Lichen Simplex Chronicus (LSC) is a skin disorder affecting patient's psychosocial and functional status. Pruritus is a diagnostic hallmark for LSC. It is the reason for sleep disturbances, anxiety and depression. Therefore, a clinical investigation of pruritus alongside with a study of their self-reported health status is a necessary precondition for successful therapeutic results. The aim of the study is to assess the impact of pruritus on quality of life (QoL) of LSC patients'. MATERIALS AND METHODS: The presented study includes 190 outpatients diagnosed with LSC. Demographic data and disease-related characteristics were collected. Measurement tools, for assessing pruritus severity and sleep disturbance were visual analogue scale (VAS), and verbal rating scale (VRS).For the evaluation of QoL Dermatological Life Quality Index (DLQI) questionnaire was applied. RESULTS AND DISCUSSION: Main complains of patients were pruritus and sleep disturbance. 40% reported having low intensity pruritus (mean VAS 1.90), 36.84% moderate pruritus (mean VAS 5.12), and 23.15% severe pruritus (mean VAS 8.57). Results from sleep disturbance were: 4.73% reported currently having no sleep disturbance (mean VAS 0.18), 43.15 % reported having mild sleep disturbance; 47.36% have moderate sleep disturbance (mean VAS 5.46), and 4.73% severe sleep disturbance (mean VAS 8.93). The total DLQI score reported by the LSC-patients is 8.58±3.348. Patients scores were significantly high for Q1 (symptoms), Q9 (sexual difficulties) and Q10 (treatment) (p<0=001). CONCLUSION: All the reported and analyzed results indicate that pruritus is a major symptom in LSC and has a negative impact on all the QoL-domains for every patient (p<0.001). Consequently, pruritus moderately affects the QoL of the patients. This is the first study in our country, which aims to measure the impact of pruritus on QoL of LSH patients'.
Researching health-related quality of life (HrQoL) at a community health promotion level is an approach to understand the health inequalities. The objective of this study is to measure the health of a representative sample by conducting a population survey in Burgas by using the EuroQoL EQ-5D-3L questionnaire, and further to assess the influence of socio-economic, demographic and behavioural factors on HrQoL. The relationship between HrQoL and social capital is analysed through a network-based approach. The achieved ambition was to build the public health capacity of the key stakeholders in order to support decision making. A cross-sectional study was conducted in 2011 using a representative sample of the citizens of Burgas (n = 1050, >18 years old). Respondents were selected through the method of two-stage random selection. HrQoL was assessed by the standardized EQ-5D-3L questionnaire. People without any problem in all five dimensions represent only 26.5% (n = 278) of the respondents, whereas 52.2% (n = 548) reported a moderate problem in at least one dimension; any extreme problem reported 11.6% (n = 122) of the respondents. The mean state of health recorded on the Visual Analogue Scale was 70 (SD ±23). There were differences in self-reported health based on the respondent's age, occupation, education, income, smoking behaviour and membership in community groups. People who have hobby and practice sports assessed their health status higher. The results were communicated in a following Delphi-study; a consensus has been reached that the combination of routine measures of health with measurement of self-rated health could provide better understandings of the community health needs.
INTRODUCTION: The number of people with disabilities has grown tremendously for the last 15 years in Bulgaria. Standardized quality of life instruments can be helpful in the development of public policies which target the needs of this population. The quality of life (QoL) paradigm is a challenging perspective for considering, planning and implementing changes within the area of disabilities. Moreover, an interview with a disabled person about her/his subjective health is a human care with a positive impact on the overall well-being of the individual. This paper aims at stimulating a debate on these topics by investigating the "QoL" and "disability" territories. Further, a study on QoL of individuals with disabilities is presented. The objectives of this study are: (1) to measure the QoL of a representative sample of 305 individuals with disabilities, who are patients from a general Territory Expert Medical Commission-TEMC (Territory Expert Medical Commission (popular abbreviation in Bulgarian language-ТЕЛК)) (St. Marina University Hospital, Varna) by using the WHO generic questionnaire (WHOQOL-BREF)-26 questions; four-domains structure: Physical health, Psychological health, Social relationships, Environment (2). To define the influence of the four domains on QoL (3). To analyze the relationship between QoL and socio-demographic characteristics (4). To assess the influence of physical pain on QoL. METHODS: A cross-sectional study was conducted in 2011 using a representative sample of the register of a general TEMC (n=305, >18 years old). Respondents were selected through the method of multi-stage random selection. RESULTS: As a result of multiple-regression analyses it was found out that all the domains have influence on QoL but the most influential is the "Environment" domain (0.394), followed by "Physical health" domain (0.354), "Psychological health" domain (0.261) and "Social relationships" domain (0.169). The total multiple regression coefficient-R is 0.984 (R 2 =0.969). The patients who reported higher levels of pain-95.80%-have lower QoL. No relations were found between socio-demographic characteristics of the patients and their QoL. Nowadays, the TEMC mission has to cover not only expert assessment and integration of persons with disabilities into society. The TEMC mission should also involve the improvement of QoL of the people with disabilities. A medico-social approach for handicap-assessment is proposed as a prerequisite for sustainable development of the public health policies concerning people with disabilities.
Health Technology Assessment (HTA) is the frame, which outlines the complex analysis of the emerging novel drugs, devices, procedures and organizational systems used in health care. HTA is still an innovation itself in Bulgaria. Therefore, picturing HTA is a challenging task as far as it is a multifaceted process. HTA by definition is the systematic evaluation of the properties and effects of a health innovation addressing the direct and intended effects of this technology, as well as its indirect and unintended consequences (INAHTA, 2016). The key method for HTA involves synthesizing available information, which has generally come to be called "systematic review" by the Cochrane Collaboration and other scientific entities. HTA is the common language that brings together the stakeholders -academics, medical researchers, physicians, economists, epidemiologists, patients' organizations, ethicists, lawyers, etc. Consensus is sought on a value-based scientific analysis of the efficacy, effectiveness, safety and appropriate conditions for use of the various healthcare technologies. Metaphorically, HTA has the role of the conciliator in the potential conflict between the health demands and the limited public resources. The HTA mission is to support the political decision-making in health care because no country can provide health therapies for all patients for any condition for all time.Historically, HTA developments are an answer to the growing scientific and social interests in health outcomes evaluation and to the rising costs in health care. The beginning of HTA was in the U.S. Office of Technology Assessment, which published its first report on the subject in 1976. In Europe, during the late 1980s, the Swedish Council on Technology Assessment in Health Care was initially formed. Internationally, the HTA concept is facilitated by many aid agencies, by the World Bank and the European Commission. Many pharmaceutical companies are strong supporters of the HTA approach. The universities also play a key role in the HTA processes. The industrialized world is already ahead in the application of the HTA methods and procedures. The poor countries, which often have the greatest need for critical assessment in order to make affordable investments in health technology, still have a limited basis for making such choices. Some countries in Eastern Europe and Latin America, and many countries in Asia also do not apply HTA procedures. Fortunately, Bulgaria shows a growing interest in the HTA field. Moreover, there is a political will and the national HTA program is framed and active. Since November 2015, the HTA process has been guaranteed both by a legal regulation and by an institutional structure and procedures. Currently, in Bulgaria HTA is applied as a process for ensuring access of medicinal products (Regulation No. 9 of MoH, Dec. 1, 2015).This issue of Scripta Scientifica Medica (SSM) reflects medical topics related to novel therapies, devices and procedures, which provoke the development of the HTA processes. Oncology is ...
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