Parental reports of the oral health-related quality of life of children with cerebral palsy

Background: The severity of physical and mental impairments and oral problems, as well as socioeconomic factors, may have an impact on quality of life of children with cerebral palsy (CP). The aim of this research was to assess the impact of impairments and oral health conditions, adjusted by socioeconomic factors, on the Oral Health-Related Quality of Life (OHRQoL) of children with CP using their parents as proxies. Methods: Sixty children, between 6-14 years of age were selected. Their parents answered a children's OHRQoL instrument (5 domains) which combines the Parental-Caregivers Perception Questionnaire (P-CPQ) and Family Impact Scale (FIS). The severity of dental caries, type of CP, communication ability, gross motor function, seizures and socioeconomic conditions were assessed. Results: Considering the total score of the OHRQoL instrument, only the reduction of communication ability and dental caries severity had a negative impact on the OHRQoL (p < 0.05). Considering each domain of the instrument, the severity of the type of CP and its reduction of communication ability showed a negative impact on oral symptoms and functional limitations domains (p < 0.05). Seizures have a negative impact on oral symptoms domain (p = 0.006). The multivariate fitted model showed that the severity of dental caries, communication ability and low family income were negatively associated with the impact on OHRQoL (p = 0.001). Conclusions: The severity of dental caries, communication ability, and family income are conditions strongly associated with a negative impact on OHRQoL of children with CP.

Dental caries related to quality of life in two Brazilian adolescent groups: a cross-sectional randomised study

Objectives: To analyse dental caries-related quality of life (QoL) in adolescent (1519-year-old) subjects in a suburban area (SA) and a downtown area (DA) of Bauru, Sao Paulo, Brazil, in 2009. Methods: This was a cross-sectional, randomised study. The sample consisted of 185 and 147 adolescents from the SA and DA, respectively. The caries index used was that for decayed, missing and filled teeth (DMFT) (World Health Organization criteria). The 14-item Oral Health Impact Profile (OHIP-14) was used to assess QoL. The non-parametric MannWhitney test, Spearmans correlation coefficient and chi-squared test were used in the statistical analysis. Results: The DMFT index, Significant Caries (SiC) Index and percentage of caries-free students were similar (P > 0.05) between these populations, but findings on the Care Index differed (P < 0.05). There was a correlation between the DMFT index and OHIP-14 score in SA subjects (mean DMFT index = 3.01) in the dimensions of physical pain (r = 0.25; P < 0.01) and psychological disability (r = 0.17; P = 0.02). The DMFT index in DA subjects (mean DMFT index = 2.95) showed a correlation with functional limitation (r = 0.19; P = 0.02). The correlation in SA subjects between the caries component (mean = 1.22) of the DMFT index and OHIP-14 was significant only for the physical pain dimension (r = 0.16; P = 0.03). In DA subjects, correlations between the caries component (mean = 0.37) and all dimensions of OHIP-14 were statistically significant (P < 0.05). Conclusions: Despite the similarities in means in the DMFT index, the SiC Index and the caries-free percentage of subjects in both localities, access to dental treatment proved to be less effective for SA adolescents. Physical pain and psychological disability were the most frequent negative manifestations of impact on QoL. The SA adolescents were more negatively affected by dental caries in terms of QoL.

What do medical students think about their quality of life? A qualitative study

Background: Medical education can affect medical students' physical and mental health as well as their quality of life. The aim of this study was to assess medical students' perceptions of their quality of life and its relationship with medical education. Methods: First-to sixth-year students from six Brazilian medical schools were interviewed using focus groups to explore what medical student's lives are like, factors related to increases and decreases of their quality of life during medical school, and how they deal with the difficulties in their training. Results: Students reported a variety of difficulties and crises during medical school. Factors that were reported to decrease their quality of life included competition, unprepared teachers, excessive activities, and medical school schedules that demanded exclusive dedication. Contact with pain, death and suffering and harsh social realities influence their quality of life, as well as frustrations with the program and insecurity regarding their professional future. The scarcity of time for studying, leisure activities, relationships, and rest was considered the main factor of influence. Among factors that increase quality of life are good teachers, classes with good didactic approaches, active learning methodologies, contact with patients, and efficient time management. Students also reported that meaningful relationships with family members, friends, or teachers increase their quality of life. Conclusion: Quality of teachers, curricula, healthy lifestyles related to eating habits, sleep, and physical activity modify medical students' quality of life. Lack of time due to medical school obligations was a major impact factor. Students affirm their quality of life is influenced by their medical school experiences, but they also reframe their difficulties, herein represented by their poor quality of life, understood as necessary and inherent to the process of becoming doctors.

The impact of dental caries and trauma in children on family quality of life

Objectives: To assess the impact of childrens dental caries (DC) and traumatic dental injuries (TDI) on parents quality of life (QoL), adjusted by family income. Methods: Parents of 219 children aged 5 and 6 years answered the Family Impact Scale (FIS) on their perception of QoL and data about income. Three calibrated dentists examined the severity of DC according to decayed, missing and filled permanent teeth index, and children were categorized into: 0 = caries free; 15 = low severity; and =6 = high severity. TDI were classified into uncomplicated and complicated injuries. QoL was measured through FIS items and total score, and Poisson regression was used to associate the variables with the outcome. Results: Severity of DC showed a negative impact on the total score and subscales on parental/family activities, parental emotions and financial burden (P < 0.001). TDI showed a negative impact on total score and in some FIS items. The multivariate-adjusted model showed that only the increase in the severity of childrens DC (RR = 3.19; 95% CI = 2.36, 4.31; P < 0.001) was associated with a greater negative impact on parents QoL, while high family income was a protective factor (RR = 0.68; 95% CI = 0.48, 0.95; P < 0.001). Conclusions: The severity of childrens DC has a negative impact on parents QoL, whereas TDI do not. A lower family income might have a negative impact on parents QoL.

Cost-Effectiveness Analysis for Surgical, Angioplasty, or Medical Therapeutics for Coronary Artery Disease 5-Year Follow-Up of Medicine, Angioplasty, or Surgery Study (MASS) II Trial

Background-The Second Medicine, Angioplasty, or Surgery Study (MASS II) included patients with multivessel coronary artery disease and normal systolic ventricular function. Patients underwent coronary artery bypass graft surgery (CABG, n = 203), percutaneous coronary intervention (PCI, n = 205), or medical treatment alone (MT, n = 203). This investigation compares the economic outcome at 5-year follow-up of the 3 therapeutic strategies. Methods and Results-We analyzed cumulative costs during a 5-year follow-up period. To analyze the cost-effectiveness, adjustment was made on the cumulative costs for average event-free time and angina-free proportion. Respectively, for event-free survival and event plus angina-free survival, MT presented 3.79 quality-adjusted life-years and 2.07 quality-adjusted life-years; PCI presented 3.59 and 2.77 quality-adjusted life-years; and CABG demonstrated 4.4 and 2.81 quality-adjusted life-years. The event-free costs were $9071.00 for MT; $19 967.00 for PCI; and $18 263.00 for CABG. The paired comparison of the event-free costs showed that there was a significant difference favoring MT versus PCI (P<0.01) and versus CABG (P<0.01) and CABG versus PCI (P<0.01). The event-free plus angina-free costs were $16 553.00, $25 831.00, and $24 614.00, respectively. The paired comparison of the event-free plus angina-free costs showed that there was a significant difference favoring MT versus PCI (P=0.04), and versus CABG (P<0.001); there was no difference between CABG and PCI (P>0.05). Conclusions-In the long-term economic analysis, for the prevention of a composite primary end point, MT was more cost effective than CABG, and CABG was more cost-effective than PCI.

The impact of asymptomatic vertebral fractures on quality of life in older community-dwelling women: the Sao Paulo Ageing & Health Study

OBJECTIVES: The aim of this study was to investigate the impact of asymptomatic vertebral fractures on the quality of life in older women as part of the Sao Paulo Ageing & Health Study. METHODS: This study was a cross-sectional study with a random sample of 180 women 65 years of age or older with or without vertebral fractures. The Quality of Life Questionnaire of the European Foundation for Osteoporosis was administered to all subjects. Anthropometric data were obtained by physical examination, and the body mass index was calculated. Lateral thoracic and lumbar spine X-ray scans were obtained to identify asymptomatic vertebral fractures using a semi-quantitative method. RESULTS: Women with asymptomatic vertebral fractures had lower total scores [61.4(15.3) vs. 67.1(14.2), p = 0.03] and worse physical function domain scores [69.5(20.1) vs. 77.3(17.1), p = 0.02] for the Quality of Life Questionnaire of the European Foundation for Osteoporosis compared with women without fractures. The total score of this questionnaire was also worse in women classified as obese than in women classified as overweight or normal. High physical activity was related to a better total score for this questionnaire (p = 0.01). Likewise, lower physical function scores were observed in women with higher body mass index values (p < 0.05) and lower physical activity levels (p < 0.05). Generalized linear models with gamma distributions and logarithmic link functions, adjusted for age, showed that lower total scores and physical function domain scores for the Quality of Life Questionnaire of the European Foundation for Osteoporosis were related to a high body mass index, lower physical activity, and the presence of vertebral fractures (p < 0.05). CONCLUSION: Vertebral fractures are associated with decreased quality of life mainly physical functioning in older community-dwelling women regardless of age, body mass index, and physical activity. Therefore, the results highlight the importance of preventing and controlling asymptomatic vertebral fractures to reduce their impact on quality of life among older women.

Evaluation of quality of life over time among 453 patients with hyperhidrosis submitted to endoscopic thoracic sympathectomy

Objectives: Current data do not provide enough information on how quality of life (QoL) evolves over time in cases of endoscopic thoracic sympathectomy (ETS). The purpose of this study was to ascertain whether the immediate improvement in QoL after the surgery was sustained until the fifth postoperative year. Methods: This was a prospective, nonrandomized and uncontrolled study. From March 2001 to December 2003, 475 consecutive patients with hyperhidrosis submitted to ETS were included. A QoL questionnaire was applied at the preoperative day, around the 30th postoperative day, and after the fifth year. Results: After excluding 22 patients who did not answer all the questions, we analyzed 453 patients. Their ages ranged from 11 to 57 years old, with a mean of 25.3 + 7.9 years, including 297 female patients (65.6%). All patients were assessed on three occasions: before surgery, around the 30th postoperative day, and after the fifth postoperative year. The QoL before surgery was considered to be poor or very poor for all patients. The QoL around 30 days after surgery was better in 412 patients (90.9%), the same in 27 patients (6.0%), and worse in 14 patients (3.1%). After 5 years, 409 patients (90.3%) were better, 27 (6.0%) were the same, and 14 (3.1%) were worse. There were no differences between these postoperative times according to the McNemar statistical test. Conclusion:The patients had an immediate improvement in QoL after ETS, and this improvement was sustained until the fifth postoperative year. (J Vase Surg 2012;55:154-6.)

Influence of children's oral health-related quality of life on school performance and school absenteeism

Objective: This study assessed the relation of child oral health-related quality of life with school performance and school absenteeism. Methods: We followed a cross-sectional design with a multistage random sample of 312 12-year-old schoolchildren living in Brazil. The participants completed the child perceptions questionnaire (CPQ1114) that provides information about psychological factors, while their parents or guardians answered questions on their socioeconomic status measured by parents' education level and household income. A dental examination of each child provided information on the prevalence of caries and dental trauma. Data on school performance, which included the results of baseline Brazilian language (Portuguese) tests, and school absenteeism (school days missed) were obtained from the school register. Multilevel linear regression was used to investigate the association among psychological and socioeconomic status and children's school performance. Results: In the multiple model, after adjusting for individual covariates, being a girl was associated with higher school performance (P < 0.05), whereas low household income (P < 0.05), higher mean of CPQ1114 (P < 0.05), and higher school days missed (P < 0.001) were identified as individual determinants of lower school performance. When the school-level covariates were included in the model, the association between subjects' level characteristics and school performance still persisted. Conclusion: Children's school performance and absence were influenced by psychological and socioeconomic conditions.

The impact of asymptomatic vertebral fractures on quality of life in older community-dwelling women: the São Paulo Ageing & Health Study

OBJECTIVES: The aim of this study was to investigate the impact of asymptomatic vertebral fractures on the quality of life in older women as part of the Sao Paulo Ageing & Health Study. METHODS: This study was a cross-sectional study with a random sample of 180 women 65 years of age or older with or without vertebral fractures. The Quality of Life Questionnaire of the European Foundation for Osteoporosis was administered to all subjects. Anthropometric data were obtained by physical examination, and the body mass index was calculated. Lateral thoracic and lumbar spine X-ray scans were obtained to identify asymptomatic vertebral fractures using a semi-quantitative method. RESULTS: Women with asymptomatic vertebral fractures had lower total scores [61.4(15.3) vs. 67.1(14.2), p = 0.03] and worse physical function domain scores [69.5(20.1) vs. 77.3(17.1), p = 0.02] for the Quality of Life Questionnaire of the European Foundation for Osteoporosis compared with women without fractures. The total score of this questionnaire was also worse in women classified as obese than in women classified as overweight or normal. High physical activity was related to a better total score for this questionnaire (p = 0.01). Likewise, lower physical function scores were observed in women with higher body mass index values (p<0.05) and lower physical activity levels (p,0.05). Generalized linear models with gamma distributions and logarithmic link functions, adjusted for age, showed that lower total scores and physical function domain scores for the Quality of Life Questionnaire of the European Foundation for Osteoporosis were related to a high body mass index, lower physical activity, and the presence of vertebral fractures (p<0.05). CONCLUSION: Vertebral fractures are associated with decreased quality of life mainly physical functioning in older community-dwelling women regardless of age, body mass index, and physical activity. Therefore, the results highlight the importance of preventing and controlling asymptomatic vertebral fractures to reduce their impact on quality of life among older women.

Relationship Between Oral Health-Related Quality of Life, Oral Health, Socioeconomic, and General Health Factors in Elderly Brazilians

Objectives To assess the impact of oral health on quality of life in elderly Brazilians and to evaluate its association with clinical oral health measures and socioeconomic and general health factors. Design Cross-sectional study. Setting Population-based cohort study on health, well-being, and aging. Participants Eight hundred fifty-seven participants representing 588,384 community-dwelling elderly adults from the city of Sao Paulo, Brazil. MeasurementS Self-perceived impact of oral health on quality of life was measured using the Geriatric Oral Health Assessment Index (GOHAI), with scores categorized as good, moderate, or poor, indicating low, moderate, and high degrees of negative impact on quality of life, respectively. Results Nearly half of the individuals had good GOHAI scores (44.7% of overall sample, 45.9% of dentate participants, and 43.4% of edentulous participants). In the overall sample, those with poor self-rated general health and a need for dental prostheses were more likely to have poor and moderate GOHAI scores. Individuals with depression were significantly more likely to have poor GOHAI scores. No socioeconomic variables were related to the outcome, except self-perception of sufficient income, which was a protective factor against a poor GOHAI score in dentate participants. Conclusion Moderate and high degrees of negative impact of oral health on quality of life were associated with general health and clinical oral health measures, independent of socioeconomic factors.

Evaluation of quality of life in severely obese patients after bariatric surgery carried out in the public healthcare system

Objectives: To assess QoL of obese patients in the Brazilian public healthcare system, before and after bariatric surgery, and to determine the appropriateness of the Moorehead-Ardelt Questionnaire II (M-A-QoLQII) compared with the Short-Form Health Survey (SF-36). Subjects and methods: Forty-one severe obese patients in a waiting-list, and 84 patients who underwent bariatric surgery were included. Correlations were tested and reliability determined by the Cronbach's coefficient. Results: BMI differed between the pre- and post-surgery groups (52.3 +/- 8.3 kg/m(2) vs. 32.5 +/- 6.4 kg/m(2), p < 0.001). The latter showed better scores in the SF-36 domains than in the pre-surgery. SF-36 and M-A-QoLQII categories were correlated (r = 0.53, 0.49 and 0.47, for vitality, mental health, and general health domains, p < 0.001). In the logistic regression, age, previous BMI, and loss of excess weight were associated with functional capacity. Conclusions:The outcomes of bariatric surgery obtained in a Brazilian public healthcare center were successful. M-A-QoLII represents a useful tool to assess surgery outcomes, including QoL. Arq Bras Endocrinol Metab. 2012;56(1):33-8

Interchangeability among therapeutic equivalents of lamotrigine: evaluation of quality of life

Epilepsy is the most common serious neurological disorder worldwide. Approximately 70% of patients with epilepsy have their seizures controlled by clinical and pharmacological treatment. This research evaluated the possible influence of interchangeability among therapeutic equivalents of LTG on the clinical condition and quality of life of refractory epileptic patients. The study was divided into three periods of 42 days, and an equivalent therapeutic LTG randomly dispensed for each period (two similars - formulations A and B, and the reference product - formulation C). The mean dose of LTG was 5.5 mg/kg/day. The presence of side effects tends to have a greater deleterious effect on quality of life of refractory epileptics compared to variations in number of seizures or changes in plasma concentrations. The results showed that independently of the drug prescribed, interchangeability among therapeutic equivalents can negatively impact epilepsy control.

Physical education and quality of life: reflections and perspectives

The study of the quality of life of individuals has become a prominent issue for contemporary society. However, research involving quality of life should consider that this is a complex issue that involves objective and subjective aspects, living conditions, lifestyles and multidimensional factors. There is a widespread idea in society that physical activity, exercise, sports and related activities can have a positive impact on improving the quality of life of the population. However, in several studies, this relationship is examined from the biological point of view, which considers only health indicators. Such practices are being studied in the area of Physical Education in various perspectives, such as biological, psychological, social, and cultural. Therefore, Physical Education should seek to produce knowledge that meets the scientific principles, and look for evidence that effectively clarifies the dynamics of this relationship. In this sense, methodological rigor, particularly the conceptual definition, is essential for a better understanding of the results and of which generalizations are actually likely to e proved. In addition, it is necessary to identify the possibilities and limitations of quantitative evaluations, qualitative evaluations and possible combinations.

Quality of life among Brazilian women living with HIV/AIDS

The purpose of the present study was to assess quality of life (QoL) in Brazilian women living with HIV/AIDS, according to the World Health Organization Quality of Life HIV-BREF (WHOQoL-HIV-BREF) domains. A quantitative-based, cross-sectional, analytical study was carried out in healthcare centers specialized in assisting people living with HIV/AIDS, located in a municipality of the state of Sao Paulo, Brazil. One hundred and six women of age 18 years or more, users of the public healthcare system, participated in the study. Socio-demographic and clinical variables were collected using a specific questionnaire. Quality of life related variables were collected by means of the WHOQoL-HIV-BREF instrument. As per the QoL domains, study results show that the Spirituality domain reached a standardized mean score of 65.7, followed by the Physical (64.7), Psychological (60.6), Social Relationships (59.5), Independence (58.6), and Environment (54.5) domains. Results of the multiple regression analysis indicate that the women's employment or retirement, income greater than the minimum wage, and higher educational level were associated with a higher standardized mean score of QoL. However, recent HIV/AIDS diagnosis and exposure to antiretroviral agents for a period shorter than two years were negatively associated with QoL. It is critical that public policies favor an all-embracing social inclusion of these women, thus promoting better social conditions. Counseling, clinical follow-up immediately after the infection diagnosis, and initiation of antiretroviral treatment are crucial moments in the lives of these individuals.

The effects of professional factors on the quality of life of family health team nurses

The objective of this study was to identify the professional factors affecting the quality of life of nurses working in the family health teams in the Macro Health Region, referred to as the South Triangle, in the State of Minas Gerais. This is a descriptive, cross-sectional study. The participants were 90 nurses, who answered a questionnaire containing the professional variables and the Quality of Life assessment instrument - WHOQOL-100. The results showed a negative impact regarding the number of jobs, unstable jobs, excessive workload and job dissatisfaction in the nurses' Quality of Life domains. There is a need to (re)define the public policies that control the working conditions of these professionals. Actions that contribute towards improving nurses' Quality of Life are important, considering their strong influence on the quality of the healthcare that is delivered.