End of life care in HIV-infected children who died in hospital

The aim of this study was to evaluate terminal care among hospitalized children who died of HIV/AIDS. The design was a retrospective chart review of the terminal hospitalization. The setting was a public, secondary and tertiary children's hospital in Cape Town, South Africa (SA). The patients included a consecutive series of in-patient deaths from HIV-related causes. The main outcome measures included: documentation of do not resuscitate (DNR) orders and comfort care plans, intensity of diagnostic and therapeutic interventions in last 24 hours of life, and presence of pain and distress in last 48 hours of life. The results are based on the review of 165 out of 167 in-patient deaths. Of those, 79% of patients died in general wards. Median age and length of stay were 4 months and 6 days respectively. A total of 84% of patients had a DNR order. DNR orders appeared simultaneously in only 41% of medical and nursing notes. Only 44% of patients had a comfort care plan. Pain and distress in the last 48 hours was documented in 55% of patients who died in the general wards. Respiratory symptomatology and painful skin conditions accounted for most discomfort. Half (36/72) the patients with pain and distress, including 16 with a comfort care plan, received no analgesia. Conclusions drawn found that, despite clinical uncertainty, doctors made tough end of life decisions that included DNR orders and comfort care plans. The lower rate of comfort care plans suggests doctors had difficulty making the transition from curative to palliative care. Many comfort care plans were incoherent and included interventions unlikely to promote patients' comfort. In light of the HIV/AIDS pandemic in SA, reforms are needed to integrate palliative care within mainstream hospital medicine. However, without adequate human resources including trained interpreters, doctors and nurses will struggle to deliver optimal terminal care in acute hospitals.     

Commentary on issues in data quality analysis in life cycle assessment

Purpose  

For compliance with the ISO standard 14044, comparative life cycle assessments are required to address data quality for time-related coverage, geographic coverage, technology coverage, precision, completeness, representativeness, consistency, reproducibility, sources of the data and uncertainty of the information. As the community of practitioners and data developers grows, the purpose of this commentary is to initiate discussion of current issues and opportunities for improvement in data quality analysis.     

The issue of considering water quality in life cycle assessment of water use

The International Journal of Life Cycle Assessment - Available water-use impact assessment methods provide insight into the potential impacts of water use. As water-use impact assessment models...     

The impact of psoriasis on the quality of life and psychological characteristics of persons suffering from psoriasis

Psoriasis, as same as other skin diseases, has an influence on many spheres of patient's life. It influences the mental image the patients have of themselves and it indirectly shapes their personality traits as well as it defines the quality of their lives. The purpose of the study was to examine the impact of psoriasis on the quality of life and gender differences in the quality of life and explore presence of neurotic symptoms among persons suffering from psoriasis in comparison to general population. During the treatment of persons suffering from psoriasis at the special hospital Naftalan in Ivani? Grad personality questionnaire and Quality of life scale were administered to 61 participants (m = 25; f = 36). Our results showed few gender differences in the satisfaction with specific life domains, but only differences in the satisfaction with sexual life could be related to the different effects psoriasis has on the quality of life of men and women. Our participants experience more anxiety and depression symptoms as well phobic fears in comparison to general population. Found genders differences in the presence and intensity of anxiety symptoms closely resemble those documented in the general population therefore aren't typical for people suffering from psoriasis.     

Generic quality of life assessment in dementia patients: a prospective cohort study

Background  

Quality of life (QoL) is increasingly used to characterize the impact of disease and the efficacy of interventions.     

Applying soil quality indicators in the context of life cycle assessment in a Finnish case study

Purpose

In this paper, we present a case study of soil quality assessments for Finnish arable crop production. The aim was to assess the applicability of three soil quality indicators by testing available assessment models and data in the context of a life cycle assessment (LCA). The indicators were erosion, soil organic matter (SOM) and compaction, which are crucial effects of soil cultivation in Finland, strongly affecting the cultivation fitness of soil especially in the long run.

Methods

In this case study, we assessed the effects of four Finnish arable crop rotations. The functional unit was 1 metric ton of cereal or turnip rape seed on the farm. The model used for assessing SOM was Yasso07, VIHMA for erosion and COMPSOIL for compaction. We used data from two conventional and two organic farms, collected from 4-year-long crop rotations that included turnip rape, cereals and green manure ley. Farm data were supplemented with geographic information and data from the literature.

Results and discussion

The data needed for the assessment of soil erosion and soil carbon decline was in the main readily available at farm level in the Finnish agricultural database, the Finnish Meteorological Institute, and from geographic information systems. However, more data would have been needed in the cultivation history of the field parcels for an accurate assessment of soil carbon decline. With regard to soil compaction, we had difficulties in finding suitable data especially on machinery use, which is not available in public data sources. Moreover, the reliability of the compaction model COMPSOIL was questioned, as its performance has not been validated in Finnish conditions.

Conclusions

The erosion and SOM models were found to be suitable for use in LCAs. However, the model for the assessment of compaction was considered too difficult to use. Furthermore, the compaction model results need to be validated with field measurements to be considered reliable in Finnish conditions. This study provides a starting point for developing soil quality assessment in Finnish agricultural production.

     

Quality of life of HIV-infected persons in Croatia

The aim of this study was to examine health-related quality of life among Croatian HIV infected individuals, and to assess the impact of socio-demographic and disease-related variables on health-related quality of life. This was a crosssectional study of 111 HIV-infected adults who received care at the University Hospital for Infectious Diseases in Zagreb, Croatia. The World Health Organization Quality of Life Questionnaire for HIV brief version (WHOQOL-HIV BREF) was used to assess each patient's quality of life. Ratings of quality of life differed across age, marital status, level of education, health status and "currently ill" status. Subjects who perceived themselves as not ill and their health status as better reported better quality of life for all quality of life domains (p < 0.01). Subjects who were in relationships gave higher ratings for the social relationships domain (p < 0.01). Subjects with higher level of education gave significantly higher ratings within the independence (p < 0.05) and environment (p < 0.01) domains. Younger subjects perceived their psychological state as better (p < 0.05). The findings demonstrate a moderate degree of overall quality of life (X = 112.2; SD = 18.92) with main concerns related to social relationships. These results highlight the need for better access to psychosocial support and medical and legal services for people living with HIV/AIDS in Croatia.     

Self-assessment of well-being as an indicator of quality of life of former war prisoners - A Croatian study

The impact of war on the population is vast, especially when it comes to those who were directly affected by war, among other things as concentration camp detainees. Because of the specific war experience of this population it is important to better understand the possible contribution of key socio-demographic variables, war traumatization and acute disturbances in mental health to their subjective assessment of their own well-being, which represents a psychological category and is based on a subjective assessment. The starting point is a theoretical precept according to which individual characteristics, together with war experience, can have repercussions on mental health, and eventually on the general well-being of an individual and their quality of life. The study comprised 184participants who had given their informed consent for participation and filled out complete questionnaires. The participants were a convenience sample of male persons who had survived war captivity in the Homeland War in the period from 1991 to 1995. The study was conducted as part of the physical examinations at the University Hospital "Fran Mihaljevi?" in Zagreb. The data was collected using several self-evaluation measuring instruments one of which served to collect socio-demographic data, two to collect data on the participants' mental health, one for the data on the participants' combat and war experiences and one to assess the participants' well-being. The data obtained suggest that only avoidance and arousal symptoms and psychosomatic difficulties are predictors of the well-being of persons who have experienced war captivity.     

The Croatian Health Survey--SF-36: I. General quality of life assessment

The objective of the Croatian Health Survey was the assessment of population health related quality of life in the transitional environment of Croatia. Health status measures incorporate dimensions such as physical, psychological, and social functioning, role performance and perception of wellbeing. In order to assess health status, "The medical outcome study 36-item short-form health survey (SF-36) model" was used. A total sample of 5048 inhabitants (1983 males and 3065 females), 18 years and over, represents approximately 1% of the general population of Croatia. Mean scores were as follows: physical functioning (PF) 69.94, role-physical (RP) 63.01, bodily pain (BP) 64.51, general health (GH) 53.40, vitality (VT) 51.85, social functioning (SF) 72.96, role-emotional (RE) 72.42, mental health (MH) 61.71 and health transition (HT) 44.79. Results of the SF-36 health survey in Croatia are very much like the results in other European countries with indication that general quality of life is lower in Croatia.     

Health-related quality of life following ambulatory surgery procedures: assessment by RAND-36

Background

Increasing numbers of elective surgical procedures are performed as day-cases. The impact of ambulatory surgery on health-related quality of life in the recovery period has seldom been described.

Methods

We assessed health-related quality of life in 143 adult outpatients scheduled for arthroscopic procedures of the knee and shoulder joints, laparoscopic cholecystectomy and inguinal hernia repair using the RAND 36-Item Health Survey preoperatively and one week after patients had returned to work or comparable normal daily routines.

Results

Postoperatively all patient groups reported significant improvements in bodily pain and vitality. Physical functioning improved significantly in orthopedic and inguinal hernia patients. However, in the orthopedic groups, postoperative scores for physical health were still relatively lower compared to the general population reference values.

Conclusions

Ambulatory surgery has a positive impact on health-related quality of life. Assessment of the recovery process is necessary for recognition of potential areas of improvement in care and postoperative rehabilitation.

     

Complex assessment of late side effects affecting quality of life - the "Debrecen model"

As the outcome of childhood cancer improved substantially during the last 3 decades, the attitude of pediatric oncology has changed from "cure at any cost" to "cure at least cost". We investigated factors affecting quality of life in long-term survivors of childhood cancer in the in- and outpatient clinics of the Department of Pediatric Hematology-oncology, Institute of Pediatrics, Medical and Health Science Center, Debrecen. As a part of a comprehensive follow-up care program, we focused our attention on nephrotoxicity, osteoporosis and on cardiovascular morbidity. For long-term survivors of childhood cancer sensitive and cost-effective diagnostic algorithms were developed that can help in guiding secondary and tertiary prevention programs, in addition to assessing accurately the condition of patients. We found that anti-cancer treatments, including some of the supportive interventions, have adverse effects on glomerular (10%) and tubular functions (37%), impair the balance of bone resorption and formation (69%) and increase the frequency of cardiovascular risk factors (62%) in a significant proportion of patients. Our data confirm and extend the findings of other investigators and cooperative groups. In conclusion, we consider it important that the treatment plans of high-risk patients with cancer should be aimed at preserving the anticancer potential of therapy, without enhancing the frequency and severity of complications. The presented "Debrecen model" may help in achieving this goal and in increasing quality of life of long-term survivors of childhood cancer.     

Oral health-related quality of life: a critical appraisal of assessment tools used in elderly people

Objective: The purpose of this study was to undertake a critical appraisal of oral health‐related quality of life (OHRQoL) measurements used for research in the elderly. Background: A variety of OHRQoL measurements have been developed in the past 20 years as a result of increased concern about the impact of oral conditions on a person’s quality of life. There is need for an assessment aimed at prioritising the recommended measurements to be used for different purposes in the elderly. Materials and methods: Original English language papers using measurements to assess OHRQoL in the elderly were identified from Web of Science, EMBASE, PubMed, Medline and Lilacs databases. The search included all papers published from 1985 to February 2007. The criteria of assessment were: (i) measurement criteria (number of items and domains, and classification of the results found for each measurement); (ii) quantitative–qualitative criteria (frequency, acceptability, reproducibility, reliability, sensitivity and capability of being reproduced in other language versions). Results: In a total of 152 papers selected, 20 measurements were identified. However, only seven fulfilled all the measurement and quantitative–qualitative criteria. Conclusion: Geriatric Oral Health Assessment Index, Subjective Oral Health Status Indicators, Oral Health Impact Profile‐49, Dental Impact on Daily Living, Oral Health Impact Profile‐14, Oral Impact on Daily Performances and German Version of the Oral Heath Impact Profile were considered as instruments of choice to assess OHRQoL in the elderly. The other 13 instruments identified require further research aimed at a validation process and the use of a language other than English.     

Factors associated with the oral health-related quality of life in elderly persons in dental clinic: validation of a Mandarin Chinese version of GOHAI

Gerodontology 2011; doi: 10.1111/j.1741‐2358.2009.00360.x
Factors associated with the oral health‐related quality of life in elderly persons in dental clinic: validation of a Mandarin Chinese version of GOHAI Objectives: To translate the original English version of Geriatric Oral Health Assessment Index (GOHAI) into Mandarin Chinese and assess its reliability and validity for use among the elderly in inland China and to explore the factors associated with oral health‐related quality of life (OHRQoL). Methods: The original English version of GOHAI was translated, back‐translated and cross‐culturally adapted. The psychometric properties of GOHAI‐M were assessed in a sample of 263 people aged 60 years and over and OHRQoL was examined in 221 subjects using GOHAI‐M. Multiple regression analysis was conducted. Results: Internal consistency of the GOHAI‐M was excellent (Cronbach’s α : 0.81). Split‐half reliability coefficient was 0.80, and item‐scale correlation coefficient ranged from 0.25 to 0.71. Self‐rated oral health was significantly associated with OHRQoL (r_s = 0.505, p < 0.01). The relation coefficient between GOHAI‐M and self‐perceived need for dental treatment and number of missing teeth were 0.231 and ?0.653, respectively (p < 0.05). Multiple regression analysis found that better OHRQoL was significantly associated with better self‐ratings of oral health (β = 0.497, p = 0.01), number of missing teeth (β = 0.187, p < 0.01) and life satisfaction (β = 0.132, p < 0.05). Conclusion: The Mandarin Chinese version of GOHAI demonstrates acceptable reliability and validity. OHRQoL is associated with self‐rated oral health, number of missing teeth and satisfaction with life.     

Comparative life cycle assessment and life cycle costing of lodging in the Himalaya

Purpose

The main aim of the study is to assess the environmental and economic impacts of the lodging sector located in the Himalayan region of Nepal, from a life cycle perspective. The assessment should support decision making in technology and material selection for minimal environmental and economic burden in future construction projects.

Methods

The study consists of the life cycle assessment and life cycle costing of lodging in three building types: traditional, semi-modern and modern. The life cycle stages under analysis include raw material acquisition, manufacturing, construction, use, maintenance and material replacement. The study includes a sensitivity analysis focusing on the lifespan of buildings, occupancy rate and discount and inflation rates. The functional unit was formulated as the ‘Lodging of one additional guest per night’, and the time horizon is 50 years of building lifespan. Both primary and secondary data were used in the life cycle inventory.

Results and discussion

The modern building has the highest global warming potential (kg CO_2-eq) as well as higher costs over 50 years of building lifespan. The results show that the use stage is responsible for the largest share of environmental impacts and costs, which are related to energy use for different household activities. The use of commercial materials in the modern building, which have to be transported mostly from the capital in the buildings, makes the higher GWP in the construction and replacement stages. Furthermore, a breakdown of the building components shows that the roof and wall of the building are the largest contributors to the production-related environmental impact.

Conclusions

The findings suggest that the main improvement opportunities in the lodging sector lie in the reduction of impacts on the use stage and in the choice of materials for wall and roof.

     

Defining the baseline in social life cycle assessment

Background, aim and scope  

A relatively broad consensus has formed that the purpose of developing and using the social life cycle assessment (SLCA) is to improve the social conditions for the stakeholders affected by the assessed product’s life cycle. To create this effect, the SLCA, among other things, needs to provide valid assessments of the consequence of the decision that it is to support. The consequence of a decision to implement a life cycle of a product can be seen as the difference between the decision being implemented and ‘non-implemented’ product life cycle. This difference can to some extent be found using the consequential environmental life cycle assessment (ELCA) methodology to identify the processes that change as a consequence of the decision. However, if social impacts are understood as certain changes in the lives of the stakeholders, then social impacts are not only related to product life cycles, meaning that by only assessing impacts related to the processes that change as a consequence of a decision, not all changes in the life situations of the stakeholders will be captured by an assessment following the consequential ELCA methodology. This article seeks to identify these impacts relating to the non-implemented product life cycle and establish indicators for their assessment.