scholarly journals Assessment of quality of life in patients with diabetes mellitus

2013 ◽  
Author(s):  
Αθανασία Παπαθανασίου
Keyword(s):  
Quality Of Life ◽  
Diabetes Mellitus ◽  
Short Form ◽  
Medical Outcomes ◽  
Short Form 36 ◽  
Sf 36 ◽  
Patients With Diabetes

Σκοπός της έρευναςΗ εκτίμηση της ποιότητας ζωής των ασθενών με ΣΔ στην ΠρωτοβάθμιαΦροντίδα Υγείας στην Ελλάδα και η συγκριτική της μελέτη με την ποιότητα ζωήςτων ασθενών ενός εξειδικευμένου διαβητολογικού κέντρου.Πληθυσμός μελέτηςΗ μελέτη εφαρμόσθηκε στους ασθενείς του Κέντρο Υγείας Στυλίδας στονομό Φθιώτιδας και στους ασθενείς του διαβητολογικού κέντρου στο ΤζάνειοΝοσοκομείο του Πειραιά.Στη μελέτη περιλαμβάνονται ασθενείς με σακχαρώδη διαβήτη τύπου 2που παρακολοθούνται τακτικά στα παραπάνω κέντρα. Οι 818 πρώτοι ασθενείςπου πληρούσαν τα παραπάνω κριτήρια και προσήλθαν στα παραπάνω κέντρα από τον Δεκέμβριο του 2006 αποτελούν τον πληθυσμό της μελέτης.ΜέθοδοιΜετά από μία συστηματική αναζήτηση στη διεθνή και ελληνικήβιβλιογραφία για τον εντοπισμό εργαλείων που εκτιμούν τη σχετιζόμενη με τοσακχαρώδη διαβήτη ποιότητα ζωής στην Ελλάδα και τη διαπίστωση της έλλειψηςμιας ειδικής κλίμακας στη χώρα μας, η κλίμακα PAID μεταφράστηκε καισταθμίστηκε σύμφωνα με τις αρχές του Medical Outcomes Trust Bulletin 1997.Στη μελέτη χρησιμοποιήθηκαν οι εξής κλίμακες: Short Form- 36 version 2(SF-36 v2), Problem Areas In Diabetes (PAID) Scale και Diabetes TreatmentSatisfaction Questionnaire status version(DTSQ-s).Για την καταχώρηση και ανάλυση των δεδομένων δημιουργήθηκε έναηλεκτρονικό σύστημα καταχώρησης ασθενών χρησιμοποιώντας FileMaker Pro από τον Δεκέμβριο του 2006 αποτελούν τον πληθυσμό της μελέτης.ΜέθοδοιΜετά από μία συστηματική αναζήτηση στη διεθνή και ελληνικήβιβλιογραφία για τον εντοπισμό εργαλείων που εκτιμούν τη σχετιζόμενη με τοσακχαρώδη διαβήτη ποιότητα ζωής στην Ελλάδα και τη διαπίστωση της έλλειψηςμιας ειδικής κλίμακας στη χώρα μας, η κλίμακα PAID μεταφράστηκε καισταθμίστηκε σύμφωνα με τις αρχές του Medical Outcomes Trust Bulletin 1997.Στη μελέτη χρησιμοποιήθηκαν οι εξής κλίμακες: Short Form- 36 version 2(SF-36 v2), Problem Areas In Diabetes (PAID) Scale και Diabetes TreatmentSatisfaction Questionnaire status version(DTSQ-s).Για την καταχώρηση και ανάλυση των δεδομένων δημιουργήθηκε έναηλεκτρονικό σύστημα καταχώρησης ασθενών χρησιμοποιώντας FileMaker Pro κέντρου υγείας Στυλίδας και 39.67 (±16.29) για τους ασθενείς του ΤζάνειουΝοσοκομείου του Πειραιά. Σχετικά με τα αποτελέσματα της κλίμακας DTSQ-s, τοτελικό αποτέλεσμα ήταν 26.81 (±8.2) για τους ασθενείς του κέντρου υγείαςΣτυλίδας και 22.13 (±8.9) για τους ασθενείς του Τζάνειου Νοσοκομείου τουΠειραιά (p< 0.0001).ΣυμπεράσματαΈνα σημαντικό αποτέλεσμα της μελέτης είναι η μετάφραση και στάθμιση στηνελληνική γλώσσα της κλίμακας Problem Areas In Diabetes (PAID) Scale, ενόςσημαντικού και πολυχρησιμοποιημένου στις διεθνείς μελέτες εργαλείου, πουαξιολογεί τις συναισθηματικές και διαπροσωπικές δυσκολίες των ασθενών μεΣΔ, που σχετίζονται με τη δίαιτα ή τη σχέση του με το γιατρό. Από τον πληθυσμό της μελέτης προέκυψε ότι οι ασθενείς πουπαρακολουθούνται στο διαβητολογικό τακτικό ιατρείο του Τζάνειου ΝοσοκομείουΠειραιά (αστικός πληθυσμός) είχαν συστηματικά χαμηλότερα αποτελέσματα σε όλες τις υποκατηγορίες της κλίμακας Short Form-36 version 2 (MCS και PCSscores) καθώς και στις κλίμακες PAID και DTSQ σε σχέση με τον πληθυσμό τουΚέντρου Υγείας Στυλίδας (αγροτικός πληθυσμός).Τα ευρήματα αυτής της μελέτης θα μπορούσαν να αξιοποιηθούν στηνπρακτική διαχείριση των ασθενών με σακχαρώδη διαβήτη, αλλά και στοναποτελεσματικό σχεδιασμό των προσφερόμενων υπηρεσιών υγείας.

scholarly journals Avaliação da qualidade de vida e da perda urinária de mulheres com bexiga hiperativa tratadas com eletroestimulação transvaginal ou do nervo tibial

2011 ◽  
Vol 18 (2) ◽  
pp. 145-150 ◽  
Author(s):  
Maíra de Menezes Franco ◽  
Flaviane de Oliveira Souza ◽  
Elaine Cristine Lemes Mateus de Vasconcelos ◽  
Maurício Mesquita Sabino de Freitas ◽  
Cristine Homsi Jorge Ferreira
Keyword(s):  
Quality Of Life ◽  
Short Form ◽  
Medical Outcomes ◽  
Short Form 36 ◽  
Life Instrument ◽  
Sf 36 ◽  
Outcomes Study

Trata-se de um ensaio clínico prospectivo comparativo que objetivou comparar os efeitos do tratamento com eletroestimulação transvaginal (ET) e do nervo tibial (ENT) sobre a qualidade de vida (QV) e queixas de perda urinária em mulheres com bexiga hiperativa. Participaram 42 pacientes com bexiga hiperativa ou incontinência urinária (IU) mista e foram divididas para tratamento com ET ou ENT. A QV foi avaliada pelo questionário de QV genérico, o Medical Outcomes Study Short Form 36 (SF-36) e um questionário específico para IU, o Incontinence Quality of Life Instrument (I-QOL). Os relatos de perdas urinárias e incômodos ocasionados foram avaliados, respectivamente, por meio do diário miccional de 24 horas e Escala Visual Analógica (EVA). O tratamento foi realizado uma vez por semana, totalizando doze semanas. O grupo da ENT teve melhora significativa em três domínios do I-QOL, na EVA, que avaliou o grau de incômodo causado pela IU e em quatro aspectos do diário miccional. No grupo de ET houve melhora significativa de dois domínios do SF-36, três domínios do I-QOL, na EVA e em quatro aspectos do diário. Houve melhora da QV em ambos os grupos, assim como uma diminuição das queixas de perda urinária, entretanto, o grupo que recebeu ET obteve melhora nos escores em dois domínios do questionário de QV genérico após o tratamento, que teve limitação por aspectos físicos e limitação por aspectos emocionais. O que não ocorreu com o grupo de ENT.

scholarly journals Pengaruh Formula Jamu Hiperglikemia Pada Quality Of Life Pasien di Klinik Saintifikasi Jamu Tawangmangu

2018 ◽  
Vol 1 (3) ◽  
pp. 177-181
Author(s):  
Agus Triyono ◽  
Widhi Astana ◽  
Fajar Novianto
Keyword(s):  
Quality Of Life ◽  
Diabetes Mellitus ◽  
Herbal Medicine ◽  
Short Form ◽  
Measurement Tool ◽  
Research Subjects ◽  
Short Form 36 ◽  
Control Blood Glucose ◽  
Sf 36

Diabetes mellitus (DM) merupakan penyakit degenerative dengan murbiditas dan mortalitas yang terus meningkat. Herbal medicine telah banyak digunakan untuk mengontrol kadar glukosa darah (KGD) pasien DM. Penelitian ini bertujuan untuk menganalisis efek penggunaan ramuan jamu hiperglikemia terhadap kualitas hidup atau quality of life (QoL) pasien DM. Penelitian ini merupakan studi kohort dengan menggunakan kuesioner Short Form-36 (SF-36) sebagai alat pengukuran kualitas hidup 40 subjek penelitian dengan KGD sewaktu 200 – 300 mg/dl. Pasien diberi ramuan jamu temulawak ,kunyit, dan meniran tiga kali sehari selama 56 hari. Kualitas hidup subjek diukur pada hari ke 0, 28, dan 56. Pengaruh penggunaan jamu terhadap QoL dianalisis menggunakan uji t berpasangan.Sebanyak 58% dari subjek penelitian adalah perempuan. Hasil penelitian membuktikan terdapat perbedaan yang signifikan antara QoL sebelum dan setelah pemberian jamu selama 56 hari, (p=<0,05). Ramuan jamu batang brotowali, herba sambiloto, rimpang temulawak, rimpang kunyit, dan herba meniran dapat meningkatkan QoL pasien DM.   Diabetes mellitus (DM) is a degenerative disease with increased morbidity and mortality. Herbal medicine has been widely used to control blood glucose levels in DM patients. This study aimed to analyze the effect of consumehyperglycemic jamu formula on quality of life (QoL) in DM patients. This study was a cohort study using a Short Form-36 (SF-36) questionnaire as a quality of life measurement tool of 40 subjects with blood gluces levels at 200 - 300 mg / dl. The patient received a jamu fomula of ginger, turmeric, and meniran three times a day for 56 days. The quality of life of the subjects was measured on days 0, 28 and 56. The effect of the admintration of jamu on QoL was analyzed using paired t test. A total of 58% of the research subjects were women.  The results showed that there were significant differences of QoL before and after administration of jamu for 56 days (p = <0.05). Jamu formlua of brotowali stems, bitter herbs, curcuma rhizomes, turmeric rhizomes, and meniran herbs can increase the QoL of DM patients

Dimensions of the quality of life negatively affected in people living with / Diabetes Mellitus Dimensões da qualidade de vida afetadas negativamente em pessoas vivendo com Diabetes Mellitus

2019 ◽  
Vol 11 (1) ◽  
pp. 199-204
Author(s):  
Delmo de Carvalho Alencar ◽  
Patriotino Fontinele Lages Filho ◽  
Maria de Jesus Lopes Mousinho Neiva ◽  
Ana Maria Parente Garcia Alencar ◽  
Wanderson Carneiro Moreira ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Diabetes Mellitus ◽  
Short Form ◽  
Short Form Health Survey ◽  
Medical Outcomes ◽  
Form Health ◽  
Sf 36 ◽  
Outcomes Study ◽  
Short Form Health

Objetivo: Avaliar a qualidade de vida relacionada à saúde de pessoas com diabetes mellitus tipo 2 atendidas pela Atenção Primária à Saúde. Métodos: Estudo descritivo, transversal realizado com 50 pacientes diabéticos. Os dados foram coletados por meio da aplicação de um formulário para informações socioeconômicas e clínicas e do Medical Outcomes Study 36-item Short Form Health Survey (SF-36). Os dados foram expressos como frequências absolutas e relativas e medidas de tendência central e dispersão. Resultados: As maiores médias dos escores do SF-36 foram verificadas nos domínios "Capacidade Funcional, Vitalidade e Aspectos Sociais", enquanto as menores concentraram-se nos domínios "Estado Geral da Saúde e Aspecto Físico". Conclusão: A funcionalidade das atividades diárias e a percepção sobre a saúde foram os principais aspectos comprometidos pelo diabetes mellitus tipo 2.

scholarly journals Dimensions of the quality of life negatively affected in people living with / Diabetes Mellitus Dimensões da qualidade de vida afetadas negativamente em pessoas vivendo com Diabetes Mellitus

2019 ◽  
Vol 11 (1) ◽  
pp. 199
Author(s):  
Delmo de Carvalho Alencar ◽  
Patriotino Fontinele Lages Filho ◽  
Maria de Jesus Lopes Mousinho Neiva ◽  
Ana Maria Parente Garcia Alencar ◽  
Wanderson Carneiro Moreira ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Diabetes Mellitus ◽  
Short Form ◽  
Short Form Health Survey ◽  
Medical Outcomes ◽  
Form Health ◽  
Sf 36 ◽  
Outcomes Study ◽  
Short Form Health

Objetivo: Avaliar a qualidade de vida relacionada à saúde de pessoas com diabetes mellitus tipo 2 atendidas pela Atenção Primária à Saúde. Métodos: Estudo descritivo, transversal realizado com 50 pacientes diabéticos. Os dados foram coletados por meio da aplicação de um formulário para informações socioeconômicas e clínicas e do Medical Outcomes Study 36-item Short Form Health Survey (SF-36). Os dados foram expressos como frequências absolutas e relativas e medidas de tendência central e dispersão. Resultados: As maiores médias dos escores do SF-36 foram verificadas nos domínios "Capacidade Funcional, Vitalidade e Aspectos Sociais", enquanto as menores concentraram-se nos domínios "Estado Geral da Saúde e Aspecto Físico". Conclusão: A funcionalidade das atividades diárias e a percepção sobre a saúde foram os principais aspectos comprometidos pelo diabetes mellitus tipo 2.

Evaluation of the quality of life of chronic renal patients in hemodialysis - a cross-current study / Avaliação da qualidade de vida de pacientes renais crônicos em hemodiálise – um estudo transversal

2019 ◽  
Vol 11 (1) ◽  
pp. 186-191
Author(s):  
Camila Zanesco ◽  
Erica De Brito Pitilin ◽  
Maíra Rossetto ◽  
Débora Tavares de Resende e Silva
Keyword(s):  
Quality Of Life ◽  
Short Form ◽  
Short Form Health Survey ◽  
Medical Outcomes ◽  
Form Health ◽  
Sf 36 ◽  
Outcomes Study ◽  
Cross Current ◽  
Short Form Health

Objetivo: Caracterizar os pacientes com DRC em tratamento de hemodiálise (HD) de uma clínica do oeste catarinense, suas relações e variáveis sociodemográficas, e, a sua QV. Metodologia: Estudo transversal descritivo, com 116 pacientes com DRC em HD. Para coleta dos dados usou-se questionário sociodemográfico e o intrumento Medical Outcomes Study 36 – Item Short – Form Health Survey (SF-36). Resultados: Houve prevalência da população com idade igual ou > 60 anos, caucasianos (74,77%), do sexo masculino (54,31%), destaca-se a presença de profissões relacionadas a classe média ebaixa e quantidade de anos de estudo reduzidos. Em relação a comorbidades, prevaleceu a Hipertensão Arterial Sistêmica(38,79%). Quanto a QV as limitações por aspectos físicos tiveram menores médias (29,09) e limitações em atividades sociais maior média (73,71). Conclusão: A QV negativa têm repercussões pessoais, familiares e sociais devido ao impacto da doença na rotina de atividades de vida diária dos doentes renais.

Quality of Life in Automated and Continuous Ambulatory Peritoneal Dialysis

2011 ◽  
Vol 31 (2) ◽  
pp. 138-147 ◽  
Author(s):  
Wieneke M. Michels ◽  
Sandra Van Dijk ◽  
Marion Verduijn ◽  
Saskia Le Cessie ◽  
Elisabeth W. Boeschoten ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Peritoneal Dialysis ◽  
Kidney Disease ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Short Form ◽  
Summary Score ◽  
Medical Outcomes ◽  
Sf 36 ◽  
Over Time

ObjectiveDespite a lack of strong evidence, automated peritoneal dialysis (APD) is often prescribed on account of an expected better quality of life (QoL) than that expected with continuous ambulatory peritoneal dialysis (CAPD). Our aim was to analyze differences in QoL in patients starting dialysis on APD or on CAPD with a follow-up of 3 years.MethodsAdult patients in the prospective NECOSAD cohort who started dialysis on APD or CAPD were included 3 months after the start of dialysis. The Medical Outcomes Survey Short Form 36 [SF-36 (Medical Outcomes Trust and QualityMetric, Lincoln, RI, USA)] and Kidney Disease and Quality of Life Short Form [KDQOL-SF (KDQOL Working Group, Santa Monica, CA, USA)] questionnaires were used to measure QoL. Differences in QoL over time were calculated using linear mixed models. Patients were followed until transplantation, death, or a first switch to any other dialysis modality.ResultsThe clinical and social characteristics of the 64 APD and 486 CAPD patients were slightly different at baseline. In the crude analysis, the pattern of the mental summary score differed between the modalities ( p = 0.03, adjusted p = 0.06), because of a different pattern for role function emotional ( p = 0.03, adjusted p = 0.05). The pattern of the physical summary score was not different between the groups. Scores on dialysis staff encouragement had a different pattern over time ( p = 0.01), because of an in-equality in scores 3 months after the start of dialysis, which disappeared after 18 months on dialysis. Over time, patients on APD scored higher on sexual function. After adjustment for age, sex, glomerular filtration rate, comorbidity, and primary kidney disease, that difference disappeared. This study showed no major differences in QoL on the KDQOL-SF and the SF-36 between the two modalities.

scholarly journals Quality of life of primary caregivers of spinal cord injury survivors

2013 ◽  
Vol 66 (1) ◽  
pp. 79-84 ◽  
Author(s):  
Ágatha Graça ◽  
Matheus Amarante do Nascimento ◽  
Edson Lopes Lavado ◽  
Márcia Regina Garanhani
Keyword(s):  
Quality Of Life ◽  
Negative Impact ◽  
Short Form ◽  
Testing Procedure ◽  
Medical Outcomes ◽  
Percentage Difference ◽  
Sf 36 ◽  
Cord Injury ◽  
Burden Scale

The aim of this study was to analyze quality of life of caregivers who are relatives of patients with spine cord injury (SCI). Fourteen women (seven caregivers and seven controls) were evaluated by the Medical Outcomes Study 36 - Item Short-Form Health Survey (SF-36) and the Caregiver Burden Scale (CBS) Questionnaires. The data from both questionnaires were compared using the Mann-Whitney U testing procedure for differences between caregivers and controls (p<0.05). The results from SF-36 were not statistically significant between groups, however, for the CBS data, there were significant differences between groups (p>0.05), characterized by the percentage difference of 62%, 66.7%, 55%, 50%, 57% and 63% for tension, isolation, disappointment, emotional involvement, environment and overall score, respectively. The CBS questionnaire was more adequate for verifying quality of life of caregivers of SCI patients, and caregiving may have a negative impact on their quality of life.

scholarly journals GAMBARAN QUALITY OF LIFE PADA PASIEN DENGAN ULKUS KAKI DIABETES MELITUS DI BALI

2020 ◽  
Vol 4 (1) ◽  
pp. 8
Author(s):  
Manik Elisa Putri
Keyword(s):  
Quality Of Life ◽  
Diabetes Mellitus ◽  
Diabetic Foot ◽  
Short Form ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Cross Sectional ◽  
Patients With Diabetes ◽  
Diabetes Melitus

ABSTRAKLatar Belakang : Quality of Life (QoL) atau Kualitas hidup pasien dengan ulkus kakik diabetes melitus lebih buruk, daripada pasien dengan Diabetes Melitus (DM) tanpa ulkus kaki dalam populasi umum. Tujuan dari penelitian ini adalah untuk mengetahui gambaran Quality of Life (Kualitas hidup) pada pasien dengan ulkus kaki diabetes melitus (Diabetic Foot Ulcer / DFU) di Bali.Metode : Desain deskriptif dengan pendekatan cross sectional. Teknik sampel direkrut menggunakan convenience sampling yang melibatkan pasien dengan ulkus kaki diabetes melitus (Diabetic Foot Ulcer / DFU) dengan total sampel yang melibatkan 201 orang responden. yang dilakukan di ruangan department rawat jalan bedah Rumah Sakit Wangaya serta klinik perawatan luka di Bali Indonesia. Data dikumpulkan menggunakan kuesioner Diabetic Foot Ulcer Scale-Short Form (DFS-SF) dan Independent t-test digunakan untuk memahami gambaran kualitas hidup antara perempuan dan laki-laki dengan DFU. Penelitian ini sudah mendapatkan ijin etik oleh komite etik Universitas Udayana.Hasil : Karakteristik responden perempuan (n= 103; 51.2%), dan laki-laki (n= 98; 48.8%). Kualitas hidup sebagian besar memiliki kualitas hidup rendah yang buruk yaitu (<50)(n=133; 66.2%), dan kualitas hidup yang lebih baik yaitu (> 50)[n=68; 33.8%]. Skor rata-rata kualitas hidup pada pasien dengan DFU 42.4±15.5.Kesimpulan: Laki-laki dan perempuan pada pasien dengan ulkus kaki diabetes melitus menunjukkan kualitas hidup perempuan lebih rendah daripada laki-laki dengan diabetes melitus (DFU). Keluarga diharapkan tetap memotivasi dan mendukung pasien agar dapat berpartisipasi dalam aktivitas keagamaan atau kegiatan positif lainnya. Berdasarkan hasil penelitian yang telah didapat, Pasien dengan ulkus kaki diabetes melitus, baik laki-laki maupun perempuan merupakan suatu hal yang perlu kita perhatikan.  Kata Kunci : Ulkus Kakik Diabetes Mellitus, Jenis kelamin, dan Kualitas Hidup  ABSTRACTBackground: Quality of Life (QoL) or Quality of Life of patients with diabetic ulcer diabetes is worse, than patients with Diabetes Mellitus (DM) without foot ulcers in the general population. The purpose of this study was to study the description of Quality of Life (quality of life) in patients with Diabetic Foot Ulcer (DFU) in Bali. Methods: Descriptive design by discussing cross sectional. Sampling techniques were recruited using convenience sampling involving diabetic foot ulcer patients with diabetes mellitus (DFU) with a total sample involving 201 respondents. Performed in the Wangaya Hospital surgical outpatient room and wound care in Bali Indonesia. Data were collected using a Diabetic Foot Ulcer Scale-Short Form (DFS-SF) questionnaire and Independent t-test was used to collect assessments of quality of life between women and men with DFU. Udayana University Ethics Committee.Results: Characteristics of female respondents (n = 103; 51.2%), and male (n = 98; 48.8%). Quality of life mostly has a low quality of life that is poor (<50) [n = 133; 66.2%], and a better quality of life (> 50) [n = 68; 33.8%]. The mean score of quality of life was 42.4±15.5. Conclusion: Male and female patients with diabetes mellitus foot ulcers show a lower quality of life for women than men with diabetes mellitus (DFU). Families are expected to continue to motivate and support patients to participate in religious activities or other positive activities.Keywords: diabetic foot ulcer, gender, and quality of life

scholarly journals Chronic daily headache: stress and impact on the quality of life

2007 ◽  
Vol 65 (4b) ◽  
pp. 1126-1129 ◽  
Author(s):  
José Carlos Busto Galego ◽  
Avelina Maria Moraes ◽  
José Antonio Cordeiro ◽  
Waldir Antonio Tognola
Keyword(s):  
Quality Of Life ◽  
Chronic Daily Headache ◽  
Short Form ◽  
Bodily Pain ◽  
Primary Headache ◽  
Medical Outcomes ◽  
Stress Symptoms ◽  
Sf 36 ◽  
Daily Headache

OBJECTIVE: To evaluate the stress presence and its influence in the quality of life of patients with chronic daily headache (CDH). METHOD: A hundred patients with at least 18 years old, with primary headache with duration greater than 4 hours a day, and frequency of 15 or more days monthly for at least three months were studied. Lipp's Inventory of Stress Symptoms and the Medical Outcomes Study Short Form (SF-36) were used. RESULTS: Stress was observed in 90% of the patients; nearly half of them was in the phase almost exhaustion. Patients with stress when compared with the ones with no stress presented significantly lower scores in all the domains of SF-36; except in physical functioning. The resistance phase presented scores significantly higher than almost exhaustion; except for bodily pain. CONCLUSION: The majority of the patients presented stress with significant reduction in their quality of life. Consequently, the stress could be related with both the development and the maintenance of CDH.

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