Search Results (434)

Thyroid cancer (TC) remains a prevalent malignancy, with over 820,000 global cases diagnosed in 2022. Differentiated thyroid carcinoma (DTC), primarily papillary and follicular types, accounts for most cases and has a favorable prognosis with total thyroidectomy and radioiodine (RAI) ablation. However, 5–15% of patients develop RAI-refractory (RAI-R) disease, leading to a significantly poorer outcome. For RAI-R patients, treatment decisions depend on disease progression. Active surveillance is suitable for indolent cases, while symptomatic or progressive disease requires systemic therapy. Multikinase inhibitors (MKIs) such as lenvatinib and sorafenib serve as first-line options, with cabozantinib recently approved for resistant cases. Additionally, novel targeted therapies, including RET and NTRK inhibitors, and immune checkpoint inhibitors, are under investigation, offering a personalized approach. A key challenge is determining the optimal timing for systemic therapy, balancing progression-free survival (PFS) benefits against MKI-related toxicities, which significantly impact quality of life (QoL). Molecular testing can identify actionable mutations, guiding therapy selection. Clinical guidelines (ATA, ESMO) recommend initiating treatment based on disease progression and patient condition, integrating strategies such as active surveillance, surgery, and radiotherapy when appropriate. Despite advances, systemic therapies carry significant adverse events (e.g., hypertension, fatigue, gastrointestinal toxicity), necessitating careful monitoring to prevent dose reductions or interruptions. A multidisciplinary approach is essential to optimize patient outcomes and maintain QoL. As targeted therapies continue to evolve, further research is needed to refine treatment sequencing and improve outcomes for RAI-R TC. This review synthesizes current evidence to guide clinical decision-making. Full article

Background/Objectives: The prevalence of breast cancer (BC) is significant globally. The malignancy itself and the related treatments have a considerable impact on patients’ overall well-being. The adoption of e-health solutions for patients is increasing rapidly worldwide, since these innovative tools hold significant potential to positively impact the mental health and quality of life (QoL) of BC patients. However, their overall impact is still being explored, and further understanding and analysis are required. This review paper aims to present, quantify, and summarize the cumulative available randomized evidence on the state of the art of supportive interventions delivered via e-health applications for patients’ mental health and QoL before, during, and after BC treatment. Methods: A systematic review was conducted following the PRISMA guidelines in the Scopus and PubMed databases on 7 November 2024 to identify studies that utilized internet-based interventions in BC patients. The inclusion criteria were as follows: adult men and women (aged > 18 years) diagnosed with breast cancer (BC) who received patient-directed e-health interventions, compared to standard care or control interventions. The studies had to focus on outcomes such as quality of life (QoL), anxiety, depression, and distress, and be limited to randomized controlled trials (RCTs). The PRISMA-P guidelines were followed. Risk of bias was assessed using the Cochrane risk-of-bias (RoB) tool for randomized controlled trials. Results: A total of 27 randomized studies, involving 2898 patients, were included in this systematic review. The e-health interventions significantly affected patients’ anxiety (SMD = −0.80; 95% CI: −1.33 to −0.27; p < 0.01; and I² = 94%), depression (SMD = −0.74; 95% CI: −1.40 to −0.09; p = 0.026; and I² = 95%) and QoL (SMD = 0.65; 95% CI: 0.27 to 1.04; p < 0.01; and I² = 90%) but had no significant effect on distress (SMD = −0.78; 95% CI: −1.93 to 0.37; p = 0.184; and I² = 95%). Conclusions: This study showed that e-health interventions can improve QoL, reduce anxiety, and decrease depression in adult BC patients. However, no noticeable impact on reducing distress levels was observed. Additionally, given the diversity of interventions, these results should be interpreted with caution. To determine the optimum duration, validate different intervention approaches, and address methodological gaps in previous studies, more extensive clinical studies are needed. Full article

Background/Objectives: Adverse effects of antipsychotics represent a significant limiting factor in achieving favorable therapeutic outcomes in the treatment of schizophrenia, and may contribute to a diminished quality of life among affected individuals. The primary objective of this study was to identify and evaluate the adverse effects of antipsychotics in patients diagnosed with schizophrenia who were treated at the social welfare institution, as well as to analyze the impact of these adverse effects on patients’ overall quality of life. Methods: A clinical, observational cross-sectional study was conducted, involving a sample of 278 patients diagnosed with schizophrenia. The patients were assessed in terms of their sociodemographic and clinical characteristics. Adverse effects of antipsychotics were evaluated using The Udvalg for Kliniske Undersøgelser (UKU) Side Effect Rating Scale, while quality of life was assessed in the previous study. Results: The average number of adverse effects per patient with schizophrenia was 3.56 for psychiatric, 1.18 for neurological, 2.62 for autonomic, and 7.12 for other side effects. The average UKU score was 17.22 ± 11.04, with significant differences based on accommodation, antipsychotic type, and dosing regimen. UKU scores were negatively correlated with the EuroQoL 5-Dimension 5-Level (EQ-5D-5L) index, Visual Analog Scale (VAS) score, the Quality-of-Life Enjoyment and Satisfaction Questionnaire—Short Form (Q-LES-Q-SF) score, and the scores of physical and psychological domains of the World Health Organization Quality-of-Life Scale (WHOQOL-BREF). Conclusions: The findings of this study suggest that the presence of antipsychotic-related adverse effects is a significant determinant that can negatively influence the quality of life in patients with schizophrenia. These results underscore the importance of an individualized approach when determining pharmacological treatment strategies in the management of schizophrenia. Full article

Total hip arthroplasty (THA) is the definitive treatment for end-stage hip osteoarthritis, reliably relieving pain and restoring joint function. However, patient-reported quality of life (QoL) after THA remains heterogeneous, with recovery trajectories influenced by a range of biological, psychological, and social factors. A comprehensive synthesis of these determinants is lacking, limiting our ability to optimize individualized perioperative care and long-term outcomes. This review examines the various factors impacting quality of life (QoL) before and after hip arthroplasty. An analysis of 67 studies reveals significant postoperative enhancements in physical function, pain alleviation, and overall patient satisfaction. Identified key factors encompass physical activity, mental health status (anxiety and depression), lifestyle choices (diet and weight management), and social support systems, particularly from spouses and family members. The review indicates that, although these elements positively influence recovery, it also recognizes limitations including dependence on subjective, self-reported QoL measures, possible selection biases, and inconsistencies in study design. The results indicate that a com-prehensive, patient-focused strategy—integrating organized rehabilitation, psychological assistance, and family engagement—can markedly improve recovery and long-term QoL for arthroplasty patients. Nonetheless, additional research employing standardized protocols and extended follow-up durations is essential to corroborate these findings and guide clinical practice. The early implementation of tailored, multidisciplinary perioperative pathways—including structured rehabilitation programs, routine psychological screening and intervention, nutritional counseling for weight management, and active family involvement—may optimize functional recovery, reduce complications, and maximize long-term QoL in patients undergoing THA. This review highlights the importance of a multidisciplinary approach to enhance post-surgical quality of life, thereby advancing the understanding of patient-centered recovery strategies in orthopedic care. Full article

Background: The validated Screening Tool of Older People’s Prescriptions (STOPP) identifies potentially inappropriate prescribing (PIP)—treatments where potential risk outweighs potential benefit. STOPP is particularly important for people aging with HIV and comorbidities, since PIP may exacerbate symptoms and decrease adherence. Methods: We analyzed data from the DC Cohort, a longitudinal cohort of people with HIV (PWH). We applied STOPP criteria to identify PIP among DC Cohort participants aged ≥ 50 years who completed a Patient Reported Outcomes (PROs) survey. All medications prescribed in the 2 years prior to PROs survey completion were considered. Negative binomial models were used to evaluate factors associated with PIP and structural equation modeling was used to evaluate whether symptom burden mediates the relationship between PIP and quality of life. Results: Of 1048 eligible DC Cohort participants, 486 (46%) had at least one PIP. The most common systems implicated were musculoskeletal (23%), analgesic drugs (16%), and the central nervous system (13%). Age, race/ethnicity, HIV transmission factor, social determinants of health, and type of HIV care site were significantly associated with number of PIP in the crude models. In the multivariable model with just demographic variables, the association between age (aIRR: 1.03 (95% CI: 1.02, 1.04)), intravenous drug use (aIRR: 1.68 (95% CI: 1.20, 2.35)), White, non-Hispanic race (aIRR: 0.67 (95% CI: 0.50, 0.92)), site type (aIRR: 0.75 (95% CI: 0.62, 0.92)), and the expected number of PIPs remained significant. In the fully adjusted multivariable model with demographics and SDOH, the association between age, intravenous drug use, White, non-Hispanic race, and expected number of PIPs remained significant. Statistical evidence that symptom burden mediates the relationship between PIP and each of the QOL dimensions was present. Conclusions: Future interventions should work to decrease PIP among these high-risk groups, especially for PIP associated with increased symptom burden. Full article

Background/Objectives: Sex differences in the relationship between subjective cognitive decline (SCD) and health-related quality of life (HRQOL), as well as psychological and physical factors affecting this relationship, have not been fully investigated. In this study, we aimed to examine the relationship between SCD severity and HRQOL in community-dwelling older adults in Japan and to clarify the psychological and physical factors affecting this relationship by sex. Methods: This cross-sectional study included 456 community-dwelling older adults and was conducted in September 2024. SCD severity was evaluated using the visual analog scale, and HRQOL was assessed using the EuroQol 5-Dimensions 5-Levels. Psychological factors (depression and insomnia) and physical factors (pain and frailty) were measured, and the relationship between SCD and HRQOL was analyzed by sex. Results: In women, HRQOL decreased as SCD severity increased and was associated with depression, insomnia, and physical pain. Conversely, in men, the association between SCD and HRQOL was not significant, and HRQOL was mainly associated with physical health factors, including pain and frailty. Conclusions: There were sex differences in the relationship between SCD and HRQOL, with women’s awareness of SCD associated with a decline in HRQOL, whereas physical health was the main determinant in men. Sex-specific interventions with psychological support being effective for women and support focusing on maintaining physical health for men are warranted. Full article

Ensuring people’s quality of life (QOL) has become increasingly challenging due to population aging. This study aimed to investigate the QOL among older people and factors associated with it in an urban setting of Central Nepal using the World Health Organization Quality of Life (WHOQOL-OLD) tool. A cross-sectional study was conducted in Central Nepal. The association between QOL and independent variables was first examined using a univariate analysis of variance followed by multiple linear regressions. The mean age of the 366 participants was 70 years (standard deviation [SD]: 8.2 years). The mean of the overall QOL scores was 74.37 (SD: 7.82). Older people who were literate (regression coefficient (β): 1.909; 95% confidence interval (CI): 3.771 (1.986, 5.556)), who had an annual household income of NPR 40,000 (Nepalese Rupees) or more (β: 1.909: 95% CI: 0.337, 3.480), who reported health services as accessible (β: 4.019; 95% CI: 0.666, 7.371) and affordable (β: 3.176; 95% CI: 1.327, 5.025), and who reported partaking in physical activity (β: 2.107; 95% CI: 0.607, 3.606) had higher QOL scores compared to their respective counterparts. A holistic model of service using the social determinants of health framework is essential to improve the well-being of older people in Nepal. Full article

Purpose: Patients with advanced glaucoma have visual field defects that impair mobility and quality of life (QoL). We aim to determine the effects of exploratory saccade training (EST) in such patients with bilateral overlapping scotomas that affect at least one visual field quadrant. Patients and Methods: This study was approved by the Ethics Committee of the Medical Faculty of the University of Tuebingen, Germany, and was registered in the German Clinical Trials Register (DRKS DRKS00031082, date of approval: 2 February 2023). We randomly assigned 27 patients to two groups, one of which trained with a computer-based EST (group 1). A control group (group 2) first used reading training (rapid serial visual presentation, RSVP, a single-word presentation to minimize eye movements) as placebo training (PRT) in regard to EST, which trains eye movements and, in a later phase, also used EST. Each training method required 6 weeks of home training. Main outcome variables were reaction time (RT) during the EST training sessions, RT during a natural search task (table test), reading speed (RS) during training on the screen, and during reading printed paragraphs aloud. QoL was assessed by a questionnaire. Results: Reaction times during EST and the table test improved significantly, which indicated transfer of the training effect to daily life. RS and QoL were reduced at baseline. Reading training improved RS significantly and reached normal median values. QoL improved significantly in the sub-categories regarding mobility problems in group 1. Patients with inferior field defects were more impaired and improved more than those without inferior field defects. Conclusions: As a supplement to the necessary treatment for glaucoma, EST is an effective home training method for rehabilitation by improving reaction time in daily living tasks for patients with advanced glaucoma. Reading training improved RS while reading from a screen as well as reading printed text. Full article

Background/Objectives: Quality of life (QoL) is recognized as a clinically significant outcome measure among patients with aortic stenosis (AS). However, there is no validated, AS-specific questionnaire available in Poland for assessing the QoL in AS patients. The aim of the study was to determine the psychometric properties of the Polish version of the Toronto Aortic Stenosis Quality of Life Questionnaire (the TASQ). Methods: The study involved 113 patients with severe AS (including 59 women), aged 74 to 82 years [mean age 77 years], hospitalized at the department of cardiology in 2024. The standardized questionnaires were used to assess the level of QoL, the TASQ, and the Minnesota Living with Heart Failure Questionnaire (the MLHFQ). Results: The mean QoL level assessed by the TASQ was 60.72 ± 22.82. The Cronbach’s alpha for the entire TASQ was 0.919, for the emotional impact subscale 0.873, and for the physical limitation subscale 0.861. Satisfactory values of fit measures were obtained for a five-factor structure (RMSEA < 0.01; CFI > 0.99). The loadings of each item were statistically significant (p < 0.001). The MLHFQ score correlated significantly (p < 0.001) and positively (r > 0) with the score on the scales of physical symptoms (r = 0.479), physical limitations (r = 0.662), social limitations (r = 0.597), emotional impact (r = 0.638), and overall QoL (r = 0.712). Conclusions: Patients with severe AS exhibit low QoL. The TASQ has very good psychometric properties and can be used to assess the QoL in the population of Polish patients with AS. Full article

Background: Peripheral arterial disease (PAD) is a growing public health problem due to its high and increasing prevalence worldwide. PAD is responsible for several severe complications that affect the quality of life (QoL) of affected patients. Social determinants of health (SDHs) cover five areas: economic stability, education access, and quality, health care access and quality, neighborhood and built environment, and social and community context. This study aims to investigate SDHs-related outcomes to better understand their potential role in the lives of patients with PAD. Methods: A qualitative study has been conducted using semi-structured interviews to understand the role of SDHs in patients with PAD. Braun and Clarke’s method was used to guide the qualitative analysis of the data. Results: Twenty-seven patients were recruited to receive the interview, including twelve males (44.44%) and fifteen females (55.56%), with a mean age of 63.3 years old (a range of 50–87 years old). SDHs related to the five areas investigated significantly impacted PAD patient diagnosis and outcomes. Conclusions: Our findings suggest that physicians and vascular surgeons should consider SDHs impairments to recognize vulnerable patient populations and tailor treatment methods and follow-up protocols to their specific needs. Full article

Background/Objectives: Malnutrition is a key determinant of quality of life (QoL) in patients with head and neck cancers (HNCs), influencing treatment outcomes and the occurrence of adverse events (AEs). Despite there being numerous studies on nutritional status and QoL, there is no standardized risk or prognostic model integrating clinical and demographic factors. Methods: A literature search was conducted in September 2024 in Scopus, PubMed, and Web of Science, covering studies published between 2013 and 2024. Articles were selected based on their relevance to AEs, nutritional interventions, and QoL assessments in HNC patients. Results: The key factors influencing QoL in HNC patients include age, sex, weight, BMI, educational level, and tumor features. Mucositis was identified as the most significant food intake-impairing AE, contributing to malnutrition and reduced QoL. Current QoL assessments rely on descriptive questionnaires, which lack personalization and predictive capabilities. Digital tools, including machine learning models and digital twins, offer potential solutions for risk prediction and personalized nutritional interventions. Conclusions: Despite significant research efforts, QoL assessment in HNC patients remains non-uniform, and risk models integrating nutritional status are lacking. A comprehensive, personalized approach is needed, leveraging digital tools to improve nutritional intervention strategies. Full article

The Cluster of Differentiation 5-like protein (CD5L) is produced by tissue-resident macrophages. It is an innate immune mediator protein with a multitude of functions, such as binding of invading microorganisms and oxidised LDL, and it is associated with clinical conditions, i.e., atherosclerosis and inflammation. The circulating CD5L level has been reported to correlate to selenium status and thyroid hormone activity. In order to test this hypothesis, we analysed CD5L in serum samples from a randomized controlled trial (RCT) with selenium and coenzyme Q₁₀ supplementation and examined associations between CD5L and thyroid hormones, health-related quality-of-life (Hr-QoL), and mortality in an elderly population low in selenium. Circulating levels of CD5L and thyroid hormones were determined in 359 elderly community-living individuals enrolled in an RCT at inclusion and after 48 months of supplementation (179 received selenium and coenzyme Q₁₀, and 180 placebo). Hr-QoL was recorded at both time-points using Short Form 36. Pre-intervention plasma selenium was low, mean 67 µg/L. CD5L correlated positively to free tri-iodothyronine (fT3) and showed an inverse relation with thyroid stimulating hormone (TSH). Low CD5L concentrations at inclusion in the placebo group were associated with increased cardiovascular mortality during 10 years of follow-up, and impaired Hr-QoL at 48 months. Selenium and coenzyme Q₁₀ supplementation significantly increased CD5L and fT3 levels, in association with a better health outcome. The data indicate that circulating CD5L positively responds to selenium and coenzyme Q₁₀ supplementation, correlates with thyroid hormone status, and associates with positive health indices. The observed effect may be due to increased selenium-dependent deiodinase isozyme expression that converts thyroxine (T4) to T3 locally and supports thyroid hormone activities. Whether the observed associations with Hr-QoL and cardiovascular mortality are a direct effect of circulating CD5L or local thyroid hormone activity is unclear and should be further investigated. Full article

Visual conditions significantly influence fear of movement (FOM), which is a condition that impairs postural control and quality of life (QOL). This study examined how visual conditions influence sway velocity during repeated one-leg standing tasks and explored the potential relationship between postural control, FOM, and QOL in older adults with and without FOM. Thirty-seven older adults with FOM and 37 controls participated in the study. Postural sway velocity was measured across three repeated trials under visual conditions in both anteroposterior (AP) and mediolateral (ML) directions. The groups demonstrated significant interaction under visual conditions (F = 7.43, p = 0.01). In the eyes-closed condition, the FOM group exhibited faster ML sway velocity than the control group, with significant differences across all three trials. There was a significant interaction between sway direction and vision (F = 27.41, p = 0.001). In addition, the FOM demonstrated strong negative correlations with several QOL measures on social functioning (r = −0.69, p = 0.001) and role limitations due to emotional problems (r = −0.58, p = 0.001) in the FOM group. While FOM influenced sway velocity during balance tasks, visual input emerged as a key determinant of postural control. The FOM group demonstrated a heightened reliance on vision, suggesting an increased need for vision-dependent strategies to maintain balance. Full article

Latinos/as are the largest ethnic group in the U.S. and are a continuous source of population growth. Therefore, their health and quality of life are important public health concerns. Acculturation is an important determinant of health for Latinos/as. However, few studies examine models identifying determinants of acculturation along with its relationship to other social and health behaviors. The current study uses social network data from a sample of crowdsourced recruited Latinos/as (N = 300) to examine a structural model between network acculturation, psychological acculturation, social capital, help-seeking, and quality of life (QoL). The model posits several paths through which social networks (i.e., network acculturation) relate to acculturation and other model variables. Directly, network acculturation was found to be significantly related to Latino/a enculturation (−0.83, p = 0.002) and White American Acculturation (0.47, p = 0.003). Latino/a enculturation was related to help-seeking (0.21, p = 0.029) and social capital (0.36, p < 0.001), while White American acculturation was only related to social capital (0.35, p = 0.003). Social capital demonstrated a robust relationship with help-seeking (0.48, p = 0.004) and QoL (0.96, p = 0.003). The findings suggest that determinants of acculturation (i.e., network acculturation) are meaningful contributors to psychological acculturation and other variables relating to Latino/as’ QoL. Full article

Background: Although previous studies have suggested a variety of sociodemographic and psychological factors as predictors of poor outcomes in patients with chronic low back pain (CLBP), longitudinal studies remain rare. Objectives: To examine the prognostic indicators for poor outcome at 6 months on pain, disability, quality of life, anxiety, depression and somatic symptom disorders (SSDs) in Greek backache patients and to evaluate the medium-term effects of a conservative physiotherapeutic approach (massage, ultrasound, transcutaneous electrical nerve stimulation, low-level laser and exercise program). Methods: A prospective cohort study of 145 volunteers receiving treatment for CLBP in a physiotherapy unit was conducted using random systematic sampling. The intervention was assessed by comparing pre-treatment, post-treatment and six-month measurements with Friedman’s test and the Bonferroni correction, using the pain numerical rating scale (PNRS), Roland–Morris disability questionnaire (RMDQ), EuroQol-5-dimension-5-level (EQ-5D-5L), Hospital Anxiety and Depression Scale (HADS) and Somatic Symptom Scale-8 (SSS-8). Multiple linear regression analysis was carried out to determine the impact of demographics and pre-treatment scores with scores at six months. Results: The mean age was 60.6 years (±14.7). Post-treatment, statistically significant improvements were observed across all outcome measures, including PNRS, RMDQ, EQ-5D-5L and SSS-8 (all p ≤ 0.001), with anxiety showing a notable reduction (p = 0.002). After examining the multiple regression analysis, pre-treatment SSS-8 emerged as a predictor of elevated levels of pain, disability, anxiety and depression at 6 months. Conclusions: The findings yielded not only somatic symptom burden, greater age and pain intensity as prognostic indicators for poor outcomes at six months, but also reported favorable medium-term effects for a conventional physiotherapy regimen in CLBP management, as well. Full article