The impact of patients' chronic disease on family quality of life : an experience from 26 specialties

BACKGROUND: Previous studies have assessed family quality of life in individual disease areas and specialties. The aim of this study was to investigate the impact of disease on family members of patients over a wide range of specialties and identify key impact areas. This information is essential in order to reveal the extent of this impact and to allow strategies to be developed to support the family members of patients with chronic disease. METHODS: Semi-structured interviews were carried out with 133 family members of mostly chronically ill patients from 26 medical specialties. Family members were invited to discuss all areas of their lives that had been affected by having an unwell relative. Thematic analysis was carried out using NVivo9® software. RESULTS: Most family members were female (61%), the partner or spouse of the patient (56%), or the parent (22%). Their mean age was 56.1 years (range: 21-85 years) and the mean duration of the patient's disease was 8.9 years (range: 1 month to 60 years). Ten key themes of family quality of life were identified from interviews. The median number of themes reported by family members was six (range: 1-10). The key themes included: emotional impact (mentioned by 92% of subjects), daily activities (91%), family relationships (69%), sleep and health (67%), holidays (62%), involvement in medical care and support given to family members (61%), work and study (52%), financial impact (51%), social life (37%), and time planning (14%). Relationships between the themes were identified. CONCLUSION: This large scale multi-specialty study has demonstrated the significant, yet similar, impact that illness can have on the quality of life of patients' family members. Family quality of life is a previously neglected area of health care which needs to be addressed in order to provide appropriate support for the patient and the family unit.Peer reviewedFinal Published versio

Japanese version of the family dermatology life quality index: translation and validation

Skin conditions affect the quality of life (QoL) of patients and their family. To assess family members' QoL, a questionnaire uniquely designed for family members is necessary. We translated the Family Dermatology Life Quality Index (FDLQI), originally created and validated by Basra et al., into Japanese, and evaluated its reliability and validity. For psychometric evaluations, 150 dermatology patients and their family members were included. The Japanese version of the FDLQI showed high test–retest reliability (intraclass correlation coefficient = 0.95) and internal consistency reliability (Cronbach's alpha = 0.86). FDLQI scores significantly correlated with DLQI scores (r = 0.58, P < 0.01, Spearman's rho) and global question (GQ) which measured the patient's skin condition on a visual analog scale (r = 0.36, P < 0.01). Family members of patients with inflammatory skin diseases showed higher FDLQI scores than those with isolated lesions, but the difference was not statistically significant (P = 0.062, Mann–Whitney U-test). Responsiveness to change was demonstrated in a group in which the patient's skin condition was assessed as improved (n = 37, r = 0.46, P < 0.01) but not in that in which it became worse. The difference of the change between the two groups was statistically significant (P < 0.01). Additionally, the change in FDLQI scores and GQ were significantly correlated (r = 0.40, P < 0.01). Exploratory factor analysis suggested essential unidimensionality of the instrument. We showed acceptable validity and responsiveness of this Japanese version of FDLQI. Further clinical epidemiological studies are required to confirm this

An Analysis of Students’ Mathematical Reasoning Ability using Metacognitive Strategy Based-Learning in Malay Culture among Junior High School Students

This study aimed to determine mathematical reasoning ability (MRA) taughts using metacognitive strategy based-learning in Malay Culture to students at SMPN 4 Sei Suka. The study was carried out to five students of the eighth graders at SMPN 4 Sei Suka. Data were obtained from both mathematical reasoning ability test (MRAT) and interview. The data were analyzed descriptively. Based on the study, it was found that students’ MRA was still below students’ learning outcome, but students from Malay Etnic who have been taught using metacognitive strategy in Malay Culture were found to gave better reasoning ability than students from other ethnics. In addition, metacognitive strategy plays an important role to enhancing students’ MRA. Keywords: mathematical reasoning ability, metacognitive strategy, malay cultur

Random scattering by rough surfaces with spatially varying impedance

A method is given for evaluating electromagnetic scattering by an irregular surface with spatially-varying impedance. This uses an operator expansion with respect to impedance variation and allows examination of its effects and the resulting modification of the field scattered by the rough surface. For a fixed rough surface and randomly varying impedance, expressions are derived for the scattered field itself, and for the coherent field with respect to impedance variation for both flat and rough surfaces in the form of effective impedance conditions

Young adolescent girls are at high risk for adverse pregnancy outcomes in sub-Saharan Africa: an observational multicountry study

Objectives: One of Africa's most important challenges is to improve maternal and neonatal health. The identification of groups at highest risk for adverse pregnancy outcomes is important for developing and implementing targeted prevention programmes. This study assessed whether young adolescent girls constitute a group at increased risk for adverse birth outcomes among pregnant women in sub-Saharan Africa. Setting: Data were collected prospectively as part of a large randomised controlled clinical trial evaluating intermittent preventive treatment of malaria in pregnancy (NCT00811421—Clinical Trials.gov), conducted between September 2009 and December 2013 in Benin, Gabon, Mozambique and Tanzania. Participants: Of 4749 participants, pregnancy outcomes were collected for 4388 deliveries with 4183 live births including 83 multiple gestations. Of 4100 mothers with a singleton live birth delivery, 24% (975/4100) were adolescents (≤19 years of age) and 6% (248/4100) were aged ≤16 years. Primary and secondary outcome measures: Primary outcomes of this predefined analysis were preterm delivery and low birth weight. Results: The overall prevalence of low birthweight infants and preterm delivery was 10% (371/3851) and 4% (159/3862), respectively. Mothers aged ≤16 years showed higher risk for the delivery of a low birthweight infant (OR: 1.96; 95% CI 1.35 to 2.83). Similarly, preterm delivery was associated with young maternal age (≤16 years; OR: 2.62; 95% CI 1.59 to 4.30). In a subanalysis restricted to primiparous women: preterm delivery, OR 4.28; 95% CI 2.05 to 8.93; low birth weight, OR: 1.29; 95% CI 0.82 to 2.01. Conclusions: Young maternal age increases the risk for adverse pregnancy outcomes and it is a stronger predictor for low birth weight and preterm delivery than other established risk factors in sub-Saharan Africa. This finding highlights the need to improve adolescent reproductive health in sub-Saharan Africa

Maintaining Seed Quality of Maize and Wheat through Dry Chain Technology in Pakistan

Seed is inevitably deteriorated during storage and higher seed moisture content is the primary cause of this decline in seed quality. Dry Chain is a valuable tool, by using moisture proof hermetic containers to preserve seed quality throughout supply chain. This study evaluated and compared the performance of wheat and maize seed in different hermetic storage packaging (Super bag, Anaaji bag and drum) with conventionally used woven polypropylene bags after six months storage in ambient conditions. Seed moisture content was increased up to 11.53 and 13.55% in wheat and maize respectively when packed in polypropylene bags while it remained low (approximately 10 and 11.4% in wheat and maize respectively) when packed in hermetically sealed bags and drum. Germination was maintained in both cereal seeds stored in hermetically sealed Super bag, anaaji bag and drum while it reduced in polypropylene bags as compared to initial seed quality. Seed stored in polypropylene bag deteriorated quickly, which resulted in loss of seed vigour as indicated by higher malondialdehyde contents and electrical conductivity of seed leachates. It can be concluded that maintenance of seed dryness with hermetic storage is useful in preservation of seed quality and related attributes under high relative humidity environment

SPATIAL, TEMPORAL AND SIZE DISTRIBUTION OF PARTICULATE MATTER AND ITS CHEMICAL CONSTITUENTS IN FAISALABAD, PAKISTAN

Spatial and temporal variations in aerosol particulate matter (PM) were investigated for distribution over the four seasons of chemical constituents and particle size fractions in Faisalabad, Pakistan from June 2012 to April 2013. At nine sampling sites, four PM mass size fractions (total suspended particulates [TSP], PM10, PM4 and PM2.5) were monitored; simultaneously, TSP mass samples were collected on glass fiber filters using a high volume air sampler. TSP samples (144) were subjected to quantitative chemical analyses for determining trace elements (Pb, Cd, Ni, Zn, Cu, Fe) using atomic absorption spectroscopy, and water-soluble cations (Ca2+, Mg2+, Na+, K+, NH4+) and anions (Cl–, SO42– and NO3–) by ion chromatography. The highest PM mass concentrations were observed at industrial sites, while they were somewhat lower in major road intersections and lowest in the remote background site. It was also observed that PM mass concentrations were about two to 20 times higher than the standard limits of the World Health Organization and the US Environmental Protection Agency. Coarse particles (TSP, PM10 and PM4) were found to be highest during the summer, while relatively fine particles (PM2.5) were higher during the winter period. Concentrations of all size fractions were lowest during the monsoon sampling period at all sites. Concentrations of different elements and water-soluble ions also followed the similar temporal pattern as PM mass concentrations. The crustal elements Ca, Fe, Mg and Na were the largest contributors to TSP mass while elements of anthropogenic origin (Pb, Cd, Ni, Cu and Zn) had relatively lower concentrations and also showed a high spatial variation. Among the anions, sulfate (SO42–) was the predominant species contributing to 50-60% of the total anion concentration. It was found that rainfall, wind speed and relative humidity were the most important meteorological factors affecting PM concentrations. The evaluation of data presented in this paper will serve as a basis for future regional modeling and source apportionment.

Dyadic adjustment, family coping, body image, quality of life and psychological morbidity in patients with psoriasis and their partners

Background Psoriasis is an incurable and chronic disease that includes unpredictable periods of remission and relapse requiring long-term therapy. Purpose This paper focuses on the relationship among family coping, psychological morbidity, body image, dyadic adjustment and quality of life in psoriatic patients and their partners. Method One hundred and one patients with psoriasis and 78 partners comprised the sample. They were regular users of the Dermatology Service of a Central Northern hospital in Portugal and a private dermatology clinic. Patients with psoriasis were assessed on anxiety, depression, body image, quality of life, dyadic adjustment and family coping. Partners were assessed on the same measures except body image and quality of life. Results A positive relationship among dyadic adjustment, psychological morbidity and family coping in patients and their partners was found. Also, patients with lower levels of quality of life had partners with higher levels of depressive and anxious symptoms. Better dyadic adjustment predicted family coping in the psoriatic patient. High levels of dyadic adjustment in patients and low partners’ trait anxiety predicted better dyadic adjustment in partners. Conclusion The results highlight the importance of incorporating family variables in psychological interventions in psoriasis’ care, particularly family coping and dyadic adjustment as well as the need for psychological intervention to focus both on patients and partners

Capsaicin-Induced Changes in Electrical Pain Perception Threshold Can Be Used to Assess the Magnitude of Secondary Hyperalgesia in Humans

Objectives Areas of secondary hyperalgesia can be assessed using quantitative sensory testing (QST). Delivering noxious electrocutaneous stimulation could provide added benefit by allowing multiple measurements of the magnitude of hyperalgesia. We aimed to characterize the use of electrical pain perception (EPP) thresholds alongside QST as a means by which to measure changes in pain thresholds within an area of secondary mechanical hyperalgesia. Methods EPP and heat pain thresholds (HPTs) were measured at five distinct points at baseline and following 1% capsaicin cream application, one within a central zone and four within a secondary zone. Areas of secondary mechanical hyperalgesia were mapped using QST. In a further 14 participants, capsaicin-induced reduction in EPP thresholds was mapped using a radial lines approach across 24 points. Results There was a reduction in EPP threshold measured at the four points within the secondary zone, which was within the mapped area of mechanical secondary hyperalgesia. The magnitude of secondary hyperalgesia could be split into a mild (∼4% reduction) and severe (∼21% reduction) area within an individual subject. There was no reduction in HPT within the secondary zone, but there was a reduction in both HPT and EPP threshold within the primary zone. EPP mapping revealed differences in the magnitude and spread of hyperalgesia across all subjects. Conclusions Measuring capsaicin-induced reduction in EPP thresholds can be used to map hyperalgesic areas in humans. This semi-automated approach allows rapid assessment of the magnitude of hyperalgesia, both within an individual subject and across a study population