To investigate the correlation between the four dimensions of Oral Health-Related Quality of Life (OHRQoL) and Health-Related Quality of Life (HRQoL) constructs in a dental patient population.
A cross-sectional study carried out at HealthPartners, Minnesota, USA. This study is a secondary data analysis of available adult dental patients’ data. The instruments used to assess the OHRQoL and HRQoL constructs were the Oral Health Impact Profile–version with 49 items (OHIP-49) and Patient-Reported Outcome Measures Information System (PROMIS) measures v.1.1 Global Health instruments Patient Reported Outcome Measures (PROMs), respectively. We used Structural Equation Modeling to determine the correlation between OHRQoL and HRQoL.
Two thousand and seventy-six dental patients participated in the study. OHRQoL and HRQoL scores correlated with 0.56 (95%CI:0.52–0.60). The OHRQoL and Physical Health dimension of HRQoL correlated with 0.55 (95%CI:0.51–0.59). The OHRQoL and Mental Health dimension of HRQoL correlated with 0.51 (95%CI:0.47–0.55). When adjusted for age, gender, and depression, the correlation coefficients changed only slightly and resulted in 0.52 between OHRQoL and HRQoL Physical Health, and 0.47 between OHRQoL and HRQoL Mental Health. Model fit statistics for all analyses were adequate and indicated a good fit.
OHRQoL and HRQoL overlap greatly. For dental practitioners, the OHRQoL score is informative for their patients’ general health status and vice versa. Study results indicate that effective therapeutic interventions by dentists improve patients’ OHRQoL as well as HRQoL.
Evidence on long-term effectiveness and cost effectiveness of treatment sequences for multiple myeloma (MM) is sparse. We used published data and country-specific data to assess the cost effectiveness of four-line treatment sequences for elderly transplant-ineligible patients with MM in Serbia.
We developed a Markov cohort model to compare long-term effectiveness and cost effectiveness of five sequential MM treatment alternatives from the perspective of the national healthcare provider. Effectiveness parameters on progression, mortality and adverse events were extracted from published clinical trials. Costs were based on price lists of the National Health Insurance Fund. We compared life expectancy, costs, and incremental cost-effectiveness ratios among alternative courses of action. The model was analyzed over a lifelong time horizon applying a 3% annual discount rate for effectiveness outcomes and costs. Robustness of the model was tested in multiple deterministic sensitivity analyses.
The sequences were defined by the frontline treatment: MPT (melphalan-prednisone-thalidomide), MPV (melphalanprednisone-bortezomib), CTD (cyclophosphamide-thalidomide-dexamethasone), VCD (bortezomib-cyclophosphamidedexamethasone) and BP (bendamustine-prednisone). MPV sequence resulted in the highest remaining life expectancy (4.76 life years). Cost-effectiveness analysis resulted in three non-dominated strategies: MPT, VCD, and MPV sequences, with an incremental cost-effectiveness ratio of EUR 35,300 per life-year gained (LYG) for VCD and EUR 47,200/LYG for MPV relative to MPT.
MPV sequence was the most effective in terms of life expectancy for elderly transplant-ineligible MM patients in Serbia. Bortezomib-based strategies would be recommended for the frontline treatment of patients with MM in Serbia if the willingness-to-pay threshold is around EUR 35,000-60,000/LYG.
Nurses often speak on patients’ behalf and safeguard their safety through their advocacy role. However, some challenges like the negative attitude of team members and lack of institutional support often hamper this role. These challenges have not been well studied in the Ghanaian context.
This study explores the perceived environmental challenges to patient advocacy among nurses in Ghana.
The study was conducted at a regional hospital in Ghana.
Participants were nurses or midwives working in the hospital.
A qualitative exploratory descriptive design was employed in the study of 15 purposively sampled participants. Participants were interviewed individually and data were analysed using content analysis.
The study revealed interpersonal challenges and institutional challenges to patient advocacy, such as hierarchical nurse–doctor relationships and ineffective multidisciplinary team, time constraints and lack of institutional support. Nurses often failed to advocate because they did not want to risk conflict with doctors. Limited interprofessional interaction, suspicion and resentment in the multidisciplinary team negatively affected nurses’ role as patient advocates. Inadequate curricular support for patient advocacy and lack of support for training programmes or to undertake further studies were the additional challenges.
Patient advocacy could be a stressful role for nurses; thus, efforts to strengthen teamwork and increase nurse involvement in hospital decision-making are required.
Implications for nursing and health policy
The findings could influence hospital management policies to enhance stronger interprofessional collaboration, increase opportunities for professional advancement for nurses and nurses’ inclusion in decision-making.
Confidentiality is one of the oldest ethical principles in healthcare. However, confidentiality in adolescent healthcare is not a universally-accepted doctrine among scholars. The ethical acceptability of confidential services in adolescents’ healthcare is based on perceptions of adolescent maturity and an appreciation of its importance to adolescents’ access and utilization of healthcare services. Despite legal policies that promote adolescents’ rights, physicians’ attitudes toward adolescent confidentiality can be a determining factor in their ultimate decision to protect adolescents’ confidentiality.
A new Attitude towards Adolescent Confidentiality Scale was developed based on the results of a qualitative interview study. This new instrument was administered to a sample of 152 physicians working at school pediatric and gynecology departments in 13 primary healthcare institutions in Belgrade. Principal component analysis was applied to determine the main components of the scale. Reliability was assessed by calculating Cronbach alpha and mean inter-item correlations.
Psychometric analysis of the final 19-item version of the scale showed a high level of reliability (Cronbach alpha of 0.83). Principal component analysis showed four components, which present subscales of the instrument: Confidentiality in clinical situation, Iimportance of confidentiality, Adolescent maturity, and Communication with parents.
The instrument showed satisfactory levels of reliability and validity. The results of the scale dissemination may be a valuable tool for needs assessment for future educational interventions and training programs that will raise physicians’ awareness of the importance of adolescent confidentiality.
Migraine is associated with significant morbidity and a significantly negative impact on the quality of life. A better understanding of the economic impact of migraine is becoming increasingly important. This paper aims to shed light on absenteeism and presenteeism costs of migraine in Slovenia.
We use the administrative national-level database on sick leave due to migraine for 2016. The absenteeism cost estimate is based on the number of patients with migraine on physician-determined sick leave and average daily labour costs. We calculate productivity costs from a social perspective regardless of who incurs them. Data from the national registry on sick leave are coupled with data from a web-based self-reported survey to also include the cost of presenteeism. MIDAS and WPAI presenteeism items were used and several different scenarios were designed to assess presenteeism costs.
We estimated annual absenteeism costs per absentee due to migraine at the amount of EUR 531 in 2016 using the NIPH’s administrative data on sick leave. Annual absenteeism costs per absentee due to migraine based on self-reported data amounted to EUR 626. The estimated annual presenteeism costs per patient range from EUR 344 – 900.
Estimating the economic burden of a disease is becoming increasingly important. This paper is an insight into the absenteeism and presenteeism costs of migraine in Slovenia.
The purpose was to determine the incidence of voice disorders in a group of professional actors and singers, to compare the two groups, and to investigate the potential causes of their voice problems.
65 actors and 63 singers from professional theatres and choirs were included. The data concerning voice problems, their possible causes, and factors adversely affecting voice quality were obtained through a questionnaire. The results were compared between the groups of professional singers and actors, and between the subgroups of singers and actors both with and without frequent voice problems.
The incidence of frequent voice problems over the entire career in singers and actors was lower than reported in the literature. Professional actors displayed more inappropriate life and vocal habits than the singers. Significant risk factors for voice disorders in singers turned out to be loud speech (p=0.029) and the presence of allergies or asthma (p=0.048). No such significant risk factors were found in actors.
The study confirmed the importance of preventive examination of the vocal tract function before enrolling in studies for an elite voice user. Professional singers and especially actors demonstrated insufficient knowledge of proper voice care. The results suggest that elite voice users require additional information on voice hygiene and occasional professional help from college to the end of career. Speech and language therapists can play a crucial role in such voice care in order to effectively prevent voice problems in elite voice users.
Heart rhythm disorders (HRD) are often present in patients visiting their family physician (FP). Dealing with their problems is not always simple, efficient and cost effective. The aim of this paper is to review the existing literature about the use and experience of telecardiology in patients experiencing HRD.
We conducted a review of literature in PubMed biographical databases (MeSH thesaurus), Web of Science and Cochrane, between 1995 and 2019. We included original articles in English that describe the use of telecardiology at primary and secondary healthcare levels. Exclusion criteria are those publications that discuss heart failure or observation of the activity of pacemakers or defibrillators and the age of patients under 18 years. A total of 19 papers met the inclusion criteria, thirteen of them were original scientific articles and we included them in the analysis.
Use of telemedicine can shorten the time from diagnosis to the necessary treatment (2/13), telemedicine can reduce mortality in patients with acute myocardial infarction (4/13), it can shorten the time to diagnose atrial fibrillations (4/13), it can help determine the diagnosis for patients complaining about heart rhythm disorders which were not detected on the standard ECG recording (2/13) and can also help identify cardiac causes for syncope or collapse (2/13). All studies have confirmed that the use of telecardiology significantly reduces the number of unnecessary referrals to a cardiologist or hospitalization, and shortens the time needed to treat patients with life-threatening conditions.
The use of telecardiological techniques increases the quality and safety of work in managing patients with cardiovascular disease in FP practice. Usage of telecardiologic devices can also save money and bridge the gap between the primary and secondary healthcare levels.
To assess the psychometric properties of the Croatian version of a Work Ability Index Questionnaire (WAIQ-CRO) in the population of nurses by using a specific methodological approach.
A cross-sectional survey was conducted in a sample of 711 Croatian nurses in 2018 in Zagreb, Croatia. The instrument’s internal consistency was assessed by using Cronbach’s alpha coefficient (α). The factor structure was verified by confirmatory (CFA) and exploratory factor analysis (EFA), with the assumption of a single-factor structure. To ensure the equality of importance of items in the assessment, the item-specific scores were transformed.
The internal consistency of the instrument was satisfactory (α=0.71). CFA showed poor first model (Model-1) compatibility data (p<0.001, CFI=0.85, GFI=0.93, RMSEA=0.13). The modificated indexes suggested the introduction of correlation parameters residual variances of results from WAIQ-CRO Item-1 and Item-2. After introducing these covariances, the index model assentation (Model-2) showed desirable assentation measures (p<0.001, CFI=0.95, GFI=0.97, RMSEA=0.08). Comparison showed better compatibility of Model-2 (p<0.001). The implementation of EFA has identified three factors. Replication of this model in CFA resulted in relatively good model assentation approaches with data (p<0.001, CFI=0.96, GFI=0.98, RMSEA=0.07). Comparison of this model (Model-3) with Model-2 showed a significantly better compatibility of Model-3 (p<0.001).
The WAIQ-CRO proved to be a reliable and valid instrument which can be used in research among Croatian nurses. The results suggest that it would be better to consider a three-factor structure than a single-factor structure, as a three-factor structure can direct decision-makers to which segment to locate interventions.
Past decade has seen the advent of several prognosticators for oral squamous cell carcinoma (OSCC). Although TNM staging is still considered as the prognostic gold standard, it is not possible to obtain all the necessary information for a pathological TNM staging until excisional biopsy. Thus, it is necessary to identify features from the initial biopsy, which could aid in early prognostication.
To compare neutrophil elastase immuno-expression in oral squamous cell carcinoma patients with and without lymph node metastasis.
Materials and Methods
Archival specimens of 50 oral squamous cell carcinoma consisting of 25 cases with and 25 cases without lymph node metastasis were immuno-stained for neutrophil elastase.
Statistically, a significant difference was noted in the neutrophil elastase staining between the 2 groups. 18 of the 25-oral squamous cell carcinoma cases with lymph node metastasis were positive and only 5 of the 25-oral squamous cell carcinoma cases without nodal involvement were positive.
Presence of neutrophil elastase in the lesional tissue is strongly associated with a lymph node involvement, and thus could serve as a prognostic factor for oral squamous cell carcinoma.
This study aimed to report a cancer registry in Clinical Oncology and Nuclear Medicine Department, Mansoura University Hospital in 2015.
Patients and Methods
All cancer patients who were registered in the department of Clinical Oncology and Nuclear Medicine, Mansoura University Hospital in the time period from January 1st, 2015 to December 31st, 2015, were enrolled in this study. The data in the outpatient clinic index including patient’s name, age, sex and diagnosis were collected.
The included patients were 1146 males (43.7%) and 1474 females (56.3%), the male to female ratio was 1:1.3. The median age for patients was 54 years, and it ranged from 1.5 to 93 years. The median age at diagnosis for female and male patients was 52 years and 57 years, respectively. The most common sites for cancer in females were breast (47.2%), thyroid (7.6%), colon and rectum (5.7%), non-Hodgkin (3.6%), uterus, brain and then ovary. However, the most common cancer sites among males were bladder (9.7%), colon and rectum (9.2%), lung (8.5%), hepatobiliary region (7.9%), brain (6.6%), non-Hodgkin lymphoma (6.6%) and then prostatic cancer.
The current report provides a first cancer registry for this hospital based on data, to be further included in cancer statistics.