Displaying publications 341 - 360 of 1549 in total

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  1. Tharumaraja T, Che-Ahmad A, Wong PF, Ahmad Hamid AH, Hasan MI, Bajuri MY, et al.
    Malays Fam Physician, 2021 Mar 25;16(1):103-113.
    PMID: 33948148 DOI: 10.51866/cpg0001
    Diabetic foot requires careful attention and coordinated management by a dedicated team. Screening, prevention, adequate assessment, and appropriate referral are crucial to prevent complications. Multimodal treatment and rehabilitation are recommended to ensure a better quality of life and reduction of amputation rate in people with diabetic foot.
    Matched MeSH terms: Quality of Life
  2. Heboyan A, Avetisyan A, Skallevold HE, Rokaya D, Marla V, Vardanyan A
    Case Rep Dent, 2021;2021:6648729.
    PMID: 33953989 DOI: 10.1155/2021/6648729
    Recurrent aphthous stomatitis is an ulcerative disease of the oral cavity and can occur in isolation or as a manifestation of many systemic diseases. It is a quite common entity and may hence often be overlooked as an isolated lesion. Gilbert's syndrome is a genetic disorder where a deficiency of an enzyme associated with the conjugation of bilirubin results in unconjugated hyperbilirubinemia. The disease is generally asymptomatic and is aggravated by certain trigger factors. No associated oral manifestations are known. In this case report, we discuss the concomitant presence of recurrent aphthous stomatitis in a patient of Gilbert's syndrome. The presence of such recurrent stomatitis may represent as an oral manifestation of Gilbert's syndrome. Early identification of these entities may improve the overall quality of life of the patient.
    Matched MeSH terms: Quality of Life
  3. Ibrahim Alzamel LG, Abdullah KL, Chong MC, Chua YP
    J Egypt Public Health Assoc, 2020 Aug 14;95(1):20.
    PMID: 32813099 DOI: 10.1186/s42506-020-00048-9
    BACKGROUND: Understanding the factors influencing nurses' turnover intention, particularly the work life quality and commitment to organization, is important to all countries suffering from nursing shortage. The study aims to determine the mediating role of commitment to organization on work life quality and its relationship with turnover intention among Malaysian nurses.

    METHODS: A descriptive cross-sectional design, using a self-report survey was conducted on 430 nurses from a teaching hospital from February to April 2019. A structural equation model version 3 was used for testing study hypotheses.

    RESULTS: The mediating effect (indirect effect) of organizational commitment on the relationship between work life quality and turnover intention (QWL→OC→IT) was negative with path coefficient - 0.234, whereas the direct effect of work life quality on turnover intention (QWL→IT) was negative with smaller path coefficient - 0.228. This means that the relationship between work life quality and turnover intention was partially mediated by the organizational commitment (P < 0.001).

    CONCLUSION: Organizational commitment has a negative partial mediating effect between work life quality of nurses and intention of turnover in teaching hospitals where the organizational commitment significantly reduced the nurses' intention to leave. The study findings can guide nursing managers to be carefully attended to the levels of nurses' commitment to their organization.

    Matched MeSH terms: Quality of Life
  4. Janifal Alipal, Razak Mohd Ali Lee
    MyJurnal
    New techniques based on digital analysis and more precise visualisation in monitoring of individual health status can improve the accessibility and reliability of healthcare services. An innovation in capturing human biofield energy level using Electrophotonic Imaging (EPI) is seen as a breakthrough approach to healthcare service. This non-invasive imaging approach produces an image, i.e. the Kirlian image in digital form to aid visualization and probe for disease identification. The diagnosis and treatment process are fast, reproducible and cost-effective. EPI technique works using computational models of human health state, commonly before and after a course of treatment or meditation. The reliability and efficacy of EPI are validated by the physician’s perceptions using biomedical measurements. At the same time, the algorithms developed by engineers embedded in the imaging system have advanced gradually with the help of clinical data from physicians. To close the gap between engineering and medicine, the field of research known as ‘Biomedical Engineering’ (BME) has been established to merge engineering principles with medicine in order to advance = diagnosis, treatment, and monitoring, which will in turn improves quality of life of mankind. Engineering approach is used to study on how the captured image indicates the energy level of human biofield. This elementary analysis introduces a pre-processing procedure to extract the effects texture. The image indicates the radiation energy level based on its most significant glow (digitallyimaged isolines) and is used for medical biometrics and health analysis.
    Matched MeSH terms: Quality of Life
  5. Peter Gan Kim Soon, Sanjay Rampal, Lim Soo Kun, Tin Tin Su
    MyJurnal
    Introduction: Kidney transplantation (KT) is the preferred end-stage renal disease (ESRD) treatment because it pro-vides a better survival rate, quality of life as well as a cheaper alternative. However, Malaysia’s KT rates is consis-tently low considering that ESRD rates have been increasing exponentially. With only four hospitals performing KT, there’s a gap to indicate a lack of evaluation in KT system of Malaysia. Qualitative study was undertaken to explore and describe the barriers and solutions improve the rates and service of KT in Malaysia. Methods: Semi-structured interviews adopted as qualitative methodological approach to explore current KT policy and service in Malaysia be-tween March – May 2018 in Kuala Lumpur. Eight key-informants selected using stakeholder analysis and informed consent were obtained. Interviews were digitally audio-recorded, transcribed verbatim and analysed using thematic analysis. Results: Barriers and solutions of Malaysia’s KT are the results of complex interplay of personal, cultural, and environmental factors that can be categorized and described using the five levels of influence conceptualized by the socio-ecological model (SEM). Guidance for developing culturally appropriate and sensitive interventional strategies was elicited from the key informants’ experiences to improve KT rate and services in Malaysia. Conclusion:Malaysia is experiencing very low rate of KT compared to other countries. The use of SEM provided a framework to foster a better understanding of current practice, barriers and solutions to KT in Malaysia. Implications of these find-ings could prompt policy change for better KT service delivery model. Further stakeholder engagement and evalua-tion is required to align best practices to improve KT rates and service in Malaysia that is comparable to high-income countries.
    Matched MeSH terms: Quality of Life
  6. Siti Norzaimalina Abd Majid
    MyJurnal
    The role of a mother alone is very challenging. With an additional role as a student or a worker add more burden to them. It is undeniable that Malaysian women in the 21st century has more roles than women in the pre-independent era. Nowadays, women have equal opportunities to work and pursue higher education like men. The need to provide quality life to the children has also encouraged women to contribute more in the family income. Despite the multiple roles play by women, the household tasks are still managed by them. For this phenomenological research, in-depth interviews were conducted with two participants who studied in public university in Malaysia. By using thematic analysis, four themes were emerged from this study. The themes were challenges, role management, assistance/support and coping strategies. In this study, the major challenge was to balance the role of mother and student. But whatever challenges they faced; family was their priority. Furthermore, spousal support also helped the mothers in managing their multiple roles. From the findings, it is hoped that it gives some insights on the type of support that student mother needs and ways of coping in challenging situation.
    Matched MeSH terms: Quality of Life
  7. Han PSH, Saub R, Baharuddin NA, Sockalingam S, Bartold PM, Vaithilingam RD
    BMC Oral Health, 2020 11 23;20(1):332.
    PMID: 33225923 DOI: 10.1186/s12903-020-01275-4
    BACKGROUND: This study aimed to assess the impact of periodontitis (PD) on the health related quality of life (HRQoL) and oral health related QoL (OHRQoL) of subjects with rheumatoid arthritis (RA) and PD.

    METHODS: Subjects from dental and RA clinics were screened. Complete periodontal examinations were performed. Subjects were divided into 4 groups: RA-PD, RA, PD and healthy controls (HC). Questionnaires on characteristics and Malaysian versions of Oral Health Impact Profile (OHIP-14(M)) and Health Assessment Questionnaire (HAQ-DI)) were answered.

    RESULTS: A total of 187 subjects were included (29 RA-PD, 58 RA, 43 PD and 57 HC). OHIP-14(M) severity score was highest in the PD group (17.23 ± 10.36) but only significantly higher than the HC group (p 

    Matched MeSH terms: Quality of Life
  8. Cheong WL, Mohan D, Warren N, Reidpath DD
    Disabil Rehabil, 2021 07;43(15):2184-2190.
    PMID: 31769306 DOI: 10.1080/09638288.2019.1695000
    BACKGROUND: The needs of patients with multiple sclerosis have been well-studied in high-income, high-prevalence countries but few studies have been based in low- and middle-income countries where resources are relatively scarce. As such, little is known about the needs of patients living in these countries.

    OBJECTIVE: The study seeks to develop an understanding of the needs of patients with multiple sclerosis living in Malaysia in order to generate insights and contribute to a global database of patients' experience.

    METHOD: 12 patients with multiple sclerosis participated in this qualitative study and took part in a semi-structured interview. The interviews were transcribed and analysed using an iterative thematic analysis approach.

    RESULTS: The experiences, challenges and needs of the patients were reported. Five themes were developed (Daily living, Financial, Emotional and psychological, Healthcare, and Family). These predominantly revolved around the struggles of coping and adapting to the symptoms and disabilities imposed by multiple sclerosis, their heavy reliance on personal finances to cope with the increased costs of living for themselves and their families, as well as the limited healthcare services and treatments available to help them to manage the physical and emotional symptoms of multiple sclerosis.

    CONCLUSION: Patients with multiple sclerosis in Malaysia have complex needs that are neglected due perceived lack of importance of the disease and the poor understanding of multiple sclerosis in general. Patients rely heavily on their finances to improve their quality of life. This perpetuates health inequities and reform of the national health financing system is needed to provide patients with the healthcare and support they need.Implications for rehabilitationPatients with multiple sclerosis in Malaysia prioritize being able to cope and adapt to their disabilities in order to continue performing their activities of daily living.There is a need to increase the availability and accessibility of healthcare professionals that are experienced with the management of multiple sclerosis.Healthcare professionals need to improve their understanding of the patients' needs and what they consider to be important in order to provide therapy that is effective and relevant.Patients also require financial support to help them with the increased costs of living associated with MS as well as the costs of healthcare services such as physiotherapy and rehabilitation.

    Matched MeSH terms: Quality of Life
  9. Mohamed Ludin S, Abdul Rashid N
    Clin Nurs Res, 2020 09;29(7):433-439.
    PMID: 30079766 DOI: 10.1177/1054773818792459
    Throughout recovery, patients with severe traumatic brain injury (TBI) show physical and functional improvement, but continue to have cognitive and psychosocial problems. The aim of this article was to review the literature regarding the functional and health-related quality of life (HRQOL) outcomes in severe TBI. There were 15 articles reviewed, 13 of them were quantitative studies and two were narrative review. Most of the articles showed an improvement occurs rapidly at 6 months post-injury. There were several factors that influence the outcome after TBI, most of it was the Glasgow Coma Scale (GCS) on admission, age, educational level, duration of posttraumatic amnesia (PTA), and length of stay (LOS) in the Intensive Care Unit (ICU). Thus, health care workers should help the survivors of severe TBI in the recovery process to ensure the latter can attain maximum function and quality of life.
    Matched MeSH terms: Quality of Life
  10. Abdullah AH, Sharip S, Rahman AHA, Bakar L
    Psych J, 2021 Jun;10(3):444-452.
    PMID: 33517588 DOI: 10.1002/pchj.423
    At present, a limited amount of information exists on the association between cognitive reserve and cognitive impairment in stroke populations. To determine predictors of cognitive reserve among stroke patients, 80 stroke patients attending the neurological and rehabilitation clinic in two different Malaysian general hospitals participated in this study. The Malay Cognitive Reserve Index questionnaire (CRIq-M), Depression Anxiety and Stress Scales-Short Form (DASS-21), WHO Quality of Life assessment BREF-21 (WHO-QOL BREF-21), Montreal Cognitive Assessment (MoCA), and modified Rankin Scale (mRS) were used as instruments in this study. The study found that cognitive reserve (CRIq-M) is positively correlated with cognitive function (MoCA), r = 0.529, p life.
    Matched MeSH terms: Quality of Life
  11. Jamaludin TSS, Mohammad NM, Hassan M, Nurumal MS
    Enferm Clin, 2021 04;31 Suppl 2:S372-S376.
    PMID: 33849203 DOI: 10.1016/j.enfcli.2020.09.028
    This study aimed to survey the level of knowledge and practice on medication adherence among Type II diabetes mellitus (DM) patients. A cross-sectional study was conducted with a total of 220 DM patients by using a convenience sampling method. It was found that 64.5% of studied participants have a high level of knowledge with good practice toward medication adherence. There was a significant association between sociodemographic characteristics with the level of knowledge and practice toward medication adherence. This study finding provides information to health care providers to improve their patient's care by playing their important role in promoting the importance of knowledge on medication adherence for a better quality of life to the DM patients. Not only a physician but also the nurse could enhance health education for their patient on medication adherence during the follow-up appointment.
    Matched MeSH terms: Quality of Life
  12. Muneswarao J, Hassali MA, Ibrahim B, Saini B, Hyder Ali IA, Rehman AU, et al.
    J Allergy Clin Immunol Pract, 2020 10;8(9):3036-3055.
    PMID: 32502547 DOI: 10.1016/j.jaip.2020.05.032
    BACKGROUND: The effectiveness of home visits is well discussed for children with asthma, but limited in adults.

    OBJECTIVE: The present systematic review aimed to investigate the potential role of home visits in improving outcomes among adult patients with asthma.

    METHODS: The systematic review was performed in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. An extensive literature search was conducted using databases such as PubMed, ProQuest, CINAHL, The Cochrane Library, PsycINFO, and Google Scholar from inception to June 2019. The studies included were randomized controlled trials, which reported asthma outcomes in adult patients.

    RESULTS: The literature search yielded 8331 publications, of which 63 studies were selected for full-text review, and of these studies, 9 studies with a total of 2011 patients were included in the final analysis. The included randomized controlled trials reported quality of life, asthma symptoms, exacerbations, health care utilization, and pulmonary function. Improvements in asthma outcomes were observed predominantly in quality of life. The effects on asthma symptom control were inconsistent. The evidence on the impact of home visits in asthma exacerbations and health care utilization was rather limited. There were no significant differences observed between intervention versus control arms in terms of pulmonary function; however, 1 study reported significant improvements in peak expiratory flow rate.

    CONCLUSIONS: Home visits may serve as an adjuvant activity that complements the existing health care system-based initiatives. It may be concluded that home visits have the potential to improve outcomes in adult patients with asthma; however, the randomized controlled trials reviewed in the present systematic review reported several limitations that warrant further investigation.

    Matched MeSH terms: Quality of Life
  13. Gupta G, Singh Y, Tiwari J, Raizaday A, Alharbi KS, Al-Abbasi FA, et al.
    Dermatol Ther, 2020 11;33(6):e14209.
    PMID: 32816372 DOI: 10.1111/dth.14209
    Psoriasis is a chronic, local as well as a systemic, inflammatory skin condition. Psoriasis influences the quality of life up to 3.8% of the population and occurs often between 15 and 30 years of age. Specific causes are linked to psoriasis, including the interleukin IL-23/IL-17 Axis, human antigen leucocyte (HLA), and tumor necrosis factor-α (TNF-α). Secukinumab is a monoclonal antibody that specifically binds and neutralizes IL-17A required in the treatment of Psoriasis. The signaling pathways of Wnt govern multiple functions of cell-like fate specification, proliferation, polarity, migration, differentiation with their signaling controlled rigorously, given that dysregulation caused by various stimuli, can lead to alterations in cell proliferation, apoptosis, and human inflammatory disease. Current data has supported non-canonical Wnt signaling pathways in psoriasis development, particularly Wnt5a activated signaling cascades. These interconnected factors are significant in interactions between immune cells, keratinocytes, and inflammatory factors due to a higher degree of transglutaminase 2, mediated by activation of the keratinocyte hyperproliferation of the psoriatic patient's epidermis. This study discusses the pathology of Wnt5a signaling and its involvement in the epidermal inflammatory effects of psoriasis with other related pathways.
    Matched MeSH terms: Quality of Life
  14. Shafie AA, Wong JHY, Ibrahim HM, Mohammed NS, Chhabra IK
    Orphanet J Rare Dis, 2021 04 07;16(1):157.
    PMID: 33827621 DOI: 10.1186/s13023-021-01791-8
    BACKGROUND: Transfusion-dependent thalassaemia (TDT) is a hereditary blood disorder in which blood transfusion is the mainstay treatment to prolong survival and improve quality of life. Patients with this disease require blood transfusion at more than 100 ml/kg annually and iron-chelating therapy (ICT) to prevent iron overload (IOL) complications. There are substantial numbers of TDT patients in Malaysia, but limited data are available regarding the economic burden associated with this disease. The purpose of this study was to determine the lifetime cost of TDT from a societal perspective and identify potential factors increasing patient and family expenditures among thalassaemia populations.

    METHODS: The total lifetime cost per TDT patient (TC1) is the sum of lifetime healthcare cost (TC2) and lifetime patient and family healthcare expenditure (TC3). TC2 was simulated using the Markov model, taking into account all costs subsidized by the government, and TC3 was estimated through a cross-sectional health survey approach. A survey was performed using a two-stage sampling method in 13 thalassaemia centres covering all regions in Malaysia.

    RESULTS: A TDT patient is expected to incur TC2 of USD 561,208. ICT was the main driver of cost and accounted for 56.9% of the total cost followed by blood transfusion cost at 13.1%. TC3 was estimated to be USD 45,458. Therefore, the estimated TC1 of a TDT patient was USD 606,665. Sensitivity analyses showed that if all patients were prescribed oral ICT deferasirox for their lifetime, the total healthcare cost would increase by approximately 65%. Frequency of visits to health facilities for blood transfusion/routine monitoring and patients who were prescribed desferrioxamine were observed to be factors affecting patient and family monthly expenses.

    CONCLUSION: The lifetime cost per TDT patient was USD 606,665, and this result may be useful for national health allocation planning. An estimation of the economic burden will provide additional information to decision makers on implementing prevention interventions to reduce the number of new births and medical service reimbursement.

    Matched MeSH terms: Quality of Life
  15. Lim MA, Ang BT, Lam CL, Loh EC, Zainuddin SI, Capelle DP, et al.
    Eur J Cancer Care (Engl), 2021 Sep;30(5):e13456.
    PMID: 33913192 DOI: 10.1111/ecc.13456
    OBJECTIVE: Suffering is a common experience in palliative care. In our study, we aimed to determine the effect of 5-min mindfulness of love on suffering and the spiritual quality of life of palliative care patients.

    METHODS: We conducted a parallel-group, blinded, randomized controlled study at the University of Malaya Medical Centre (UMMC), Malaysia from February 2019 to April 2019. Sixty adult palliative care patients with an overall suffering score of 4/10 or above based on the Suffering Pictogram were recruited and randomly assigned to either the 5-min mindfulness of love group (N = 30) or the 5-min supportive listening group (N = 30).

    RESULTS: There were statistically significant improvements in the overall suffering score (mean difference = -2.9, CI = -3.7 to -2.1, t = -7.268, p = 0.000) and the total FACIT-Sp-12 score (mean difference = 2.9, CI = 1.5 to 4.3, t = 4.124, p = 0.000) in the intervention group compared to the control group.

    CONCLUSION: The results provided evidence that 5-min mindfulness of love could affect the actual state of suffering and the spiritual quality of life of palliative care patients.

    Matched MeSH terms: Quality of Life
  16. Bahanordin, J., Md Anuar, Abd.S., Roslan Johari, M.G., Teng, S.C., Mohd Azahadi, O., Siti Zubaidah, A.
    Journal of Health Management, 2012;10(1):30-36.
    MyJurnal
    Purpose – Evidences have shown that participation in a cardiac rehabilitation programme improves outcomes and quality of life for cardiac patients. Hospital Serdang has conducted this programme since 2007 and it is the first to be run by the Rehabilitation Medicine Department. The purpose of this survey is to find out whether the programme is suitable, informative and useful from the patient’s perspective as well as to determine whether the 6 weeks duration is sufficient.

    Design/ methodology/approach - A patient feedback survey using a self-administered questionnaire on the programme was conducted from January 2008 to December 2010 in Hospital Serdang.

    Findings - A total of 323 patients were invited to join the programme but only 182 completed the programme and took part in this survey. 30% of the patients thought that the six weeks programme was not enough for them. 100% of the respondents agreed that the programme was beneficial, well suited to their problems and were willing to promote the programme to their friends. Therefore, it is recommended that this programme be extended to the community level.

    Conclusion - In conclusion, this programme is beneficial, suitable, informative and adequate from the patient’s point of view. Extension of this programme into the community as a continuation of the hospital-based programme is likely to improve the outcome further.
    Matched MeSH terms: Quality of Life
  17. Lua, Pei Lin, Wong, Sok Yee, Neni Widiasmoro Selamat
    MyJurnal
    Objective: This study was aimed to determine the prevalence of anxiety and depressive symptoms , to examine their association with health-related quality of life (HRQoL) profiles and to determine the predictors on overall HRQoL. Methods: This was a cross-sectional study conducted in Hospital Sultanah Nur Zahirah, Kuala Terengganu, Malaysia. The Malay Hospital Anxiety and Depression Scale (HADS) and McGill Quality of Life Questionnaire (MMQoL) were administered to a sample of 150 cancer patients (mean age = 50.4 years).
    Chi-square test, correlation and multiple regression were utilised for data analysis. Results: The prevalence for mild anxiety and depressive symptoms was 30.7% and 23.3% espectively. The HADS-A correlated strongest with Total MMQoL Score (r = - 0.578) and Psychological Well-Being (r = -0.526). Only HADS-A (beta = - 0.486), and HADS-D (beta = -0.173) were significant in predicting overall health-related quality of life. Conclusion: Findings in our study indicated that the prevalence of anxiety and depressive symptoms in
    Terengganu cancer patients are moderate. If anxiety and depression are identified and treated, health-related quality of life among oncology patients appropriately could significantly be improved.
    Matched MeSH terms: Quality of Life
  18. Mastura I
    Malays Fam Physician, 2010;5(1):53-56.
    MyJurnal
    Non-communicable diseases (NCDs) represent among the most common and debilitating conditions seen in primary care. Patients’ care will often involves multiple providers and follow-up requires persistence by patients and clinicians alike, therefore ideal outcomes are often difficult to achieve. The need for better disease management policies and practice is growing. This is due to the changing demographic profile of the population, the increasing cost of managing people in acute care hospitals and the availability of new technologies and services. All these changes enable a different care paradigm which is more cost effective and provides people with chronic conditions an improved quality of life. Management of the NCDs therefore offers an excellent opportunity to practice chronic disease management - a systems approach designed to ensure excellent care.
    The NCD team has developed a comprehensive approach to chronic disease care. We would like to describe the NCD Program in Ampangan Health Clinic which represents many typical government health clinics in Malaysia and the processes by which it was developed. Included are specific examples of the tools and how they can be used by individual clinicians in caring for patients. The integration of Chronic Disease Management Services into health care systems is the direction being undertaken to tackle the burden of chronic disease. Disease management supports the shift in healthcare from an emphasis on managing the acute episode to managing the entire disease course, highlighting both prevention and maintenance of wellbeing for patients with chronic diseases. Disease management promotes better integration and coordination of care across all aspects of the health sector.
    Matched MeSH terms: Quality of Life
  19. Ahmad N, Javaid A, Syed Sulaiman SA, Basit A, Afridi AK, Jaber AA, et al.
    PLoS One, 2016 Jul 28;11(7):e0159560.
    PMID: 27467560 DOI: 10.1371/journal.pone.0159560
    At present, within the management of multidrug resistant tuberculosis (MDR-TB) much attention is being paid to the traditional microbiological and clinical indicators. Evaluation of the impact of MDR-TB treatment on patients' Health Related Quality of Life (HRQoL) has remained a neglected area.
    Matched MeSH terms: Quality of Life
  20. Wo, Su Woan, Lai, Pauline Siew Mei, Ong, Lai Choo, Low, Wah Yun, Lim, Kheng Seang, Tay, Chee Geap, et al.
    Neurology Asia, 2016;21(3):235-245.
    MyJurnal
    Objective: To determine the validity and reliability of the Chinese parent proxy and child self-report
    health related quality of life measure for children with epilepsy (CHEQOL-25) in Malaysia. Methods:
    Face and content validity of the Chinese parent proxy and child self-report CHEQOL-25 was verified
    by an expert panel, and piloted in five children with epilepsy (CWE). The Chinese CHEQOL-25 was
    then administered to 40 parent proxies and their CWE (aged 8-18 years), from two tertiary hospitals,
    at baseline and 2 weeks later. Results: Forty parents and their CWE were recruited. Cronbach’s alpha
    for each subscale ranged from 0.56-0.83. At test-retest, the interclass correlation for all items ranged
    from 0.68-0.97. Items 8 and 25 were removed as their corrected item-total correlation values were
    Matched MeSH terms: Quality of Life
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