Skip Navigation
Skip to contents

PHRP : Osong Public Health and Research Perspectives

OPEN ACCESS
SEARCH
Search

Articles

Page Path
HOME > Osong Public Health Res Perspect > Volume 11(5); 2020 > Article
Original Article
Health-Related Quality of Life and its Associated Factors in COVID-19 Patients
Morteza Arab-Zozania, Fatemah Hashemib, Hossein Safaric, Mahmood Yousefid, Hosein Amerie
Osong Public Health and Research Perspectives 2020;11(5):296-302.
DOI: https://doi.org/10.24171/j.phrp.2020.11.5.05
Published online: October 22, 2020

aSocial Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran

bHealthcare Management, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

cHealth Promotion Research Center, Iran University of Medical Sciences, Tehran, Iran

dIranian Center of Excellence in Health Management, School of Management and Medical Informatics, Health Economics Department, Tabriz University of Medical Sciences, Tabriz, Iran

eHealth Policy and Management Research Center, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

*Corresponding author: Hosein Ameri, Health Policy and Management Research Center, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran, E-mail: hamery7@yahoo.com
• Received: June 22, 2020   • Revised: July 23, 2020   • Accepted: August 20, 2020

Copyright ©2020, Korea Centers for Disease Control and Prevention

This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

  • 12,811 Views
  • 475 Download
  • 65 Web of Science
  • 78 Crossref
  • 77 Scopus
  • Objectives
    Health-related quality of life (HRQoL) is one of the most important outcome measures for patients. The purpose of this study was to evaluate HRQoL and related factors in Coronavirus disease 2019 (COVID-19) patients.
  • Methods
    A total of 420 COVID-19 patients who had been discharged from hospital were selected using a systematic sampling. The EuroQol 5-dimensional-5 levels (EQ-5D-5L) questionnaire along with medical records of the patients were used to gather the data. The t test and analysis of variance were employed to test the difference between mean EQ-5D-5L scores, and the BetaMix model was used to investigate factors associated with EQ-5D-5L scores.
  • Results
    The mean score for the patients who completed the EQ-5D-5L questionnaire (n = 409) was 0.6125. The EQ-5D-5L scores were significantly higher in males, patients with younger age, those with a low level of education, the employed, patients who worked in uncrowded workplaces, patients without diabetes, and those who were not admitted to intensive care unit. The BetaMix model showed that gender, age, education, employment status, having diabetes, heart failure, and admission to the intensive care unit were significant independent predictors of the EQ-5D-5L index values.
  • Conclusion
    The mean score for EQ-5D-5L in COVID-19 patients was low in this study. Some of the factors, especially aging and having diabetes, should be considered in the aftercare of patients to improve their HRQoL.
Coronavirus disease 2019 (COVID-19) is a new infectious disease that was first discovered in Wuhan, China, on the 31st December 2019 [1]. It has subsequently spread to almost all countries around the world. According to the latest report by the World Health Organization (April 25th, 2020), this disease has spread to 210 countries and territories around the world, and 2 international conveyances [2]. Iran, with more than 100,000 cases of COVID-19, and a deaths-to-infections ratio of 6.4%, is amongst the highest ranked countries in terms of outbreak and mortality [2]. The spread of COVID-19 through all 31 provinces of Iran was very rapid (less than a month) [3]. Yazd, located in center of Iran, had more than 1,500 confirmed cases of COVID-19 in Iran in June 2020.
COVID-19 is a serious disease that can significantly affect the daily lives of recovered patients and their families in terms of mental health problems such as post-traumatic stress [4], depression [5], anxiety [6] and insomnia [7], as well as the negative impact COVID-19 has on patients quality of life (QoL) [8]. Since the patients are not immune to future infection [9], it may lead to a more negative impact on patients’ QoL. Health-related quality of life (HRQoL) is an important measure that is used for assessing the impact of diseases, disorders, or disabilities on the physical, mental, and social domains of patient health. The assessment of HRQoL helps healthcare providers identify the factors affecting QoL and recognize the aspects of COVID-19 management that needs to be enhanced for improving the QoL of patients [10,11].
The EuroQol 5-dimensional-5 levels (EQ-5D-5L) questionnaire is one of the most commonly used instruments for measuring HRQoL in clinical and outcome research, and its use is recommended by the National Institute for Health and Clinical Excellence [12,13]. This instrument was translated into Persian and was confirmed by the EuroQol group [14]. This study used the EQ-5D-5L instrument to describe the HRQoL of COVID-19 patients who had been discharged from the only hospital dedicated to COVID-19 patients in Yazd, and assessed the impact of socio-demographic and clinical factors on COVID-19 patients’ HRQoL.
1. Study design and data collection
This cross-sectional study was conducted in COVID-19 patients who had been discharged from the Shahid Sadoughi hospital (dedicated to the treatment of patients with COVID-19 in Yazd). According to the medical records of COVID-19 patients, a total of 420 patients were selected in systematic sampling in March 2020.
The EQ-5D-5L questionnaire, along with socio-demographic characteristics, were completed for patients during a telephone interview. Clinical data were extracted from the medical records of patients. Oral consent was obtained from all patients before participating in the study. All procedures performed were in accordance with the ethical standards of the national research committee (approval no.: IR.BUMS.REC. 1399.109)
2. EQ-5D-5L instrument
The EQ-5D-5L is a common instrument to assess HRQoL (developed by the EuroQol group in 2011) [15]. The EQ-5D-5L includes 5 dimensions (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression). Each of the dimensions has 5 levels of response options (no problems, slight problems, moderate problems, severe problems, and unable to/extreme problems) to define all possible health states. In addition, the EQ-5D-5L questionnaire has a visual analog scale measured on a vertical line to determine the overall health status of the respondents [0 (the worst imaginable health) to 100 (the best imaginable health)] [16].
The Iranian interim EQ-5D-5L value set (generated through the crosswalk technique introduced by the EuroQoL group [17]), and the interim value set confirmed by 2 studies in Iran [18,19] were used in this current study. This technique generated the value set for the EQ-5D-5L by making a correlation between the EQ-5D-5L and the EQ-5D-3L descriptive systems.
3. Statistical analysis
Given that the distribution of EQ-5D data is commonly skewed, multimodal, and is limited at the top and the bottom, and it often has a large number of observations at the top (ceiling effects), use of basic models such as ordinary least squares (OLS) and Tobit is theoretically inappropriate for analysis of such data [20]. Recently, 2 new mixture models were developed to deal with the distributional characteristics of the EQ-5D instrument [adjusted limited dependent variable mixture model and extensions to a beta mixture model (BetaMix model)]. In this study, the betamix command was used for assessing the factors affecting HRQoL.
Data was not normally distributed (using the Kolmogorov–Smirnov test) however, the t test and ANOVA were used in this study because parametric tests had the same results as nonparametric tests. All analyses were performed using Stata\Version 15.0 for Windows (StataCorp, College Station, TX, USA).
Out of 420 interviews, 11 interviews were excluded from the final analysis because data on many of the dimensions of the EQ-5D-5L questionnaire were not available. Table 1 shows the socio-demographic and clinical characteristics of patients. The mean age of patients was 58.4 ± 18.21 years, and the average of household occupancy was 2.10 ± 0.18. Among COVID-19 patients, the majority were males, aged 51 to 60 years, married, unemployed, with a primary level of education, and in a household of between 1 to 2 members, and those who worked did so in a crowded environment.
The clinical characteristics of patients are presented in Table 2. The mean duration of hospitalization and days following hospital discharge was 8 ± 7 and 21.6 ± 14.8 days, respectively. The majority of COVID-19 patients had a hospital duration of ≤ 10 days and the duration of days following hospital discharge was > 30 days. In this study, 30% of the patients who were treated in the intensive care unit (ICU) were more than 60 years old.
1. Distribution of the EQ-5D-5L dimensions
The distribution of HRQoL problems reported by patients for each of the EQ-5D-5L dimensions is shown in Figure 1. The percentage of patients reporting no problems (healthy state) for mobility, self-care, usual activities, pain/discomfort, and anxiety/depression was 53.34%, 87.75%, 58.97%, 57.97%, and 41.26%, respectively. Patients only reported unable to/extreme problems for the anxiety dimension.
2. Univariate analyses
The mean EQ-5D-5L index values for patients were 0.6125 ± 0.006. The results of univariate analysis for the association between socio-demographic factors and the EQ-5D-5L index values are presented in Table 1. The difference between the mean EQ-5D-5L index values was significant for gender (p = 0.002), age (p = 0.005), education status (p < 0.001), employment status (p < 0.001), and workplace status (p = 0.002). Univariate analysis also showed that among clinical factors, the difference between the mean EQ-5D-5L index values was significant if the patient had diabetes (p < 0.001), or heart failure (p = 0.002) and/or was admitted to hospital (p < 0.001).
3. Regression analyses
The factors associated with HRQoL scores using the BetaM model showed that female gender, older age, higher education level, being unemployed, ICU admission, and having diabetes had significant negative effects on the EQ-5D-5L index values (p < 0.05). The marginal effect analysis showed that the largest marginal effect was caused by age among the demographic variables (0.44), and having diabetes (0.31) among the clinical demographics (Table 3).
This study evaluated HRQoL of COVID-19 patients using the EQ-5D-5L questionnaire and assessed the effects of socio-demographic and clinical factors on HRQoL. The results of this study provided important insights of the HRQoL based on the characteristics of hospitalized COVID-19 patients that can be used in the management of the disease. The mean EQ-5D-5L score for the patients was 0.6125.
A study conducted on people (n = 4,029) with suspected COVID-19 symptoms (S-COVID-19-S) visiting outpatient departments and health centers in Vietnam, in 2020 reported a mean score of 0.621 for the assessment of HRQoL [8]. The overall EQ-5D-5L score for COVID patients (0.612) in this study was lower than Asian patients suffering from diabetes (0.84) [21], type 2 diabetes (0.84) [22], cardiovascular diseases (0.84) [23], acute coronary syndrome (0.75) [24] human immunodeficiency virus (0.8) [25], skin diseases (0.73) [26], and respiratory diseases (0.66) [27], but higher than frail elderly (0.58) [28] and elderly patients after a fall injury (0.46) [29].
The percentage of individuals reporting problems affecting their HRQoL in each EQ-5D-5L dimension showed the most common problem was anxiety. Similar results also were reported by Nguyen et al [8]. They showed that the odds ratio of depression for people with S-COVID-19-S was higher than that of the people without S-COVID-19-S (3.69 vs. 1) [8].
Among the demographic factors, univariate analyses showed that the mean EQ-5D-5L scores were significantly different depending on gender, age, education level, employment status, and workplace of the patients. The findings were similar to the findings reported in the study by Nguyen et al [8]. They reported the difference between mean HRQoL scores for people with S-COVID-19-S was significant depending on age, gender, marital status, education level, occupation status, ability to pay for medication, social status, comorbidity, and physical activity [8].
The older age groups of patients had lower scores of HRQoL compared with the younger patients. This may reflect the fact that COVID-19 impacts more on older patients. Sommer et al [30] reported that severe cases of COVID-19 (involving ICU admission) skewed towards patients who were > 60 years old. This current study revealed that women had lower scores for HRQoL than men. This finding may be due to a difference in the level of physical activity between men and women in developing countries, as women have a lower level of physical activity than men [31]. Another reason may be due to the fact that women are more worried about disease and may have less ability to cope. It was also observed that the difference between mean HRQoL scores in patients with different levels of education was significant. Lower scores of HRQoL were observed in patients with a higher level of education a greater level of awareness and concern of COVID-19 and its impact on life. Nguyen et al [8] observed that people with a college/university education had a higher prevalence of depression during the pandemic that created a burden of stress which further affected their HRQoL. The present study also showed that employed patients had higher scores of HRQoL. This could be due to the fact that the employed patients had not lost their income; therefore, they had more opportunity to have better healthcare [32]. A significant difference between HRQoL mean scores was also observed in workplaces of the patients. The patients who worked in crowded environments such as factories, shopping malls, and banks, had lower scores of HRQoL compared with people who worked in an uncrowded environment. The majority of the patients in crowded environments reported high anxiety of re-infection. We asked the patients to state their anxiety/depression regarding re-infection using the 5-Likert scale (no anxiety, slight anxiety, some anxiety, a lot of anxiety, or very anxious/depressed). In contrast to the results of this study, executives in Chongqing, China (n = 122) were reported to have a lower prevalence of depression and anxiety when they returned to work during COVID-19 pandemic [33]. There is an urgency to redesign training programs and communication activities for a more effective dissemination of information related to the COVID-19 [34].
Among clinical factors, the difference between mean scores of HRQoL was significant for ICU admission, having diabetes, and heart failure in this study. The mean HRQoL scores were different between the patients who had been admitted to hospital wards. The patients admitted to the ICU for COVID-19 treatment had lower scores of HRQoL than those admitted to a hospital wards, probably because ICU patients experienced more severe problems related to COVID-19. The mean scores of HRQoL were lower in the patients with diabetes than those without diabetes. This is because the disease was more severe in the patients with diabetes and it exacerbates their diabetes symptoms [35]. These results are consistent with the findings of a recent study conducted in critical care COVID-19 patients in the US. The study reported that COVID-19 in cases severe enough to require ICU admission, skewed the patient population towards patients with medical comorbidities, such as hypertension, diabetes mellitus, or cardiovascular diseases [30]. Furthermore, the patients with heart failure had lower HRQoL scores compared with those without heart failure.
The regression analysis showed that amongst demographic factors, age had the most marginal effect therefore, it has the most impact on HRQoL. It can be explained by the direct relationship between aging and increasing incidence of problems in patients. Among the clinical factors, having diabetes had the most marginal effect on HRQoL. Diabetes has been reported as a comorbidity of COVID-19 [35].
One limitation of the study was that the design was not cross-sectional, which did not allow the determination of the exact effects of patients’ socio-demographic and clinical factors on HRQoL. Further research is required using a longitudinal study to understand how these factors may affect the HRQoL. Another limitation is the use of crosswalk to calculate the Iranian EQ-5D-5L value set. The value set based on crosswalk is less reliable than the one obtained directly from the general public-preference. However, crosswalk is currently the only available technique to generate the EQ-5D-5L value set for countries that do not have the EQ-5D-5L value set based on their own context.
The mean score of HRQoL for the patients was 0.6125 in this study. Identifying strategies to improve the HRQoL in patients, especially in aging and diabetic patients, is therefore of particular importance. This study showed that gender, among demographic factors, and diabetes, among clinical factors, had the most marginal effect on the dimensions of EQ-5D-5L.
Acknowledgements
We would like to thank all patients who agreed to participate in this study.

Conflicts of Interest

The authors have no conflicts of interest to declare.

Figure 1
Percentage of all COVID-19 patients admitted to hospital, who experienced HRQoL problems after hospital discharge (indicated by the EQ-5D-5L dimensions).
EQ-5D-5L = EuroQol-5 dimensions - 5 levels; HRQoL = health-related quality of life.
ophrp-11-296f1.jpg
Table 1
Socio-demographic characteristics and the EQ-5D-5L index values (N = 409).
Variable n (%) Mean EQ-5D-5L index (SD) T F p
Gender
 Male 247 (60.27) 0.628 (0.201) 2.738 0.002*
 Female 162 (39.73) 0.585 (0.198)

Age group (y)
 ≤ 40 27 (6.60) 0.618 (0.321) 4.270 0.005
 41–50 108 (26.40) 0.602 (0.298) -
 51–60 167 (40.84) 0.581 (0.192)
 > 60 107 (26.16) 0.554 (0.145)

Education status
 Illiterate 18 (4.40) 0.601 (0.178) - 5.533 < 0.001
 Primary 130 (41.56) 0.615 (0.174)
 Secondary 237 (48.17) 0.575 (0.201)
 University degree 24 (5.87) 0.546 (0.206)

Marital status
 Single 2 (0.49) 0.618 (0.157) - 3.124 0.2051
 Married 357 (87.29) 0.615 (0.121)
 Divorced or widow 50 (12.22) 0.602 (0.271)

Household occupancy
 ≤ 2 282 (68.94) 0.610 (0.431) 1.21 0.541*
 > 2 127 (31.06) 0.606 (0.576)

Employment status
 Employed 187 (45.72) 0.623 (0.167) 4.35 < 0.001
 Unemployed 222 (58.28) 0.592 (0.201)

Workplace status
 Uncrowded 130 (31.79) 0.613 (0.187) 2.98 0.002
 Crowded 279 (68.21) 0.597 (0.132)

EQ-5D-5L = EuroQol -5 dimensions - 5 levels.

* Statistical significance of differences calculated using t test.

Statistical significance of differences calculated using ANOVA.

Table 2
Clinical characteristics and the EQ-5D-5L index values (N = 409).
n (%) mean EQ-5D-5L index (SD) T F p
Duration of hospitalization (d)
 ≤ 10 222 (58.28) 0.591 (0.201) 1.91 0.064*
 > 10 187 (45.72) 0.603 (0.167)

Duration after hospital discharge (d)
 ≤ 14 34 (8.31) 0.602 (0.157) 2.97 0.674
 15–30 168 (41.07) 0.611 (0.271)
 > 30 207 (50.61) 0.608 (0.121)

Admission ward
 ICU admission 74 (18.09) 0.581 (0.201) 3.97 < 0.001*
 No ICU admission 335 (81.91) 0.613 (0.167)

Comorbidities
 Diabetes (Yes) 262 (64.06) 0.586 (0.121) 3.41 < 0.001*
 Diabetes (No) 147 (35.94) 0.612 (0.107)
 Heart failure (Yes) 45 (11.00) 0.597 (0.157) 2.13 0.002*
 Heart failure (No) 364 (89.00) 0.605 (0.131)
 Cholesterol (Yes) 212 (51.83) 0.608 (0.101) 1.89 0.078*
 Cholesterol (No) 197 (48.17) 0.612 (0.167)
 Hypertension (Yes) 245 (59.90) 0.598 (0.167) 1.76 0.089*
 Hypertension (No) 164 (40.10) 0.609 (0.201)

EQ-5D-5L= EuroQol-5 dimensions - 5 levels; ICU= intensive care unit.

* Statistical significance of differences calculated using t test.

Statistical significance of differences calculated using ANOVA.

Table 3
BetaMix regression analysis to determine EQ-5D-5L dependent variables associated with COVID-19 patients.
EQ-5D-5L (dependent variable) Coef dy/dx SE z p 95% CI
Gender
 Female −0.0898 −0.3216 0.0211 −4.25 0.035 [−0.1341 − 0.0642]

Age (y)
 41–50 0.0561 0.1981 0.0381 1.47 0.138 [0.0246 – 0.0916]
 51–60 −0.0811 −0.9212 0.0091 −8.91 <0.001 [−0.1290 – −0.0650]
 > 60 −0.1961 −01.041 0.0231 −8.49 <0.001 [−0.2188 – −0.1695]

Education status
 Primary −0.0420 −0.0123 0.0319 −1.31 0.429 [−0.1180 – −0.0412]
 Secondary −0.1052 −0.0751 0.0312 −3.37 0.098 [−0.1540 – −0.0715]
 University degree −0.1075 −0.0891 0.0208 −5.17 0.028 [−0.1367 – −0.0884]
 Unemployed −0.1020 −0.0323 0.0239 −4.26 0.029 [−0.1268 – −0.0580]
 ICU admission −0.2052 −0.0882 0.0372 −5.51 0.013 [−0.2280 – −0.1745]
 Diabetes −0.0875 −0.9812 0.0108 −8.10 <0.001 [−0.1074 – −0.0618]
 Heart failure −0.0724 −0.8723 0.0155 −4.67 0.026 [−0.0911 – −0.0329]
 Constant 1.2131 2.6783 0.0747 16.24 <0.001 [1.2043 – 1.4972]

CI = confidence interval; Coef = coefficence; ICU = intensive care unit; EQ-5D-5L =EuroQol-5 dimensions-5 levels; SE =standard error.

Figure & Data

References

    Citations

    Citations to this article as recorded by  
    • Examining the Trajectory of Health-Related Quality of Life among Coronavirus Disease Patients
      Jia Li, Juan P. Wisnivesky, Jenny J. Lin, Kirk N. Campbell, Liangyuan Hu, Minal S. Kale
      Journal of General Internal Medicine.2024;[Epub]     CrossRef
    • Health-related quality of life among adults living with chronic non-communicable diseases in the Ho Municipality of Ghana: a health facility-based cross-sectional study
      William Kwame Witts, Hubert Amu, Robert Kokou Dowou, Frank Oppong Kwafo, Luchuo Engelbert Bain
      BMC Public Health.2024;[Epub]     CrossRef
    • A lifestyle adjustments program in long COVID-19 improves symptomatic severity and quality of life. A randomized control trial
      A. Navas-Otero, A. Calvache-Mateo, I. Calles-Plata, G. Valenza-Peña, S. Hernández-Hernández, A. Ortiz-Rubio, MC Valenza
      Patient Education and Counseling.2024; 122: 108180.     CrossRef
    • Actividad física, independencia funcional y calidad de vida relacionada con la salud en los pacientes post COVID-19
      J. Rodríguez-Castro, J. Betancourt-Peña
      Fisioterapia.2024;[Epub]     CrossRef
    • Post-traumatic stress disorder, anxiety, depression and related factors among COVID-19 patients during the fourth wave of the pandemic in Vietnam
      Hoang Bac Nguyen, Thi Hong Minh Nguyen, Thi Hong Nhan Vo, Thi Cam Nhung Vo, Duc Nguyet Quynh Nguyen, Huu-Thinh Nguyen, Tuan-Ngan Tang, Thi-Hiep Nguyen, Van Trang Do, Quang Binh Truong
      International Health.2023; 15(4): 365.     CrossRef
    • One-year follow-up of depression, anxiety, and quality of life of Peruvian patients who survived COVID-19
      Jeff Huarcaya-Victoria, Christoper A. Alarcon-Ruiz, William Barzola-Farfán, Claudia Cruzalegui-Bazán, Michaell Cabrejos-Espinoza, Gabriela Aspilcueta-Montoya, Feleydi Cornero-Quispe, Javier Salazar-Bellido, Beltrán Villarreal
      Quality of Life Research.2023; 32(1): 139.     CrossRef
    • Postdischarge pain, fatigue severity and quality of life in COVID-19 survivors
      Esma DEMİRHAN, Sevgi ATAR, Günay ER, İpek OKUTAN, Ömer KURU
      The European Research Journal.2023; 9(1): 57.     CrossRef
    • Salud mental de cuidadores de niños con trastornos del neurodesarrollo durante la pandemia
      Jorge Emiro Restrepo, Tatiana Castañeda-Quirama, Mónica Gómez-Botero, David Molina-González
      Neurología Argentina.2023; 15(1): 28.     CrossRef
    • The trend in quality of life of Chinese population: analysis based on population health surveys from 2008 to 2020
      Dingyao Wang, Shitong Xie, Jing Wu, Bei Sun
      BMC Public Health.2023;[Epub]     CrossRef
    • Post-discharge quality of life of COVID-19 patients at 1-month follow-up: A cross-sectional study in the largest tertiary care hospital of Bangladesh
      Mohammad Mahfuzul Hoque, Ponkaj Kanti Datta, Kamalesh Chandra Basu, Muhammad Faizur Rahman, Mohammed Masudul Hassan Khan, Mohammad Mostafa Kamal, Reaz Mahmud, Kazi Ali Aftab, Ejrarul Alam Khan, Imran Mahmud, Rumana Sharmin, Md. Abdullah Saeed Khan, Mohamm
      PLOS ONE.2023; 18(1): e0280882.     CrossRef
    • Health-related quality of life and associated factors among COVID-19 individuals managed with Indian traditional medicine: A cross-sectional study from South India
      Rajalakshmi Elumalai, Bhavani Shankara Bagepally, Manickam Ponnaiah, Tarun Bhatnagar, Suganya Barani, Poornima Kannan, Lakshmi Kantham, P. Sathiyarajeswaran, Sasikumar D
      Clinical Epidemiology and Global Health.2023; 20: 101250.     CrossRef
    • The influencing factors of health–related quality of life of the general population of Iran during the COVID-19 Pandemic
      Maryam Shirvani Shiri, Hassan Karami, Hosein Ameri, Ali Akbari Sari, Maryam Tatari, Sara Emamgholipour, Somayeh Afshari
      Frontiers in Medicine.2023;[Epub]     CrossRef
    • Health-Related Quality of Life of COVID-19 Survivors Treated in Intensive Care Unit—Prospective Observational Study
      Josipa Domazet Bugarin, Lenko Saric, Nikola Delic, Svjetlana Dosenovic, Darko Ilic, Ivana Saric, Sanda Stojanovic Stipic, Bozidar Duplancic
      Journal of Intensive Care Medicine.2023; 38(8): 710.     CrossRef
    • Pain and Clinical Presentation: A Cross-Sectional Study of Patients with New-Onset Chronic Pain in Long-COVID-19 Syndrome
      Andrés Calvache-Mateo, Laura López-López, Javier Martín-Núñez, Alejandro Heredia-Ciuró, María Granados-Santiago, Araceli Ortiz-Rubio, Marie Carmen Valenza
      International Journal of Environmental Research an.2023; 20(5): 4049.     CrossRef
    • Evaluation and follow-up of pain, fatigue, and quality of life in COVID-19 patients
      Sevda Adar, Petek Şarlak Konya, Ali İzzet Akçin, Ümit Dündar, Neşe Demirtürk
      Osong Public Health and Research Perspectives.2023; 14(1): 40.     CrossRef
    • Validation of the Slovakian Version of the “Post‑acute (Long) COVID‑19 Quality of Life Instrument” and Pilot Study
      Romana Ulbrichtova, Peter Vysehradsky, Alica Bencova, Maria Tatarkova, Oto Osina, Viera Svihrova, Henrieta Hudeckova
      Patient Preference and Adherence.2023; Volume 17: 1137.     CrossRef
    • Quality of life in patients treated for COVID-19–associated mucormycosis at a tertiary care hospital
      Pragya Kumar, Rajath Rao UR, Nilanjan Roy, Deepika Agrawal, Shamshad Ahmad, Kranti Bhavana
      Osong Public Health and Research Perspectives.2023; 14(2): 119.     CrossRef
    • Clinical characterization and factors associated with quality of life in Long COVID patients: Secondary data analysis from a randomized clinical trial
      Mario Samper-Pardo, Sandra León-Herrera, Bárbara Oliván-Blázquez, Santiago Gascón-Santos, Raquel Sánchez-Recio, Gustavo Plaza-Manzano
      PLOS ONE.2023; 18(5): e0278728.     CrossRef
    • Health-Related Quality of Life for Jordanian-Recovered Individuals During Post-COVID-19 Era: A Cross-Sectional Study
      Sawsan Abuhammad, Omar F Khabour, Karem H Alzoubi, Shaher Hamaideh, Basheer Y Khassawneh, Amat Al-Khaleq O Mehrass, Baha F Alsmadi, Abdelrahman M Ababneh
      Patient Preference and Adherence.2023; Volume 17: 1303.     CrossRef
    • Physical therapy management of an individual with post-COVID fatigue considering emotional health in an outpatient setting: A case report
      Neeti Pathare, Dylan MacPhail
      Physiotherapy Theory and Practice.2023; : 1.     CrossRef
    • Post-acute (long) COVID-19 quality of life: validation of the German version of (PAC19QoL) instrument
      Srikanth Umakanthan, Mariam Monice, Salona Mehboob, Cheryl Linda Jones, Sam Lawrence
      Frontiers in Public Health.2023;[Epub]     CrossRef
    • Evaluation of Primary Allied Health Care in Patients Recovering From COVID-19 at 6-Month Follow-up: Dutch Nationwide Prospective Cohort Study
      Anne I Slotegraaf, Marissa H G Gerards, Arie C Verburg, Marian A E de van der Schueren, Hinke M Kruizenga, Maud J L Graff, Edith H C Cup, Johanna G Kalf, Antoine F Lenssen, Willemijn M Meijer, Renée A Kool, Rob A de Bie, Philip J van der Wees, Thomas J Ho
      JMIR Public Health and Surveillance.2023; 9: e44155.     CrossRef
    • Predictors of fear control related to COVID-19 among older population: an investigation on COVID-19 risk perception and health related quality of life during the pandemic
      Saeedeh Avazzadeh, Neda Gilani, Leila Jahangiry
      Health and Quality of Life Outcomes.2023;[Epub]     CrossRef
    • Post COVID-19 condition and health-related quality of life: a longitudinal cohort study in the Belgian adult population
      Pierre Smith, Robby De Pauw, Dieter Van Cauteren, Stefaan Demarest, Sabine Drieskens, Laura Cornelissen, Brecht Devleesschauwer, Karin De Ridder, Rana Charafeddine
      BMC Public Health.2023;[Epub]     CrossRef
    • Health and well-being of the Portuguese citizens: impacts of the COVID-19
      Lara N. Ferreira, Luís N. Pereira, Pedro L. Ferreira
      Journal of Patient-Reported Outcomes.2023;[Epub]     CrossRef
    • Assessment of Qol among COVID-19 Patients in South India: A Tertiary Care Center Study: An Original Research
      Sreedevi Janapareddi, Kiran S. Shankar, Mansi Mendiratta, Neha Chauhan, Sachin Kumar Jadhav, Divya Jahagirdar
      Journal of Pharmacy and Bioallied Sciences.2023; 15(Suppl 1): S218.     CrossRef
    • Cost-effectiveness of therapeutics for COVID-19 patients: a rapid review and economic analysis
      Andrew Metry, Abdullah Pandor, Shijie Ren, Andrea Shippam, Mark Clowes, Paul Dark, Ronan McMullan, Matt Stevenson
      Health Technology Assessment.2023; : 1.     CrossRef
    • Impact of COVID-19 Infection on Health-Related Quality of Life, Work Productivity and Activity Impairment by Symptom-Based Long COVID Status and Age in the US
      Manuela Di Fusco, Joseph C. Cappelleri, Laura Anatale-Tardiff, Henriette Coetzer, Alon Yehoshua, Mary B. Alvarez, Kristen E. Allen, Thomas M. Porter, Laura Puzniak, Ashley S. Cha-Silva, Santiago M. C. Lopez, Xiaowu Sun
      Healthcare.2023; 11(20): 2790.     CrossRef
    • Post-COVID-19 fatigue and health-related quality of life in Saudi Arabia: a population-based study
      Moath S. Al-Johani, Rehana Khalil, Yazeed A. Al-Mohaimeed, Omar M. Al-Mundarij, Abdulmajeed S. Al-Samani, Osama S. Al-saqry, Alwaleed A. Al-saawi, Ibrahim K. Al-dhali, Waleed A. Al-Essa
      Frontiers in Public Health.2023;[Epub]     CrossRef
    • Calidad de vida relacionada con la salud en chilenos de comunas vulnerables
      Isabel Rada, Manuel S. Ortiz, Baltica Cabieses
      Gaceta Sanitaria.2023; 37: 102328.     CrossRef
    • One-year quality of life among post-hospitalization COVID-19 patients
      Ignacio Pérez Catalán, Celia Roig Martí, Sergio Fabra Juana, Elena Domínguez Bajo, Germán Herrero Rodríguez, Ana Segura Fábrega, María Varea Villanueva, Sofía Folgado Escudero, María José Esteve Gimeno, Daniela Palomo de la Sota, Alejandro Cardenal Álvare
      Frontiers in Public Health.2023;[Epub]     CrossRef
    • Association between Body Mass Index, Physical Activity and Quality of Life amongst Older People in Malaysia during COVID-19: A Cross-Sectional Analysis
      Nor Safura Mohd Noor, Nur Kamilah Mohd Fauzy, Sakinah Harith, Wan Rohani Wan Taib, Rosliza Yahaya, Almira Sitasari, Furaida Khasanah
      Malaysian Journal of Medicine and Health Sciences.2023; 19(6): 42.     CrossRef
    • Quality of Life in Adolescents and Young Adults with Cleft Lip and Palate with and Without Speech Therapy During COVID-19
      Zahra Moshtaghi Fard, Samira Aghadoost, Negin Moradi, Sarvin Sarmadi, Farnoosh Mohammadi, Naghmeh Bahrami
      The Cleft Palate Craniofacial Journal.2023;[Epub]     CrossRef
    • Health related quality of life in adults with asthma: a systematic review to identify the values of EQ-5D-5L instrument
      Somayeh Afshari, Hosein Ameri, Rajab Ali Daroudi, Maryam Shiravani, Hassan Karami, Ali Akbari Sari
      Journal of Asthma.2022; 59(6): 1203.     CrossRef
    • Evaluation of perceived fears of COVID-19 virus infection and its relationship to health-related quality of life among patients with diabetes mellitus in Egypt during pandemic: a developing country single-center study
      Mohamed Abdelghani, Mohamed G. Hamed, Amira Said, Eman Fouad
      Diabetology International.2022; 13(1): 108.     CrossRef
    • Post‐acute COVID‐19 syndrome (PCS) and health‐related quality of life (HRQoL)—A systematic review and meta‐analysis
      Preeti Malik, Karan Patel, Candida Pinto, Richa Jaiswal, Raghavendra Tirupathi, Shreejith Pillai, Urvish Patel
      Journal of Medical Virology.2022; 94(1): 253.     CrossRef
    • Infección grave por SARS-CoV-2: valoración clínica y evaluación funcional biomecánica al mes del alta hospitalaria
      A. Ezzeddine Angulo, J.M. Elía Martínez, V. Iñigo Huarte, I. Máñez Añón, J.M. Tenías Burillo, F. Peydro de Moya
      Rehabilitación.2022; 56(2): 142.     CrossRef
    • Quality of life and other patient-reported outcomes in adult Lebanese patients with type 2 diabetes during COVID-19 pandemic
      E. Naous, M. Boulos, G. Sleilaty, A. A. Achkar, M.-H. Gannagé-Yared
      Journal of Endocrinological Investigation.2022; 45(4): 763.     CrossRef
    • Economic evaluations of inactivated COVID-19 vaccines in six Western Pacific and South East Asian countries and regions: A modeling study
      Yawen Jiang, Dan Cai, Si Shi
      Infectious Disease Modelling.2022; 7(1): 109.     CrossRef
    • Psychological Symptoms in COVID-19 Patients: Insights into Pathophysiology and Risk Factors of Long COVID-19
      Angel Yun-Kuan Thye, Jodi Woan-Fei Law, Loh Teng-Hern Tan, Priyia Pusparajah, Hooi-Leng Ser, Sivakumar Thurairajasingam, Vengadesh Letchumanan, Learn-Han Lee
      Biology.2022; 11(1): 61.     CrossRef
    • Health-related quality of life among COVID-19 individuals: A cross-sectional study in Tamil Nadu, India
      Suganya Barani, Tarun Bhatnagar, Meenakumari Natarajan, Kumari Gayathri, Harshal Bhimrao Sonekar, Akhil Sasidharan, T.S. Selvavinayagam, Bhavani Shankara Bagepally
      Clinical Epidemiology and Global Health.2022; 13: 100943.     CrossRef
    • Evaluation of post-COVID health status using the EuroQol-5D-5L scale
      Siddhi Hegde, Shreya Sreeram, Kaushik R Bhat, Vaishnavi Satish, Sujith Shekar, Mahesh Babu
      Pathogens and Global Health.2022; 116(8): 498.     CrossRef
    • European Respiratory Society statement on long COVID follow-up
      Katerina M. Antoniou, Eirini Vasarmidi, Anne-Marie Russell, Claire Andrejak, Bruno Crestani, Marion Delcroix, Anh Tuan Dinh-Xuan, Venerino Poletti, Nicola Sverzellati, Michele Vitacca, Martin Witzenrath, Thomy Tonia, Antonio Spanevello
      European Respiratory Journal.2022; 60(2): 2102174.     CrossRef
    • Quality of life of COVID 19 patients after discharge: Systematic review
      H. M. R. K. G. Nandasena, M. L. Pathirathna, A. M. M. P. Atapattu, P. T. S. Prasanga, Mohamed A Yassin
      PLOS ONE.2022; 17(2): e0263941.     CrossRef
    • Factors Associated with Poor Treatment Outcome among Hospitalized COVID-19 Patients in South Central, Ethiopia
      Abdene Weya Kaso, Habtamu Endashaw Hareru, Taha Kaso, Gebi Agero, Mohd Saeed
      BioMed Research International.2022; 2022: 1.     CrossRef
    • The health-related quality of life in patients with post-COVID-19 after hospitalization: a systematic review
      Eduardo Augusto Barbosa Figueiredo, Whesley Tanor Silva, Sabrina Pinheiro Tsopanoglou, Débora Fernandes de Melo Vitorino, Luciano Fonseca Lemos de Oliveira, Keity Lamary Souza Silva, Hiago Daniel Herédia Luz, Matheus Ribeiro Ávila, Lucas Fróis Fernandes d
      Revista da Sociedade Brasileira de Medicina Tropic.2022;[Epub]     CrossRef
    • Quality of life during COVID-19 pandemic: a community-based study in Dakahlia governorate, Egypt
      Shorouk Mohsen, Ragaa El-Masry, Olfat Farag Ali, Doaa Abdel-Hady
      Global Health Research and Policy.2022;[Epub]     CrossRef
    • Quality of life (QoL) among COVID-19 recovered healthcare workers in Bangladesh
      Md Utba Rashid, Md Abdullah Saeed Khan, Koustuv Dalal, Soumik Kha Sagar, Mosharop Hossian, Sabrina Yesmin Barsha, Miah Md. Akiful Haque, Mohammad Ali Hossain, Mohammad Hayatun Nabi, Mohammad Delwer Hossain Hawlader
      BMC Health Services Research.2022;[Epub]     CrossRef
    • ASSESSMENT OF QUALITY OF LIFE AND EFFECTS IN RECOVERED AND VACCINATED COVID-19 POPULATION: A CROSS-SECTIONAL OBSERVATIONAL STUDY
      VANLALFAKZELI, VARADHA PAYANGOTT, ABUBAKER SIDDIQ
      International Journal of Pharmacy and Pharmaceutic.2022; : 1.     CrossRef
    • The Persistent Symptoms and Decreased Quality of Life of COVID-19 Patients (A 3-month Follow-up after Discharge)
      Nur Farhanah, Charles Budiman, Muchlis Achsan Udji Sofro, Budi Riyanto, Suharyo Hadisaputro, Muhammad Hussein Gasem
      Open Access Macedonian Journal of Medical Sciences.2022; 10(B): 1419.     CrossRef
    • Knowledge, Attitudes, and Practices Regarding “New Normal” Guidelines and Quality of Life Among Thai People During the COVID-19 Outbreak: An Online Cross-Sectional Survey
      Pathavee Waewwab, Wirichada Pan-ngum, Sukhontha Siri, Bhophkrit Bhopdhornangkul, Wiriya Mahikul
      Frontiers in Public Health.2022;[Epub]     CrossRef
    • Patterns in the relationship between acute COVID-19/long COVID-19 and quality of life: A cross-sectional study of patients attending a tertiary care hospital in Turkey
      Hakan Tuzun, Cansu Özbaş, Burkay Budak, Gizem Altunay, FN Baran Aksakal
      Asian Pacific Journal of Tropical Medicine.2022; 15(6): 274.     CrossRef
    • The effect of coronavirus disease-2019 (COVID-19) according to gender on health-related quality of life
      Betül ÇİFTÇİ
      Journal of Health Sciences and Medicine.2022; 5(4): 1030.     CrossRef
    • Health-Related Quality of Life of Moroccan COVID-19 Survivors: A Case-Control Study
      Asmaa Azizi, Doha Achak, Elmadani Saad, Abderraouf Hilali, Chakib Nejjari, Mohamed Khalis, Ibtissam Youlyouz-Marfak, Abdelghafour Marfak
      International Journal of Environmental Research an.2022; 19(14): 8804.     CrossRef
    • Food Intake Changes and Their Impact on Quality of Life in Spanish Citizens with and without COVID-19 during Lockdown
      María García-de-Miguel, Elisabet Huertas-Hoyas, Jorge Pérez-Corrales, Cristina Rodríguez-Rivas, Cristina García-Bravo, Sara García-Bravo, Lucía Rocío Camacho-Montaño
      Healthcare.2022; 10(8): 1414.     CrossRef
    • Health-Related Quality of Life and Its Socio-Demographic and Behavioural Correlates during the COVID-19 Pandemic in Estonia
      Merili Tamson, Rainer Reile, Diana Sokurova, Kaire Innos, Eha Nurk, Kaia Laidra, Sigrid Vorobjov
      International Journal of Environmental Research an.2022; 19(15): 9060.     CrossRef
    • Quality of life among patients with chronic non-communicable diseases during COVID-19 pandemic in Southern Ethiopia: A cross-sectional analytical study
      Mohammed Ayalew, Bedilu Deribe, Siraj Hussen, Semira Defar, Abel Gedefaw
      Frontiers in Psychiatry.2022;[Epub]     CrossRef
    • Calidad de vida relacionada a la salud en personas con COVID-19, internados en un establecimiento hospitalario en el Callao.
      Diana Karim Matta Solis
      Revista Cuidado y Salud Pública.2022; 2(1): 56.     CrossRef
    • Headache in Post-COVID-19 Patients: Its Characteristics and Relationship with the Quality of Life
      Endang Mutiawati, Hendrix Indra Kusuma, Marhami Fahriani, Harapan Harapan, Syahrul Syahrul, Nasrul Musadir
      Medicina.2022; 58(10): 1500.     CrossRef
    • Quality of Life in COVID-19 Outpatients: A Long-Term Follow-Up Study
      Vincent Tarazona, David Kirouchena, Pascal Clerc, Florence Pinsard-Laventure, Bastien Bourrion
      Journal of Clinical Medicine.2022; 11(21): 6478.     CrossRef
    • Health-Related Quality of Life and Associated Factors Among Covid-19 Survivors. Experience from Ethiopian Treatment Centers
      Abdene Weya Kaso, Hailmariam Getachew Tesema, Habtamu Endashaw Hareru, Taha Kaso, Zemachu Ashuro, Adugna Asefa Talemahu, Soressa Tafere Jore, Reta Kassa, Gebi Agero, Alemayehu Hailu
      Infection and Drug Resistance.2022; Volume 15: 6143.     CrossRef
    • Long COVID-19 and Health-Related Quality of Life of Mild Cases in Korea: 3-Months Follow-up of a Single Community Treatment Center
      Hi Sun Soh, BeLong Cho
      Journal of Korean Medical Science.2022;[Epub]     CrossRef
    • Health-related quality of life in survivors of severe COVID-19 infection
      Gabriele d’Ettorre, Paolo Vassalini, Vincenzo Coppolelli, Elio Gentilini Cacciola, Letizia Sanitinelli, Luca Maddaloni, Silvia Fabris, Claudio M. Mastroianni, Gabriella d’Ettorre, Giancarlo Ceccarelli
      Pharmacological Reports.2022; 74(6): 1286.     CrossRef
    • Impact of COVID-19 and effects of BNT162b2 on patient-reported outcomes: quality of life, symptoms, and work productivity among US adult outpatients
      Manuela Di Fusco, Xiaowu Sun, Mary M. Moran, Henriette Coetzer, Joann M. Zamparo, Laura Puzniak, Mary B. Alvarez, Ying P. Tabak, Joseph C. Cappelleri
      Journal of Patient-Reported Outcomes.2022;[Epub]     CrossRef
    • Health-related quality of life of children and adolescents with type 1 diabetes during the COVID-19 pandemic in Kuwait
      Dalia Al-Abdulrazzaq, Doaa Khalifa, Taiba Alqaisi, Fatima Al-Juailla, Fouzeyah Othman, Sarah Qabazard, Hessa Al-Kandari
      Frontiers in Public Health.2022;[Epub]     CrossRef
    • Updated APLAR consensus statements on care for patients with rheumatic diseases during the COVID‐19 pandemic
      Lai‐Shan Tam, Yoshiya Tanaka, Rohini Handa, Zhanguo Li, Jose Paulo Lorenzo, Worawit Louthrenoo, Catherine Hill, Kevin Pile, Philip C. Robinson, Leonila F. Dans, Li Yang Hsu, Sang‐Min Lee, Jiacai Cho, A. T. M. Tanveer Hasan, Babur Salim, Saba Samreen, Syah
      International Journal of Rheumatic Diseases.2021; 24(6): 733.     CrossRef
    • Physical and mental health complications post-COVID-19: Scoping review
      Sanaz Shanbehzadeh, Mahnaz Tavahomi, Nasibeh Zanjari, Ismail Ebrahimi-Takamjani, Somayeh Amiri-arimi
      Journal of Psychosomatic Research.2021; 147: 110525.     CrossRef
    • Avoiding Trouble Ahead: Lessons Learned and Suggestions for Economic Evaluations of COVID-19 Vaccines
      Chris Painter, Wanrudee Isaranuwatchai, Juthamas Prawjaeng, Hwee Lin Wee, Brandon Wen Bing Chua, Vinh Anh Huynh, Jing Lou, Fang Ting Goh, Nantasit Luangasanatip, Wirichada Pan-Ngum, Wang Yi, Hannah Clapham, Yot Teerawattananon
      Applied Health Economics and Health Policy.2021; 19(4): 463.     CrossRef
    • Protocol for the economic evaluation of COVID-19 pandemic response policies
      Brandon Wen Bing Chua, Vinh Anh Huynh, Jing Lou, Fang Ting Goh, Hannah Clapham, Yot Teerawattananon, Hwee Lin Wee
      BMJ Open.2021; 11(9): e051503.     CrossRef
    • Quality of life of COVID-19 recovered patients in Bangladesh
      Mohammad Delwer Hossain Hawlader, Md. Utba Rashid, Md. Abdullah Saeed Khan, Tasnim Ara, Mohammad Hayatun Nabi, Miah Md. Akiful Haque, Kazi Farhana Matin, Mohammad Ali Hossain, Mahfil Ara Rahman, Mosharop Hossian, Shuvajit Saha, Ridwana Maher Manna, Md. Ye
      PLOS ONE.2021; 16(10): e0257421.     CrossRef
    • Investigating the COVID-19 related behaviors in the public transport system
      Fatemeh Bakhtari Aghdam, Homayoun Sadeghi-Bazargani, Kavous Shahsavarinia, Fatemeh Jafari, Leila Jahangiry, Neda Gilani
      Archives of Public Health.2021;[Epub]     CrossRef
    • Impact of Covid-19 on health-related quality of life of patients: A structured review
      Ak Narayan Poudel, Shihua Zhu, Nicola Cooper, Paul Roderick, Nisreen Alwan, Carolyn Tarrant, Nida Ziauddeen, Guiqing Lily Yao, Prasenjit Mitra
      PLOS ONE.2021; 16(10): e0259164.     CrossRef
    • Comprehensive and long-term surveys of COVID-19 sequelae in Japan, an ambidirectional multicentre cohort study: study protocol
      Kensuke Nakagawara, Ho Namkoong, Hideki Terai, Katsunori Masaki, Takae Tanosaki, Kyoko Shimamoto, Ho Lee, Hiromu Tanaka, Satoshi Okamori, Hiroki Kabata, Shotaro Chubachi, Shinnosuke Ikemura, Hirofumi Kamata, Hiroyuki Yasuda, Ichiro Kawada, Makoto Ishii, Y
      BMJ Open Respiratory Research.2021; 8(1): e001015.     CrossRef
    • Determinants of quality of life among COVID-19 patients in Southwestern region of Bangladesh
      Md. Injamul Haq Methun, M. Sheikh Giash Uddin, Iqramul Haq, Md. Asaduzzaman Noor, Md. Jakaria Habib, Md. Ismail Hossain, Ahmed Abdus Saleh Saleheen, Sutopa Roy, Shatabdi Shamrita Ume, Md. Rukonozzaman Rukon, Md. Amit Hasan, Md. Jahangir Alam
      Indian Journal of Medical Sciences.2021; 74: 15.     CrossRef
    • Evaluation of health-related quality of life of Covid-19 patients: a hospital-based study in South Central Ethiopia
      Abdene Weya Kaso, Gebi Agero, Zewdu Hurisa, Taha Kaso, Helen Ali Ewune, Alemayehu Hailu
      Health and Quality of Life Outcomes.2021;[Epub]     CrossRef
    • Cardiovascular diseases, social and demographic factors, and quality of life in convalescents of COVID-19-associated pneumonia three months after hospital discharge
      O.A. Guskova, E.I. Yaroslavskaya, B.Yu. Prilenskii, T.I. Petelina
      Profilakticheskaya meditsina.2021; 24(11): 36.     CrossRef
    • Health-Related Quality of Life Among COVID-19 Individuals: A Cross-Sectional Study in Tamil Nadu, India, 2020
      Suganya Barani, Tarun Bhatnagar, Meenakumari Natarajan, Kumari Gayathri, Harshal Sonekar, Akhil Sasidharan, T S Selvavinayagam, Bhavani Shankara Bagepally
      SSRN Electronic Journal .2021;[Epub]     CrossRef
    • Efficacy of Ayurveda and Yoga in the management of SARS-CoV-2: Two case reports
      RajaRam Mahto, Arshath Jyothi, Aparna Dileep, Archana Shukla, Aleena Gauri
      Journal of Ayurveda Case Reports.2020; 3(4): 127.     CrossRef

    Figure

    PHRP : Osong Public Health and Research Perspectives