scholarly journals Fracture profiles of a 4-year cohort of 266,324 first incident upper extremity fractures from population health data in Ontario

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Joy C. MacDermid ◽  
J. Andrew McClure ◽  
Lucie Richard ◽  
Kenneth J. Faber ◽  
Susan Jaglal
Keyword(s):  
Upper Extremity ◽  
Radial Head ◽  
Statistical Significance ◽  
Management Strategies ◽  
Population Level ◽  
Distal Humerus ◽  
Similar Proportion ◽  
Fracture Type ◽  
Multiple Fractures ◽  
Multiple Regions

Abstract Background Understanding the profiles of different upper extremity fractures, particularly those presenting as a 1st incident can inform prevention and management strategies. The purpose of this population-level study was to describe first incident fractures of the upper extremity in terms of fracture characteristics and demographics. Methods Cases with a first adult upper extremity (UE) fracture from the years 2013 to 2017 were extracted from administrative data in Ontario. Fracture locations (ICD-10 codes) and associated characteristics (open/closed, associated hospitalization within 1-day, associated nerve, or tendon injury) were described by fracture type, age category and sex. Standardized mean differences of at least 10% (clinical significance) and statistical significance (p < 0.01) in ANOVA were used to identify group differences (age/sex). Results We identified 266,324 first incident UE fractures occurring over 4 years. The most commonly affected regions were the hand (93 K), wrist/forearm(80 K), shoulder (48 K) or elbow (35 K). The highest number of specific fractures were: distal radius (DRF, 47.4 K), metacarpal (30.4 K), phalangeal (29.9 K), distal phalangeal (24.4 K), proximal humerus (PHF, 21.7 K), clavicle (15.1 K), radial head (13.9 K), and scaphoid fractures (13.2 K). The most prevalent multiple fractures included: multiple radius and ulna fractures (11.8 K), fractures occurring in multiple regions of the upper extremity (8.7 K), or multiple regions in the forearm (8.4 K). Tendon (0.6% overall; 8.2% in multiple finger fractures) or nerve injuries were rarely reported (0.3% overall, 1.5% in distal humerus). Fractures were reported as being open in 4.7% of cases, most commonly for distal phalanx (23%). A similar proportion of females (51.5%) and males were present in this fracture cohort, but there were highly variant age-sex profiles across fracture subtypes. Fractures most common in 18–40-year-old males included metacarpal and finger fractures. Fractures common in older females were: DRF, PHF and radial head, which exhibited a dramatic increase in the over-50 age group. Conclusions UE fracture profiles vary widely by fracture type. Fracture specific prevention and management should consider fracture profiles that are highly variable according to age and sex.

scholarly journals Sociodemographic, health and fracture profiles of a 4-year cohort of 266,324 first incident upper extremity fractures in Ontario.

2020 ◽  
Author(s):  
Joy Christine MacDermid ◽  
J Andrew McClure ◽  
Lucie Richard ◽  
Susan Jaglal ◽  
Kenneth J. Faber
Keyword(s):  
Rheumatoid Arthritis ◽  
Upper Extremity ◽  
Radial Head ◽  
Social Deprivation ◽  
Distal Humerus ◽  
Tendon Injury ◽  
Fracture Type ◽  
Multiple Fractures ◽  
Social Risks ◽  
Multiple Regions

Abstract Background The purpose of this study was to describe 1st incident fractures of the upper extremity in terms of fracture characteristics, demographics, social deprivation and comorbid health profiles. Methods:Cases with a 1st adult upper extremity fracture from the years 2013 to 2017 were extracted from administrative data in Ontario, (population 14.3M). Fracture locations (ICD-10 codes) and associated characteristics (open/closed, associated hospitalization within 1-day, associated nerve or tendon injury) were described by fracture type, age category and sex. Fracture comorbidity characteristics were described in terms of the prevalence of diabetes, rheumatoid arthritis; and the Charlson Comorbidity Index. Social marginalization was expressed using the Ontario Marginalization Index (ON-Marg) for material deprivation, dependency, residential instability, ethnic concentration. ResultsFrom 266,324 first incident UE fractures occurring over 4 years, 51.5% were in women and 48.5% were in men. This masked large differences in age-sex profiles. Most commonly affected were the hand (93K), wrist/forearm(80K), shoulder (48K) or elbow (35K). The highest number of fractures: distal radius (DRF, 47.4K), metacarpal (30.4K), phalangeal (29.9K), distal phalangeal (24.4K), proximal humerus (PHF, 21.7K), clavicle (15.1K), radial head (13.9K), and scaphoid fractures (13.2K). The most prevalent multiple fractures included: multiple radius and ulna fractures (11.8K), fractures occurring in multiple regions of the upper extremity (8.7K), or multiple regions in the forearm (8.4K). Fractures most common in 18 – 40-year-old men included metacarpal and finger fractures. A large increase in fractures in women over the age of 50 occurred for: DRF, PHF and radial head. Tendon (0.6% overall; 8.2% in multiple finger fractures) or nerve injuries (0.3% overall, 1.5% in distal humerus) were rarely reported. Fractures were open in 4.7%, highest for distal phalanx (23%). Diabetes occurred in 15.3%, highest in PHF (29.7%). Rheumatoid arthritis occurred more commonly in women (2.8% vs 0.8% men). The Charlson Index indicated low comorbidity (mean=0.2; median=0: 2.4% 3+), highest in PHF (median=0; 6.6% 3+). Higher fracture burden was related to instability (excess of fractures in lower 2 quartiles 4.8%), although social indices varied by fracture type. ConclusionsFracture specific prevention strategies should consider fracture-specific age-sex interactions, health, behavioural and social risks

Upper Extremity Deep Venous Thrombosis in Cancer Patients with Venous Access Devices - Prophylaxis with a Low Molecular Weight Heparin (Fragmin)

1996 ◽  
Vol 75 (02) ◽  
pp. 251-253 ◽  
Author(s):  
Manuel Monreal ◽  
Antoni Alastrue ◽  
Miquel Rull ◽  
Xavier Mira ◽  
Jordi Muxart ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Upper Extremity ◽  
Statistical Significance ◽  
Central Venous Access ◽  
Venous Access ◽  
Bleeding Complications ◽  
Fisher Exact Test ◽  
Central Venous ◽  
True Incidence ◽  
Venous Access Devices

SummaryCentral venous access devices are often essential for the administration of chemotherapy to patients with malignancy, but its use has been associated with a number of complications, mainly thrombosis. The true incidence of upper extremity deep vein thrombosis (DVT) in this setting is difficult to estimate since there are very few studies in which DVT diagnosis was based on objective tests, but its sequelae include septic thrombophlebitis, loss of central venous access and pulmonary embolism.We performed an open, prospective study in which all cancer patients who underwent placement of a long-term Port-a-Cath (Pharmacia Deltec Inc) subclavian venous catheter were randomized to receive or not 2500 IU sc of Fragmin once daily for 90 days. Venography was routinely performed 90 days after catheter insertion, or sooner if DVT symptoms had appeared. Our aims were: 1) to investigate the effectiveness of low doses of Fragmin in preventing catheter-related DVT; and 2) to try to confirm if patients with high platelet counts are at a higher risk to develop subclavian DVT, as previously suggested.On the recommendation of the Ethics Committee, patient recruitment was terminated earlier than planned: DVT developed in 1/16 patients (6%) taking Fragmin and 8/13 patients (62%) without prophylaxis (Relative Risk 6.75; 95% Cl: 1.05-43.58; p = 0.002, Fisher exact test). No bleeding complications had developed. As for prediction of DVT, there was a tendency towards a higher platelet count in those patients who subsequently developed DVT, but differences failed to reach any statistical significance (286 ±145 vs 207 ±81 X 109/1; p = 0.067). According to our experience, Fragmin at the dosage used proved to be both effective and safe in these patients.

scholarly journals Traumatic myositis ossificans: multifocal lesions suggesting malignancy on FDG-PET/CT—a case report

2020 ◽  
Vol 50 (1) ◽  
pp. 249-254
Author(s):  
Miho Sasaki ◽  
Yuka Hotokezaka ◽  
Reiko Ideguchi ◽  
Masataka Uetani ◽  
Shuichi Fujita
Keyword(s):  
Case Report ◽  
Fdg Pet ◽  
Myositis Ossificans ◽  
Whole Body ◽  
Left Cheek ◽  
Multiple Fractures ◽  
Fdg Uptake ◽  
Pet Ct ◽  
Multiple Regions ◽  
Fdg Pet Ct

AbstractMyositis ossificans (MO) is a benign soft-tissue lesion characterized by the heterotopic formation of the bone in skeletal muscles, usually due to trauma. MO is occasionally difficult to diagnose because of its clinical and radiological similarities with malignancy. We report a case of traumatic MO (TMO) in the masseter and brachial muscles of a 37-year-old man who presented with painless swelling in the left cheek and severe trismus. Due to the absence of a traumatic history at the first consultation and identification of a tumorous lesion in the left masseter muscle by magnetic resonance imaging (MRI), the lesion was suspected to be a malignant tumor. Subsequently, 18F-fluorodeoxyglucose positron-emission tomography/computed tomography (FDG-PET/CT) showed multiple regions of high FDG uptake across the whole body, suggestive of multiple metastases or other systemic diseases. However, intramuscular calcifications were also observed in the left masseter and brachial muscles, overlapping the areas with high FDG uptake. Moreover, multiple fractures were seen in the rib and lumbar spine, also overlapping the areas with high FDG uptake. Based on these imaging findings, along with a history of jet-ski trauma, TMO was suspected. The left cheek mass was surgically excised and histologically diagnosed as TMO. In this case report, FDG-PET/CT could detect multiple TMOs across the whole body. To the best of our knowledge, cases of multiple TMOs located far apart in different muscles are rare, and this may be the first report.

Physician-related predictors of referral for multidisciplinary paediatric obesity management: a population-based study

2021 ◽  
Author(s):  
Nicole D Gehring ◽  
Maryam Kebbe ◽  
Sarah Rathwell ◽  
Arnaldo Perez ◽  
Chenhui Peng ◽  
...  
Keyword(s):  
Management Strategies ◽  
Family Physicians ◽  
Population Level ◽  
Population Based ◽  
Overweight And Obesity ◽  
Obesity Management ◽  
Logistic Regression Models ◽  
Physician Characteristics ◽  
Paediatric Obesity ◽  
Multivariable Regression

Abstract Background It is recommended that primary care-based physicians refer children with overweight and obesity to multidisciplinary paediatric obesity management, which can help to improve weight and health. Objective To determine predictors of referral to multidisciplinary paediatric obesity management. Methods This retrospective, population-level study included physicians who could refer 2–17 years old with a body mass index ≥85th percentile to one of three multidisciplinary paediatric obesity management clinics in Alberta, Canada. Physician demographic and procedural data were obtained from Practitioner Claims and Provider Registry maintained by Alberta Health from January 2014 to December 2017. Physician characteristics were compared based on whether they did or did not refer children for obesity management. Univariable and multivariable logistic regression models analysed associations between physician characteristics and referral making. Results Of the 3863 physicians (3468 family physicians, 395 paediatricians; 56% male; 49.3 ± 12.2 years old; 22.3 ± 12.6 years since graduation) practicing during the study period, 1358 (35.2%) referred at least one child for multidisciplinary paediatric obesity management. Multivariable regression revealed that female physicians (versus males) [odds ratio (OR): 1.68, 95% confidence interval (CI): 1.46–1.93; P &lt; 0.0001], paediatricians (versus family physicians) (OR: 4.89, 95% CI: 3.85–6.21; P &lt; 0.0001) and urban-based physicians (versus non-urban-based physicians) (OR: 2.17, 95% CI: 1.79–2.65; P &lt; 0.0001) were more likely to refer children for multidisciplinary paediatric obesity management. Conclusions Approximately one-third of family physicians and paediatricians referred children for multidisciplinary paediatric obesity management. Strategies are needed to improve referral practices for managing paediatric obesity, especially among male physicians, family physicians and non-urban-based physicians as they were less likely to refer children.

scholarly journals Hip Fracture Types in Canadian Men and Women Change Differently with Age: A Population-Level Analysis

2016 ◽  
Vol 9 ◽  
pp. CMAMD.S38531 ◽  
Author(s):  
Richard G. Crilly ◽  
Marita Kloseck ◽  
Selam Mequanint
Keyword(s):  
Hip Fracture ◽  
Relative Proportion ◽  
Local Population ◽  
Population Level ◽  
Community Dwelling ◽  
Administrative Database ◽  
Fracture Type ◽  
Discharge Abstract Database ◽  
Fracture Types

Background We have previously reported a gender difference in the occurrence of hip fracture type with age in our local population. In the current report, we have explored this phenomenon in a Canadian population using five years of data from a national administrative database. We have compared community-dwelling and institutionalized individuals to determine if frailty is important and has a differential effect on the type of hip fracture experienced. Methods Hospitalization records from 2005 to 2009, in which the most responsible diagnosis, that is the diagnosis causing the admission to hospital, was a hip fracture, were obtained from the Discharge Abstract Database of the Canadian Institute for Health Information. Hip fracture type was identified using the Canadian Classification of Health Interventions and the International Classification of Diseases 10th Revision, Canada (ICD-10-CA). Hip fracture proportions were calculated for the study period and stratified by age group and sex. Results The relative proportion of intertrochanteric fractures in women rose from 35% in the youngest group (55–59 years) to 51% in the oldest group (84+ years; P < 0.0001). In men, the proportions remain relatively stable (47% and 44%, respectively). Community and institutionalized patients showed the same pattern. Conclusions The change in the proportion of the two hip fracture types that occur in women but not men may point to differences in the etiology and consequently the approaches to prevention for the two fracture types. Level of frailty did not seem to be important.

Fracture of the Medial Epicondylar Apophysis of Distal Humerus with Subluxation of the Radial Head: A Case Report

2003 ◽  
Vol 16 (2) ◽  
pp. 304
Author(s):  
Han Yong Lee ◽  
Kee Won Rhyu ◽  
Jin Young Jeong ◽  
Joo Hyoun Song ◽  
Hae Seok Koh ◽  
...  
Keyword(s):  
Case Report ◽  
Radial Head ◽  
Distal Humerus

scholarly journals A framework for the Saudi universities governance to achieve competitive advantage in decision making according to the aspirations of Vision 2030

2019 ◽  
Vol 3 (17) ◽  
Author(s):  
Reem Thabet Mohammad Bny Zeed Alqahtani
Keyword(s):  
Public Universities ◽  
Statistical Significance ◽  
Management Strategies ◽  
Point Of View ◽  
Department Heads ◽  
Years Of Experience ◽  
King Saud University ◽  
The Public ◽  
Vision 2030 ◽  
Department Directors

The study aimed at identifying the degree of applying the visual management strategies and the obstacles of applying them in the public universities in Riyadh region in light of the vision of the Kingdom in 2030. In addition, it aimed at identifying the statistical significance differences on the implementation of the visual management strategies from the point of view of department heads according to the variables of gender, Years of service). The researcher followed the descriptive approach. The study community is composed of all department directors at the public universities in Riyadh, specifically King Saud University, Princess Norah Bint Abdul Rahman University, and Saudi Electronic University. The sample of the study was limited to a randomly selected sample of 137 department heads in the public universities under study. The tool consisted of a two-pronged questionnaire, namely the degree of application of the visual management strategies. It includes three sub-axes (rules of operation, disinfection, and elimination of waste), the second axis: obstacles to the implementation of visual management strategies. The results of the study came out with a number of results, the most important of which were: After the implementation of the business rules strategy, a total average of (3.74 of 5) was achieved with a grade of (large), followed by the clearance strategy with an average of (3.61 of 5) (3.53). The results indicated that there were statistically significant differences between the respondents' responses to the implementation of the visual management strategies of the heads of departments In the universities in question are due to the variables (gender, female favor, In addition to the number of years of experience and for the benefit of their experience 5 years than less. In addition, there were statistically significant differences between the responses of the sample members on the obstacles of visual administration in the heads of departments at King Saud University, Princess Nora University, In the Riyadh region in view of the vision of the Kingdom in 2030 due to the gender variable. And for the benefit of males. There were no statistically significant differences between the responses of the sample members on the obstacles of visual administration in the heads of departments due to the variable (years of experience, qualification). In the light of the results, a set of recommendations and proposals were presented to activate the implementation of the visual management strategies in the public universities in Riyadh and other Saudi universities in light of the vision of the Kingdom in 2030.      

scholarly journals A synthesis of scale-dependent ecology of the endangered mountain caribou in British Columbia, Canada

Rangifer ◽  
2008 ◽  
Vol 28 (1) ◽  
pp. 33
Author(s):  
Robert Serrouya ◽  
Bruce N. McLellan ◽  
Clayton D. Apps ◽  
Heiko U. Wittmer
Keyword(s):  
British Columbia ◽  
Rangifer Tarandus ◽  
Spatial Scales ◽  
Management Strategies ◽  
Population Level ◽  
Limiting Factors ◽  
Conservation Strategies ◽  
Integrative Approach ◽  
Rangifer Tarandus Caribou ◽  
Multi Scale

Mountain caribou are an endangered ecotype of woodland caribou (Rangifer tarandus caribou) that live in highprecipitation, mountainous ecosystems of southeastern British Columbia and northern Idaho. The distribution and abundance of these caribou have declined dramatically from historical figures. Results from many studies have indicated that mountain caribou rely on old conifer forests for several life-history requirements including an abundance of their primary winter food, arboreal lichen, and a scarcity of other ungulates and their predators. These old forests often have high timber value, and understanding mountain caribou ecology at a variety of spatial scales is thus required to develop effective conservation strategies. Here we summarize results of studies conducted at three different spatial scales ranging from broad limiting factors at the population level to studies describing the selection of feeding sites within seasonal home ranges of individuals. The goal of this multi-scale review is to provide a more complete picture of caribou ecology and to determine possible shifts in limiting factors across scales. Our review produced two important results. First, mountain caribou select old forests and old trees at all spatial scales, signifying their importance for foraging opportunities as well as conditions required to avoid alternate ungulates and their predators. Second, relationships differ across scales. For example, landscapes dominated by roads and edges negatively affect caribou survival, but appear to attract caribou during certain times of the year. This juxtaposition of fine-scale behaviour with broad-scale vulnerability to predation could only be identified through integrated multi-scale analyses of resource selection. Consequently we suggest that effective management strategies for endangered species require an integrative approach across multiple spatial scales to avoid a focus that may be too narrow to maintain viable populations. Abstract in Norwegian / Sammendrag:Skala-avhengig økologi og truet fjellvillrein i Britisk ColumbiaFjellvillreinen i de nedbørsrike fjellområdene i sørøstre Britisk Columbia og nordlige Idaho som er en truet økotype av skogsreinen (Rangifer tarandus caribou), har blitt kraftig redusert både i utbredelse og antall. Mange studier har vist at denne økotypen er avhengig av vinterføden hengelav i gammel barskog hvor det også er få andre klovdyr og dermed få predatorer. Slik skog er også viktige hogstområder, og å forstå økologien til fjellvillreinen i forskjellige skaleringer er derfor nødvendig for å utvikle forvaltningsstrategier som kan berge og ta vare på denne reinen. Artikkelen gir en oversikt over slike arbeider: fra studier av begrensende faktorer på populasjonsnivå til studier av sesongmessige beiteplasser på individnivå. Hensikten er å få frem et mer helhetlig perspektiv på fjellvillreinen og finne hvordan de begrensende faktorene varierer etter skaleringen som er benyttet i studiet. Oversikten vår frembragte to viktige resultater; 1) Uansett skalering så velger dyrene gammel skog og gamle trær. 2) Dyrenes bruk av et område kan variere med benyttet skalering, for eksempel vil landskap utbygd med veier og hogstflater være ufordelaktig for overlevelsen, men synes likevel å kunne tiltrekke fjellvillreinen til visse tider av året. Forholdet mellom atferd ut fra fin-skalering og stor-skalering sårbarhet hva gjelder predasjon, ville kun blitt avdekket ved flere-skaleringsanalyse av hvordan ressursene benyttes. Ut fra dette foreslår vi at forvaltningsstrategier for truete bestander som eksempelvis fjellvillreinen, må baseres på tilnærminger ut fra ulike skaleringer for å hindre at et for snevert perspektiv kan begrense muligheten for vedvarende levedyktighet.

scholarly journals Formation of clusters in cultural heritage – strategies for optimizing resources in museums

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Héctor Moreno - Mendoza ◽  
Agustín Santana - Talavera ◽  
José Molina - González
Keyword(s):  
Cultural Heritage ◽  
Statistical Significance ◽  
Management Strategies ◽  
Cultural Development ◽  
Point Of View ◽  
Content Type ◽  
Homogeneous Groups ◽  
Heritage Sites ◽  
Tourism Product ◽  
New Ideas

PurposeThe purpose of this study is to affirm that it is possible to segment visitors of cultural heritage into homogeneous groups according to a series of characteristics to detect the variables that have statistical significance to identify visitor clusters.Design/methodology/approachFour case studies were selected, where a total of 500 questionnaires were made to visitors. The authors proceeded with cluster analysis using SPSS software to differentiate visitor segments. Four groups of visitors were first identified and which have subsequently been reduced to three, according to several factors.FindingsThe main contributions of this paper are: (1) the segment to which each one of the determinants of the cultural tourism product is dedicated; (2) the variable object of the analysis, i.e. the formation of visitor segments; and (3) the inclusion of less studied variables such as type of accommodation contracted, treatment offered in the museums or entrance price.Research limitations/implicationsThe analysis has been developed in different museums, with different management models, in a specific place. However, the results are generalizable to other places and to other institutions that manage cultural heritage. The implications are management strategies for a sustainable cultural development in institutions of tourism and heritage.Practical implicationsFrom a practical point of view, the results are useful for cultural managers, travel agencies, tour operators, tourism companies or political offices, among others, because they generate new ideas and strategies focused on maximizing the use of the resources of cultural institutions.Social implicationsFor both local and non-local agents, the knowledge of the factors that make up the groups of visitors in the heritage sites represents a strategy in aspects of marketing, promotion and distribution, thus generating capacities for the different intermediaries, and the possibility of negotiating lower prices with better benefits. It is also possible to create new products destined for other publics.Originality/valueThe study is original because this has not been published.

scholarly journals Knowledge, attitudes and quality of life of caregivers towards asthma in their children: a Nigerian perspective

2020 ◽  
Author(s):  
Kosisochi Chinwendu Amorha ◽  
Ebere Emilia Ayogu ◽  
Blessing Adaora Ngwoke ◽  
Eleje Oboma Okonta
Keyword(s):  
Quality Of Life ◽  
Statistical Significance ◽  
Cross Sectional Study ◽  
Similar Proportion ◽  
Cross Sectional ◽  
Asthma Knowledge ◽  
Positive Attitudes ◽  
Nigeria Teaching Hospital ◽  
Knowledge And Attitude

Introduction: The burden of uncontrolled asthma is high and caregivers can offer support in the management of asthma. Asthma is one of the most common chronic diseases in children. The objective of this study was to assess the knowledge, attitudes, and quality of life (QoL) of caregivers toward asthma in their children. Methods: This cross-sectional study was conducted in the Paediatric Respiratory Unit of the University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu State (July 2017-September 2017). We utilized a 46-item questionnaire comprising knowledge and attitude domains and the 13-item Pediatric Asthma Caregiver’s QoL Questionnaire (PACQLQ). Data were analyzed using the IBM SPSS Version 25.0. Statistical significance was set at p < 0.05. Results: Fifty-one caregivers participated in the study. More than half (n = 36, 70.6%) of the caregivers were 40 years old and above, female (n = 37, 72.5%), graduates from higher institutions (n = 33, 64.7%), and self-employed (n = 27, 52.9%). About a quarter (n = 13, 25.5%) had a family history of asthma and a similar proportion (n = 14, 27.5%) knew the three main symptoms of asthma. Conclusion: Less than half (n = 24, 47.1%) of the caregivers had good asthma knowledge. Dust (n = 35, 68.6%) and smoke (n = 31, 60.8%) were identified as the most common asthma triggers in their children. The majority of the caregivers (n = 41, 80.3%) agreed that most people can have well-controlled asthma without seeing a doctor regularly. Overall, less than half of the caregivers (n = 24, 47.1%) showed positive attitudes toward their children’s asthma. The overall score for the PACQLQ was 3.91 (0.98) which implied a poor QoL. The caregivers had both impaired activity and emotional function from managing asthma in their children. More female caregivers had better knowledge about asthma than their male counterparts (t = −3.178; df = 49; p = 0.003). Less than half of the caregivers had good asthma knowledge and positive attitudes toward asthma in their children. They had an impaired QoL from managing asthma in their children.

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