Quality of life (QOL) is an extremely important concept in the promotion of appropriate and successful health care programmes. However, there is a need for conceptual clarity to unravel the complexities of terminology in different medical conditions and the underlying factors that have a direct influence on the quality of life for people with coronary heart disease. The primary objective of this thesis is to propose a theoretical model which specifies the domains of QOL and the interrelationships among these domains. The objectives of the study are four-fold: (1) To examine whether a cardiac rehabilitation programme has a beneficial effect on cardiac heart disease patients; (2) To evaluate the primary components of generic health-related quality of life assessment tools for people with coronary heart disease; (3) To identify the main factors governing disease-specific health-related quality of life assessment tools amongst patients with coronary heart disease; (4) To examine a variety of conceptual models of QOL and to determine their relevance to cardiac patients. First, in order to provide conceptual clarity, a comprehensive review of QOL measures was undertaken. Second, data was collected on a cardiac rehabilitation programme in a county hospital using Short Form-36 (SF-36) and Quality of Life for Myocardial Infarction (QLMI) instruments. This data was analysed using a number of techniques including (l)meta-analysis; (2)discriminant analysis; (3)factor analysis and (4)structural equation modelling. Analysing the data in this way enabled the development and clarification of the specific domains of the quality of life model. Meta-analysis involved pooling the results of several studies, these were then analysed to provide a systematic, quantitative review of the data. The results found that the related studies did not have consistent outcomes to support the positive effects of a cardiac exercise rehabilitation programme on quality of life in coronary patients. Findings from the SF-36 indicate that older people with coronary heart disease gain more pain relief than their younger counterparts. After a cardiac exercise rehabilitation progranune, statistically significant improvements occurred in physical function, social function, role limitation/physical, energy/vitality, body pain, and change in health-related dimensions of quality of life. The first-order five domains model includes the symptom domain, the restriction domain, the confidence domain, the self-esteem domain and the emotion domain. This model represents an appropriate model of quality of life for people with coronary heart disease compared to the three-domain model and the four-domain model. In terms of the second-order QOL model, the five-domain model also has an adequate fit to the data. According to the result of structural equation modelling, three models, including the null model, the alternative model I and the alternative model n, did not fit the data perfectly. However, the construct of full latent variable model gradually increased the fit statistics from the null model to the alternative model I and from the null model to alternative model n. Therefore, it can be concluded that the paths and indicators of the three models need to be further adjusted in order to provide a more appropriate model. Nevertheless, this is a first trial to examine a full model of quality of life for people with coronary heart disease using the structural equation analyses. As such, this study provides a new approach to examining the difference between empirical studies and theoretical approaches.

In response to ingestion of nutrients, enteroendocrine L cells secrete the incretin hormone, glucagon-like peptide-1 (GLP-1), to enhance glucose-dependent insulin release. Therapies related to GLP-1 are approved for type 2 diabetes. The GLP-1 receptor (GLP-1R) is expressed in cells of the gastrointestinal tract and elsewhere. In pancreatic beta cells, GLP-1R are coupled to the Gs/cAMP/PKA pathway. The expression and function of GLP-1R in gastrointestinal smooth muscle are not known. Aim. To test the hypothesis that GLP-1 regulates smooth muscle function by acting on GLP-1R expressed on smooth muscle. Methods. Smooth muscle cells (SMC) were isolated and cultured. Expression of GLP-1R mRNA was measured by RT-PCR. Expression of GLP-1R protein was measured by western blot. The effect of GLP-1 (7-36) amide on Gαs activation, cAMP formation, and PKA activity was examined in cultured SMC. The effect of GLP-1 on basal activity and on acetylcholine-induced contraction was measured in intact colon via organ bath. Results. Amplification of GLP-1R mRNA suggested expression of GLP-1R mRNA in mucosal and non-mucosal colon cells, which was confirmed in pure SMC cultures. Similar patterns of protein expression were obtained with western blot. Addition of GLP-1 caused relaxation of phasic activity and agonist-induced tonic contractions in intact colon, suggesting a role of smooth muscle Gs-coupled GLP-1R in mediating relaxation. In SMC, GLP-1 (7-36) amide activated Gas, increased cAMP levels, and stimulated PKA activity. Conclusion. Colonic SMC express GLP-1R, and GLP-1 inhibits both basal and acetylcholine-induced contraction. The GLP1-R is coupled to the heterotrimeric G protein, Gas.

Ce mémoire vise à explorer les manières dont les discours autour de la sexualité furent créés et comment ils ont circulé dans les médias québécois suite à la décision de la Cour suprême du Canada en décembre 2013 de réviser les articles de loi en matière de prostitution (Canada (Procureur général) c. Bedford, 2013 CSC 72). En mobilisant une analyse de discours tout en puisant dans la théorie féministe afin de conceptualiser la sexualité en ce qui concerne les systèmes de classes sexuelles et de dynamiques sexuelles, l’analyse suivante aborde des discours rivaux dans un cadre temporel qui suit l'invalidation des lois jusqu'au dépôt du projet de loi C-36 présenté par le Parti conservateur. Les discours déployés dans les médias et les systèmes de régulation qu’ils entraînent (voix privilégiées, couverture orientée, débats encadrés etc.) aident à mettre de l’avant certaines idées autour de la sexualité tout en les normalisant. Par l’entremise de nombreux sujets sociaux (des politicien-nes, des groupes de femmes, des universitaires, des femmes prostituées et des avocat-es), les discours rivaux articulés autour de la morale et du choix en matière de sexualité ont nourri un débat public construit sur un antagonisme semblable à celui exprimé lors des sex wars féministes. Ce mémoire comprend ces discours encadrés au sein du débat sur la prostitution comme étant constitutifs dans la compréhension des systèmes actuels de sexualité et de classes sexuelles. / This thesis aims to explore how discourses around sexuality were created and circulated in the Québec media following the Supreme Court of Canada’s decision to strike down the prostitution laws in December 2013 (Canada (Attorney General) v. Bedford, 2013 SCC 72). Using discourse analysis and drawing on feminist theory in order to conceptualize sexuality in regards to sex class systems and sexual dynamics, the thesis addresses rival discourses in a time frame that follows the striking down of the laws up until when Bill C-36 was introduced by the Conservative government. Media discourses and the regulating systems that they entail (privileged voices, oriented coverage, framed debates etc.) all help create certain ideas around sexuality whilst simultaneously normalizing them. With the input of numerous social agents (politicians, women’s groups, academics, prostituted women and lawyers), the rival discourses set around morality and choice in sexuality fed a public debate built on a similar antagonism to that of the feminist “sex wars”. This thesis understands these discourses framed within the debate of prostitution as constitutive of current understandings of sexuality and sex class systems.

D.L. A 790-2008

La qualité de vie liée à la santé (QdV) s’est imposée comme une préoccupation essentielle dans la prise en charge des patients. Elle est devenue un des objectifs majeurs des essais cliniques.Notre revue bibliographique a montré un réel manque de données sur la QdV de la femme enceinte, puisqu’entre 2005 et 2015, elle n’a identifié que 75 articles portant sur cette problématique. Nous avons donc voulu déterminer l’évolution de la QdV chez les femmes enceintes du premier trimestre au 9ème mois, à l’aide du questionnaire EQ5D-3L version française, en différenciant les grossesses physiologiques des grossesses pathologiques, et en comparant cette évolution inter et intra grossesse. A cette fin, nous avons suivi une cohorte de 500 femmes enceintes entre 2015 et 2017 au CHU de Toulouse qui ont complété mensuellement un cahier d’observation en ligne. Après avoir réalisé une régression par morceaux, entre le 4ème et le 8ème mois, la QdV était significativement plus basse pour les grossesses pathologiques et diminuait significativement pour chaque type de grossesse. Ces résultats nous ont amené à nous demander si la QdV de la femme enceinte pouvait avoir un impact sur le mode d’allaitement à la naissance (maternel ou artificiel). A partir de cette même cohorte, où nous avions également recueilli le mode d’allaitement à la naissance, nous n’avons pas montré de lien entre QdV au cours de la grossesse et mode d’allaitement à la naissance, que ce soit lors de l’analyse mensuelle ou lors de l’analyse catégorielle qui était fonction de la QdV au 3ème mois de grossesse et de son évolution au cours de la grossesse / Health Related Quality of life (HRQoL) has emerged as a major concern in the care of patients and has become a major objective of clinical trials.Our literature review showed us a real lack of data on the QoL of the pregnant woman, since between 2005 and 2015, she identified only 75 articles dealing with this problem.We therefore wanted to determine the evolution of QoL in pregnant women from the first trimester to the 9th month using the EQ5D-3L French version, by differentiating physiological pregnancies from pathological pregnancies and comparing this inter and intra pregnancy progression. . We therefore followed a cohort of 500 pregnant women between 2015 and 2017 at Toulouse University Hospital, who completed a monthly online observation form. After performing piecemeal regression, between the 4th and 8th month, QoL was significantly lower for pathological pregnancies and significantly decreased for each type of pregnancy.These results led us to question whether the QoL of the pregnant woman could have an impact on breastfeeding at birth (maternal or artificial). From this same cohort, where we also collected breastfeeding at birth, we did not show a link between QoL during pregnancy and breastfeeding at birth, whether at birth. monthly analysis or categorical analysis that was based on QoL at the 3rd month of pregnancy and its course during pregnancy

Made available in DSpace on 2016-04-28T20:38:46Z (GMT). No. of bitstreams: 1 Camila Souza Novaes.pdf: 5824337 bytes, checksum: 0e69f53b1ab8cf707be1f24ab68cd5a5 (MD5) Previous issue date: 2013-11-01 / This study aims to determine whether the Complementary Spiritist Therapy promotes improvement in quality of life and perceived health of the patient according to their selfreport. Based in Jungian Psychosomatic Model of diseases, this paper uses the method of qualitative and quantitative research, through the application of semi-structured interviews and The Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) before and after the participants undergo a spiritual healing treatment. The sample consists of thirtythree participants with various diseases, 34-81 years, of different religions, frequenters of a spiritist center of the city of São Paulo. The interview results showed that for the majority of the sample the treatment was effective because the respondents had a perception of improvement in their health status, reported a decrease in symptoms, acquired some kind of learning and changed their relationship with the disease itself. This way faith proved to be an important element of healing. For a minority of the sample, there has been little improvement in their perception of physical symptoms. However, they obtained psychological and spiritual gains. When comparing the average results of the participants in the first and second application of the SF-36, there was significant improvement in the mental component summary and in the following domains of quality of life: role-physical, bodily pain, general health, vitality, social functioning, role-emotional and mental health. The differences between the outcomes of the first and second application of the SF-36 of physical functioning and the physical component summary were not statistically significant / Este trabalho tem como objetivo verificar se a Terapia Complementar Espírita (TCE) promove melhora na qualidade de vida e na percepção de saúde do paciente segundo seu autorrelato. Fundamentada no Modelo Psicossomático Junguiano de doenças, esta dissertação utiliza o método qualitativo e quantitativo de pesquisa, através da aplicação de entrevistas e do Instrumento Genérico de Avaliação de Qualidade de Vida em Saúde (questionário SF-36) antes e depois dos participantes se submeterem a um tratamento de cura espiritual. A amostra é composta por trinta e três sujeitos com enfermidades diversas, de 34 a 81 anos, de distintas religiões, frequentadores de um centro espírita da cidade de São Paulo. Os resultados das entrevistas indicaram que para a maioria da amostra o tratamento foi eficaz, pois os entrevistados obtiveram uma percepção de melhora no estado de saúde, observaram uma diminuição dos sintomas apresentados, adquiriram algum tipo de aprendizado e modificaram a relação com a própria doença. A fé se mostrou assim um importante elemento de cura. Para uma minoria, houve percepção de pouca melhora nos sintomas físicos. Contudo, obtiveram ganhos de ordem psicológica e espiritual. Ao comparar as médias dos resultados dos participantes obtidos na primeira e na segunda aplicação do questionário, observaram-se resultados de melhora significativa no sumário de componentes mentais e nos seguintes domínios de qualidade de vida: aspectos físicos, dor, aspecto geral de saúde, vitalidade, aspectos sociais, aspectos emocionais, saúde mental. A diferença entre as médias da capacidade funcional e no sumário de componentes físicos não foi estatisticamente significativa

<p>Delirium is common among old patients admitted to hospital, but is often a neglected problem in patient care. The principal aim of this thesis was to evaluate aspects of delirium in relation to incidence, risk factors, behavioural changes, cognitive function and health-related quality of life (HRQOL). A further aim was to describe patients’ experiences of being delirious. The study was prospective, descriptive and comparative, with repeated measures (six-month follow up). The sample consisted of 225 consecutive patients, aged 65 years or older, who were to be operated on due to hip fracture or hip replacement. Exclusion criteria were serious cognitive disorder or delirium on admission. Data were collected via frequent daily observations, cognitive functioning tests (MMSE), HRQOL questionnaires (SF-36) and interviews. Delirium was assessed according to the DSM-IV criteria. A total of 45/225 became delirious, with an incidence of 24.3% among patients undergoing hip fracture surgery and 11.7% among those with hip replacement surgery. A predictive model for delirium included four factors: impaired hearing, passivity, low cognitive functioning, and waiting more than 18h for hip fracture surgery. Disorientation and urgent calls for attention were the most frequent behavioural changes in the prodromal phase prior to delirium. Delirium in connection with hip fracture revealed deteriorated HRQOL and cognitive functioning when measured at a six-month follow-up. The experience of being delirious was described by the patients as a sudden change of reality. Such an experience gave rise to strong emotional feelings, as did recovery from delirium. Nurses’ observations of behavioural changes in old patients with impaired cognitive function may be the first step in managing and reducing delirium. The predictive model of delirium ought to be tested further before use in clinical practice.</p>

<p>The aim the thesis was to investigate, the prevalence of Lower Urinary Tract Symptoms (LUTS). Moreover, we examine symptom severity and different levels of distress and describe how different symptoms from the lower urinary tract affect the self-assessed health, sadness, happiness and the quality of life in men. </p><p>The studies are based on two data collections. In the first data collection, all men aged 40 – 80 years (n=2571) living in the Swedish community received a postal questionnaire. Twelve months later, 504 men who had earlier reported LUTS and 504 who had not reported symptoms were asked to complete the DAN-PSS and the SF-36 questionnaires. </p><p>The overall prevalence of LUTS was 24%. Post-micturition dribbling (21%) was the most frequent symptom, and stress incontinence (2%) was the least frequent symptom. Urge incontinence, stress incontinence and “other” incontinence cause a high level of distress, even if the symptoms do not occur very often. Men experiencing mild, moderate or severe urge, stress or “other incontinence” had lower mean scores for all of the eight dimensions measured by the SF-36 than men without the same symptoms. Men experiencing a moderate/severe degree of weak stream or nocturia reported a poorer quality of life in all dimensions compared to men with a mild level of the same symptoms. The total burden of moderate/severe LUTS is related to self-assessed health, sadness and happiness. For each of the 12 specific LUTS, men with mild, moderate or severe symptoms had lower scores for self-assessed health and happiness, and higher scores for self-assessed sadness, than men without the same symptoms. </p><p>In conclusions, one of every four men reports LUTS. Urinary incontinence causes high level of distress even to men who experience this symptom rarely. LUTS have a negative impact on quality of life, health, sadness and happiness. </p>

Delirium is common among old patients admitted to hospital, but is often a neglected problem in patient care. The principal aim of this thesis was to evaluate aspects of delirium in relation to incidence, risk factors, behavioural changes, cognitive function and health-related quality of life (HRQOL). A further aim was to describe patients’ experiences of being delirious. The study was prospective, descriptive and comparative, with repeated measures (six-month follow up). The sample consisted of 225 consecutive patients, aged 65 years or older, who were to be operated on due to hip fracture or hip replacement. Exclusion criteria were serious cognitive disorder or delirium on admission. Data were collected via frequent daily observations, cognitive functioning tests (MMSE), HRQOL questionnaires (SF-36) and interviews. Delirium was assessed according to the DSM-IV criteria. A total of 45/225 became delirious, with an incidence of 24.3% among patients undergoing hip fracture surgery and 11.7% among those with hip replacement surgery. A predictive model for delirium included four factors: impaired hearing, passivity, low cognitive functioning, and waiting more than 18h for hip fracture surgery. Disorientation and urgent calls for attention were the most frequent behavioural changes in the prodromal phase prior to delirium. Delirium in connection with hip fracture revealed deteriorated HRQOL and cognitive functioning when measured at a six-month follow-up. The experience of being delirious was described by the patients as a sudden change of reality. Such an experience gave rise to strong emotional feelings, as did recovery from delirium. Nurses’ observations of behavioural changes in old patients with impaired cognitive function may be the first step in managing and reducing delirium. The predictive model of delirium ought to be tested further before use in clinical practice.

The aim the thesis was to investigate, the prevalence of Lower Urinary Tract Symptoms (LUTS). Moreover, we examine symptom severity and different levels of distress and describe how different symptoms from the lower urinary tract affect the self-assessed health, sadness, happiness and the quality of life in men. The studies are based on two data collections. In the first data collection, all men aged 40 – 80 years (n=2571) living in the Swedish community received a postal questionnaire. Twelve months later, 504 men who had earlier reported LUTS and 504 who had not reported symptoms were asked to complete the DAN-PSS and the SF-36 questionnaires. The overall prevalence of LUTS was 24%. Post-micturition dribbling (21%) was the most frequent symptom, and stress incontinence (2%) was the least frequent symptom. Urge incontinence, stress incontinence and “other” incontinence cause a high level of distress, even if the symptoms do not occur very often. Men experiencing mild, moderate or severe urge, stress or “other incontinence” had lower mean scores for all of the eight dimensions measured by the SF-36 than men without the same symptoms. Men experiencing a moderate/severe degree of weak stream or nocturia reported a poorer quality of life in all dimensions compared to men with a mild level of the same symptoms. The total burden of moderate/severe LUTS is related to self-assessed health, sadness and happiness. For each of the 12 specific LUTS, men with mild, moderate or severe symptoms had lower scores for self-assessed health and happiness, and higher scores for self-assessed sadness, than men without the same symptoms. In conclusions, one of every four men reports LUTS. Urinary incontinence causes high level of distress even to men who experience this symptom rarely. LUTS have a negative impact on quality of life, health, sadness and happiness.