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Huang, Wenwei, and 黄文伟. "Sub-health and health-related quality of life." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2013. http://hub.hku.hk/bib/B49858713.
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Sub-health has been used to describe an intermediate state between health and disease. The impact of SH on HRQOL deserves more attention because HRQOL is an important goal of health care, and a significant determinant of health service utilization.
The aim of this study was to establish the epidemiology of Sub-health and explore the relationship between SH and HRQOL. Two studies were conducted in Hong Kong.
The first study was to develop and validate a Sub-health questionnaire (SHQ) for classifying people into Health, SH & Disease. The standard 7-step method of development of a psychometric measure was used to develop the SHQ. The initial SHQ, was then field tested on a sample of 13 Chinese adults. Pilot testing of the final version was conducted on 55 Chinese adults to confirm. Psychometric testing by a longitudinal survey on 353 Chinese adults who completed the SHQ, the SF-12v2 Health Survey and a structured questionnaire on sociodemographic data, and health service utilization at baseline, 2 to 4 weeks and 3-month. All HS items had Content Validity Index (CVI) on clarity and relevance of > 75%. The HS items demonstrated good internal consistency (Cronbach’s alpha=0.82). The overall test-retest reliabilities of classification of the health state were moderate with Kappa > 0.57. The SHQ was responsive in detecting a change in health states in 36.4% subjects in 3 months. Item scores of HS scales had significant correlation (r>0.4) with corresponding SF-12v2 scores, and there were significant differences in SF-12v2 summary scores between SHQ groups.
The second was a longitudinal study on Sub-health and HRQOL of general population to evaluate the validity and psychometric property of SHQ, to establish determine the epidemiology SH, and to explore the relationship between HRQOL of SH. 1231 Chinese adults were randomly selected from the general population by telephone survey with the SHQ, SF-12 Health Survey and a structured questionnaire on demographics and service utilization. 353 subjects had completed 3 to 12 months follow up surveys. The prevalence of Sub-health is 40.67% in Hong Kong. There were significant differences in SF-12v2 scores in that SH group had higher scores than those of disease group but lower scores than those of health group. SH was associated with higher use of medical resources than health.
Conclusively, the SHQ is a useful screening tool for the diagnosis of SH. There is a linear relationship between change in health status and changes in HRQOL or health service utilizations. It preliminary explored the clinical relevance of the SH to a culture and health care system that is different from that of mainland China where the concept originated. The results would be useful in populations worldwide if the SHQ could be cross-culturally adapted to identify the SH epidemiology. The study has also, provided evidence supporting the conceptual base of SH in the Chinese medicine context, which may be modifiable by treatment based on TCM Body Constitution classification.published_or_final_version
Family Medicine and Primary Care
Doctoral
Doctor of Philosophy
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Leander, Mai. "Health-Related Quality of Life in Asthma." Doctoral thesis, Uppsala universitet, Arbets- och miljömedicin, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-129626.
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Health-related quality of life (HRQL) has become an important outcome in asthma, since traditional outcomes, such as respiratory symptoms and pulmonary function, might not entirely express the patient’s perception of the limitations caused by the disease. The aim of this thesis was to study HRQL in asthma and to analyse if HRQL was related to asthma onset and prognosis. Other aims were to identify determinants of low HRQL in clinically-verified asthmatics, and to study whether low HRQL was a predictor of mortality. In 1990, a self-administered questionnaire was completed by 12,560 individuals from three age groups (16, 30-39, and 60-69 years) in two counties of Sweden. In a second phase, all subjects who reported a history of obstructive respiratory symptoms (n = 1,851) and 600 randomly-selected controls were invited to a clinical investigation including spirometry, allergy testing, and assessment of HRQL with the Gothenburg Quality of Life instrument. In 2003, the eligible subjects in the cohort (n=11,282) were sent a new questionnaire. Mortality data in the cohort was followed up during 1990–2008 using data from the National Board of Health and Welfare Mortality Database. The 616 subjects with clinically-verified asthma 1990 had significantly lower HRQL than subjects without asthma. In the 2003 follow-up, the 305 subjects with persistent asthma had a lower HRQL than the 155 subjects who showed improvement in asthma during the follow-up. Subjects who had developed asthma by the follow-up had a significantly lower HRQL at baseline than those who did not develop asthma. Significant determinants of quality of life in asthma were female sex, smoking habits, higher airway responsiveness to irritants, respiratory symptom severity, positive skin prick test, and absenteeism from work or school. Low HRQL was related to increased mortality, but this association was not found when analyzing the asthmatic group alone. In conclusion, measurements of HRQL are of value for evaluating both the impact and progression of asthma.
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Garin, Boronat Olatz 1979. "Measuring health related quality of life in heart failure." Doctoral thesis, Universitat Pompeu Fabra, 2013. http://hdl.handle.net/10803/123573.
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L’objectiu global d’aquesta tesis doctoral va ser identificar les fortaleses i limitacions de les mesures de Qualitat de Vida Relacionada amb la Salut desenvolupades específicament per pacients amb insuficiència cardíaca. Una revisió sistemàtica va trobar 7 qüestionaris de Qualitat de Vida Relacionada amb la Salut específics per insuficiència cardíaca: Chronic Heart Failure Assessment Tool (CHAT), Cardiac Health Profile congestive heart failure (CHPchf), Kansas City Cardiomyopathy questionnaire (KCCQ), Left Ventricular Disease Questionnaire (LVDQ), Minnesota Living with Heart Failure questionnaire (MLHFQ), i Quality of Life in Severe Heart Failure Questionnaire (QLSHFQ). L’evidència publicada fins 2006 senyalava el MLHFQ com el qüestionari més estès i recomanable. La versió espanyola del MLHFQ va mostrar característiques similars a l’original, així com també l’avaluació conjunta de versions de 20 països. A més, l’avaluació del model de mesura va confirmar la unidimensionalitat de la puntuació total del MLHFQ, i les seves dimensions física, emocional i social. L’actualització al 2011 de la revisió sistemàtica juntament amb l’avaluació estandarditzada per experts, varen destacar les propietats mètriques del KCCQ per sobre de les del MLHFQ.
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Dunderdale, Karen. "Health-related quality of life in chronic heart failure : development and validation of a patient-centred health-related quality of life measure." Thesis, University of York, 2007. http://etheses.whiterose.ac.uk/9910/.
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Zhu, Haiwei. "Oral health-related quality of life after stroke." Click to view the E-thesis via HKUTO, 2006. http://sunzi.lib.hku.hk/hkuto/record/B37922567.
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Beeken, Rebecca J. "Health-related quality of life and response shift." Thesis, University of Sheffield, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.521916.
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Zhu, Haiwei, and 竺海瑋. "Oral health-related quality of life after stroke." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2006. http://hub.hku.hk/bib/B37922567.
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John, Mike Torsten. "Oral health-related quality of life in Germany /." Thesis, Connect to this title online; UW restricted, 2002. http://hdl.handle.net/1773/10866.
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Hocaoglu, Mevhibe Banu. "Measuring health-related quality of life in Huntingtons' disease." Thesis, University of Reading, 2010. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.553073.
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Huntington's Disease (HD) is a fatal, neurodegenerative disease for which there is no known cure. The thesis describes the impact of Huntington's disease on health-related quality of life and reports the development and validation of the first disease specific questionnaire HDQ-D2 with established psychometric measurement properties which address the aspects of quality of life considered important to persons living with Huntington's disease. Literature review revealed that studies have relied on various generic health and quality of life instruments to measure patient experiences of living with HD. Generic instruments may not capture the reality of living with HD, address its specific aspects and measure its effect on the quality of life of persons sufficiently. A disease specific health-related quality of life (HRQOL) instrument may facilitate research into HRQOL in HD. The 40-item HDQ-D2 was developed on the basis of experiences of persons living with HD and consequently covers areas of concern which are of particular importance to this group. The development and validation process comprised three stages. In-depth interviews with 31 persons living with HD generated items for the item selection questionnaire (HDQ-D1). The 81-HDQ-D1 was administered to 313 persons living with HD in twelve different countries to select 40 items for HDQ-D2. Following pre-testing and pilot testing, the 40- item HDQ-D2 was administered to 261 persons living with HD for psychometric evaluation and assessment of measurement properties. Qualitative data was analysed systematically and sequentially. Statistical analysis of the HDQ-D1 and HDQ-D2 data utilized methods of Classical Test Theory and Item Response Theory in triangulation. The 40-item HDQ-D2 covers six key aspects of HRQOL of persons living with HD: cognitive, hopes and worries, services, physical and functional, mood state, self and vitality. It is an acceptable, reliable and valid instrument to measure the extent of impact of HD on the quality of life of persons living with the condition. HDQ-D2 as an instrument can be used for evaluation as well as for research and practice innovation. HDQ-D2 has three primary, six specific and an summary index scales. Thirty-eight of its items can be used to calculate six specific profile scores; thirty-five of its items can be used to calculate three primary profile scores; and twenty-one of its items can be used to calculate a summary index score. The primary and specific profile scores are useful for measuring the impact of interventions upon particular areas of HRQOL and the summary index score is relevant for evaluation of the overall effect of interventions on HRQOL. The development of HOQ-02 provides the option of using psychometrically based patient-generated questionnaires to measure quality of life of persons living with HO. The study contributed to the body of knowledge by designing the first disease specific instrument for measuring health-related quality of life in persons living with HO. For this reason, this newly developed disease specific HRQOL instrument for persons living with HO is a unique contribution to patient reported outcomes research and tools.
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Johansson, Gunvi. "Oral health-related quality of life and young adults /." Malmö : Dept. of Oral Public Health, Malmö University, 2009. http://hdl.handle.net/2043/8591.
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Ahuja, Vinti. "Oral health related quality of life among Iowa adolescents." Thesis, University of Iowa, 2013. https://ir.uiowa.edu/etd/4943.
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Our study involved secondary analyses of the oral health-related quality of life data collected in the Iowa Fluoride Study at the 17-year time-point. Both adolescents and their parents filled out questionnaires related to the assessment of the OHRQoL of the adolescents. In addition, adolescents also underwent clinical examination to assess dental caries, dental fluorosis, orthodontic characteristics, and non-fluoride opacities. Dental casts were also made with the assent of the participants. These casts were later used to estimate the social acceptability of the participants' dental appearance and assess their malocclusion severity, using the Dental Aesthetic Index (Cons et al, 1978). This study assessed the relationships between the OHRQoL of Iowa adolescents and the presence of selected oral conditions, such as dental caries, dental fluorosis, and malocclusion.
Based on the multivariable analyses, dental caries and malocclusion severity (reflected by DAI score) were the two oral conditions that were found to be significantly associated with poorer OHRQoL in adolescents. In addition, the influence of sex on adolescents' perceptions of OHRQoL was found to be statistically significant in our study and being female was associated with poorer OHRQoL.
The findings of our study corroborate the results of other investigations that have demonstrated significant associations between: i) dental caries and OHRQoL (Arrow P, 2013; Barbosa et al, 2013; Bastos et al, 2012; Castro et al,2010; Do and Spencer, 2007; Martinis et al, 2012); ii) malocclusion and OHRQoL (Foster Page et al., 2005; Do and Spencer, 2007; Locker et al, 2007; Bernabe et al, 2008; Agou et al, 2008; O'Brien et al, 2006; Feu et al, 2010; Ukra et al, 2013); and iii) sex and OHRQoL (Foster Page et al, 2005; Calis et al, 2009; Bos et al, 2010; Barbosa et al, 2013; Ukra et al, 2013).
Thus, oral conditions such as dental caries and malocclusion can be a source of stress and can have a negative impact on the life of an individual and can impede their ability to succeed. Females tend to be more sensitive to the negative impact of oral health conditions. Thus, in order to better understand the impact of oral health conditions, subjective measures should be used in conjunction with normative measures or clinical measures of assessing oral health. This can help in better treatment planning, and better allocation of resources, as oral health perceptions can vary for different individuals.
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Tessier, Annie. "Toward an understanding of weight-related quality of life." Thesis, McGill University, 2010. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=86620.
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Introduction: Obesity is a pandemic that impacts on the ability of people to lead a fulfilling life. Improving the quality of life of obese people (referred to as weight-related quality of life-WRQL) has become a complementary objective to weight loss. The identification of the contributors to WRQL could enable the development of targeted interventions. In addition, WRQL has multiple facets that can be measured. The identification of the content of a measure could ensure that the measure selected consists of domains that are expected to be affected by the intervention. It is important to verify that the definition of a construct has not changed with time and that the content of a measure continues to correspond to people's experience with the condition. The Impact of Weight on Quality Of Life questionnaire (IWQOL-Lite) is widely used. Its content was generated with a sample of 20 participants and has not been revised since its development, 15 years ago.Objective: To improve the effectiveness of interventions for obese people by enhancing the understanding and measurement of the impact of obesity on quality of life.
Methods: Frameworks were hypothesized based on the Wilson Cleary conceptual model and tested on 2 different samples with multiple linear regression, path analysis, and structural equation modeling. The content of the IWQOL-Lite was analyzed, first by comparing it to the description of people's experience with obesity obtained through an online focus group. Secondly, the content of the questionnaire was mapped to the International Classification of Functioning, Disability, and Health (ICF) by 21 health professionals.
Results: The frameworks identified obesity, cardiopulmonary functions, mental symptoms, functional status in regard to activities of daily living and mobility as variables affecting WRQL. There appears to be differences across genders. The findings suggested that the IWQOL-Lite has good content validity but may benefit from some revisions.
Conclusion: Weight, symptoms associated with obesity, and functional limitations are part of the contributors of WRQL and may need to be targeted to lead to improvement. Interventions may need to be gender specific. The findings support the continued used of the IWQOL- Lite.
Introduction: L'obésité est une pandémie mondiale qui affecte l'habileté des gens à poursuivre une vie satisfaisante. L'amélioration de la qualité de vie des gens obèses (qualité de vie en lien avec le poids - QdV-P) est devenue un objectif complémentaire à la perte de poids.
L'identification des déterminants de la QdV-P nous permettrait de développer des interventions ciblées. GdV-P a plusieurs facettes mesurables. L'identification du contenu d'une mesure peut assurer que la mesure sélectionnée consiste en des domaines qui devraient être affecté par l'intervention. De plus, il est important de vérifier que la définition du concept n'a pas changé avec le temps et que le contenu continue à correspondre au vécu des personnes obèses. Le questionnaire sur la qualité de vie liée à la santé (IWQOL-Lite) est utilisé fréquemment. Le contenu a été généré par un échantillon de 21 participants, et n'a pas été révisé depuis son développement, il y a 15 ans.
Objectif: Améliorer l'efficacité des interventions pour les personnes obèses par l'accroissement de la compréhension et de la mesure de l'impact de l'obésité sur la qualité de vie.
Méthodes: Les structures sous-jacentes au concept de la qualité de vie chez les personnes obèses ont été présumées à partir du modèle conceptuel de Wilson et Cleary et testées dans 2 échantillons différents de personnes avec une régression linéaire multiple, analyse des pistes causales, et modélisation d'équation structurale. Le contenu du questionnaire IWQOL-Lite a été analysé, premièrement, en comparant la description du vécu de personnes ayant un excès de poids, obtenue lors d'un groupe de discussion sur Internet. Deuxièmement, le contenu du questionnaire a été jumelé a la Classification Internationale du fonctionnement, du handicap et de la santé (CIF) par 21 professionnels de la santé.
Résultats: Les structures développées identifient l'obésité, les fonctions cardio-pulmonaires, symptômes mentaux, statut fonctionnel en ce qui a trait aux activités de la vie quotidienne et la mobilité comme étant des variables affectant la qualité de vie chez les personnes obèses. Il semble y avoir des différences selon les sexes. Les résultats suggèrent que le contenu de l'IWQOL-Lite est valide mais pourrait bénéficier de quelques révisions.
Conclusion: Le poids, les symptômes associés à l'obésité et les limites fonctionnelles font partie des déterminants de la qualité de vie des personnes obèses et doivent possiblement être ciblés pour son amélioration. Les interventions ont peut être besoin d'être spécifiques selon le sexe de la personne. Les résultats supportent l'utilisation du IWQOL-Lite.
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Ahmed, Sara 1974. "Response shift and health-related quality of life post-stroke." Thesis, McGill University, 2004. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=84979.
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There is growing consensus that health-related quality of life (HRQL) outcomes are important for the allocation of scarce medical resources and for facilitating clinical decision-making. However, because most instruments of HRQL are self-report measures inappropriate conclusions may be drawn from studies that assess changes in HRQL over time or between groups. If the individuals evaluating themselves experience a response shift (defined as changes in their internalized standard of evaluating their level of functioning, in their values, or in their conceptualization of the target construct), then measures taken over time or between groups are no longer comparable. To date, response shift has not been formally assessed in the stroke population, and only to a limited extent in the HRQL field. The global objective of this thesis was to examine how the experience of recovering from a stroke modifies people's perception of their health-related quality of life (HRQL), and the extent to which response shift occurs during the first six months post-stroke.The first study used structural equation modeling for data from a prospective cohort to evaluate response shift by examining changes in a theoretical model of HRQL based on the measurement model of the Medical Outcome Study 36-Item Short Form Health Survey (SF-36). This study found no evidence of reconceptualization and changes in internal standards over time, but suggested that if response shift does occur with stroke it is likely to be mediated by the event itself and not the recovery process. Two subsequent studies evaluated response shift using the then test (a retrospective assessment of HRQL) and an individualized measure of HRQL. The data collection for these studies was incorporated into a randomized controlled trial. The results from the then test provided support for the occurrence of response shift among persons with stroke with no such effect in a control group. Changes on the individualized measure of HRQL showed that individuals with stroke experienced a reconceptualization and a change in values between 6 and 24-weeks post-stroke. A final comparison of the three techniques evaluated in this thesis provided the basis for proposed guidelines for future assessments of change in HRQL based on the comparative feasibility and validity of the methods. To date, there is evidence to show that individuals undergoing changes in physical health experience changes in internal standards of health and values. If response shift is not measured and accounted for, inappropriate conclusions regarding the impact of a disease such as stroke or the efficacy of a treatment intervention may go unnoticed.
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Johansson, Veronica. "Oral health-related quality of life and patient payment systems /." Malmö : Dept. of Oral Public Health, Malmö University, 2009. http://dspace.mah.se/bitstream/2043/9017/1/Veronica%20Johansson%20Avhandling.pdf.
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Wong, C. Y. Macrina. "Health-related quality of life in patients with cardiac arrhythmias." View the Table of Contents & Abstract, 2006. http://sunzi.lib.hku.hk/hkuto/record/B36887171.
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Collin, Bagewitz Ingrid. "Prosthodontics, care utilization and oral health-related quality of life /." Malmö : Malmö högskola, 2007. http://dspace.mah.se/handle/2043/3896.
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McNutt, Matthew David White Raymond P. "The impact of pericoronitis on health related quality of life." Chapel Hill, N.C. : University of North Carolina at Chapel Hill, 2007. http://dc.lib.unc.edu/u?/etd,953.
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Thesis (M.S.)--University of North Carolina at Chapel Hill, 2007.Title from electronic title page (viewed Dec. 18, 2007). "... in partial fulfillment of the requirements for the degree of Master of Science in the School of Dentistry (Orthodontics)." Discipline: Orthodontics; Department/School: Dentistry.
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Adams, Robert John Trenaman. "Health-related quality of life and psychological aspects of asthma /." Title page, contents and introduction only, 1998. http://web4.library.adelaide.edu.au/theses/09MD/09mdt792.pdf.
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Jung, Helen. "Physical performance and health-related quality of life post-stroke." Thesis, McGill University, 2002. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=33788.
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Reduced levels of health-related quality of life (HRQL) post-stroke are an important issue to address in rehabilitation. Despite improvement in function over time, HRQL remains poor for many stroke survivors. This longitudinal study is aimed at estimating the extent to which physical performance, social, and psychological functioning influence HRQL.Forty-three community-living persons with stroke were recruited to participate in a six-week intervention preceded and followed by a performance- and interview-based evaluation assessing different levels of disability and functioning. HRQL was measured by the VAS of the EQ-5D.
Regression models generated cross-sectionally demonstrated that physical performance, social, and psychological functioning explained up to 90% of the variation in HRQL. A GEE model revealed that, over time, only upper extremity functioning had a significant relationship with HRQL.
Much attention has already been focused on increasing physical performance in rehabilitation. However, clinicians should consider other components that affect HRQL directly or indirectly through physical performance. Only by treating the different components of functioning at various levels can HRQL be ultimately increased.
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Hilari, Katerina. "Assessing health-related quality of life in people with aphasia." Thesis, City University London, 2002. http://openaccess.city.ac.uk/7471/.
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Background: Health related quality of life (HRQL) measures are becoming increasingly used in the evaluation of health care interventions. They allow us to better understand the impact of disease on a patient's life as a whole and to incorporate the patient's perspective in clinical decision making and in the evaluation of health care. A number of studies have explored the HRQL of people with stroke. Still, due to a number of conceptual and methodological issues, there is no clear understanding of the HRQL of a stroke subgroup: people with aphasia. Aims: The broad aim of this research was to explore the HRQL of people with chronic aphasia following stroke in a way that could be replicated in clinical practice. Thus, a single stroke-specific scale (the SS-QOL) was chosen for the assessment of HRQL. The specific research questions that were addressed were: A) Can an acceptable, reliable and valid version of the SS-QOL be developed for people with chronic aphasia? This involved: i) development of an aphasia-adapted version of the SS-QOL and ii) evaluation of its psychometric properties. B) What are the predictors of HRQL in people with chronic aphasia, as measured by the aphasia adapted version of the SS-QOL? Methods: The development of an aphasia-adapted version of the SS-QOL involved consultation with professionals with experience in measure development, language and aphasia, and pilot testing for the modification of the instrument, and a pre-test of the adapted version with 18 people with aphasia. This process resulted in the Stroke and Aphasia Quality of Life Scale (SAQOL). A cross-sectional interview-based survey study was undertaken to evaluate the psychometric properties (acceptability, reliability and validity) of the SAQOL and to determine the predictors of HRQL as measured by the SAQOL. Convenience sampling was used in the pilot and pre-test studies and cluster sampling in the survey study. Measures: HRQL was measured with the SAQOL. In the construct validation of the SAQOL, the following measures were used: for emotional distress the GHQ-12, for cognition the RCPM, for activities the FAI, for social support the SSS and for language the FAST and the ASHA-FACS. Potential predictors of HRQL included demographic, stroke-related variables and variables implicated in previous research or of theoretical interest measured with the following instruments: the GHQ-12, the FAI, the SSS, the ASHA-FACS, the RCPh1 and the PSI (patients' satisfaction with stroke care). Results A) i) Development of an aphasia-adaptedv ersion of the SS-QOL resulted in the SAQOL, an interview administered self-report measure. People with moderate or mild receptive aphasia (as determined by a score of >_ 7 in the receptive domains of the FAST) found the SAQOL acceptable and were able to self-report to it. A) ii) Psychometric evaluation: 83 out of 95 participants self-reported on the SAQOL. The results supported the reliability and the validity of the overall SAQOL, but not of its subdomains' structure. A shorter 39-item version was derived through factor analysis (SAQOL-39). This instrument had a stable, conceptually clear 4-factor structure (physical, psychosocial, communication and energy) and high acceptability, internal consistency [scale(a= .93) and subdomains' (a=. 74-. 94)], test-retest reliability [scale (ICC=. 98) and subdomains' (ICC=. 89-. 98)] and construct validity [corrected domain-total correlations (r=. 38-. 58), subdomains' convergent (r=. 55-. 67) and discriminant (r=. 02-. 27), and scale's discriminant (r=. 19-. 31) and correlated measures (r=. 45-. 58)]. B) Predictors of HRQL: High emotional distress, reduced involvement in home and outdoors activities, high communication disability and >_2 comorbid conditions predicted poorer HRQL (adjusted R2=. 52). Stroke type (infarct vs haemorrhage) and demographic variables (age, gender, ethnicity, marital status, employment status and socioeconomic status) were not significant predictors of HRQL in these participants. Conclusions:The SAQOL-39 is an acceptable, reliable and valid measure for the assessment of HRQL in people with chronic aphasia. Further testing is needed to establish the usability of this measure in evaluative research and routine clinical practice. Poor HRQL is predicted by distress, reduced involvement in activities, communication disability and comorbidity. Service providers need to take these factors into account when designing intervention programmes.
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Hazell, Michelle Louise. "Health related quality of life in adults with respiratory symptoms." Thesis, Manchester Metropolitan University, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.429472.
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McClimans, Leah Marian. "Measurement and meaning in health-related quality of life research." Thesis, London School of Economics and Political Science (University of London), 2007. http://etheses.lse.ac.uk/2954/.
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In this thesis I take up the topic of our understanding of questions in a detailed case study of non-utility measures of health-related quality of life. I argue that efforts to standardize these measures lead to limitations in our ability to understand and measure quality of life. In the first half of this thesis I describe two types of bias that affect quality of life measures despite efforts to validate them. On the one hand, quality of life measures can perpetuate ethnocentric understandings of quality of life. On the other hand, respondents often understand the questions in these measures very differently than researchers imagined. I argue that the residual bias found in quality of life measures is the result of two assumptions built into the use of construct validity: 1) when a measure's outcomes confirm our hypotheses, we are warranted in having greater confidence in the accuracy of our theory 2) respondents understand the questions and answers in our measures in the same way as researchers imagined they would. In the second half of this thesis I argue that the limitations of construct validity stem from the logic of asking questions, a logic which precludes standardization. I propose that quality of life measures ought to be understood differently-they are not independent instruments capable of unambiguous claims, but rather one element in a dialogic framework whose questions and outcomes serve as the starting point for further inquiry. Finally, I examine what might have motivated the misguided use of construct validity. I suggest that the motivation lies in an erroneous picture of the human subject. I argue for an alternative picture that allows me to introduce an ethical dimension to our questions about quality of life.
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Mat, Amdah. "The determinants of children's oral health related quality of life." Thesis, University of Sheffield, 2010. http://etheses.whiterose.ac.uk/14535/.
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Oral health-related quality of life (OHRQOL) refers to the impact of oral disorders on aspects of everyday life that are important to patients and persons, with those impacts being of sufficient magnitude, whether in terms of severity, frequency or duration, to affect an individual's perception of their life overall. OHRQOL has become an important focus for assessing the impact of oral conditions on every day life, sometimes as an outcome of clinical care (e.g. Allen et al 2001; Locker 2004; Marshman and Robinson 2007). To date, several studies have explored children's OHRQOL using such child-centred measures. These studies show that oral health can impact on children's functioning and well-being. However, none of these studies have incorporated a broad range of clinical and other non-clinical variables factors that may influence children's OHRQOL or attempted to explicitly test the relationships between them within a theoretical model. Such research hopefully would highlight important issues to further our understanding of the antecedents and consequents of children OHRQOL in order to facilitate effective intervention strategies. Thus, this research alms to assess relationships between clinical and non-clinical variables in relation to children's OHRQOL. The theoretical model chosen to guide the research is that by Wilson and Cleary (1995), which classifies the variables at five main levels; clinical status, symptom status, functioning, general health perceptions and overall quality of life. The model has been used in adults in relation to several health chronic conditions, including oral health (Baker et al 2007; Baker et al 2008) but is relatively untested in children's oral health and oral health related quality of life. 12 This thesis is structured as follows: Chapter One captures the overview of the research. Chapter Two is a narrative reVIew of the literature. It considers health as conceptualized within different approaches; the biomedical, psychosocial model and bio-psychosocial models, to develop an understanding on OHRQOL. The review also introduces two models feasible for use in the study; Locker (1988) and Wilson and Cleary (1995). The Wilson and Cleary model is then used to structure a brief discussion on individual factors, sense of coherence, self esteem, oral health beliefs and health locus of control that may play a role in OHRQOL. Included also are environmental factors such as parental income, education level and work status. Chapter Three summarises the rationale, aim and objectives of the study. It argues that clinical and non clinical variables impact on children's QOL. Individual factors and environment issues may be important factors that need to be considered in understanding children's oral health. Furthermore, no study so far has systematically considered these factors guided by a theoretical framework. The study therefore aimed to identify the determinants and consequences of oral health related quality of life in children. The objectives are as follows; • To test the relationships between clinical variables, symptom status, functioning, general health perceptions and overall well-being as hypothesised within Wilson and Cleary's model of patient outcomes. • To examine whether socio-demographic and individual difference factors influence children's OHRQOL and the key relationships identified within the Wilson and Cleary model. • To explore different configurations of SOC, COHRQOL and the model Chapter Four describes the translation procedures conducted to achieve high quality translated measures that are suitable for children. Chapter Five details the material and methods including a brief description on the data analysis strategy, missing data management and data analysis management. 13 Chapter Six presents the research findings. The sample had good clinical status. Broadly speaking in lagged analyses the linear relationships of the model were not strongly supported, whereas individual factors, notably sense of coherence, were consistently linked to symptoms, functional limitation and overall quality of life. Chapter Seven brings together the discussion highlighted from the findings. Chapter Eight highlights the major conclusions and summarises the recommendations arising from the research. Chapter Nine lists the references. Appendices section contains copies of key research documents.
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Agala, D. A., and S. E. Devis. "Health-related quality of life children with acute hematogenous osteomylitis." Thesis, Сумський державний університет, 2013. http://essuir.sumdu.edu.ua/handle/123456789/32549.
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Acute hematogenous osteomyelitis (AHO) is the most common type of osteomyelitis, an infection of bone that occurs in children.
When you are citing the document, use the following link http://essuir.sumdu.edu.ua/handle/123456789/32549
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Hart, Catherine K. "Health-related Quality of Life in Children with Aerodigestive Disorders." University of Cincinnati / OhioLINK, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=ucin151091845523319.
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Javdan, Nazafarin. "Silver Diamine Fluoride and Oral Health-Related Quality of Life." VCU Scholars Compass, 2017. http://scholarscompass.vcu.edu/etd/4698.
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Purpose: The purpose of this study was to study the association between Silver Diamine Fluoride (SDF) and Oral Health-Related Quality of Life as assessed by “The Early Childhood Oral Health Impact Scale” questionnaire. Methods: Parents of healthy children (ASA I and II) ages 1-5 with early childhood caries with reversible pulpitis who had application of SDF filled out a questionnaire at baseline and again after one month. The questionnaire was designed to evaluate the child’s behavior, physical abilities, pain, temperament, and how well the child gets along with others. Results: Wilcoxon Signed Rank Test was used to determine if responses to various ECOHIS items and the total scores were different between the two time points. Conclusion: Children with dental caries who had application of SDF reported less dental pain, less eating problems, higher quality of sleep and overall higher quality of life at one-month follow up compared with the baseline.
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Bagewitz, Ingrid Collin. "Prosthodontics, care utilization and oral health-related quality of life." Malmö [Sweden] : Malmö högskola, Dept. of Prosthetic Dentistry, Dept. of Oral Public Health, Faculty of Odontology, 2007. http://catalog.hathitrust.org/api/volumes/oclc/122895139.html.
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Leung, Julie. "Health-related quality of life in women with gynaecological cancer." Thesis, Queensland University of Technology, 2019. https://eprints.qut.edu.au/130759/1/Julie_Leung_Thesis.pdf.
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A diagnosis of gynaecological cancer and its treatments have considerable impact on affected women's quality of life. The purpose of this study was to establish patient and clinical characteristics associated with better quality of life after the treatment of cancer, guided by the revised Wilson and Clearly model. The findings in this study will have substantial implications for clinical practice and will inform psychosocial interventions aimed at improving the quality of life of patients in the future.
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Lalonde, Lyne. "Health-related quality of life measures in coronary heart disease prevention and treatment." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape11/PQDD_0006/NQ44484.pdf.
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Brooks, Robert School of Community Medicine UNSW. "Health related quality of life of intensive care patients: Development of the Sydney quality of life questionnaire." Awarded by:University of New South Wales. School of Community Medicine, 1998. http://handle.unsw.edu.au/1959.4/17465.
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This thesis has three main research aims. First the development of a questionnaire to measure HRQOL of ICU patients. Second, to examine a model of HRQOL proposed to assist with the development of the questionnaire. Third, to examine the HRQOL outcomes of patient after hospital discharge. The proposed model is based on a review of conceptual issues related to Quality of Life (QOL), Health Status and HRQOL. After a content analysis of a broad range of definitions of QOL, Health Status and HRQOL, QOL was defined as a dynamic attitude, continually being modified by experience. It is a function of the cognitive and affective appraisals of the discrepancies between domain specific perceptions and expectations. HRQOL was defined as an individuals cognitive and affective response to, or the QOL associated with, their health status. Health status was seen to consist of two health dimensions, physical and psychological health, with each dimension being composed of a number of component measures assessed subjectively. The developed questionnaire, the Sydney Quality of Life (SQOL) had good construct validity, based on substantial correspondence between qualitative and quantitative data, and internal consistency data (factor analysis and Cronbach's alpha). It had good concurrent validity in relation to the Sickness Impact Profile. The second order factor analysis of the SQOL suggested that health status may consist of three dimensions, physical health, positive mental health and negative mental health. The HRQOL model when formally examined, using Structural Equation Modelling (using LISREL), was not supported. However, exploratory modelling supported the separation of mental health into positive and negative components. The structure of HRQOL was different for patients than for the community from which they came. Patients QOL was determined largely by positive mental and physical health, whereas community members QOL was largely determined by negative mental health. Sixty three percent of patients at 12 months after discharge had significantly worse physical and functional health, lower satisfaction with their lives, lower positive affect and poorer QOL. Overall, mental health adapts rapidly to the impact of serious physical ill health and hospitalisation. Implications for clinical practice are examined.
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Hofhuis, Jozefina Gerarda Maria. "Health related quality of life in critically ill patients a study of health related quality of life in critically ill patients admitted on the intensive care /." [S.l.] : Rotterdam : [The Author] ; Erasmus University [Host], 2008. http://hdl.handle.net/1765/13442.
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Batross, Deana J. "Correlation of Health Related Quality of Life and Health Literacy Levels in Patients with Heart Failure." Otterbein University / OhioLINK, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=otbn1461096576.
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Hallberg, Inger. "Health-Related Quality of Life in Postmenopausal Women with Osteoporotic Fractures." Doctoral thesis, Linköpings universitet, Omvårdnad, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-51524.
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Background: The global burden of osteoporosis includes considerable numbers of fractures, morbidity, mortality and expenses, due mainly to vertebral, hip and forearm fractures. Underdiagnosis and undertreatment are common. Several studies have shown decreased health-related quality of life (HRQOL) after osteoporotic fracture, but there is a lack of data from long-term follow-up studies, particularly regarding vertebral fractures, which are often overlooked despite patients reporting symptoms. Aim: The overall aim of this thesis was to evaluate the usefulness of a recent low-energy fracture as index event in a case-finding strategy for osteoporosis and to describe and analyse long-term HRQOL in postmenopausal women with osteoporotic fracture. The specific aims were to describe bone mineral density and risk factors in women 55-75 years of age with a recent low-energy fracture (I), estimate the impact of osteoporotic fractures on HRQOL in women three months and two years after a forearm, proximal humerus, vertebral or hip fracture (II), investigate the changes and long-term impact of vertebral or hip fracture on HRQOL in women prospectively between two and seven years after the inclusion fracture (III), and describe how HRQOL and daily life had been affected in women with vertebral fracture several years after diagnosis (IV). Design and methods: Data were collected from southern Sweden between 1998 and 2008. A total of 303 women were included in Study I, and this group served as the basis for Studies II (n=303), III (n=67), and IV (n=10). A cross-sectional observational, case-control design (I), and a prospective longitudinal observational design (II-III) were used. In Study IV a qualitative inductive approach with interviews was used and data were analysed using a qualitative conventional content analysis. Results: The type of recent fracture and number of previous fractures are important information for finding the most osteoporotic women in terms of severity (I). Hip and vertebral fractures in particular have a significantly larger impact on HRQOL evaluated using the SF-36 than do humerus and forearm fractures, both during the three months after fracture and two years later, compared between the different fracture groups and the reference population (II). Women who had a vertebral fracture as inclusion fracture had remaining pronounced reduction of HRQOL at seven years. At the mean age of 75.5 years (±4.6 SD), the prevalence of vertebral fracture suggests more negative long-term impact on HRQOL, more severe osteoporosis and a poorer prognosis than a hip fracture does, and this effect may have been underestimated in the past (III). Study IV demonstrates that the women’s HRQOL and daily life have been strongly affected by the long-term impact of the vertebral fracture several years after diagnosis. The women strive to maintain their independence by trying to manage different types of symptoms and consequences in different ways. Conclusions and implications: Type and number of fractures should be taken into account in the case-finding strategy for osteoporosis in postmenopausal women between 55 and 75 years of age. The long-term reduction of HRQOL in postmenopausal women (age span 55-75 yr) with vertebral fracture emerged clearly, compared to women with other types of osteoporotic fractures and references in this thesis. The results ought to be taken into consideration when developing guidelines for more effective fracture prevention and treatment, including non-pharmacological intervention for women with osteoporotic fractures, with highest priority placed on vertebral fractures and multiple fractures, to increase or maintain HRQOL.
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Eriksson, Lars E. "HIV therapies : from health-related quality of life to DNA levels /." Stockholm, 2003. http://diss.kib.ki.se/2003/91-7349-519-0/.
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Wong, Wing-yee. "Weight status and health-related quality of life in Hong Kong." View the Table of Contents & Abstract, 2007. http://sunzi.lib.hku.hk/hkuto/record/B38479382.
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Petersen, Solveig. "Recurrent pain and health related quality of life in young schoolchildren." Doctoral thesis, Umeå : Univ, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-1592.
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Basri, Etidal. "Development of a pediatric oral health-related quality-of-life questionnaire." Thesis, McGill University, 2000. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=30808.
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Oral and dental health illness among children is prevalent, and associated impairments are common. However, the impact of these conditions on the lives of children has yet to be determined. The objective of this study was to carry out the initial development phase for an oral health-related quality of life instrument to assess the impact of oral and dental conditions on children aged 3--5 years. Items were generated through literature review, the use of a conceptual model, and by interviewing parents and health professionals. The most frequent and important items were retained to comprise the Pediatric Oral Health Questionnaire, evaluating five dimensions: physical, functional, emotional, and social status, and impact on the family. This preliminary questionnaire is the first to be developed for the measurement of oral health-related quality of life (QoL) in children.
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Wong, Wing-yee, and 王詠怡. "Weight status and health-related quality of life in Hong Kong." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2007. http://hub.hku.hk/bib/B39724669.
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Pang, Har-ling Harry, and 彭遐寧. "A study of oral health-related quality of life during adolescence." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2008. http://hub.hku.hk/bib/B42182098.
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Wong, King-ho, and 黃競浩. "Health-related quality of life of Chinese patients with colorectal neoplasms." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2012. http://hdl.handle.net/10722/193041.
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Increasing number of people is diagnosed with colorectal neoplasms (CRN) in the form of polyps or cancers. Colorectal cancer (CRC) is one of the most common causes of cancer deaths among Chinese in Hong Kong. Advances in diagnosis and treatments have increased the survival rate of CRN patients, resulting in a large group of cancer survivors. Preserving and maintaining health-related quality of life (HRQOL) has become an important direction in research and clinical care of patients with CRN. This research aimed to evaluate the HRQOL and its association with socio-demographics and disease-related characteristics among patients with CRN, and illustrate how HRQOL data could be converted to preference for the estimation of quality adjustment of life years in health economic evaluations.
This research comprised of three parts. First was the establishment of the validity and reliability of the traditional Chinese version of Functional Assessment of Cancer Therapy-Colorectal (FACT-C) as a HRQOL measure for Chinese patients by a cross-sectional sample of 536 adult patients with CRN. Psychometric testing and concurrent validation of the FACT-C with European Organization for Research and Treatment of Cancer Core Questionnaire plus Colorectal-specific Module Questionnaire and the Short-Form 12-item Health Survey_Version2 (SF-12V2) were carried out. Second was a longitudinal study on the HRQOL of 554 CRN patients at baseline, six (n=479) and twelve (n=414) months of recruitment. The associations of HRQOL with socio-demographics and disease-related factors, and change of HRQOL over time were explored. Comparisons of HRQOL between CRN patients and the general population and among different CRN groups were made. Cross-sectional data were used to develop mapping functions to estimate SF-6D preference scores from FACT-C subscale scores. Third was the application of the health preference scores by CRN stages collected at baseline of the longitudinal study, in combination with survival data extracted from the literature in a Markov model on the cost-effectiveness of different CRC screening strategies (colonoscopy, guaiac and immunochemical fecal occult blood tests) in comparison to no screening in terms of quality-adjusted life-years gained.
This research comprised of three parts. First was the establishment of the validity and reliability of the traditional Chinese version of Functional Assessment of Cancer Therapy-Colorectal (FACT-C) as a HRQOL measure for Chinese patients by a cross-sectional sample of 536 adult patients with CRN. Psychometric testing and concurrent validation of the FACT-C with European Organization for Research and Treatment of Cancer Core Questionnaire plus Colorectal-specific Module Questionnaire and the Short-Form 12-item Health Survey_Version2 (SF-12V2) were carried out. Second was a longitudinal study on the HRQOL of 554 CRN patients at baseline, six (n=479) and twelve (n=414) months of recruitment. The associations of HRQOL with socio-demographics and disease-related factors, and change of HRQOL over time were explored. Comparisons of HRQOL between CRN patients and the general population and among different CRN groups were made. Cross-sectional data were used to develop mapping functions to estimate SF-6D preference scores from FACT-C subscale scores. Third was the application of the health preference scores by CRN stages collected at baseline of the longitudinal study, in combination with survival data extracted from the literature in a Markov model on the cost-effectiveness of different CRC screening strategies (colonoscopy, guaiac and immunochemical fecal occult blood tests) in comparison to no screening in terms of quality-adjusted life-years gained.
Psychometric analysis confirmed that FACT-C had satisfactory reliability, construct validity and responsiveness in Chinese patients Patients with CRN reported worse physical HRQOL but better mental HRQOL and similar health preference score compared to the general population. Disease severity indicated by tumor stage at initial diagnosis was the most significant determinant of HRQOL of CRN patients. Rectal cancer also significantly associated with a decrease in physical HRQOL and health preference scores. Markov modelling showed that immunochemical fecal occult blood (I-FOBT) yearly was the most effective and two-yearly was the most cost-effective screening strategy compared to no screening.published_or_final_version
Family Medicine and Primary Care
Doctoral
Doctor of Philosophy
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Malone, Margaret. "Assessment of health-related quality of life in patients with cancer." Thesis, Cardiff University, 1991. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.357347.
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Stapley, Sally. "Meaning and measurement in longitudinal 'health-related' quality of life research." Thesis, University of Newcastle Upon Tyne, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.437945.
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Alakärppä, A. (Antti). "Primary sinonasal surgery and health-related quality of life in adults." Doctoral thesis, Oulun yliopisto, 2019. http://urn.fi/urn:isbn:9789526222370.
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Abstract Surgery for ear, nose and throat (ENT) diseases most often aims to improve quality of life (QoL). The extent of having QoL as an outcome in papers included in evidence-based medicine databases is not known. In primary sinonasal surgery, the QoL outcomes and predictors and usability of various QoL instruments need more clarification. The aim was to: 1. Find out with a systematic literature review how the Cochrane database currently includes the QoL dimension. 2. Investigate the effect of primary sinonasal surgery on QoL, to identify predictors of QoL outcomes and to compare QoL instruments. In total 160 adults undergoing primary septoplasty (SP) or endoscopic sinus surgery (ESS) were recruited in 2010–2014 with 206 controls for a prospective matched cohort study. QoL was measured with a disease-specific Sino-Nasal Outcome Test–22 (SNOT–22) and generic RAND–36 before surgery and 12 months after surgery. Retrospective Glasgow Benefit Inventory (GBI) was also used. QoL was an outcome measure in 10% (3 out of 30) of trials included in Cochrane databases on most common ENT surgeries. The use of QoL since the year 2000 has increased. The total SNOT–22 score improved in both patient groups after surgery, almost to the level of the controls, In the SP group (N=64) from 34.9 to 19.1 and in ESS (N=70), from 35.1 to 19.3. The control cohort’s SNOT–22 was 17.7 at entry and after follow-up, 15.3 (N=165). RAND–36 and GBI also improved after surgery. The best predictor for a good QoL outcome in multivariate analysis after surgery was a high preoperative (≥20) SNOT–22 score in the SP and ESS groups (adjusted odds ratio 10; 95% confidence interval 1.6–64 and 12; 2.5–55, respectively). In receiver operating characteristic curve analysis, the highest preoperative SNOT–22 total score of 30 was the most sensitive (74%) and specific (70%). GBI seemed to be the most sensitive instrument to detect a change, but the three instruments in this study agreed in only about 10% of the patients who had the worst impact before surgery or best outcome. The results suggest that papers on the Cochrane databases on ENT surgeries have rarely addressed the QoL outcome. Septal deviation and recurrent acute or chronic rhinosinusitis lowered QoL. Primary surgery on these conditions improved QoL almost to the level of the control population, which was not symptom-free either. A high preoperative SNOT–22 total score was the best predictor of a beneficial outcome. The QoL instruments identified different patients experiencing the best improvement after surgeryTiivistelmä Korva-, nenä- ja kurkkutautien (KNK) kirurgia tähtää useimmiten elämänlaadun (EL) parantamiseen. EL:n huomioinnin yleisyys näyttöön perustuvien tietokantojen sisältämissä tutkimuksissa ei ole tiedossa. Primaareissa nenäleikkauksissa EL:n tulokset, ennustekijät ja eri mittareiden käytettävyys kaipaavat lisätietoja. Tarkoituksena oli 1: Tutkia systemaattisella kirjallisuuskatsauksella miten nykyiset Cochrane-suositukset huomioivat EL:n. 2: Tutkia primaarin nenäkirurgian vaikutus EL:uun, tunnistaa EL:n ennustekijöitä ja vertailla eri mittareita. Yhteensä 160 primaariin nenän väliseinäleikkaukseen (VL) tai sivuonteloiden tähystysleikkaukseen (ESS) tulevaa aikuista ja 206 ikä- ja sukupuolivakioitua verrokkia osallistui etenevään kaltaistettuun kohorttitutkimukseen vv. 2010-2014. EL mitattiin tautispesifillä Sino-Nasal Outcome Test -22:lla (SNOT–22) ja yleisellä RAND–36:lla ennen leikkausta ja 12 kk leikkauksen jälkeen. Kolmantena mittarina käytettiin taannehtivaa Glasgow Benefit Inventoryä (GBI). Cochrane-tietokannan yleisimpien KNK-leikkausten tutkimuksista 10 %:ssa (3 30:stä) sisälsi EL-tuloksia. Vuoden 2000 jälkeen EL:n käyttö on lisääntynyt. SNOT–22 kokonaispistemäärä parani VL- ja ESS-ryhmissä lähes kontrollien tasolle, VL-ryhmässä (N=64) 34.9:stä 19.1:een ja ESS-ryhmässä (N=70) 35.1:stä 19.3:een. Kontrollien SNOT–22 oli alussa 17.7 ja seurannan jälkeen 15.3. Myös RAND–36 ja GBI paranivat leikkauksen jälkeen. Monimuuttuja-analyysissä hyvän EL-tuloksen paras ennustetekijä oli korkea leikkausta edeltävä SNOT–22 sekä VL- että ESS-ryhmissä (vakioitu vetokertoimien suhde 10; 95 % luottamusväli 1.6–64 ja 12; 2.5–55, ryhmittäin). ROC (receiver operating characteristic) -käyräanalyysissä leikkausta edeltävä arvo 30 antoi parhaan herkkyyden (74 %) ja tarkkuuden (70 %). GBI vaikutti herkimmältä aistimaan muutoksen, mutta mittarit olivat samaa mieltä vain noin 10%:ssa niistä potilaista, joilla oli huonoin EL ennen leikkausta tai paras tulos leikkauksen jälkeen. Tulosten mukaan Cochrane-tietokannassa olevat KNK-tautien kirurgian tutkimukset ovat ottaneet harvoin elämänlaadun huomioon. Nenän väliseinän vinous ja toistuva äkillinen tai krooninen sivuontelotulehdus laskivat EL:ua. Näiden tautien primaarikirurgia paransi EL:n lähes samalle tasolle kuin kontrolliryhmällä. Korkea leikkausta edeltävä SNOT–22 –kokonaispistemäärä ennusti parhaiten hyvää tulosta. Eri EL-mittarit tunnistivat eri potilaat, jotka hyötyivät parhaiten leikkauksista
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Jones, Stephanie. "Assessment of health related quality of life in HIV positive children." Master's thesis, University of Cape Town, 2005. http://hdl.handle.net/11427/8657.
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Includes bibliographical references.Background: Quality of life is an important concept because it is the essence of health as defined by the WHO. Pain and other distressing symptoms affect children's quality of life. There is very little published information on pain in children with HIV infection, its prevalence or its affect on their quality of life. This study will add to a growing body of literature on health-related quality of life (HRQOL), but more specifically address these issues in a South African context of HlV/AIDS in children. Such data is currently not available. Methods: A cross sectional descriptive study with an analytic component was performed on a convenience sample of 30 caregivers who attended the Paediatric HIV Clinic at Chris Hani Baragwanath Hospital, Johannesburg. All data was collected by a single investigator over a 4 month period. An established, multidimensional health related quality of life assessment tool (The PedsQL(TM) 4.0) designed for children, was used to measure HRQOL. Results: Mean HRQOL scores were evaluated as well as those for physical and psychosocial health. Scores resembled those of children with other chronic diseases. Disease progression affected the scores with lower values for those children with advanced disease. Where no disclosure of HIV status occurred scores were lower for all dimensions. The prevalence of pain in HIV-affected children was 83%. Caregivers reported 55 individual pains in 12 different regions of the body. On average each patient had 2.3 pain sites. Parents often had difficulty describing the nature of the children's pain. Moderate to severe pain was associated with decreased HRQL scores. Discussion: This study is the first to examine pain and HRQOL in HIV-infected children in South Africa. As the nature of HIV changes to a chronic disease with the availability of antiretroviral treatment, HRQOL will become more important as a medical outcome measure. The PedsQL inventory is brief, easy to understand and takes only about 10 minutes to complete. This makes it an ideal tool for a busy clinic setting. Comprehensive, multidisciplinary health services will be required to minimize long-term illness and disability and to maximize children's potential as they move into adolescence and adulthood. The small study number leant itself to a descriptive study of exploratory nature. A follow up study which includes children's self report in their first language would be valuable.
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Todorov, Boris K. "Determinants of Health Related Quality of Life among Adolescents with Migraine." Ohio University / OhioLINK, 2009. http://rave.ohiolink.edu/etdc/view?acc_num=ohiou1243993494.
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Ward, Jared A. "Oral Health-Related Quality of Life in Children with Orofacial Clefts." The Ohio State University, 2011. http://rave.ohiolink.edu/etdc/view?acc_num=osu1299014480.
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Pang, Har-ling Harry. "A study of oral health-related quality of life during adolescence." Click to view the E-thesis via HKUTO, 2008. http://sunzi.lib.hku.hk/hkuto/record/B42182098.
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Chen, Xiaoying. "Determinants of Health-related Quality of Life after acute ischaemic stroke." Thesis, The University of Sydney, 2021. https://hdl.handle.net/2123/24876.
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Background and rationale
Stroke is a leading cause of death and disability, worldwide. Most strokes are ischaemic, due to varying types of thrombo-embolic occlusion of extra- and intra-cerebral vessels, for which there have been major advances in acute reperfusion therapies. However, such treatment is only accessible to a minority of patients, has only moderate beneficial effects and has risks. Moreover, the burden of stroke is predicted to increase with continued aging of populations, unhealthy lifestyles and incomplete update of prevention strategies. More research is required to better understand how patients adjust the stroke-related disability and return to their usual activities and role in society. The large and diverse study population of the international Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED) provided a unique opportunity to undertake more detailed analysis of the patterns and predictors of functional recovery and health-related quality of life (HRQoL) after acute ischaemic stroke.
Methods
This thesis used data from the ENCHANTED clinical trial undertaken to evaluate two novel approaches to improve recovery using a quasi-factorial design in patients who were eligible to receive thrombolysis treatment with intravenous alteplase (or recombinant tissue plasminogen activator [rtPA]) for acute ischaemic stroke. One arm was to assess the non-inferiority of low- compared to standard-dose intravenous alteplase on death and disability at 90 days after the onset of symptoms. The other arm was to test the superiority of more intensive blood pressure (BP) lowering treatment compared to guideline-recommended level of control of BP. Overall, the ENCHANTED trial recruited a total of 4587 patients with acute ischaemic stroke over several years, with 3310 randomly assigned to low-dose (0.6mg/kg) or standard-dose (0.9mg/kg) intravenous alteplase; and 2227 treated with alteplase randomly assigned to intensive BP lowering (target systolic BP 130-140 mmHg) or guideline recommended BP lowering (target systolic BP <180 mmHg).«/p» «p»I analysed data from the above-mentioned patients to test the reliability and validity of new type of measure of functional recovery, the simplified (structured) modified Rankin scale questionnaire (smRSq) against the conventional (semi-structured, interview-based) modified Rankin scale (mRS). also analysed those data to detect clinical and imaging predictors of ‘poor’ HRQoL at 90 days, which was defined as ≤0.7 (mean) 5-Dimensional European Quality of Life Scale (EQ-5D) utility score, or scores of 2 or 3 defining problems within each dimension of the EQ-5D. also assessed the treatment effects on another metric of functional recovery which combines mRS scores with HRQoL scores, the utility-weighted mRS. Finally, evaluated the cost-effectiveness of low-dose versus standard-dose alteplase. undertook all the statistical analyses with a variety of approaches including descriptive statistics, Kappa statistic, c2 test, Fisher test, Pearson correlation, Spearman correlation, univariable and multivariable logistic regression, ordinal logistic regression, simple linear regression, multiple linear regression, log-rank test, base-case analysis, generalised linear model, probabilistic sensitivity analysis, multiple imputations, bootstrapping, and stratification.
Results
The main results of the trial were that low-dose alteplase was not clearly non-inferior to a standard-dose alteplase and intensive BP lowering was not superior to standard BP lowering on recovery from thrombolysed acute ischaemic stroke. However, both low-dose alteplase and intensive BP lowering, showed significant reduction in the risks of intracerebral haemorrhage after intravenous thrombolysis.
My work showed that the smRSq had good agreement (weighted Kappa 0.79, 95% confidence interval [CI] 0.78-0.81) with the mRS, indicating that it is reliable and valid alternative outcome measure, which has some advantages of application in multinational, multicenter studies.
I also showed that older age (odds ratio [OR] 1.19, 95% CI 1.12–1.27, per 10-year increase), non-Asian ethnicity (1.91, 1.61–2.27), greater stroke severity on the National Institutes of Health Stroke Scale (1.11, 1.09–1.12), diabetes mellitus (1.41, 1.18–1.69), premorbid disability (mRS score 1 versus 0; 1.62, 1.33–1.97), large vessel atheromatous pathogenesis (1.32, 1.12–1.54), and proxy respondent for patients disabled or unavailable (2.35, 2.01–2.74), independently predicted poor HRQoL, with ethnicity influence driven by high proportion of Chinese participants.
Moreover, two key imaging features of acute ischaemia on the right hemisphere (OR 1.69, 95% CI 1.24-2.29) and within the deep middle cerebral artery territory of the brain (OR 1.50, 95% CI 1.03-2.19) predicted poor HRQoL
I derived utility-weighted mRS scores for the ENCHANTED trial participants, across the levels of mRS scores from 0 (‘no symptoms’) to 5 (‘severe disability, bedbound’) being 0.977, 0.885, 0.748, 0.576, 0.194, and −0.174. As utility-weighted mRS is a continuous measure, it is a promising alternative outcome measure to assess treatment effects with reduced sample size compared with the conventional use of mRS scores as a binary outcome.
Finally, low-dose alteplase was not found non-inferior on overall cost savings compared to standard-dose alteplase from health economic evaluation perspective. Although the mean cost of alteplase treatment itself was lower in the low-dose group, the total net cost of the illness was $56 (95% CI -1000, 1113) higher and was not statistically significant compared to standard-dose.
Conclusion
I have provided data on the profile of recovery and pattern of HRQoL in patients with acute ischaemic stroke who have been treated with thrombolysis with intravenous alteplase. Poor HRQoL after ischaemic stroke can be predicted on the basis of older age, non-Asian ethnicity, greater severity of neurological deficit, diabetes mellitus, premorbid disability, large vessel atheromatous pathogenesis and proxy respondent for patients disabled or unavailable, and brain imaging markers of acute ischaemia in the right and deep middle cerebral artery territory of the brain. I found that ongoing disability after acute ischaemic stroke is strongly related to patients’ well-being. Two alternative outcome measures, smRSq and utility-weighted mRS, showed great potential and benefits for use in future research. These findings provide a foundation for sensible clinical decision-making in the management of patients with acute ischaemic stroke, and in selecting appropriate outcome measures for research in this serious illness.
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Gupta, Ekta. "The determinants of oral health related quality of life in adults." Thesis, University of Sheffield, 2014. http://etheses.whiterose.ac.uk/6823/.
Full textAbstract:
Objectives: Weak and indirect relationships between oral clinical status and oral health related quality of life (OHQoL) suggest individual and environmental factors might intervene in this relationship. Therefore, the aim of this research was to identify clinical and psychosocial determinants of OHQoL in adults. Methods: Prospective cohort study of 495 adult employees of an automobile parts manufacturer in India. Measures of OHQoL, general health perceptions, overall QoL, individual factors [sense of coherence, social support, stress, oral health beliefs, dental behaviours and subjective SES] and environmental factors [SES and social network] were collected at baseline and three month follow-up, together with a clinical examination at baseline. Analysis using lagged structural equation modelling (SEM) was guided by the Wilson and Cleary model linking clinical variables to quality of life. Results: Participants’ mean age was 33.12 years (18-72), 96% were males and mean DMFT was 2.13. The final SEM model was an excellent fit to the data accounting for 10%, 26% and 24% of the variance (prospectively) in OHQoL, GHP and Overall QoL respectively. Clinical status (decayed teeth) at baseline (β = 0.14, p < 0.01) had a direct effect on OHQoL at follow-up. Baseline individual characteristics: social support (β = 0.12, p < 0.05), SOC (β = 0.12, p < 0.05) and stress (β = 0.14, p < 0.01) had direct effects on OHQoL at follow-up. SES and social network indirectly predicted OHQoL through the individual characteristics. Conclusion: The findings offer longitudinal evidence that clinical and psychosocial factors may determine OHQoL, GHP and overall QoL in adults and suggest routes by which environmental factors such as SES might influence them. These factors might provide avenues for health promotion interventions and should be accounted for when evaluating clinical treatment to improve OHQoL.
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Rowland, Christine Alison. "Smoking and health-related quality of life in lung cancer patients." Thesis, University of Sheffield, 2012. http://etheses.whiterose.ac.uk/3984/.
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