciente. OBJETIVO: Analisar a relação entre comprometimento motor facial e bem estar em pacientes com PFP. MÉTODO: Trata-se de uma pesquisa de caráter descritivo, observacional, do tipo transversal. Os critérios de elegibilidade consistiam em ter diagnóstico de paralisia facial e estar sendo atendido namclínica escola de Fisioterapia da FACISA. A amostra foi constituída porm20 pessoas com PFP. Os pacientes foram avaliados por uma ficha de avaliação sociodemográfica e pelos instrumentos: Escala de HouseBrackmann (HB) e o Índice de Incapacidade Facial (IIF).Utilizou-se o coeficiente de correlação de Spearman para analisar o grau de correlação entre HB, IF e o tempo de lesão. RESULTADOS: Os participantes foram 65% do sexo feminino, a mediana da idade foi de 50,5 anos, o tempo de lesão foi de 3 a 331 dias (mediana 17,5 dias), a etiologia predominante foi idiopática 65%, e ambas hemifaces foram acometidas em igual proporção (50%). Quanto as características clínicas da PFP, o nível de comprometimento motor facial graduado pela escala de HB obteve mediana 4, o IFF-física obteve mediana 60. IFF-função social obteve mediana 38. Nas correlações entre HB, tempo de lesão e IFF, foi observado que os valores obtidos indicaram que não houve correlações estatisticamente significantes. CONCLUSÃO: Mesmo que o nível de comprometimento motor facial esteja acentuado, não houve correlação com o bem-estar dos participantes.

Peripheral Facial Paralysis (PFP) is the result of facial nerve dysfunction. The inability to move the face has social and functional consequences for the patient. OBJECTIVE: To analyze the relationship between facial motor impairment and wellbeing in patients with Peripheral Facial Paralysis (PFP). METHOD: This is a descriptive, observational, cross-sectional study. The eligibility criteria consisted of having a diagnosis of facial paralysis and being seen at the FACISA School of Physiotherapy clinic. The sample consisted of 20 people affected by PFP. The patients were evaluated by a socio-demographic data sheet and by the instruments: House-Brackmann Scale (HB) and Facial Impairment Index (IIF). Spearman's correlation coefficient was used to analyze the degree of correlation between HB, IF and injury time. RESULTS: The participants were 65% female, the median age was 50.5 years, the injury time was 3 to 331 days (median 17.5 days), the predominant etiology was idiopathic 65%, and both hemifaces were affected in equal proportion (50%). As for the clinical characteristics of PFP, the level of facial motor impairment graded by the HB scale obtained a median of 4, the IFF-physics obtained a median of 60. IFFsocial function obtained a median of 38. In the correlations between HB, injury time and IFF, it was observed that the values obtained indicated that there were no statistically significant correlations. CONCLUSION: Even though the level of facial motor impairment is marked, there was no correlation with the participants' well-being.

Validation of the oral health impact profile in spanish for paraguayan adults (OHIP-14Py) / Validación del perfil de impacto de salud oral en español para adultos paraguayos (OHIP-14Py)

Objetive: The objective of this study was to culturally adapt and validate the short version of the Oral Health Impact Profile (OHIP) instrument into Spanish for use by Paraguayan adults who attended dental clinics. Material and methods: The design was a cross-sectional observational study based on Classical Test Theory (CTT). The original English language version was subjected to a forward-backward translation processes; a calibration of the examiners and pilot test were performed. The questionnaire was applied by dentists through interviews; the same dentists also made the oral examination. The dimensionality of the questionnaire was evaluated using Confirmatory Factorial Analysis (CFA). The total and item-total internal consistencies were evaluated using Cronbach's alpha. To evaluate the discriminating validity, the Mann-Whitney and Kruskal-Wallis tests were used. Spearman's correlation analysis was used to measure convergent validity for total-dimension, self-assessment of oral health, and dental caries experience index with the DMFT Index. Results: Three-hundred-thirty-three patients participated in the study. The CFA indicates the Paraguayan's OHIP (OHIP-14Py) is considered a multi-dimensional instrument. The Cronbach's alpha values were appropriate for both the total (α=0.061) and for item total (α=0.80) correlation. The OHIP-14Py discriminated for the variable self-perception of oral health (p=0.001), symptoms of the temporomandibular joint (TMJ) (p=0.026), need of upper dental prosthesis (p=0.001), need of lower dental prosthesis (p=0.001), and ≥20 teeth healthy (p=0.001). For measuring convergent validity, all coefficients of correlation were statistically significant (p=0.001). Conclusion: The OHIP-14Py is a reliable and valid questionnaire for the evaluation of oral health-related quality of life in Paraguayan adults.

Objetivo: El objetivo del estudio fue adaptar culturalmente y validar el instrumento Perfil de Impacto de Salud Oral (OHIP) en la versión corta de 14 ítems en español, en adultos paraguayos que acudieron a consultorios odontológicos durante el primer trimestre del año 2017. Material y Métodos: El diseño del estudio fue transversal, basado en la Teoría Clásica de los Test (TCT). La versión original en inglés fue sometida al proceso de traducción-retraducción. Se realizó calibración de exa-minadores y prueba piloto. El cuestionario fue aplicado por odontólogos mediante entrevista, quienes además realizaron examen bucal. Se evaluó la dimensionalidad del cuestionario mediante el Análisis Factorial Confirmatorio (AFC). La consistencia interna fue evaluada mediante Alfa de Cronbach (α) para total e ítem-total. Se evaluó la validez discriminante utilizando las pruebas de Mann-Whitney y Kruskal-Wallis, validez convergente utilizando correlación de Spearman para total-dominio, autoevaluación del estado de salud oral e índice de experiencia de caries CPO-D. Resultados: Participaron del estudio 333 pacientes de 18 a 59 años. El AFC se consideró al instrumento multidimensional. Para el total α=0,861 y para correlación ítem-total al suprimir cada elemento α=0,80 siendo todos adecuados. Discriminó para las variables autoevaluación de salud bucal (p=0,001), síntomas de ATM (p=0,026), necesidad de prótesis superior (p=0,001) e inferior (p=0,001) y ≥20 dientes sanos (p=0,001). Todos los coeficientes de correlación de Spearman resultaron estadísticamente significativos con p=0,001. Conclusión: El OHIP-14Py es un cuestionario fiable y válido para la evaluación de la calidad de vida relacionada con la salud oral en adultos paraguayos.

LIFESTYLE AND QUALITY OF LIFE IN WORKING-AGE PEOPLE AFTER STROKE.

Recommendations for changing one's lifestyle in the aspect of factors that increase the risk of another stroke are often included in the plan of caring for patients after stroke. The style of life is connected to the quality of life and can be formed not only by socialization but also by conscious work on its health-promoting aspect. Lifestyle is a unique configuration of everyday behavior depending mostly on the quality of life available. The aim of the research was to identify the correlation between lifestyle and quality of life in people of working age after stroke. There were 279 patients after first-ever ischemic or hemorrhagic stroke, including 131 women and 148 men. Abbreviated version of the World Health Organization Questionnaire and the Sickness Impact Profile scale were used to examine the quality of life. For assessment of the quality of life, the following indicators were created: lifestyle before stroke and lifestyle after stroke. Less healthy lifestyle before stroke resulted in lower quality of life in the psychological and environmental sphere of life in these people after stroke, especially those having suffered stroke six months to two years before. Better quality of life in people after stroke was found to be connected to a pro-health lifestyle.

Gender differences in the surgical management of lumbar degenerative disease: a scoping review.

OBJECTIVE: Despite efforts toward achieving gender equality in clinical trial enrollment, females are often underrepresented, and gender-specific data analysis is often unavailable. Identifying and reducing gender bias in medical decision-making and outcome reporting may facilitate equitable healthcare delivery. Gender disparity in the utilization of surgical therapy has been exemplified in the orthopedic literature through studies of total joint arthroplasty. A paucity of literature is available to guide the management of lumbar degenerative disease, which stratifies on the basis of demographic factors. The objective of this study was to systematically map and synthesize the adult surgical literature regarding gender differences in pre- and postoperative patient-reported clinical assessment scores for patients with lumbar degenerative disease (disc degeneration, disc herniation, spondylolisthesis, and spinal canal stenosis). METHODS: A systematic scoping review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. MEDLINE, Embase, and the Cochrane Registry of Controlled Trials were searched from inception to September 2018. Study characteristics including patient demographics, diagnoses, procedures, and pre- and postoperative clinical assessment scores (pain, disability, and health-related quality of life [HRQoL]) were collected. RESULTS: Thirty articles were identified, accounting for 32,951 patients. Six studies accounted for 84% of patients; 5 of the 6 studies were published by European groups. The most common lumbar degenerative conditions were disc herniation (59.0%), disc degeneration (20.3%), and spinal canal stenosis (15.9%). The majority of studies reported worse preoperative pain (93.3%), disability (81.3%), and HRQoL (75%) among females. The remainder reported equivalent preoperative scores between males and females. The majority of studies (63.3%) did not report preoperative duration of symptoms, and this represents a limitation of the data. Eighty percent of studies found that females had worse absolute postoperative scores in at least one outcome category (pain, disability, or HRQoL). The remainder reported equivalent absolute postoperative scores between males and females. Seventy-three percent of studies reported either an equivalent or greater interval change for females. CONCLUSIONS: Female patients undergoing surgery for lumbar degenerative disease (disc degeneration, disc herniation, spondylolisthesis, and spinal canal stenosis) have worse absolute preoperative pain, disability, and HRQoL. Following surgery, females have worse absolute pain, disability, and HRQoL, but demonstrate an equal or greater interval change compared to males. Further studies should examine gender differences in preoperative workup and clinical course.