The effect of Baduanjin sequential therapy on the quality of life and cardiac function in patients with acute myocardial infarction after percutaneous coronary intervention：A randomized controlled trial (Preprint)

2019 ◽  
Author(s):  
Ming-Gui Chen ◽  
Xuefei Liang ◽  
Lili Kong ◽  
Jingjing Wang ◽  
Fangfang Wang ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cardiac Function ◽  
Controlled Trial ◽  
Sequential Therapy ◽  
Abdominal Circumference ◽  
Control Group ◽  
Sf 36 ◽  
Percutaneous Coronary ◽  
Significant Difference

BACKGROUND Acute myocardial infarction (AMI) is a serious type of coronary artery disease (CAD) with the potential for substantial morbidity and mortalit. Percutaneous coronary intervention (PCI) is an effective treatment. However, most patients still suffer from angina pectoris, anxiety, depression and reduced cardiac function after PCI. OBJECTIVE The purpose of this study was to examine the effects of Baduanjin sequential therapy (BST) on the quality of life and cardiac function in patients with AMI after PCI. METHODS The study was a randomized controlled trial. Patients with AMI after PCI randomly assigned to a BST group (N = 48) or a control group (N = 48). The BST exercise consists of the sitting and standing forms. The sitting Baduanjin was conducted twice a day in the hospital, for 30 min/session. After the patient was discharged from the hospital, the standing Baduanjin was performed fifth weekly, lasting up to 24-weeks, for 30 min/session. The control group received usual care without Baduanjin. The primary outcomes were the changes of SF-36 subscales. Secondary outcomes included measures of left ventricular ejection fraction(LVEF), N-terminal pro B-type natriuretic peptide (NT-pro-BNP), the Body Mass Index (BMI) and the abdominal circumference. RESULTS Of the 96 participants, 82 total patients completed the entire study. At 12 weeks, Role Physical and Health Transition of SF-36 were significantly different between the two groups, with a difference of 26.12 [95% CI, 11.59 to 40.64] in Role physical and a difference of 15.94 [95% CI, 5.60 to 26.28] in Health Transition (p<0.05). However, there were statistically significant differences in all aspects of SF-36 between the two groups at 24 weeks (p<0.05). The BST also lowered the abdominal circumference and BMI as compared with control group. In the 24-week follow-up, a significant difference was found in the decline of the LVEF in control group (p=0.020),while there was non-significant difference in the BST group (p=0.552). Compared with control group, the BST group reduced 50pg/ml on the NT-Pro-BNP at 24 weeks(p=0.013). The effects of BST exercise were maintained at 24weeks after the intervention. No serious adverse events were observed. CONCLUSIONS The BST appears to improve the quality of life in patients with AMI, with additional benefits of lowered the abdominal circumference and BMI and improved the level of cardiac function. CLINICALTRIAL Clinical Trials.gov:NCT02693795. https://clinicaltrials.gov/ct2/ show/NCT02693795?term=NCT02693795&rank=1.

scholarly journals Effect of Baduanjin Sequential Therapy on the Quality of Life and Cardiac Function in Patients with AMI After PCI: A Randomized Controlled Trial

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Ming-Gui Chen ◽  
Xuefei Liang ◽  
Lili Kong ◽  
Jingjing Wang ◽  
Fangfang Wang ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cardiac Function ◽  
Sequential Therapy ◽  
Abdominal Circumference ◽  
Left Ventricular Ejection ◽  
Control Group ◽  
Health Transition ◽  
Role Physical ◽  
Sf 36

Purpose. The purpose of this study was to examine the effects of Baduanjin sequential therapy (BST) on the quality of life and cardiac function in patients with AMI after PCI. Subjects. 96 patients with AMI after PCI were randomly assigned as subjects to two groups: BST group who received 24 weeks of BST training and control group who received no training. Methods. The methods used in this study included the changes in SF-36 subscales, the measures of left ventricular ejection fraction (LVEF), N-terminal pro-B-type natriuretic peptide (NT-pro-BNP), the body mass index (BMI), and the abdominal circumference. Results. Of the 96 participants, 82 total patients completed the entire study. At 12 weeks, role physical and health transition of SF-36 were significantly different between the two groups, with a difference of 26.12 (95% CI, 11.59 to 40.64) in role physical and a difference of 15.94 (95% CI, 5.60 to 26.28) in health transition (p<0.05). However, there were statistically significant differences in all aspects of SF-36 between the two groups at 24 weeks (p<0.05). The BST also lowered abdominal circumference and BMI as compared with the control group. In the 24-week follow-up, a significant difference was found in the decline of the LVEF in the control group (p=0.020), while there was a nonsignificant difference in the BST group (p=0.552). Compared with the control group, the BST group reduced 50 pg/ml on the NT-pro-BNP at 24 weeks (p=0.013). The effects of BST exercise were maintained at 24 weeks after the intervention. No serious adverse events were observed. Conclusions. The BST appears to improve the quality of life in patients with AMI after PCI, with additional benefits of lowered abdominal circumference and BMI and improved level of cardiac function. This trial is registered with NCT02693795.

The Effects of Kinesiological Taping and Aerobic Exercise in Women with Primary Dysmenorrhea: A Randomized Single-Blind Controlled Trial

2021 ◽  
Author(s):  
Simge Temizkan ◽  
Miray BUDAK
Keyword(s):  
Quality Of Life ◽  
Menstrual Cycle ◽  
Short Form ◽  
Controlled Trial ◽  
Depression Scale ◽  
Control Group ◽  
Mcgill Pain Questionnaire ◽  
Sf 36 ◽  
Significant Difference

Abstract Purpose: The purpose of this study was to investigate the effects of KT and AE on pain, attitude, depression, and quality of life in women with dysmenorrhoea. Methods: Forty-five women with dysmenorrhoea were randomly divided into three groups as KT group(n=15), AE group(n=15) and control group(n=15). In KT Group, 6 sessions of KT were applied, starting on the 14th day of the menstrual cycle and 2 times a week for 3 weeks until the cycle ended. In the AE group, walking and climbing stairs were given during the menstrual cycle, 3 days a week, 45 minutes. No application was made to the control group. All groups were evaluated with Beck Depression Scale(BDS), Mcgill Pain Questionnaire(MPQ), Menstrual Attitude Scale(MAS), and Short Form-36(SF-36) before and after treatment. Results: A significant difference was found in MAS and SF-36 mental and physical in the KT group(p<0.05). There was a significant decrease in the MPQ in the AE group(p<0.05). No significant result was found in the control group. There were significant differences in MPQ and MAS Time*Group interaction(p<0.05). There was no significant difference between the KT and AE Group in post-hoc tests(p<0.05). Conclusion: In conclusion, KT and AE may decrease pain and improve attitude and quality of life in women with dysmenorrhoea. “retrospectively registered” Trial registration number (NCT04856280), date of registration (20.04.2021).

The effects of breathing exercises on respiratory functions, functional capacity and quality of life in vehicle spray painters

2021 ◽  
Vol 28 (12) ◽  
pp. 1-8
Author(s):  
Burak Yilmaz ◽  
Cagtay Maden ◽  
Begümhan Turhan
Keyword(s):  
Quality Of Life ◽  
Functional Capacity ◽  
Control Group ◽  
Study Group ◽  
Breathing Exercises ◽  
Sf 36 ◽  
Significant Difference ◽  
Before And After ◽  
Respiratory Exercises

Background/aims Workers engaged in vehicle spray painting are at a risk of developing respiratory problems because of the solvents in the spray paints. Changes in respiratory functions and functional capacities caused by spray painting can be improved with respiratory exercises. The aim of this study was to examine the effects of respiratory exercises on the respiratory functions, functional capacity and quality of life in vehicle spray painters. Methods A total of 70 volunteers with similar characteristics participated in the study. The groups were divided into two groups randomly (35 study group, 35 control group). Respiratory functions (value of forced expiratory volume percentage in 1 second [FEV1]), forced vital capacity percentage [FVC], FEV1/FVC percentage, peak expiratory flow percentage [PEF (%)] and maximum voluntary ventilation percentage [MVV (%)]), functional capacity (6-Minute Walk Test) and quality of life (Short Form Health Survey [SF-36]) were evaluated. The study group undertook supervised breathing exercises 3 days a week for 6 weeks. The same exercises were given to the control group as a home programme. Home programmes were followed up by telephone calls. Evaluations were performed again after 6 weeks. Results In the study group, FEV1 (%) increased more than in the control group (P<0.05). The increase in PEF (%) was similar in both groups (P>0.05). In the study group, FEV1/FVC (%) and MVV (%) were significantly different before and after the intervention (P<0.05), but there was no difference in the control group (P>0.05). There was a greater increase in the study group than in the control group (P<0.05). 6-Minute Walk Test distance (m) before and after the intervention in both groups were similar (P>0.05). Before and after the intervention, a significant difference was found in the vitality and the social function domains of the SF-36 in the study group. In the comparisons of groups, a significant difference was found in the study group in the role-emotional, social function and bodily pain domains of the SF-36 after the intervention (P<0.05). Conclusions Breathing exercises can be recommended for vehicle spray painters to avoid an increase in respiratory resistance and to improve their quality of life.

scholarly journals Effectiveness of Hydrogalvanic Bath on Improving Pain, Disability, and Quality of Life in Individuals with Chronic Nonspecific Neck Pain: A Randomized Controlled Trial

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Mastour Saeed Alshahrani ◽  
Jaya Shanker Tedla ◽  
Ravi Shankar Reddy ◽  
Faisal Asiri
Keyword(s):  
Quality Of Life ◽  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
Control Group ◽  
Randomized Controlled ◽  
Pain Disability ◽  
Sf 36 ◽  
Neck Disability ◽  
Experimental Group

Background. Neck pain is one of the world’s leading factors in years lived with disability. Ambiguity in the effect of electrotherapy modalities for the treatment of chronic nonspecific neck pains (CNSNP) needs to be examined further. This study sought to elucidate the effectiveness of hydrogalvanic bath on improving pain, disability, and quality of life among individuals with CNSNP. Methods. Thirty-four individuals with a diagnosis of CNSNP were selected through convenient sampling and randomly divided into two groups by block randomization. The control group treatment underwent low Transcutaneous Electrical Nerve Stimulation (TENS) and exercise, and the experimental group was subjected to hydrogalvanic bath therapy (HGBT) and exercise. Individuals were evaluated for pain using a visual analog scale (VAS), disability with the Neck Disability Index (NDI), and quality of life with Short Form-36 (SF-36). These measures were applied at baseline and after 12 weeks of treatment. Results. The pretreatment and posttreatment results for VAS, NDI, and SF-36 were compared for both control and experimental groups. We found that all the three variables showed significant differences between the two time points with p < 0.05 in both the groups but the experimental group improvements were more significant than the control group with p < 0.05 . Conclusion. Twelve weeks of low TENS or HGBT along with exercises can decrease pain and neck disability and increase the quality of life in individuals with CNSNP. However, HGBT along with exercise has superior effects relative to low TENS along with exercise. This randomized controlled trial was registered in the International Standard Randomized Controlled Trials Number-ISRCTN29695190 and registered on 05/02/2020. This study is a retrospective registration.

scholarly journals Assessment of anxiety and quality of life in fibromyalgia patients

2004 ◽  
Vol 122 (6) ◽  
pp. 252-258 ◽  
Author(s):  
Tathiana Pagano ◽  
Luciana Akemi Matsutani ◽  
Elisabeth Alves Gonçalves Ferreira ◽  
Amélia Pasqual Marques ◽  
Carlos Alberto de Bragança Pereira
Keyword(s):  
Quality Of Life ◽  
Outpatient Service ◽  
Test Group ◽  
Control Group ◽  
Control Groups ◽  
Sf 36 ◽  
Significant Difference ◽  
And Control ◽  
The Impact

CONTEXT: Fibromyalgia is a syndrome characterized by chronic, diffuse musculoskeletal pain, and by a low pain threshold at specific anatomical points. The syndrome is associated with other symptoms such as fatigue, sleep disturbance, morning stiffness and anxiety. Because of its chronic nature, it often has a negative impact on patients' quality of life. OBJECTIVE: To assess the quality of life and anxiety level of patients with fibromyalgia. TYPE Of STUDY: Cross-sectional. SETTING: Rheumatology outpatient service of Hospital das Clínicas (Medical School, Universidade de São Paulo). METHODS: This study evaluated 80 individuals, divided between test and control groups. The test group included 40 women with a confirmed diagnosis of fibromyalgia. The control group was composed of 40 healthy women. Three questionnaires were used: two to assess quality of life (FIQ and SF-36) and one to assess anxiety (STAI). They were applied to the individuals in both groups in a single face-to-face interview. The statistical analysis used Student's t test and Pearson's correlation test (r), with a significance level of 95%. Also, the Pearson chi-squared statistics test for homogeneity, with Yates correction, was used for comparing schooling between test and control groups. RESULTS: There was a statistically significant difference between the groups (p = 0.000), thus indicating that fibromyalgia patients have a worse quality of life and higher levels of anxiety. The correlations between the three questionnaires were high (r = 0.9). DISCUSSION: This study has confirmed the efficacy of FIQ for evaluating the impact of fibromyalgia on the quality of life. SF-36 is less specific than FIQ, although statistically significant values were obtained when analyzed separately, STAI showed lower efficacy for discriminating the test group from the control group. The test group showed worse quality of life than did the control group, which was demonstrated by both FIQ and SF-36. Even though STAI was a less efficient instrument, it presented significant results, showing that fibromyalgia patients presented higher levels of anxiety, both on the state and trait scales. Thus, patients with fibromyalgia had higher levels of tension, nervousness, preoccupation and apprehension, and higher propensity towards anxiety. CONCLUSION: The three instruments utilized showed efficiency in evaluating fibromyalgia patients. FIQ was found to be the most efficient instrument for discriminating and assessing the impact of fibromyalgia on their quality of life. It can be concluded that such patients have a worse quality of life and higher levels of anxiety.

scholarly journals Modulation of the human immune status by spinal thermal massage: a non-randomized controlled study

2021 ◽  
Keyword(s):  
Quality Of Life ◽  
Nk Cells ◽  
Nk Cell ◽  
Controlled Trial ◽  
Controlled Study ◽  
Control Group ◽  
Randomized Controlled ◽  
Significant Difference ◽  
Experimental Group

Thermal and massage therapies have long been used to control pain. Although spinal thermal massage (STM) has been used worldwide, its effectiveness has not been proven in a controlled clinical study. We here conducted a non-randomized controlled trial to assess the pain-relieving and immunomodulatory effects of STM in old-aged patients experiencing pain or disability. The experimental group was treated with STM five times a week for 8 weeks and rehabilitative regular care (RRC). The control group was treated with only RRC. Pain and immunological parameters were tested before treatment and after 4 and 8 weeks of treatment. The scores of three pain parameters were lowered by STM, and the differences between the groups were statistically significant at the two time points (p < 0.01). Quality of life determined using the 3-level EuroQol five-dimensional questionnaire scores was significantly higher in patients in the experimental group than those in the control group. Effect sizes (ES) were in the range of medium to large in the pain-related measures (0.54–1.22). The total leukocyte counts and the proportions of lymphocytes and subsets were not significantly different between the groups, whereas the proportions of monocytes and natural killer (NK) cells were higher in the experimental group than in the control group after 8 weeks (p < 0.05). The production of interleukin (IL)-4 and interferon γ in T cells was not significantly different between the groups, whereas the production of IL-2 was high in the control group. However, there was a significant increase in IFN-γ production by NK cells in the experimental group (at 4 weeks, p < 0.05). ES were medium in the immunological measures (0.53–0.68). No significant difference was observed in the production of proinflammatory cytokines, IL-1β, tumor necrosis factor α, or IL-6 between the groups. In conclusion, STM treatment has a positive effect on subjective pain and quality of life. It also enhanced NK cell proportion and activity, suggesting that STM may be beneficial in the prevention of viral diseases and cancer in old-aged people.

scholarly journals The effect of group-based education on gastrointestinal symptoms and quality of life in patients with celiac disease: randomized controlled clinical trial

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Zahra Akbari Namvar ◽  
Reza Mahdavi ◽  
Masood Shirmohammadi ◽  
Zeinab Nikniaz
Keyword(s):  
Quality Of Life ◽  
Celiac Disease ◽  
Gastrointestinal Symptoms ◽  
Control Group ◽  
Post Intervention ◽  
Sf 36 ◽  
Gi Symptoms ◽  
Significant Difference ◽  
The Mean

Abstract Background In this trial, we investigated the effect of a group-based education program on gastrointestinal (GI) symptoms and quality of life (QOL) in patients with celiac disease (CD). Method In the present study, 130 patients with CD who were on a GFD for at least 3 months, randomly assigned to receive group-based education (n = 66) or routine education in the celiac clinic (n = 64) for 3 months. We assessed gastrointestinal symptoms and quality of life using the gastrointestinal symptom rating scale (GSRS) questionnaire and SF-36 questionnaire at baseline and 3 months after interventions. Results The mean age of the participants was 37.57 ± 9.59 years. There were no significant differences between the two groups regarding the baseline values. Results showed that the mean score of total GSRS score in the intervention group was significantly lower compared with the control group 3 months post-intervention (p = 0.04). Also, there was a significant difference in the mean score of SF-36 between the two groups 3 months post-intervention (p = 0.02). Conclusion Results showed that group-based education was an effective intervention in patients with celiac disease to improve gastrointestinal symptoms and quality of life. Trial registration IRCT code: IRCT20080904001197N21; registration date: 5/23/2019.

scholarly journals IMPACT ON QUALITY OF LIFE, WEIGHT LOSS AND COMORBIDITIES: a study comparing the biliopancreatic diversion with duodenal switch and the banded Roux-en-Y gastric bypass

2014 ◽  
Vol 51 (4) ◽  
pp. 320-327 ◽  
Author(s):  
Maria Ignez Xavier de Toledo DUARTE ◽  
Debora Pastore BASSITT ◽  
Otávio Cansanção de AZEVEDO ◽  
Jaques WAISBERG ◽  
Nagamassa YAMAGUCHI ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Bariatric Surgery ◽  
Weight Loss ◽  
Gastric Bypass ◽  
Sexual Interest ◽  
Control Group ◽  
Sf 36 ◽  
Significant Difference ◽  
Different Types

Context Few studies have evaluated the results of different types of bariatric surgery using the Medical Outcome Study 36 - Health Survey Short-Form (SF-36) quality of life questionnaire, the Bariatric and Reporting Outcome System (BAROS) and the reviewed Moorehead-Ardelt Quality of Life II Questionnaire (M-A QoLQ II) that is part of BAROS. The Roux-en-Y gastric bypass (RYGB) is the most common morbid obesity surgery worldwide. However, there is evidence indicating that a biliopancreatic diversion with duodenal switch (DS) is more effective than RYGB in weight loss terms. Objectives To evaluate the impact of different types of bariatric surgery on quality of life, comorbidities and weight loss. Methods Two groups of patients who underwent bariatric surgery conventional Banded Roux-en-Y gastric bypass (BRYGB) or DS were evaluated through monitoring at 12 to 36 months after surgery, as well as a control group of obese patients who had not undergone surgery. The tools used for this were SF-36, BAROS and M-A QoLQ II. The DS group consisted of 17 patients and the BRYGB group consisted of 20. The control group comprised 20 independent, morbidly obese individuals. Results The mean age of the patients in the groups was 45.18 in the DS group, 49.75 in the BRYGB group and 44.25 in the control group, with no significant difference. There was no difference in the ratio of men to women in the groups. The patients that had surgery showed a significant improvement in all domains of quality of life vs the control group. Comparing the two groups that underwent surgery, the DS group achieved better quality of life results in terms of “general state of health” and “pain”, according to responses to the SF-36 tool, and in terms of “sexual interest”, according to responses to the M-A QoLQ II tool. There was no significant difference among the three groups regarding the ratio of occurrence of comorbidities. In the groups that had surgery, the resolution of comorbidities was similar. The final classification according to the BAROS Protocol was excellent for the DS group and very good for the BRYGB group, with a statistical difference in favor of the DS group (P = 0.044*). There was no difference in the percentages of excess weight loss between the DS group (82.1%) and the BRYGB group (89.4%) (P = 0.376). Conclusions A comparison of the performance of the groups, which were monitored from 12 to 36 months after surgery, showed that the two types of surgery are effective to improve quality of life, comorbidities and weight loss. The DS surgery produced better results in the quality of life evaluations regarding 2 of 8 domains according to the SF-36, and “sexual interest” according to the M-A QoLQ II. In the groups that had surgery, the patients showed high rates of comorbidity resolution. Weight loss was similar for the two surgical groups.

scholarly journals Levodropropizine for cough treatment in adults: a randomized controlled trial

2018 ◽  
Vol 3 (3) ◽  
pp. e030361
Author(s):  
Olha Alifer
Keyword(s):  
Quality Of Life ◽  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
Control Group ◽  
Randomized Controlled ◽  
Sf 36 ◽  
Mood Scale ◽  
Time Frames ◽  
To Receive

Background. A cough is one of the most frequent cause for seeking treatment. It is often associated with a substantial decrease in quality of life. Levodropropizine is a cough suppressant, that can be prescribed for this condition. In current trial was evaluated levodropropizine effectiveness in improving quality of life in adults with a cough. Methods. The study had a design of a randomized controlled trial. Adult patients (n=60) were randomized into 2 groups to receive levodropropizine or plantain syrup, a phytotherapy medication. Quality of life was evaluated with an SF-36 scale at baseline and after 7 days of treatment. Additionally, patients' overall health status was assessed with Health, Activity and Mood Scale at pointed above time frames.    Results. After the treatment, it was found a statistically significant improvement in QOL physical component in  levodropropizine group compared to control group (

Abstract 12604: Effect of Psychotherapy on Quality of Life and Recurrence of Events in Patients With Recurrent Vasovagal Syncope: A Randomized Study

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Renata de Barros e Silva ◽  
Denise Hachul ◽  
PEDRO GABRIEL M DE BARROS E SILVA ◽  
Mauricio I Scanavacca
Keyword(s):  
Quality Of Life ◽  
Vasovagal Syncope ◽  
Intervention Group ◽  
Tilt Test ◽  
Control Group ◽  
Sf 36 ◽  
Significant Difference ◽  
One Year

Introduction: Vasovagal syncope presents a benign prognosis in terms of survival but is associated with significant impairment on quality of life (QoL). Poor emotional status contributes to the recurrence of events. Hypothesis: Among patients with recurrent vasovagal syncope, weekly sessions of psychotherapy may improve QoL and reduce the number of events during one year of follow-up. Methods: A randomized controlled trial was conducted including 10 patients with recurrent vasovagal syncope and positive tilt test. Cardiac disease and ongoing psychotherapeutic interventions were the main exclusion criteria. After randomization, half of the eligible patients underwent weekly sessions of psychotherapy during 12 months, while the control group was followed according to the standard of care, without psychotherapy. QoL by SF-36 and recurrence of syncope and pre-syncope were compared between the 2 groups and also in each group pre and post randomization. Results: All patients had a positive tilt test (80% with mixed vasovagal response), 70% were female and the mean age was 47.4 ± 11.1 years. The average rate of events before inclusion was 4.1 (± 3.4) syncopes/year and 1.26 (± 0.5) episodes of presyncope/week. The groups were well balanced at baseline and all patients completed the planned follow-up of one year. In the assessment of QoL by SF-36, comparing before and one year after randomization, there was no statistically significant difference in the control group (49.9 ± 9.8 vs 46.9 ± 3.4, P = 0.20) but there was a significant improvement in the intervention group (44.9 ± 11.9 vs 68.8 ± 7.8, P < 0.01). Comparing both groups at 12 months, patients that underwent sessions of psychotherapy had better QoL (68.8 ± 7.8 vs 46.9 ± 3.4, P < 0.01). Regarding the recurrence of syncope events, there was no significant change in the control group; however, in the intervention group there was a significant reduction in the rate of presyncope episodes per month (5.6 ± 2.1 vs 1.7 ± 0.9; P = 0.02) and also a significant reduction in the rate of syncope per year (4.6 ± 3.3 vs 1.0 ± 0.7; P = 0.04). Conclusions: In a randomized clinical trial, patients with recurrent vasovagal syncope undergoing regular psychotherapeutic intervention had less recurrence of events and improved quality of life in one year.

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