How are quality of life ratings made? Toward a model of quality of life in people with dementia.

Quality of life (QOL) has become a focus of research in dementia. In measuring QOL, the views of people with dementia often have not been considered as researchers have proposed that they may not be able to articulate their opinions. This paper counters this belief, presenting a study using a grounded theory methodology to explore the issues that people with dementia felt were important for their QOL. Further, we propose a model of QOL including hypothesised links between important issues (including family and health), QOL and other variables. Twenty-five participants took part in one of nine focus groups. The groups included participants with mild to severe dementia with ages ranging from 49 to 93 years. Results indicate that most of the participants were willing and able to talk about their QOL. Of the 25 participants, only two said that their cognitive problems affected their QOL. Twenty-two issues were discovered through analysis to contribute to QOL, including continuingto live in your own home, independence, spouse and other family, feeling happy and feeling useful. People with dementia used social comparisons in talking about their QOL, as well as direct evaluation of their own happiness. A model of QOL based on theories of coping and response shift is suggested. The fact that so few of the participants talked about disease-orientated issues challenges the large cognitive components included in many QOL measures for use with people with dementia.

Attitudes to fluorosis and dental caries by a response latency method.

BACKGROUND: Understanding socially relevant attitudes to fluorosis and dental caries is important. Previous studies have concentrated mainly on aesthetic implications. AIMS: To investigate social judgements beyond the aesthetic, made when viewing digitally manipulated extraoral images of dental fluorosis of varying degrees of severity and images of dental caries. METHODOLOGY: Using a response latency technique, which allowed both the direction and strength of attitudes to be measured, 40 volunteers made judgements on 144 image/characteristic combinations. RESULTS: Participants made social judgements which extended beyond the aesthetic to factors such as sociability, reliability and cleanliness. Judgements on mild fluorosis were not markedly different from those made about the same individual with normal enamel, but severe fluorosis had a significant negative impact on social judgements. Untreated dental caries was judged less favourably than normal enamel and mild fluorosis. CONCLUSIONS: Attribution of characteristics that go beyond the aesthetic are significantly influenced by altered tooth appearance.

Treatment of radiation-induced tissue injury by hyperbaric oxygen.

Hyperbaric oxygen therapy appears to be a beneficial adjunctive treatment modality in the management of radionecrosis of bone and soft tissue in the head and neck. The mechanism of such wound healing enhancement appears to be related to oxygen stimulation of fibroblastic activity and neovasculation. In this pilot study, involving 13 cases of refractory mandibular radionecrosis treated with hyperbaric oxygen, complete healing of soft tissue disease with covering of exposed bone has been noted in seven cases 11 to 27 months posttreatment; transient healing was seen in three cases; moderate to marked improvement in soft tissue disease has been noted in three cases. Pain relief was marked in six cases, moderate in four cases, and slight in one case of the 11 patients with significant pretreatment pain. Radiographic improvement was slight to moderate in ten cases. Four of the five patients with pathologic fractures developed a firm fibrous union of the mandibular segments during or shortly after treatment. Three additional cases of head and neck radionecrosis of other sites have noted significant improvement in their lesions during treatment. Three other patients with radionecrosis of the foot, hip, and vagina have also been treated with good results only in the vaginal case. None of the 19 patients treated with hyperbaric oxygen developed persistent or significant complications.