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BACKGROUND: Complementary medicine, which refers to therapies that are not part of conventional medicine, comprising both evidence-based and non-evidence-based interventions, is increasingly used following a diagnosis of cancer. We aimed to investigate out-of-pocket spending patterns on complementary medicine and its association with adverse financial outcomes following cancer in middle-income countries in southeast Asia.METHODS: In this prospective cohort study, data on newly diagnosed patients with cancer were derived from the ASEAN Costs in Oncology (ACTION) cohort study, a prospective longitudinal study in 47 centres located in eight countries in southeast Asia. The ACTION study measured household expenditures on complementary medicine in the immediate year after cancer diagnosis. Participants were given cost diaries at baseline to record illness-related payments that were directly incurred and not reimbursed by insurance over the 12-month period after study recruitment. We assessed incidence of financial catastrophe (out-of-pocket cancer-related costs ≥30% of annual household income), medical impoverishment (reduction in annual household income to below poverty line following subtraction of out-of-pocket cancer-related costs), and economic hardship (inability to make necessary household payments) at 1 year.FINDINGS: Between March, 2012, and September, 2013, 9513 participants were recruited into the ACTION cohort study, of whom 4754 (50·0%) participants were included in this analysis. Out-of-pocket expenditures on complementary medicine were reported by 1233 households. These payments constituted 8·6% of the annual total out-of-pocket health costs in lower-middle-income countries and 42·9% in upper-middle-income countries. Expenditures on complementary medicine significantly increased risks of financial catastrophe (adjusted odds ratio 1·52 [95% CI 1·23-1·88]) and medical impoverishment (1·75 [1·36-2·24]) at 12 months in upper-middle-income countries only. However, the risks were significantly higher for economically disadvantaged households, irrespective of country income group.INTERPRETATION: Integration of evidence-supported complementary therapies into mainstream cancer care, along with interventions to address use of non-evidence-based complementary medicine, might help alleviate any associated adverse financial impacts.FUNDING: None.

Induction immunosuppressive therapy is used to prevent rejection and maintain allograft function in transplantation. Rabbit antithymocyte globulin (rATG), a T-cell depleting antibody, is the most commonly used induction agent for kidney transplantation. To date there is still limited data on outcomes of pediatric kidney transplants with rATG as induction therapy.Retrospective single-center study of first-time kidney transplant recipients ≤18 years old who received rATG induction between 2005 and 2019 at the National Kidney and Transplant Institute. Data were collected up to 1 year post transplant.Eleven patients were included in the study. They received rATG at 1.5 mg/kg/dose (±0.3 mg/kg/dose) once a day for 3 days. Patient survival was 100% at 6 months, and 90.9% at 1 year. Graft survival was 90.9% at 6 months, and 81.8% at 1 year. Four patients (36.4%) had a glomerular filtration rate of60 at 1 year. One died of sepsis at 7 months. One patient (9.1%) had acute allograft rejection with recurrence of disease, C3 glomerulopathy, on day 13. A total of 3 patients (27.3%) developed leukopenia and 4 patients (36.4%) developed thrombocytopenia. The majority were anemic at baseline (9.7 mg/dL), and a significant increase in the mean hemoglobin was seen at 4 weeks (11.6 mg/dL) to 1 year (13 mg/dL). Incidence of recurrent infections was 9.1% (with culture growth) and 36.4% (no culture growth). Hypertension remained unchanged before and after transplant.Induction with single dose rATG at 1.5 mg/kg/dose (±0.3 mg/kg/dose) for 3 days provided effective and safe outcomes in pediatric kidney transplant patients in this study.

These practice guidelines provide evidence-based recommendations on the management of neuromuscular monitoring and antagonism of neuromuscular blocking agents during and after general anesthesia. The guidance focuses primarily on the type and site of monitoring and the process of antagonizing neuromuscular blockade to reduce residual neuromuscular blockade.

Background The number of youth living with HIV in the United States (US) continues to rise, and racial, ethnic, and sexual minority youth including young men who have sex with men (YMSM) and young transgender women (YTGW) bear a disproportionate burden of the HIV epidemic. Due to social and healthcare system factors, many YMSM and YTGW do not seek HIV testing services and are therefore less likely to be aware that they are infected. Mobile health technology (mHealth) has the ability to increase uptake of HIV testing among these populations. Thus, the mLab App—which combines HIV prevention information with a mobile phone imaging feature for interpreting at-home HIV test results—was developed to improve testing rates and linkage to care among Black, Latino, and other YMSM and YTGW living in New York City and Chicago and their surrounding areas. Methods This study is a three-arm randomized controlled trial among YMSM and YTGW aged 18–29 years. Participants are randomized to either the mLab App intervention including HIV home test kits and standard of preventive care, standard of preventive care only, or HIV home test kits and standard of preventive care only. Discussion mHealth technology used for HIV prevention is capable of delivering interventions in real-time, which creates an opportunity to remotely reach users across the country to strengthen their HIV care continuum engagement and treatment outcomes. Specifically during the COVID-19 pandemic, mHealth technology combined with at-home testing may prove to be essential in increasing HIV testing rates, especially among populations at high-risk or without regular access to HIV testing. Trial registration This trial was registered with Clinicaltrials.gov (NCT03803683) on January 14, 2019.

The influence of climate on parasite distribution has been demonstrated in different regions worldwide. Despite its small size, Gran Canaria (Canary Islands, Spain) constitutes a ‘biodiversity laboratory’ due to the huge climatic differences between municipalities. Feral cats may represent a threat to biodiversity due to their predatory behaviour. In addition, they may be a source of pathogens zoonotic to humans. To study the climatic/seasonal influence and prevalence of feral cat parasites throughout the island, a total of 290 stool samples from 29 feral cat colonies were analysed following standard concentration protocols (sodium chloride, formol-ether and zinc sulphate). In total, 13 feline parasitic taxa were found, with the most common species being Ancylostoma spp., which, together with Toxocara spp., Toxoplasma gondii and Giardia spp., are considered a concern for human health. Nematodes were the most common parasites in all areas. Nematodes and protozoans were significantly more prevalent in temperate mild (75.0% and 30.0%) than in dry desert areas (29.3% and 18.7%). In contrast, cestodes were significantly more prevalent in dry desert than in temperate mild areas (26.0% and 13.3%). Only protozoans exhibited statistically significant seasonal patterns, mostly in the wet season. Data reported in this study endorse the usage of small and diverse islands such as Gran Canaria to study the climatic influence on parasitic communities in wild/feral animals. Cat colonies require better management to reduce their threat to endemic wildlife, domestic animals and public health, being invasive species that harbour zoonotic parasites.

[Abstract] To evaluate the influence of mitochondrial DNA haplogroups on the risk of knee OA in terms of their interaction with obesity, in a population from Mexico. Samples were obtained from (n = 353) knee OA patients (KL grade ≥ I) and (n = 364) healthy controls (KL grade = 0) from Mexico city and Torreon (Mexico). Both Caucasian and Amerindian mtDNA haplogroups were assigned by single base extension assay. A set of clinical and demographic variables, including obesity status, were considered to perform appropriate statistical approaches, including chi-square contingency tables, regression models and interaction analyses. To ensure the robustness of the predictive model, a statistical cross-validation strategy of B = 1000 iterations was used. All the analyses were performed using boot, GmAMisc and epiR package from R software v4.0.2 and SPSS software v24. The frequency distribution of the mtDNA haplogroups between OA patients and healthy controls for obese and non-obese groups showed the haplogroup A as significantly over-represented in knee OA patients within the obese group (OR 2.23; 95% CI 1.22-4.05; p-value = 0.008). The subsequent logistic regression analysis, including as covariate the interaction between obesity and mtDNA haplogroup A, supported the significant association of this interaction (OR 2.57; 95% CI 1.24-5.32; p-value = 0.011). The statistical cross-validation strategy confirmed the robustness of the regression model. The data presented here indicate a link between obesity in knee OA patients and mtDNA haplogroup A. This work is supported by Grants from Fondo de Investigación Sanitaria (PI17/00210, PI16/02124, PI20/00614, RETIC-RIER-RD16/0012/0002 and PRB3-ISCIII-PT17/0019/0014) integrated in the National Plan for Scientific Program, Development and Technological Innovation 2013–2016 and funded by the ISCIII-General Subdirection of Assessment and Promotion of Research-European Regional Development Fund (FEDER) “A way of making Europe” and Grant IN607A2017/11 from Xunta de Galicia. The authors further acknowledge AE CICA-INIBIC (ED431E 2018/03) for financial support. IRP is supported by Contrato Miguel Servet-II Fondo de Investigación Sanitaria (CPII17/00026) and AD-S is supported by Grant IN606A-2018/023 from Xunta de Galicia, Spain. The Biomedical Research Networking Center (CIBER) is an initiative from Instituto de Salud Carlos III (ISCIII) Xunta de Galicia; IN607A2017/11 Xunta de Galicia; ED431E 2018/03 Xunta de Galicia; IN606A-2018/023

Objective: Current treatment for borderline personality disorder (BPD) involves psychological and pharmacological interventions. However, neuromodulation techniques such as repetitive transcranial magnetic stimulation (rTMS) may positively affect BPD symptomatology. The objective of this study was to evaluate the clinical and neuropsychological effects of rTMS on the dorsomedial prefrontal cortex (DMPFC) in BPD patients. Methods: Fourteen patients with BPD were randomized into two groups (active vs. sham) for 15 sessions of rTMS on the DMPFC. Clinical effects were measured using the Borderline Symptoms List (BSL), Clinical Global Impression Scale for BPD (CGI-BPD), Borderline Evaluation of Severity over Time (BEST), Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Rating Scale (HARS), and Barratt’s Impulsiveness Scale (BIS). Neuropsychological effects were determined by a Stop-Signal Task (SST), the Wisconsin Card-Sorting Test (WCST), and the Iowa Gambling Test (IGT). Results: Within-group comparison showed significant differences (p < 0.05) in CGI-BPD (total score and six of nine psychopathologic domains), BEST, HDRS, HARS, and IGT scores for active modality. Conclusion: The 5 Hz-DMPFC rTMS technique was well tolerated and lessened the severity of BPD symptomatology, especially abandonment, affective issues, interpersonal relationships, suicidal behavior, anger, and paranoid ideation. Cognitive improvement was seen in decision-making. Additional studies are needed to fully evaluate the effects of rTMS on BPD symptomatology. Clinical Trial Registration: NCT03832777.

Initiation of skeletal muscle contraction is triggered by rapid activation of RYR1 channels in response to sarcolemmal depolarization. RYR1 is intracellular and has no voltage-sensing structures, but it is coupled with the voltage-sensing apparatus of CaV1.1 channels to inherit voltage sensitivity. Using an opto-electrophysiological approach, we resolved the excitation-driven molecular events controlling both CaV1.1 and RYR1 activations, reported as fluorescence changes. We discovered that each of the four human CaV1.1 voltage-sensing domains (VSDs) exhibits unique biophysical properties: VSD-I time-dependent properties were similar to ionic current activation kinetics, suggesting a critical role of this voltage sensor in CaV1.1 activation; VSD-II, VSD-III, and VSD-IV displayed faster activation, compatible with kinetics of sarcoplasmic reticulum Ca2+ release. The prominent role of VSD-I in governing CaV1.1 activation was also confirmed using a naturally occurring, charge-neutralizing mutation in VSD-I (R174W). This mutation abolished CaV1.1 current at physiological membrane potentials by impairing VSD-I activation without affecting the other VSDs. Using a structurally relevant allosteric model of CaV activation, which accounted for both time- and voltage-dependent properties of CaV1.1, to predict VSD-pore coupling energies, we found that VSD-I contributed the most energy (~75 meV or ∼3 kT) toward the stabilization of the open states of the channel, with smaller (VSD-IV) or negligible (VSDs II and III) energetic contribution from the other voltage sensors (

More research is needed that elucidates the mechanisms by which critical consciousness impacts marginalized youth’s academic and career development. To address this gap, this short-term longitudinal study (i.e., two waves) examined motivations for post-high school plans (i.e., career/personal motivation; humanitarian motivation; encouragement received from important individuals; pressure from parents/family to succeed) as mediators in the relationship between dimension of critical consciousness and academic and career activities. The sample consisted of low-income, Black and Latinx youth (N = 191; Mage = 16, SD = 0.80; 59% female) living in Chicago. The results from structural equation path models show that youth’s beliefs about their ability to engage politically (i.e., sociopolitical efficacy) predict motivations for post-secondary plans (e.g., encouragement; pressure from parents/family), which is subsequently related to engagement in academic and career activities, albeit in different directions. To continue fostering positive youth development, critical consciousness programming will need to integrate how youth understand their role in changing social inequality in relation to their perception of and interactions with parents and mentors.

Much is known about how experiences of community violence negatively affect youth, but far less research has explored how youth remain resilient while living in dangerous neighborhoods. This study addresses this need by analyzing in-depth, geo-narrative interviews conducted with 15 youth (60% Black, 27% Latinx, 53% female, 14 to 17 years old) residing in low-income, high-crime Chicago neighborhoods to explore youths' perceptions of safety and strategies for navigating neighborhood space. After carrying geographical positioning system (GPS) trackers for an eight-day period, youths' travel patterns were mapped, and these maps were used as part of an interview with youth that explored daily routines, with special consideration paid to where and when youth felt safe. Drawing on activity settings theory and exploring youth voice, we find that experiences of community violence are commonplace, but youth describe how they have safe spaces that are embedded within these dangerous contexts. Perceptions of safety and danger were related to environmental, social, and temporal cues. Youth reported four overarching safety strategies, including avoidance, hypervigilance, self-defense, and emotional management, but these strategies considerably varied by gender. We discuss implications for practice and future directions of research. HIGHLIGHTS: This study explored Chicago youths' safety strategies and resilience in high-crime neighborhoods. Safe and dangerous spaces are embedded or overlapping settings. All youth practiced safety strategies but they considerably varied by gender. Perceptions are intersubjectively created due to the codes, rules, and norms of community life. Violence is common and extreme in everyday life of this sample of Chicago adolescents.

The purpose of this study was to determine the risk of noncommunicable diseases (NCDs) development in four indigenous Totonac communities.Poverty and low education levels increase the risk of unhealthy lifestyles, leading to a higher incidence of NCDs in indigenous communities. In addition, limited access to health services significantly reduces the opportune screening of risk factors.This was a cross-sectional observational study, in which we evaluated the incidence and/or the risk (%) to develop NCDs in adults from indigenous Totonac communities of Puebla State, Mexico. The sample consisted of 255 adults over 20 years old. Analysis of variance (ANOVA), Student's t-test, and Pearson's correlation were used for statistical analysis.We found significant differences between communities regarding the risk of diabetes (p 0.05) and hypertension (p 0.01). However, there were no significant differences in terms of CVD risk (p 0.05). Men were at higher risk for hypertension and CVD than women (37.8% vs 27.3% and 20.9% vs 12.2%, respectively), whereas women were at a higher risk of diabetes than men based on the FINDRISC score (11.7 vs 9.7, respectively).The Zapotitlan community showed a higher risk of developing both diabetes and hypertension compared with the other communities. Men showed higher risks of hypertension and CVD compared with women. Women are at higher risk of diabetes than men.

Duchenne muscular dystrophy is caused by mutations in DMD which disrupt the reading frame. Therapeutic strategies that restore DMD's reading frame, such as exon skipping and CRISPR/Cas9, need to be tested in the context of the human DMD sequence in vivo. We have developed a novel dystrophic mouse model by using CRISPR/Cas9 to delete exon 45 in the human DMD gene in hDMD mice, which places DMD out-of-frame. We have utilized this model to demonstrate that our clinically-relevant CRISPR/Cas9 platform, which targets deletion of human DMD exons 45-55, can be directly applied in vivo to restore dystrophin.

The thymus supports differentiation of T cell precursors. This process requires relocation of developing thymocytes throughout multiple microenvironments of the organ, mainly with thymic epithelial cells (TEC), which control intrathymic T cell differentiation influencing the formation and maintenance of the immunological synapse. In addition to the proteins of the major histocompatibility complex (MHC), this structure is supported by several adhesion molecules. During the process of thymopoiesis, we previously showed that laminin-mediated interactions are involved in the entrance of T-cell precursors into the thymus, as well as migration of differentiating thymocytes within the organ. Using small interference RNA strategy, we knocked-down the ITGA6 gene (which encodes the CD49f integrin α-chain) in cultured human TEC, generating a decrease in the expression of the corresponding CD49f subunit, in addition to modulation in several other genes related to cell adhesion and migration. Thymocyte adhesion to TEC was significantly impaired, comprising both immature and mature thymocyte subsets. Moreover, we found a modulation of the MHC, with a decrease in membrane expression of HLA-ABC, in contrast with increase in the expression of HLA-DR. Interestingly, the knockdown of the B2M gene (encoding the β-2 microglobulin of the HLA-ABC complex) increased CD49f expression levels, thus unraveling the existence of a cross-talk event in the reciprocal control of CD49f and HLA-ABC. Our data suggest that the expression levels of CD49f may be relevant in the general control of MHC expression by TEC and consequently the corresponding synapse with developing thymocytes mediated by the T-cell receptor.

Positioning our analyses within two theoretical frameworks, system justification (SJ) theory and critical consciousness (CC), we examine relationships between social class and endorsement of SJ and CC beliefs and behaviors within a sample of low-income, Latinx and Black youth living in Chicago. We operationalize social class using five indicators: income-to-needs ratio (INR), subjective social status (SSS), financial strain, violence exposure, and neighborhood income. We find that for Black youth, higher INR is related to a greater likelihood of rejecting the status quo. Comparatively, living in a higher income neighborhood is negatively related to and being exposed to violence is positively related to the likelihood of engaging in social change behaviors. A different pattern emerged for Latinx youth where, higher perceived status was positively associated with accepting the status quo and greater exposure to violence was negatively related to youths' perceived ability to make a difference in the world around them.

Constitutional complex chromosomal rearrangements (CCRs) are rare events that typically involve 2 or more chromosomes with at least 3 breakpoints and can result in normal or abnormal phenotypes depending on whether they disturb the euchromatic neighborhood. Here, we report an unusual balanced CCR involving chromosomes 1, 9, and 10 that causes an unbalanced karyotype in a severely affected toddler. The CCR was initially reported as a maternal 2-way translocation but was reclassified as a 3-way translocation after a microarray analysis of the propositus revealed the involvement of another chromosome not identified by G-banding in his phenotypically normal mother. FISH assays on maternal metaphase cells confirmed that the 1qter region of der(1) was translocated to der(10), whereas the 10qter segment was translocated to der(9), which in turn donated a segment to der(1). Subsequently, this CCR was also identified in her phenotypically normal father (the patient's grandfather). Thus, the patient inherited the previously unreported pathogenic combination of der(1) with a loss of 1q43→qter (including AKT3, ZBTB18, HNRNPU, and SMYD3) and der(9) with a gain of 10q25.2→qter (including FGFR2), leading to a compound phenotype with key features of the 1q43→qter deletion and distal 10q trisomy syndromes. Our observations suggest that the loss of SMYD3 accounts for cardiac defects in a subset of patients. Moreover, due to recurrent miscarriages in this family, our findings allowed improved genetic counseling.

Background: Evidence to guide policymakers in developing affordable and equitable cancer control plans are scarce in low- and middle-income countries (LMIC).Methods: The 2012-2014 ASEAN Costs in Oncology Study prospectively followed-up 9513 newly diagnosed cancer patients from eight LMIC in Southeast Asia for 12 months. Overall and country-specific incidence of financial catastrophe (out-of-pocket health costs >= 30% of annual household income), economic hardship (inability to make necessary household payments), poverty (living below national poverty line), and all-cause mortality were determined. Stepwise multinomial regression was used to estimate the extent to which health insurance, cancer stage and treatment explained these outcomes.Results: The one-year incidence of mortality (12% in Malaysia to 45% in Myanmar) and financial catastrophe (24% in Thailand to 68% in Vietnam) were high. Economic hardship was reported by a third of families, including inability to pay for medicines (45%), mortgages (18%) and utilities (12%), with 28% taking personal loans, and 20% selling assets (not mutually exclusive). Out of households that initially reported incomes above the national poverty levels, 4 9% were pushed into poverty at one year. The adverse economic outcomes in this study were mainly attributed to medical costs for inpatient/outpatient care, and purchase of drugs and medical supplies. In all the countries, cancer stage largely explained the risk of adverse outcomes. Stage-stratified analysis however showed that low-income patients remained vulnerable to adverse outcomes even when diagnosed with earlier cancer stages.Conclusion: The LMIC need to realign their focus on early detection of cancer and provision of affordable cancer care, while ensuring adequate financial risk protection, particularly for the poor. (C) 2017 Elsevier Ltd. All rights reserved.

Prostate cancer (PC) is the most prevalent among men and yet its risk factors are little known. This article aims to determine the hospital incidence, trend and municipal distribution of PC in Health Area of León (HAL).We included new cases of prostate cancer (ICD-9: 185, ICD-10: C61) enrolled in the Hospital Tumor Registry of the Complejo Asistencial Universitario de León, between 1996 to 2010 with residence in HAL. We calculated crude triennial hospital incidences and adjusted at global and European population. As denominator we used the INE population data disaggregated by five-year age groups of residents in municipalities of the HAL. To analyze the spatial distribution, we estimated municipal relative risks (RR) smoothed by fitting the Besag, York and Mollié model and the posterior probability (PP) of RR1 using Bayesian methods.3,366 cases were included. Standardized rates at European population amounted of 30.3 (1996-98) to 119.0 (2008-2010) new cases per 100,000 men. The number of organ-confined cases were increased from 281 (1999-2001) to 999 (2008-2010). PSA determinations amounted from 30,985 (1999-2001) to 117 396 (2008-2010).A great increase was observed in the frequency of PC at the expense of organ-confined cases which correlate very well with PSA determinations performed in HAL. There were no differences of interest in the municipal distribution incidences.

In normal elderly subjects, the best electroencephalogram (EEG)-based predictor of cognitive impairment is theta EEG activity abnormally high for their age. The goal of this work was to explore the effectiveness of a neurofeedback (NFB) protocol in reducing theta EEG activity in normal elderly subjects who present abnormally high theta absolute power (AP). Fourteen subjects were randomly assigned to either the experimental group or the control group; the experimental group received a reward (tone of 1000 Hz) when the theta AP was reduced, and the control group received a placebo treatment, a random administration of the same tone. The results show that the experimental group exhibits greater improvement in EEG and behavioral measures. However, subjects of the control group also show improved EEG values and in memory, which may be attributed to a placebo effect. However, the effect of the NFB treatment was clear in the EG, although a placebo effect may also have been present.

Fundamentos. El cáncer de próstata (CaP) es el de mayor incidencia entre los varones y sin embargo se conoce muy poco sobre sus factores de riesgo. El presente artículo tiene por objetivo conocer la incidencia hospitalaria, tendencia y distribución municipal del CaP en el área de salud de León (ASL). Métodos. Fueron incluidos los casos nuevos de cáncer de próstata (CIE-9: 185, CIE-10: C61) del registro hospitalario de tumores del Complejo Asistencial Universitario de León, entre 1996 y 2010 en sujetos con residencia en el ASL. Se calcularon las incidencias hospitalarias brutas trienales y ajustadas a población mundial y europea. Como denominador se utilizaron los datos del Instituto Nacional de Estadística de población desagregada por grupos quinquenales de edad de residentes en municipios del ASL. Para el análisis de la distribución espacial se estimaron los riesgos relativos (RR) municipales suavizados mediante el ajuste del modelo de Besag, York y Mollié y sus probabilidades posteriores de que los RR fuesen > 1 (PP), utilizando métodos bayesianos. Resultados: Se incluyeron 3.366 casos. Las tasas estandarizadas con población europea ascendieron de 30,3 (1996-98) a 119,0 (2008-2010) casos nuevos por 100.000 hombres. El número de casos órgano-confinados pasó de 281 (1999-2001) a 999 (2008-2010). Las determinaciones de PSA ascendieron de 30.985 (1999-2001) a 117.396 (2008-2010). Conclusiones: Se observó un gran incremento de la frecuencia de CaP a expensas de los casos órgano-confinados, que correlacionan muy bien con las determinaciones de PSA llevadas a cabo en el ASL. No hubo diferencias de interés en la distribución municipal de las incidencias. Sí

Objective: Poor speech intelligibility adversely affects quality of life self-assessment in long term survivors of head and neck cancer treatment. Study Design: Observational case series including both objective clinical speech testing and subjective quality of life questionnaire administration. Methods: Five-year head and neck cancer survivors were recruited to study the association between speech intelligibility and quality of life. Survivors were analyzed as an entire group, and also subdivided into laryngectomees and non-laryngectomees. Objective testing included sentence and word intelligibility. Subjective testing included quality of life questionnaires (UWQOL, FACT, FACT-head and neck, and PSS-HN) and a locally prepared “cancer concern” question. Associations were sought between intelligibility, quality of life and demographics. Results: Sixty-two survivors underwent testing. Lower sentence intelligibility and word intelligibility scores were associated with diminished self-perceived UWQOL Speech (P = .0001 and P = .0001, respectively) and PSS-HN Understandability of Speech (P = .009 and P = .005). Decreased word intelligibility was additionally associated with decreased UWQOL Chewing (P = .003), UWQOL Swallowing (P = .02), UWQOL Recreation (P = .05), PSS-HN Willingness to Eat in Public (P = .03), and PSS-HN Normalcy of Diet (P = .0001). The associations continued even after patients who had undergone laryngectomy were excluded. Conclusions: Long-term survivors of head and neck cancer continue to have both objective and subjective deficits in speech parameters five years after treatment. Objective deficits are associated with subjective concerns about speech, eating, and recreation. Understanding how communication deficits affect quality of life in long-term head and neck cancer survivors may allow more effective therapies to modulate these concerns in the recovery period.

Background Comprehensive incidence estimates indicate that 1.7 million healthcare-associated infections (HAIs) and 99,000 HAI-associated deaths occur in US hospitals. Preventing HAIs could save $25.0 to $31.5 billion. Identifying effective quality improvement (QI) strategies for promoting adherence to evidence-based preventive interventions could reduce infections. Methods We searched MEDLINE, CINAHL, and EMBASE from 2006-2012 for English-language articles with ≥ 100 patients that described an implementation strategy to increase adherence with evidence-based preventive interventions and that met study design criteria. One reviewer abstracted and appraised study quality, with verification by a second. QI strategies included audit and feedback; financial incentives, regulation, and policy; organizational change; patient education; provider education; and provider reminder systems. Results We evaluated data on HAIs from 30 articles reporting adherence and infection rates that accounted for confounding or secular trends. Many of the measures improved significantly, especially adherence. Results varied by QI strategy(s). Conclusions Moderate strength of evidence supports improvement in adherence and infection rates when audit and feedback plus provider reminder systems or audit and feedback alone is added to organizational change and provider education. Strength of evidence is low when provider reminder systems alone are added to organizational change and provider education. There were no studies on HAIs in nonhospital settings that met the selection criteria.

Background To determine whether there is greater employee satisfaction in organisations that have made more progress in implementation of the European Foundation for Quality Management (EFQM) model. Methods A series of cross-sectional studies (one for each assessment cycle) comparing staff satisfaction survey results between groups of healthcare organisations by degree of implementation of the EFQM model (assessed in terms of external recognition of management quality in each organisation). Setting: 30 healthcare organisations including hospitals, primary care and mental health providers in Osakidetza, the Basque public health service. Participants: Employees of 30 Osakidetza organisations. Intervention: Progress in implementation of EFQM model. Main outcome measures: Scores in 9 dimensions of employee satisfaction from questionnaires administered in healthcare organisations in 4 assessment cycles between 2001 and 2010. Results Comparing satisfaction results in organisations granted Gold or Silver Q Awards and those without this type of external recognition, we found statistically significant differences in the dimensions of training and internal communication. Then, comparing recipients of Gold Q Awards with those with no Q Certification, differences in leadership style and in policy and strategy also emerged as significant. Conclusions Progress of healthcare organisations in the implementation of the EFQM Excellence Model is associated with increases in their employee satisfaction in dimensions that can be managed at the level of each organisation, while dimensions in which no statistically significant differences were found represent common organisational elements with little scope for self-management.

Telephone interviews were conducted on a random sample of 164 dairy farmers knowledge and beliefs about pesticide hazards, intentions to use precautions, perceptions of pesticide safety peer norms, perceived self-efficacy to prevent personal exposure, and use of protective equipment. Self-efficacy and risk perception appear less relevant to safety behavior than other variables. Future research should focus prospectively and on national samples. Language: en

BACKGROUND: Programs that train health professionals to identify and treat battered women have not previously incorporated systematically obtained advice from battered women to guide physician behavior. OBJECTIVES: To survey battered women to (1) rate the desirability of specific physician behaviors, (2) describe their actual experiences with physicians while seeking abuse-related medical services, and (3) examine relationships between participants' demographics, history of victimization, history of seeking medical help, and ratings of physician behavior. PARTICIPANTS: One hundred fifteen women who had been battered by a male partner, recruited from support groups and other battered women's programs in a 5-county area in southeastern Wisconsin. METHODS: Self-report survey of demographic information, relationship history, observations of physician behavior, and ratings of desirability for those behaviors. Analysis used cross-tabulations, chi2, and multiple t tests with Bonferonni adjustments for multiple comparisons. RESULTS: Women identified specific physician behaviors as desirable and undesirable. Desirability ratings did not differ with history of victimization, history of seeking medical help, or most other demographic variables. African American and white women rated a few physician behaviors differently. CONCLUSIONS: We identified discrete sets of desirable and undesirable physician behaviors. Further research is needed to clarify racial differences found in this study. Findings can help guide both clinical practice and the development of physician training curricula. Language: en

Article-at-a-Glance Background As primary care physicians develop ongoing relationships with their patients, each contact provides another opportunity for primary, secondary, or tertiary prevention activities. In 1991 an interdisciplinary prevention project team using continuous quality improvement (CQI) principles was established to improve family practice residents' provision of such services. Diagnostic journey For a random sample of 60 patient charts, abstractors looked for documentation of 23 clinical preventive services, including nursing screens, physician on-site and off-site implemented services, lifestyle education (diet, tobacco use), and self-screening education. After the chart review, the physicians, nurses, residents, and clinical staff used a fishbone analysis to identify physician-, clinic system–, and patient-centered factors contributing to the lack of conformance with clinical prevention guidelines. Remedial journey The residency program began a series of didactic sessions on clinical prevention and instituted a procedures rotation to teach prevention procedure skills such as flexible sigmoidoscopy, stress testing, and colposcopy. On the CQI team's recommendation, a checklist developed by physicians and staff which itemized age- and gender-specific clinical prevention services was placed at the front of all patient charts. Clinic-system and patient factors were also addressed. Holding the gains—monitoring performance The 1993 postintervention chart review showed significant improvements for 17 (81%) of the 21 targeted services. Discussion Providing educational sessions on prevention, permitting residents to select the areas of prevention on which to focus, and giving feedback on resident and staff performance through ongoing, nonpunitive monitoring resulted in increased provision of clinical prevention services in a family practice residency training center.

To estimate the economic and health impact of chronic complications (macrovascular and microvascular) of type 2 diabetes mellitus (T2DM) in the autonomous community of Madrid (Spain) (ACM).The number of expected complications was obtained from a descriptive, cross-sectional study on a cohort of 3,268 patients with T2DM from the ACM. Cost of complications (€, 2012) was assessed both at hospitals and in primary care. The number of medical visits in primary care and drug treatment for complications were collected by a panel of 21 physicians experienced in treatment of T2DM. Population and epidemiological data and healthcare costs were obtained from Spanish sources. Univariate sensitivity analyses were performed.It is estimated that there are 390,944 patients with T2DM in the ACM, and that they experience 172,406 and 212,283 macrovascular and microvascular complications respectively during their lifetimes. Mean cost of T2DM complications per patient is estimated at € 4,121.54 (66% due to macrovascular complications). The economic impact of T2DM complications in the ACM would be € 1,611 million (1,065 and 545 millions from macrovascular and microvascular complications respectively). The economic impact would range from € 1,249 and 2.509 million euro depending on T2DM prevalence.Complications of T2DM have a great health and economic impact in ACM.

The appearance of rice grain is a key aspect in quality determination. Mainly, this analysis is performed by expert analysts through visual observation; however, due to the subjective nature of the analysis, the results may vary among analysts. In order to evaluate the concordance between analysts from Latin-American rice quality laboratories for rice grain appearance through digital images, an inter-laboratory test was performed with ten analysts and images of 90 grains captured with a high resolution scanner. Rice grains were classified in four categories including translucent, chalky, white belly, and damaged grain. Data was categorized using statistic parameters like mode and its frequency, the relative concordance, and the reproducibility parameter kappa. Additionally, a referential image gallery of typical grain for each category was constructed based on mode frequency. Results showed a Kappa value of 0.49, corresponding to a moderate reproducibility, attributable to subjectivity in the visual analysis of grain images. These results reveal the need for standardize the evaluation criteria among analysts to improve the confidence of the determination of rice grain appearance.

Background Our aim was to analyze both metabolic control and chronic complications of type 2 diabetes mellitus (T2D) patients regularly attended in primary care during a 3 years of follow-up in the Community of Madrid (Spain). Methods From 2007 to 2010 we prospectively included 3268 patients with T2D attended by 153 primary care physicians from 51 family health centers. An prospective cohort study with annual evaluation over 3 years to the same population was performed. We measured the goals of control in diabetic patients and the incidence of chronic complications of diabetes during the study period. Results A significant decrease in serum glucose levels (143 ± 42 mg/dl vs 137 ± 43 mg/dl, p

We combine electrophysiological and optical techniques to investigate the role that the expression of chloride channels (ClC-1) plays on the age-dependent electrical properties of mammalian muscle fibres. To this end, we comparatively evaluate the magnitude and voltage dependence of chloride currents (ICl), as well as the resting resistance, in fibres isolated from control and human skeletal actin (HSA)(LR) mice (a model of myotonic dystrophy) of various ages. In control mice, the maximal peak chloride current ([peak-ICl]max) increases from -583 ± 126 to -956 ± 260 μA cm(-2) (mean ± SD) between 3 and 6 weeks old. Instead, in 3-week-old HSA(LR) mice, ICl are significantly smaller (-153 ± 33 μA cm(-2)) than in control mice, but after a long period of ∼14 weeks they reach statistically comparable values. Thus, the severe ClC-1 channelopathy in young HSA(LR) animals is slowly reversed with aging. Frequency histograms of the maximal chloride conductance (gCl,max) in fibres of young HSA(LR) animals are narrow and centred in low values; alternatively, those from older animals show broad distributions, centred at larger gCl,max values, compatible with mosaic expressions of ClC-1 channels. In fibres of both animal strains, optical data confirm the age-dependent increase in gCl, and additionally suggest that ClC-1 channels are evenly distributed between the sarcolemma and transverse tubular system membranes. Although gCl is significantly depressed in fibres of young HSA(LR) mice, the resting membrane resistance (Rm) at -90 mV is only slightly larger than in control mice due to upregulation of a Rb-sensitive resting conductance (gK,IR). In adult animals, differences in Rm are negligible between fibres of both strains, and the contributions of gCl and gK,IR are less altered in HSA(LR) animals. We surmise that while hyperexcitability in young HSA(LR) mice can be readily explained on the basis of reduced gCl, myotonia in adult HSA(LR) animals may be explained on the basis of a mosaic expression of ClC-1 channels in different fibres and/or on alterations of other conductances.

To update the Agency for Healthcare Research and Quality (AHRQ) Evidence Report Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies: Volume 6-Prevention of Healthcare-Associated Infections on quality improvement (QI) strategies to increase adherence to preventive interventions and/or reduce infection rates for central line-associated bloodstream infections (CLABSI), ventilator-associated pneumonia (VAP), surgical site infections (SSI), and catheter-associated urinary tract infections (CAUTI).MEDLINE®, CINAHL®, and Embase® were searched from January 2006 to January 2012 for English-language studies with sample size ≥100 patients, a defined baseline period, and reported statistical analysis for adherence and/or infection rates. Articles from the previous report were screened and those meeting selection criteria were included.We sought studies that evaluated the following QI strategies to improve adherence to evidence-based preventive interventions and/or reduce healthcare-associated infection (HAI) rates: audit and feedback; financial incentives, regulation, and policy; organizational change; patient education; provider education; and provider reminder systems. Data were abstracted by a single reviewer and fact-checked by a second. Outcomes were adherence to preventive interventions, infection rates, adverse outcomes, and cost savings. Study quality was assessed using relative rankings based on study design, adequacy of statistical analysis, length of followup, reporting and analysis of baseline and postintervention adherence and infection rates, and implementation of the intervention independent of other QI efforts. Combinations of QI strategies were assessed, not individual strategies. Strength of evidence was judged according to the AHRQ Methods Guide.Sixty-one articles yielded 71 analyses at the infection level, including 9 articles (10 analyses) from the 2007 report, which evaluated the use of one or more QI strategies to improve adherence or infection rates and also controlled for confounding or secular trend. Twenty-six analyses were performed on CLABSI, 19 on VAP, 15 on SSI, and 11 on CAUTI. There were 34 analyses on adherence, of which 31 (91%) showed significant improvement. There were 63 analyses of infection rates, of which 42 (67%) showed significant improvement.There is moderate strength of evidence across all four infections that both adherence and infection rates improve when either audit and feedback plus provider reminder systems or audit and feedback alone is added to the base strategies of organizational change and provider education. There is low strength of evidence that adherence and infection rates improve when provider reminder systems alone are added to the base strategies. There was insufficient evidence for reduction of HAI in nonhospital settings, cost savings for QI strategies, and the nature and impact of the clinical contextual factors.

This study had two goals: (a) to describe the results of the Wechsler Adult Intelligence Scale-III (WAIS-III) and of the quantitative analyses of electroencephalograms (EEG) in elderly adults (60–84 y.o.) that are both healthy and active, and (b) to explore the relationship between the WAIS-III results and EEG in this group. A correlation analysis was made between WAIS-III scores and the Z -transformed absolute power (AP) and relative power (RP) values of delta, theta, alpha, and beta frequency bands. Lower values of delta and theta and higher values of alpha AP and RP were significantly related to better scores in the WAIS-III subtest scores. There were few significant relationships between WAIS-III scores and beta activity. These results suggest that the WAIS-III could be used as a brain function indicator in this age group, paying special attention to the subtests that correlated most significantly with EEG values.

Objective To determine risk factors of medical injury, defined as untoward injury from diagnostic or therapeutic healthcare interventions. Identifying risk factors for medical injuries could inform the development of preventive interventions. Methods A hospital-based case–control study. Cases and controls were selected among patients discharged from a large Midwestern teaching hospital between 1 January 2003 and 31 December 2004. Cases (n=268) were selected in a three-step process. First, medical injuries in the discharge database were identified using the Wisconsin Medical Injury Prevention Programme Surveillance Criteria. Second, provisional cases were randomly chosen from patients flagged with a medical injury. Provisional controls were randomly selected from patients not flagged with a medical injury, matching for Diagnosis Related Group of the provisional cases. Third, a chart review determined ultimate case–control status. Severity of illness and risk of mortality were calculated using the All Patients Refined–Diagnosis Related Groups system. Zahn's comorbidity score was calculated. Conditional logistic regressions were run with injury status as the dependent variable. Results Among the 268 cases, 47.8% were procedure-related injuries and 44.8% were medication-related injuries. Conditional logistic regressions found higher severity of illness and higher risks of mortality were related to risk of medical injury (OR 3.29 (95% CI 1.05 to 10.31) and OR 5.16 (95% CI 1.42 to 18.79), respectively). Additional regressions showed the Zahn comorbidity score related to the risk of medical injury (OR 1.63, 95% CI 1.31 to 2.02). Conclusions Patients with higher severity of illness, higher risk of inpatient mortality and multiple comorbidities are at increased risk for a medical injury.

Electronic Medical Records (EMRs) are quickly becoming a standard component of medical practices.We longitudinally studied the impact of EMR implementation on physician perceptions of quality of care, documentation, and work hours, as well as on measured physician productivity.Physicians were surveyed at 3-month intervals regarding perceived impact of the EMR on quality of care, documentation, and productivity. Relative Value Units (RVUs) per clinic hours were used to measure productivity. Paired t-tests were used to compare the mean RVUs per clinic hour in the pre-EMR with the immediate post-EMR time period and the long-term post-EMR time period.RVUs per hour increased significantly from the pre-EMR time period to the immediate post-EMR time period (means 1.49 and 1.82, respectively, P = 0.0007). The long-term post-EMR time period also showed a significant increase over the pre-EMR period (mean 1.79, P = 0.007). Sixty-six percent of physicians perceived that EMR implementation increased their work amount a little or much more.Not only did physician production rise immediately, it stayed at the increased level for the duration of our study period. This may be due to improved documentation supporting more appropriate billing. However, physicians also perceived the EMR as taking up more of their time.

The polymorphism of Pvs25 and Pvs28 ookinete surface proteins, their association to circumsporozoite protein repeat (CSPr) genotypes (Vk210 and Vk247) and their infectivity to local Anopheles albimanus and Anopheles pseudopunctipennis were investigated in Plasmodium vivax-infected blood samples obtained from patients in Southern Mexico. The pvs25 and pvs28 complete genes were amplified, cloned and sequenced; and the CSPr genotype was determined by PCR amplification and hybridization. The amino acid Pvs25 and Pvs28 polymorphisms were mapped to their corresponding protein structure. Infected blood samples were simultaneously provided through artificial feeders to both mosquito species; the ratio of infected mosquitoes and oocyst numbers were recorded. The polymorphism of pvs25 and pvs28 was limited to few nucleotide positions, and produced three haplotypes: type A/A parasites presented Pvs25 and Pvs28 amino acid sequences identical to that of Sal I reference strain; parasites type B1 presented a mutation 130 Ile-->Thr in Pvs25, while type B2 presented 87 Gln-->Lys/130 Ile-->Thr in the same molecule. Both types B1 and B2 parasites presented changes in Pvs28 at 87 Asn-->Asp, 110 Tyr-->Asn and five GSGGE/D repeat sequences between the fourth EGF-like domain and the GPI. Most P. vivaxparasites from the coastal plains and the overlapping region were Pvs25/28 A/A, CSPrVk210 and were infective only to An. albimanus (p< or =0.0001). Parasites originating in foothills were Pvs25/28 type B1/B or B2/B and CSPrVk210 or Vk247, and were more infective to An. pseudopunctipennis than to An. albimanus (p< or =0.001). These results and the analysis of Pvs25/28 from other parts of the world indicated that non-synonymous variations in these proteins occur in amino acid residues exposed on the surface of the proteins, and are likely to interact with midgut mosquito ligands. We hypothesize that these molecules have been shaped by co-evolutionary adaptations of parasites to their susceptible vectors.

Introduction/context Torture is widely practiced throughout the world and, yet, the ways by which torture is perpetrated, its regional similarities and differences, is not well understood. Our goal for this cases series was to elucidate the methods of torture practiced within different countries to both add to and expand upon previous research. This knowledge is important since it can buttress efforts to assist with torture survivors’ recovery—medically, psychologically, and legally. Methods Fifty-eight survivors of torture who presented to a single interviewer over a 15-year period (1990–2005) for purposes of assisting with their claim for political asylum in the U.S. were enrolled into the study. The survivors’ legal affidavits were examined and both quantitative and qualitative data were extracted for analysis. This data included the following: (1) duration, condition, and frequency of imprisonment, (2) abductors’ affiliation and dress, (3) torture type, method, and frequency (both physical and mental), and (4) qualitative description of above items. Results Twenty-three countries were represented in the sample covering six major world regions. Women appear to be at greater risk for sexual torture than men. Sub-Saharan Africans tend to have more abuse compared to other world regions. Furthermore, the length of confinement also appears to trend towards longer duration in those survivors from Sub-Saharan African countries. Certain types of torture were almost universal in their application such as threats of death and beatings, but the manner by which survivors were beaten varied considerably, with hitting/kicking and beating with a stick/baton being the most common. There was no correlation between types of torturous acts and religion. Conclusion This case series confirms some earlier findings about regional similarities and differences in torture methodology. Study results built upon previous studies as well as uncovered new findings suggesting that more work needs to be done. Further, our results will help survivors of torture with their recovery both through improved patient care outcomes and by impacting upon the way asylum cases are adjudicated.

Alemtuzumab (Campath-1H) is a monoclonal antibody directed against CD52-positive B and T lymphocytes. Initial results of its use as an induction agent in adult renal transplantation have been encouraging. We report a case series of four low-risk pediatric renal transplantation patients who received 20 to 40 mg of alemtuzumab as induction followed by a steroid-free regimen consisting of a calcineurin inhibitor and mycophenolate mofetil. No infusion-related reactions occurred. Patients were aged 9 to 14 years with a mean creatinine of 1.2 mg/dL (range = 0.5-2.3 mg/dL) at a mean follow-up of 10 months (range = 4-16 months). One patient experienced biopsy-proven acute cellular rejections at 4 and 12 months posttransplantation, which were steroid sensitive. Lymphopenia post-alemtuzumab induction started to improve at 3 months posttransplantation. Two patients who received 40 mg of alemtuzumab experienced repeated infections that responded to 7-day courses of antibiotics. There was no cytomegalovirus disease detected. From these preliminary results, alemtuzumab seems to show a promising role to achieve adequate graft function with a steroid-free regimen among low-risk pediatric patients.

This study investigates the Wisconsin adolescent self-poisoning problem, using state discharge data on medication-related self-inflicted injuries, focusing on medications used and risk factors.Wisconsin inpatient discharge files for 3 years (January 1, 2000-December 31, 2002) were evaluated. Medication-related injuries were analyzed for intentionality, medications used, discharge status, and risk factors such as mental illness, eating disorders, and alcohol abuse or dependence.There were nearly 3000 medication-related injury hospitalizations--1150 of them self-poisoning hospitalizations--among Wisconsin 12-17 year olds during 2000-2002. Females 12-17 years had twice as many medication-related injuries as males. Sixty percent of medication-related injuries occurred in patients with a mental disorder diagnosis. Non-narcotic analgesics were most commonly used and had one of the highest rates of intentionality (65%). A large proportion of intentional/suicidal medication-related injuries were discharged to another facility (35%), compared to 14% among all medical injuries. Males with medication-related injuries were twice (95% CI: 1.60, 2.75) as likely and females 1.4 (95% CI: 1.2, 1.6) times as likely to have intentional/suicidal injuries if they also abused or depended on alcohol.Given that a nonfatal suicide attempt is the strongest predictor of eventual suicide, the hundreds of self-poisoning discharges per year in Wisconsin 12-17 year olds is a serious public health concern. Both the medical community and public health community should heed the warnings of these nonfatal suicide attempts and implement educational programs addressing this issue.

Objective. To describe the implementation of the European Foundation for Quality Management (EFQM) excellence model as a common framework for quality management in a regional health care service. Design. Prospective, descriptive observational study. Setting. Thirty-one organizations (hospitals, primary care organizations, mental health institutions, and emergency services) of the Basque Health Service (serving a population of 2200000 inhabitants) in Basque Country, Spain. Methods. Since 1995, the experiences with the EFQM excellence model were initiated by training, the design of quality tools and application guidelines, and actions related to criteria of the EFQM model. Results. Four assessment cycles in which most of the organizations have participated were completed. Scores for most of the criteria improved, particularly in ‘processes’. The overall patients’ satisfaction was higher than 89% in all settings, in most of the cases higher than 95%. Ten organizations (32%) exceeded 400 points in an external evaluation with the EFQM excellence model, and 2 (6%) 500 points. Eighty-three percent of hospitals have some ISO-certified areas of activity. In the primary care setting, 40% of people were attended in a certified center. Conclusions. Stimulating actions towards quality have resulted in progressive implementation of the EFQM model, this approach being possibly related to positive evolution of some outcomes. Key factors identified have been pursuing the objective of total quality management during several years and the assignment of the resources for training and implementation of quality systems.

Few studies using biologic markers to examine nonpersistent pesticide exposure among pesticide applicators were conducted in field settings. This study compares self-reported dermal, inhalation, and ingestion exposures with urinalysis results after one-time application of the commonly used herbicide atrazine to field crops. It was hypothesized that: i) applicator reports of exposure would be associated positively with detection of urinary atrazine metabolites, and ii) applicator reports of personal-protective-equipment (PPE) use would be associated negatively with detection of urinary atrazine metabolites.Wisconsin dairy farmers were randomly selected to participate in 1997 to 1998 and were instructed to collect a urine sample 8 hours after the first pesticide application of the season. Farmers then were interviewed within 1 week of their first application to report on application practices. Eighty-six urine samples were analyzed for deethylatrazine, a major atrazine metabolite.Comparing urinalysis results with self-reported dermal, inhalation, and ingestion exposure showed poor agreement between self-reported exposure and urinary deethylatrazine detections (all kappa0.40). Multivariate linear regression modeling with deethylatrazine level as the outcome showed that self-reported practices did not significantly predict atrazine metabolite levels.Possible explanations for the discrepancies between urinalysis results and self-reported data include: i) inaccuracies in self-reported data and ii) substantial interpersonal variation in atrazine metabolism, resulting in major differences in body burden for similar exposures. Either explanation poses challenges for epidemiologic studies of the health effects of pesticides, which rely solely on self-reported measures of exposure. Additional evaluation of determinants of accuracy in self-assessed occupational and environmental exposures is needed.

Objectives To analyze how the dental status of long-term head and neck cancer survivors affects their subjective quality of life. Study design Observational case series. Methods A convenience sample of 5-year head and neck cancer survivors underwent the following battery of tests: 1) targeted head and neck examination, 2) updated medical history, 3) dental evaluation, 4) standardized quality of life questionnaires. Results Eighty-six survivors were included in the study. The following associations were identified: 1) those who became edentulous secondary to cancer treatment and those without occlusion at time of the study demonstrated worse Pain, Activity, Recreation/Entertainment, Chewing, Swallowing, Speech, Eating in Public, Normalcy of Diet, Physical Well-Being, Social/Family Well-Being, Functional Well-Being, and Additional Concerns scores; 2) higher Decayed/Missing/Filled scores were associated with worse Pain, Disfigurement, Activity, Recreation/Entertainment, Employment, Chewing, Swallowing, Speech, Eating in Public, Understandability of Speech, Normalcy of Diet, Physical Well-Being, Additional Concerns scores, and weight loss; 3) decreased oral opening measurements were associated with worse Chewing, Swallowing, Eating in Public, Normalcy of Diet, Additional Concerns scores, and weight loss; 4) edentulous survivors who did not use dentures had worse Pain, Activity, Recreation/Entertainment, Understandability of Speech, and Eating in Public scores. Conclusions Although previous studies have shown that many of the effects of cancer treatment disappear between 1 and 3 years, this study shows that the dental status has a persistent impact on subjective quality of life.

To identify and rate the importance of several psychosocial and physiologic influences on quality of life (QOL) among a cohort of 5-year head and neck cancer survivors, we conducted a cross-sectional study of a convenience sample that used both questionnaires and physiologic evaluations.QOL was assessed by the Functional Assessment of Cancer Therapy (FACT) and the FACT Head and Neck additional concerns (FACT-HN) questionnaires. Psychosocial characteristics (or risk factors) potentially influencing QOL were measured by the Millon Behavioral Health Inventory (MBHI) and the Social Support Questionnaire (SSQSR). Physiologic risk factors were measured in examinations that included shoulder and neck range of motion, whole and stimulated saliva measurements, and oropharyngeal swallowing efficiency. We evaluated the association of selected QOL measures with three groups of potential risk factors: psychosocial factors, consisting of selected MBHI and SSQSR scales; physiologic factors, consisting of selected physical ability measures; and a combination of psychosocial/physiologic factors.The entire study population of 105 subjects completed the FACT and FACT-HN questionnaires; 86 of these completed the physiologic tests as well. Combined psychosocial/physiologic models best predicted all QOL measures considered. Psychosocial models alone, compared with physiologic models alone, better predicted FACT physical and social/family well-being measures. Physiologic models alone, compared with psychosocial models alone, better predicted FACT-HN additional concerns measures. Premorbid pessimism (MBHI) was consistently the best predictor of QOL measures.Both psychosocial and physiologic factors influence QOL in patients with head and neck cancer, but many QOL measures are most strongly influenced by psychosocial considerations. Physicians and surgeons caring for long-term head and neck cancer survivors should be cognizant of the importance of psychosocial risk factors in the QOL of their patients.