Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Life”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 289 records · Page 16Linked to original sources
PubMed1997

Comparison of multiple-dose and once-daily nitrate therapy in 1212 patients with stable angina pectoris: effects on quality of life indices. Dutch Mononitrate Quality of Life (DUMQOL) Study Group.

BACKGROUND: Nitrates, although important for the management of anginal symptoms, produce significant side effects. Little is known about their net effects on health-related, quality-of-life indices. METHODS: In a self-controlled, 6-month study, the effects on symptoms and quality of life of multiple-dose and once-daily nitrate therapy were evaluated in 1212 patients with stable angina pectoris. Quality of life was assessed by a test battery based on the exercise-tolerance index of Wiklund, the psychological well-being index of Dupuy, and the Short Form 36 questionnaire of Stewart. The internal consistency and reliability of the multi-item scales were estimated by Cronbach's alpha coefficients. RESULTS: The effects of the two treatment regimens on pain index and number of additional sublingual nitrate tablets required were not different. However, based on the New York Heart Association (NYHA) angina classification, patients improved better on the once-daily than on the multiple-dose regimen: by > 1 category in 281 vs 62 of the patients (P < 0.0001); mobility and psychological distress indices also improved (P = 0.006, and P = 0.007). CONCLUSIONS: Once-daily nitrate therapy not only provides a better NYHA angina classification than multiple-dose therapy does, but also provides a better quality of life as estimated by improvement of mobility and distress indices, the most important indicators of quality of life in this category of patients.

Activities of Daily Living↗
PubMed2005

Use of the Pediatric Quality of Life Inventory to assess the health-related quality of life in children with recurrent respiratory papillomatosis.

OBJECTIVES: The objective of this study was to use the Pediatric Quality of Life Inventory (PedsQL), a 23-question modular instrument designed to measure the health-related quality of life (HRQOL) in children and adolescents, to compare the HRQOL in children with recurrent respiratory papillomatosis (RRP) with the HRQOLs reported for healthy children and children with other chronic medical conditions. METHODS: The PedsQL version 4.0 Generic Core Scales consist of 23 questions in 4 subscales (Physical, Emotional, Social, and School Functioning) for parent-proxy reporting on the HRQOL in children ages 2 to 4 years, parent reporting for children 5 to 18 years, and child self-reporting for ages 5 to 7 years (age-adjusted questions and rating scales) and 8 to 18 years. The questionnaires were administered in person or by telephone to 22 children with RRP and (or, for children 2 to 4 years of age) one parent recruited from a tertiary pediatric otolaryngology practice. The results were compared with validated norms for healthy children and scores for children whose parents reported a chronic medical condition. RESULTS: Compared with healthy controls, the children 5 to 18 years of age with RRP self-reported a significantly (p < .05) worse HRQOL as measured by the PedsQL Total Score, Psychosocial Health score (a combination of Emotional, Social, and School Functioning Scores), and Social Functioning and School Functioning scores. Self-reported scores for the children 5 to 18 years of age with RRP compared with children with other chronic illnesses followed the same trend, and the difference approached statistical significance (p = .05) for the School Functioning Subscale scores. The parent-proxy report (for children 2 to 18 years of age) scores for children with RRP were significantly lower (p < .0001) on every scale and in total compared with scores for healthy children. Compared with scores of children with other chronic medical conditions, the parent-proxy report scores were significantly lower for psychosocial health (p = .005) and school functioning (p < .0001). CONCLUSIONS: Children with RRP report a lower quality of life than do those who are healthy, and a quality of life similar to that of those who have other chronic medical problems. The parent reports also reflect a lower quality of life for children affected by this disease, as compared with healthy children. The PedsQL demonstrated a statistically significant low HRQOL in children with RRP; however, the clinical implications of this finding appear trivial. A distinct, disease-specific survey for RRP, if developed, would have enhanced responsiveness and sensitivity to change (due to the natural course of the disease and/or surgical treatments).

Adolescent↗
PubMedDate not supplied

Statistical methods that distinguish between attributes of assessment: prolongation of life versus quality of life.

The authors propose a method to generate information relevant to the decision tree that adds additional perspective to the characterization of health quality during survival. Their approach uses survival data to distinguish two attributes of utility: prolongation of life and quality of life (QOL). Health-state transition probabilities correspond to the prolongation of life and are modeled in a discrete-time transient semi-Markov process. Quality-of-life-state transition probabilities are derived from the assumptions of a simple recurrent Markov process. They reflect events within the health-state sojourn time that differentiate perceptions of pain and suffering over a short fixed time period. Outcomes for these two dimensions of utility are highly relevant to the assessment of medical technology that might prolong life at the cost of increased pain and suffering, implying a reduced QOL. The methods are demonstrated on a subset of follow-up data from the Beta-Blocker Heart Attack Trial (BHAT).

Adult↗
PubMed2004

Is quality of life a healthy concept? Measuring and understanding life experiences of older people.

The concept of quality of life has received considerable attention as an inclusive notion of health and as a basis for health interventions. The authors' argument in this article is that notwithstanding this attention, little consensus exists as to definition of the term. In addition, a focus on measurement has led to the neglect of wider aspects of quality of life. Such difficulties are particularly relevant to the study of quality of life of older people. Analysis of interview data suggests that older people's understandings of quality of life are not readily measurable and should be viewed in terms of phenomenological experience. The authors discuss the implications for studying quality of life of this group and difficulties for the concept itself.

Age Factors↗
PubMedDate not supplied

Is there congruence in hospice nurses' view of their patients' quality of life and their hospice patients' view of their own quality of life?

Since the development of the hospice movement in the United States, care of the terminally ill has undergone vital change. This change involves the alternative of home care for the terminally ill. It allows the patients, the primary caregiver, and the rest of the family to be in control of care. As stated by Masters, hospice is unique in that the patient and family controls the environment, and lifestyle, including treatment modalities, more than in any other concept in health care. Hospice was developed to give people with a terminal illness an option to traditional medicine. Hospice is a concept of care that has been established to improve the quality of life of the terminally ill. Therefore, the ultimate goal of hospice care is to enhance the quality of life of patients with terminal illness, mainly cancer. In the hospice setting, the nurse applies a holistic approach when planning and providing primary care. The nurse becomes increasingly more knowledgeable about the problems and strengths of the patient and family to whom he/she is caring for. The nurse must make the transition in her philosophy from cure-to-care in hospice, and symptom control being the nurses' priority in order to enhance the patients quality of life. Curtis and Fernsler explain that hospice care focuses on helping patients to communicate effectively and to share life agendas with their primary caregiver and the hospice nurse. These researchers continue to state that these efforts promote congruence between patient, primary caregiver, and the hospice nurses' view of the patients quality of life.(ABSTRACT TRUNCATED AT 250 WORDS)

Attitude of Health Personnel↗
PubMed2005

Health-related quality of life in young survivors of childhood cancer using the Minneapolis-Manchester Quality of Life-Youth Form.

OBJECTIVE: To assess the health-related quality of life (HRQL) of 8- to 12-year-old children undergoing therapy for cancer or childhood-cancer survivors by using the Minneapolis-Manchester Quality of Life-Youth Form (MMQL-YF), a comprehensive, multidimensional self-report instrument with demonstrable reliability and validity. DESIGN, SETTING, AND PATIENTS: The MMQL-YF consists of 32 items comprising 4 scales: physical functioning, psychologic functioning, physical symptoms, and outlook on life. Scoring on the MMQL ranges from 1 to 5; 5 indicates maximal HRQL. An overall quality-of-life (QOL) score is also computed. By using a cross-sectional study design, the MMQL-YF was administered to 90 off-therapy cancer survivors, 72 children with cancer undergoing active therapy, and 481 healthy children without a history of cancer or other chronic disease. RESULTS: Compared with healthy controls, children actively undergoing cancer treatment report low overall QOL, physical functioning, and outlook-on-life scores. However, off-therapy survivors report a superior overall QOL, compared with age-matched healthy controls. CONCLUSIONS: Young survivors of childhood cancer report a favorable HRQL relative to healthy controls. These results are reassuring, suggesting that this group of survivors may have been too young to encounter some of the negative psychosocial impacts of cancer and its treatment.

Case-Control Studies↗
PubMed2000

Increasing the hematocrit has a beneficial effect on quality of life and is safe in selected hemodialysis patients. Spanish Cooperative Renal Patients Quality of Life Study Group of the Spanish Society of Nephrology.

Target hematocrit/hemoglobin values in dialysis patients are still controversial. The Spanish Cooperative Renal Patients Quality of Life Study Group (including 34 hemodialysis units) conducted a prospective, 6-mo study of the effect on patient functional status and quality of life of using epoetin to achieve normal hematocrit in hemodialysis patients with anemia. The possible adverse effects of increased hematocrit, patient hospitalization, and epoetin requirements were also studied. The study included 156 patients (age range, 18 to 65 yr). Given the minimal experience in the safety of increasing hematocrit in dialysis patients to normal levels with epoetin, stable patients on hemodialysis who had received epoetin treatment for at least 3 mo and had a stable hemoglobin level of > or = 9 g/dl were included in the study. Patients with antecedents of congestive cardiac failure, ischemic cardiopathy, diabetes mellitus, uncontrolled hypertension, cerebrovascular accident or seizures, malfunction of the vascular access or severe comorbidity (defined by a comorbidity index), and those over 65 yr of age were excluded from the study. Quality of life was measured with the Sickness Impact Profile (SIP) and Karnofsky scale. Patients completed questionnaires at home at onset and conclusion of the 6-mo study. Mean hematocrit increased from 30.9 to 38.4% and hemoglobin from 10.2 to 12.5 g/dl during the study. Health indicator scores improved significantly: mean Physical Dimension (SIP) from 5.38 to 4.1 (P < 0.005); mean Psychosocial Dimension from 9.2 to 7 (P < 0.001); mean global SIP from 8.9 to 7.25 (P < 0.001); mean Karnofsky scale score from 75.6 to 78.4 (P < 0.01). (SIP is scaled so that lower scores represent better functional status, and vice versa for the Karnofsky scale). Therefore, functional status and quality of life improved with increased hematocrit. No deaths occurred. Three patients (2%) were censored for hypertension and nine (5.7%) for thrombosis of the vascular access. The cumulative probability of thrombosis of the vascular access was 0.067. The average epoetin dose rose from 93 +/- 62 U/kg per wk at onset to 141 +/- 80 U/kg per wk at conclusion, a 51% increase. The number of patients hospitalized decreased and hospital lengths of stay were shorter during the study period than in the same patients in the 6-mo period preceding the study (P < 0.05). Nine patients (5.7%) had thrombosis of the vascular access. There were no changes in the prevalence of arterial hypertension, but three patients (2%) showed hypertension that was difficult to control. It is concluded that normalization of hematocrit in selected hemodialysis patients, i.e., nondiabetic patients without severe cardiovascular or cerebrovascular comorbidities, improves quality of life and decreases morbidity without significant adverse effects.

Adult↗
PubMed2001

Quality of life and utility in patients with non-small cell lung cancer. Quality-of-life Study Group of the Master 2 Project in Pharmacoeconomics.

BACKGROUND: Although several studies have determined quality of life in patients with lung cancer, there is still little information about the use of generic questionnaires [e.g. the 36-item Short Form health survey (SF-36)] and utility questionnaires [e.g. the EuroQOL instrument (EQ-5D)] in this disease. OBJECTIVES: To (i) measure quality of life and utility in patients with non-small cell lung cancer (NSCLC) using the SF-36 and the EuroQOL questionnaires; (ii) to evaluate the impact of some clinical variables on quality of life and utility; (iii) to assess the correlation between the measurements produced by the 2 questionnaires. STUDY DESIGN: Cross-sectional study. PARTICIPANTS: 95 patients from 15 Italian hospitals with NSCLC (93% male, mean age 62 years) completed both questionnaires. RESULTS: The mean scores for the 8 domains of the SF-36 ranged from 20.8 (physical role) to 63.0 (social functioning). The mean physical and mental summed scores of the SF-36 were 36.8 [standard deviation (SD) 9.8] and 43.0 (SD 11.5), respectively. The EuroQOL mean score was 0.58 (SD 0.32) in the self-classifier (SC) version and 0.58 (SD 0.20) in the visual analogue scale (VAS) version. Among the clinical variables that affected quality of life and utility, the presence of metastasis had the greatest impact: patients with metastasis had statistically significantly lower scores for 2 domains of the SF-36 (physical functioning, p = 0.009; bodily pain, p = 0.016), for the physical component summed score of the SF-36 (p = 0.015) and for both utility estimates (EuroQOL-SC, p = 0.027; EuroQOL-VAS, p = 0.038) than patients without metastasis. Both the SC and VAS EuroQOL scores showed a statistically significant correlation with each of the 8 domains of the SF-36. The scores for both the SF-36 and the EuroQOL in patients with NSCLC were considerably worse (relative differences ranging from -8 to -73%) than the corresponding values (normative data) previously reported for healthy individuals. CONCLUSIONS: Our study quantified the degree to which quality of life is impaired in patients with NSCLC, showed that the presence of metastasis had an important role, and indicated a strong correlation between the measurements produced by the 2 questionnaires. The EuroQOL measurements obtained from these patients will aid evaluation of the cost-utility ratio for NSCLC therapies.

Aged↗
PubMed1999

The relative accuracy of the clinical estimation of the duration of life for patients with end of life cancer.

BACKGROUND: Although the prediction of the duration of life of patients with end of life cancer most often relies on the clinical estimation of survival (CES) made by the treating physician, the accuracy and practical value of CES remains controversial. METHODS: The authors prospectively evaluated the accuracy of CES in an inception and population-based cohort of 233 cancer patients who were seen at the onset of their terminal phase. They also systematically reviewed the literature on CES in advanced or end-stage cancer patients in MEDLINE, CANCERLIT, and EMBASE data bases, using two search strategies developed by a research librarian. RESULTS: CES had low sensitivity in detecting patients who died within shorter time frames (< or =2 months), and a tendency to overestimate survival was noted. A moderate correlation was observed between actual survival (AS) and CES (Pearson correlation coefficient = 0.47, intraclass correlation coefficient = 0.46, weighted kappa coefficient = 0.42). CONCLUSIONS: Treating physicians appear to overestimate the duration of life of end of life ill cancer patients, particularly those patients who die early in the terminal phase and who may potentially benefit from earlier participation in palliative care programs. CES should be considered one of many criteria, rather than a unique criterion, by which to choose therapeutic intervention or health care programs for patients in the end of life cancer phase.

Adult↗
PubMed2004

[Effect of a life review process to improve quality of life for the homebound elderly in Japan].

OBJECTIVE: This study examined the therapeutic effects of Life Review processes on physical and psychological functions of homebound elderly in Japan. METHODS: From 1998, a cohort of people aged 65 and over living in two cities in Yamagata Prefecture has been followed. Sixty-three subjects (24 men, 39 women) were classified as rank A (homebound). Fifty-two persons completed the baseline survey in 1999 and 46 eligible persons (18 men and 28 women) were allocated to intervention and control groups whose age and sex distribution were matched. Intervention entailed giving some health information and Life Review processing for four months, twice a month on average. Each session started with provision of health information followed by the Life Review process which took an hour to finish. All subjects of both groups were assessed for dependent variables at the beginning and the end of the intervention period (pretest and post-test). Dependent variables were physical (Activities of Daily Living, Visual deficit, and others), psychological (subjective health, life satisfaction, self-efficacy scale, and others), and social (functional ability and frequency of getting out of the house). The control group received only the pretest and the post-test. RESULTS: Pretest scores for all physical, psychological, and social variables did not significantly differ between the two groups. The rate for improvement/no change were higher with regard to hearing deficit, ADL (eating, dressing), cognition, subjective health, ikigai and frequency of getting out of house in the intervention group than in the control group, but there were no significant differences. CONCLUSION: The developed intervention program featuring delivery of health information and structured Life Review Process had no negative influence on physical and psycho-social functions. Practicability of the intervention was suggested. But the study highlights problems such as selection of subjects, duration and method of intervention.

Aged↗
PubMed2006

[Word patterns in the LIM (Life-line Interview Method) / life story].

In this exploratory study, life story data on the word patterns in the LIM (Life-line Interview Method) are reported for 98 men and women, almost equally divided over a younger (18-30), a middle-aged (31-55) and an older (56-84) age group. All respondents tell about their past in great detail, but have a short view of the future. In terms of word frequency are memories (past) and expectations (future) in the proportion of about five to one. As expected, older persons need more words for telling their past story than younger people; word counts of the future life story, however, do not yield in any difference between young, middle-aged and older men and women. In general, the word frequency for memories of negative and positive life events is in the proportion of about three to two. The significance of the LIM word patterns for practical interventions (reminiscence, life-review) is discussed briefly.

Adolescent↗
PubMed1985

Mortality in Japanese with life-styles similar to Seventh-Day Adventists: strategy for risk reduction by life-style modification.

Using 16 years of follow-up results of a prospective cohort study for 122,261 men, 95% of the census population, aged 40 years and older in 29 Health Center Districts in Japan as subjects, we compared the age-standardized mortality rates for cancer of each site and other causes of death in Japanese with life-styles similar to those of Seventh-Day Adventists (SDA), i.e., no smoking, no drinking, no meat consumption daily and eating green and yellow vegetables daily, with those of Japanese with opposite life-styles. Compared with the latter Japanese, the risks were one-fifth or less in Japanese with SDA-like life-styles for cancers of the mouth, pharynx, esophagus, and lung, and subarachnoid hemorrhage. Risks were less than one-half for cancers of all sites, stomach, and liver, and for peptic ulcer and heart disease. As a single factor, the addition of daily smoking was observed to elevate the risk most strikingly in Japanese who followed SDA life patterns. Influences of further addition of habits of daily drinking of alcohol and dietary changes were significant for cancers of the esophagus, liver, and bladder and other selected diseases. Strategies for cancer prevention by means of life-style modification, e.g., increased consumption of green and yellow vegetables, were discussed.

Adult↗
PubMed1994

["Single shot" prevention in abdominal surgery. Antibiotics with long half-life (ceftriaxone, ornidazole) vs. antibiotics with short half-life (cefazolin, metronidazole, clindamycin)].

Single-shot antibiotic prophylaxis is well established in abdominal surgery. There is evidence suggesting that it prevents wound infections and some authors report also prevention against postoperative urinary tract infection and pneumonia. From April 1988 to December 1990 we randomly assigned 429 patients with gastro-intestinal operations to a defined protocol: 210 patients (5 drop-outs) with elective operations of the upper GI-tract were given Ceftriaxone (half-life 8 hours, 102 patients) or Cefazolin (half-life 2 hours, 103 patients). 117 (12 drop-outs) patients with operations of the lower GI-tract were given Ceftriaxone/Ornidazole (half-life 13 hours, 50 patients) or Cefazolin/Metronidazole (half-life 8 hours, 55 patients). 102 (20 drop-outs) patients with appendicitis were given Ornidazole (40 patients) or Clindamycin (42 patients). There were no differences in sex, age or type of operation in the different groups. The overall postoperative infection-rate was low. In the upper GI-tract we found one wound infection in both groups, in the lower GI-tract two wound infections in the Ceftriaxone/Ornidazole-group vs. nine in the Cefazolin/Metronidazole-group (p < 0.05). In patients with appendicitis there were three infections in the Ornidazole-group and four in the Clindamycin-group. There was no statistically significant difference in pulmonary or urinary tract infections in all groups. Although the protocol for antibiotics with a short half-life included a second dose of antibiotics in cases of operations with a duration of more than four hours, this was forgotten in 19 of 39 concerned patients (49%!).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Cognition and life stress in depression: cognitive factors and the definition, rating, and generation of negative life events.

The relationship between cognitive factors and different conceptualizations and measures of life stress poses important questions for contemporary theories of depression. We examined whether cognitive factors (dysfunctional attitudes and attributional style) are related to the definition, rating, and generation of negative life events. Life events were assessed with both subjective self-report and more objective interview-based methods in endogenously depressed outpatients. The results partially support the hypothesis that cognitive factors are related to definition and severity ratings of self-report measures of particular types of life events. These relationships held primarily for achievement, as compared with interpersonal, events. The results also support the hypothesis that elevated scores on measures of cognition are associated with the number of objectively defined events occurring prior to the onset of depression, suggesting that some patients may generate the life events that in turn may initiate a depressive episode.

Adult↗
PubMedDate not supplied

Life stress and risk of precancerous cervical lesions: a pretest directed by the life stress model.

PURPOSE/OBJECTIVES: To present the results of a pilot study to pretest instruments designed to measure selected variables named in the Life Stress Model, a model of health outcomes. Additional aims were to determine the effect of completing personal risk assessments for precancerous squamous-cell intraepithelial lesions of the cervic (SIL) on receptivity to cervical cancer prevention information and to extend knowledge of stressful life events experienced by inner-city women attending high-risk health clinics. DESIGN: Cross-sectional. SAMPLE: 20 adult women attending high-risk prenatal or human immunodeficiency virus (HIV) outpatient clinics in one of two New York City hospitals. Most were recovering drugs abusers; half were diagnosed with HIV infections. METHODS: Data were collected by self-report using standard measures. Demographics, medical histories of immunosuppressive states, and investigator-developed screening inventories of behavioral and dietary risk factors associated with SIL also were administered. MAIN RESEARCH VARIABLES: Life event stressors, psychological state, social support, symptom distress, and SIL diagnosis. FINDINGS: Instruments met acceptable psychometric standards for internal consistency, but the standard measure of stressful life events did not capture the full range of stressors experienced by this group of patients: hovering relatives, abusive spouses, HIV diagnosis, changes in welfare benefits, the HIV status of the unborn, and mandatory foster care. Although unable to recall cancer histories of family members, about half of the women who completed study instruments were interested in receiving more information cervical cancer. Exploratory analyses suggest that women diagnosed with SIL experience more psychological distress and family disfunction than women without SIL. CONCLUSIONS: Completing personal SIL risk assessments may stimulate patients' receptivity to cancer risk factor information. Health outcomes studies guided by the Life Stress Model may prove fruitful. IMPLICATIONS FOR NURSING PRACTICE: Cancer risk factor assessments may be an important method for promoting receptivity to cancer prevention information.

Adult↗
PubMed1977

Life events and schizophrenia. II. Impact of life events and symptom configuration.

This study investigates the impact of life events on symptom configuration in a group of 132 posthospitalized schizophrenics living in the community. Multivariate techniques were used to isolate specific dimensions of symptoms and to study the influence of life events, viewed in terms of number, the psychological control dimension, and qualitative nature, in contrast to other factors thought to determine symptoms. Life events exert their greatest influence on nonpsychotic symptoms such as anxiety, depression, and somatic concerns. Aspects of psychotic behavior such as gradiosity, delusions, and looseness of associations appear to be somewhat vulnerable to the impact of life events, particularly those events that are undesirable, social losses, and beyond individual psychological control. We discuss the findings in relation to the issue of causal effect in the study of life events and psychiatric impairment.

Anxiety↗
PubMed1998

Quality of life and end stage renal disease therapeutic programs. DIA-QOL Group. Dialysis quality of life.

Because patients with ESRD cannot be cured of their underlying conditions and because the therapeutic programs have an important impact on the patients' life style, the patient's own assessment of health should have a central place in clinical care. Until now, attention has almost exclusively focused on technical and clinical outcomes, and survival. Functional status, well-being and quality of life, satisfaction with care, or in other words "patient's experience", have been only marginally considered. There is a growing recognition that use of mortality data alone is not the most effective way to asses the quality of care provided to these patients. Generic and disease-specific health issues can be investigated with the use of questionnaires, by asking questions that cover physical, psychological and social domains. Health related quality of life data regarding chronic renal failure, dialysis and transplantation are briefly presented and discussed. These data show differences between patient's subjective feelings and physician's opinions about patients, between objective quality of life indexes and subjective quality of life scores. A more comprehensive view of our patients seems possible and useful.

Erythropoietin↗
PubMed1991

Mortality trend in a rapidly developing economy in Taiwan. Part II: Life expectancy and "potential years of life lost".

Taiwan has made remarkable economic progress in the last 30 years. The life expectancy of its population improved steadily during this period. A male child born in 1983 could look forward to 70.4 years of life and a female child to 75.3 years, gains of 17.5 years and 19.0 years, respectively, since 1950. The potential gains in life expectancy of the Taiwan population are also examined if the five leading causes of death are reduced or eliminated. In addition, this paper discusses the concept of potential productive years of life lost (PYLL), examines the leading causes of premature death and shows how this measure can be used to target prevention programs and health care planning.

Adolescent↗