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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
31

Étude longitudinale de la qualité de vie liée à la santé chez la femme enceinte : état des lieux, comparaison de l'évolution selon le devenir obstétrical et impact sur le mode d'allaitement à la naissance / Longitudinal study of quality of life related to the health of pregnant women : state of play, comparison of evolution according to obstetric outcome and impact on breastfeeding at birth

Morin, Mathieu 17 December 2018 (has links)
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
32

Trajectory Classes of Decline in Health-Related Quality of Life in Parkinson’s Disease: A Pilot Study

Klotsche, Jens, Reese, Jens Peter, Winter, Yaroslav, Oertel, Wolfgang H., Irving, Hyacinth, Wittchen, Hans-Ulrich, Rehm, Jürgen, Dodel, Richard 23 April 2013 (has links) (PDF)
Objective: To analyze the change in health-related quality-of-life (HRQoL) in patients with Parkinson’s disease (PD) and to identify different classes of HRQoL decline. Methods: A longitudinal cohort study was performed to assess clinical parameters (unified PD rating scale, Beck Depression Inventory) and HRQoL data (EuroQol, Parkinson’s Disease Questionnaire [PDQ]-39) at baseline, 3, 6, 12, 24, and 36 months. A total of 145 patients with PD were consecutively recruited in the county of Northern Hessia, Germany, between January and June 2000. A latent growth mixture model was applied to analyse the heterogeneity in HRQoL trajectories. Results: We successfully applied latent mixture growth modeling in order to identify different classes of HRQoL trajectories in PD. Three growth models were developed and each resulted in a four-class model of distinct patterns using the generic EuroQol instruments’ outcomes (EuroQol-5 Dimensions and visual analogue scale) and the disease-specific PDQ- 39. The four classes were defined by individual trajectory characteristics. Classes one and two represented trajectories with moderate declines over 36 months, but with different initial intercepts. Class three consisted mainly of patients who passed away during the observation period and therefore had a large HRQoL decline. Class four was characterized by a low level of HRQoL at baseline and a significant subsequent decline. Conclusions: The findings provide a more elaborate understanding of the variability in HRQoL reduction in PD over time. The classification of different HRQoL subgroups may help to explain the response of PD patients to the natural history of the disease. Future research will enable the identification of HRQoL responder subgroups on different treatment regimens.
33

Competencia emocional del profesorado de un instituto de bachillerato. : Experiencia de seis profesores / Emotional skills of a high school teaching staff. : Experiences from six teachers.

Monsalve, Carlos January 2011 (has links)
Monsalve, Carlos. (2010) Emotional skills of a high school teaching staff. Experiences from six teachers. Master in Pedagogy - final examination, 30 hp, Institute of Pedagogy, Stockholm University. This research will be conducted as a final examination for the Master in Pedagogy, which I am currently attending in the Institute of Pedagogy at the Stockholm University (Sweden). My interest on this research grew up from the moment in which I identified in my experience as a teacher, the importance of a good emotional management (own emotions and other's as well) by teachers at a high school in the city of Badajoz, Spain. This is so, because this educational institute is localized in a low socio-economical status (marginalized area), which causes the students to have specific emotional difficulties that affect their normal performance in their studies and outcomes. In the same way and as a consequence of the above, it became evident to me the conclusion that teachers should be properly prepared for an effective support that students with such difficulties required. As another main reason for this investigation, it should be pointed out the existing necessity of new input in the researching ground required within the Emotional Intelligence area and its relationship with education. Most of the concepts in this respect will be supported by the formulations of the American psychologist D. Goleman. (1996). In this work, I would also like to contribute with a different analysis, employing the phenomenological method of the French philosopher Merleau-Ponty for interview analysis. Within this research, six teachers from the mentioned institution were interviewed so as to find out about their personal experiences related to the emotional ambit. Such experiences were analyzed using the phenomenological method formulated by Merleau-Ponty as I mentioned before. After the respective conclusions derived from the analysis conducted on the interviews, they followed a confrontation with the Emotional Intelligence theory by Goleman, (1996), and finally, the formulation of a conclusion which enables a solution to the questions posed in the objectives, and consequently responds to the hypothesis conceived.   Key words: EQ, Emotional Intelligence (IE), Emotional Skills, Phenomenology of Merleau-Ponty, Phenomenological Methodology of Merleau-Ponty. / Competencia Emocional del profesorado de un Instituto de Bachillerato. Experiencias de seis profesores. Máster en pedagogía – Examen final, 30 hp, Instituto de Pedagogía, Universidad de Estocolmo. Este estudio de investigación es realizado como examinación final del máster en pedagogía que actualmente curso en el instituto de Pedagogía de la Universidad de Estocolmo (Suecia). Mi interés en la investigación surgió al haber identificado y evidenciado, según mi experiencia como profesor, la importancia que tiene el buen manejo de las emociones (las propias y la de los demás) por parte de los profesores de un instituto de bachillerato de la ciudad de Badajoz, España. Ello, por encontrarse el instituto ubicado en un área social de estrato bajo (zona de marginación) por lo que los alumnos tienen especiales dificultades emocionales que afectan el desempeño normal de sus estudios y sus resultados. Así mismo y como consecuencia de lo anterior, me resulta clara la conclusión de que los profesores deben estar preparados adecuadamente para un apoyo efectivo que requieren dichos alumnos con ese tipo de dificultades. Como otro motivo primordial, cabe señalar la necesidad existente de nuevos aportes en el ámbito investigativo que requiere el ámbito de la Inteligencia Emocional y su relación con la educación. La mayoría de los conceptos al respecto, estarán apoyados en las formulaciones del psicólogo americano Goleman (1996). En este trabajo, deseo también aportar un análisis diferente, empleando el método fenomenológico del filósofo francés Merleau-Ponty para el análisis de las entrevistas. En la investigación se entrevistó a seis profesores de bachillerato del citado instituto para así indagar sobre sus vivencias o experiencias personales relacionadas con el ámbito emocional. Dichas vivencias fueron luego analizadas utilizando el método fenomenológico formulado por Merleau-Ponty como mencioné con anterioridad. Después de las respectivas conclusiones del análisis de las entrevistas, se procedió a confrontarlas con la teoría de la inteligencia emocional de Goleman (1996), para finalmente formular una conclusión y así llegar a una solución de  las preguntas formuladas en los objetivos y consecuentemente responder a la hipótesis planteada. Palabras claves: EQ, Inteligencia Emocional (IE), Competencia Emocional, Fenomenología, Metodología Fenomenológica de Merleau-Ponty.
34

Integrativ vård : En undersökning av hälsovinster - egen upplevd hälsa, för patienter som erhållit antroposofisk vård på Vidarklinikens öppenvårdsmottagning i Norrköping / Integrative care : A survey of health benefits – self-rated health, for patients receiving anthroposophic care at the Vidar Clinic outpatient facility in

Nestor, Inger January 2012 (has links)
Introduktion: WHO betonar vikten av att integrera traditionell- och komplementärmedicin i nationella hälsovårdssystem. I Sverige förekommer integrativ medicin med antroposofisk inriktning på Vidarkliniken i Järna. Syfte: Att studera förändringar av självskattat hälsotillstånd hos patienter som erhållit antroposofisk vård på Vidarklinikens öppenvårdsmottagning i Norrköping. Metod: En kvantitativ metod med enkäter till 26 patienter på Vidarklinikens öppenvårdsmottagning i Norrköping, konsekutiv datainsamling. Hälsorelaterad livskvalitet skattades med hjälp av EQ-5D (rörlighet, hygien, aktivitet, smärta och oro) och EQ-VAS (totalt hälsotillstånd) samt två enkäter, konstruerade för denna studie, med VAS-skalor för sömnkvalitet, fysiskt tillstånd, psykiskt tillstånd och förutsättningar att hantera sin livssituation, samt patienternas beskrivning av måluppfyllelse. Därutöver undersöktes patienternas sjukskrivningsgrad och läkemedelsförbrukning. Resultat: Patienterna hade mycket varierande diagnoser och ofta sammansatt problematik. Vanligast var utmattning, fibromyalgi och smärta. Resultaten varierade mellan diagnosgrupperna. Huvuddelen av patienterna rapporterade stor tillfredsställelse med vård, behandling och bemötandet från personal, till hög grad uppnådda förväntningar och mål, samt att överlag ha fått bättre förutsättningar att hantera sin livssituation. Det fanns ingen signifikant skillnad i medelvärdet för EQ-5D index eller EQ-VAS, men trend till signifikant förbättring vad gäller sömnkvalitet och psykiskt tillstånd, samt signifikant förbättring av självskattat fysiskt tillstånd (p=0.021). Vid delanalys av de enskilda dimensionerna (EQ-5D) fann man förbättrat tillstånd i någon/några av dimensionerna hos 36 % av patienterna, oftast vad gäller rörlighet och minst vanligt vad gäller smärta. Slutsats: I denna grupp med omfattande och varierande och ofta mycket långvarig problematik påvisades stor uppskattning av vården, trender till förbättrade resultat vid sömnkvalitet och psykiskt tillstånd, samt signifikant förbättrade resultat vid självskattat fysiskt tillstånd. / Introduction: WHO stresses the importance of integrating traditional and complementary medicine into national health systems. In Sweden, integrative medicine with an anthroposophical focus is practised at Vidar Clinic in Järna. Purpose: To study changes in the self-rated health status of patients receiving anthroposophic care at Vidar Clinic outpatient facility in Norrköping. Method: A quantitative method using questionnaires to 26 patients at the Vidar Clinic outpatient facility in Norrköping, [using] consecutive data collection. Health-related quality of life was estimated using EQ-5D (mobility, hygiene, activity, pain and anxiety) and EQ-VAS (overall health status) along with two questionnaires specially designed for this study, with VAS scales for sleep quality, physical condition, mental condition and the ability to manage their lives, as well as the patients’ description of whether or not they felt fulfilled in their lives. In addition, the patients’ sickness absence rates and drug consumption were analysed. Results: The patients had extremely varying diagnoses and often complex problems. The most common were fatigue, fibromyalgia and pain. The results varied between the diagnostic groups. The majority of the patients reported great satisfaction with their care and treatment and how they were being cared for by the staff; to a large extent they felt that their expectations and goals had been achieved, and that in general they had been given better capabilities to manage their lives. There was no significant difference in the mean value for the EQ-5D index or EQ-VAS, but a tendency to significant improvement in sleep quality and mental condition, and a significant improvement in self-estimated physical condition (p=0.021). When a partial analysis was conducted of the individual dimensions (EQ-5D), improved conditions were found in one/some of the dimensions in 36 per cent of the patients, usually in terms of mobility and least common with regard to pain. Conclusion: In this group, with extensive and varied and often very long-term problems, great appreciation of the care was shown, there were tendencies to improved results in sleep quality and mental condition, and significantly improved results in self-estimated physical condition.
35

Ledarintelligens, självkänsla och personlighetsdrag före och efter deltagande i UGL / Leadership intelligence, self-esteem and personality traits before and after participation in UGL

Ekegren, Maria January 2012 (has links)
Sedan 1981 har ledarutbildningen UGL (Utveckling av Grupp och Ledare) varit en grundkurs för blivande officerare och är idag ett mycket använt koncept även inom näringsliv och offentlig förvaltning. Kursens mål är i enlighet med inbjudan bl.a. att få ökad förmåga att arbeta med reflektion, förstå känslors inverkan, kunna ta och ge utvecklande feedback, förstå hur värderingar påverkar ledarskap samt förstå behovet av olika ledarstilar. Syftet med föreliggande studie var att undersöka om det förelåg skillnad i följande variabler: ledarintelligens (emotionell, rationell och själslig intelligens), självkänsla (bas-, förvärvad och prestationsinriktad) och personlighetsdrag före resp. efter deltagande i UGL. Ledarintelligens är en ny ledarskapsmodell (Ronthy, 2006) och ett frågeformulär som bygger på denna teori är under utveckling. Ett annat syfte med studien var därför att undersöka begreppsvaliditeten hos detta instrument. Studien omfattade 125 ledare (M = 38,5 år, SD = 7,8), varav 82 kvinnor. Samtliga genomgick ledarutvecklings­programmet UGL under 2011. Tre självskattningsformulär användes i studien.  Före och direkt efter utbildningen undersöktes samtliga variabler, efter sex månader endast ledarintelligens. Resultatet visade signifikant skillnad före resp. direkt efter utbildning gällande emotionell intelligens, rationell intelligens, själslig intelligens, bassjälvkänsla, bitterhet, psykisk ångestbenägenhet, stresskänslighet samt social konformitet. De självskattade ökningarna i ledarintelligens kvarstod i nivå efter sex månader. Resultat från korrelationsprövningar indikerade teoretiskt rimliga samband. Då den självskattade nivån av den emotionella, den rationella samt den själsliga intelligensen uppmätte högre resultat efter deltagande i UGL i föreliggande studie, verkar det som att denna kompetensutvecklingsinsats möjligen kan ha bidragit positivt till ökad ledarintelligens hos deltagarna. / Since 1981 the leadership training UGL (Understanding Group and Leader) has been used as a basic course for new officers, and it´s today a frequently applied concept even in the commercial sector and public administration. The objectives of the course is, in accordance with the invitation to improve the participants’ abilities working with reflections, understanding the influence of emotions, providing developing feedback, understanding how our values influence leadership as well as understanding the needs of different leadership styles. The aim of the present study was to evaluate if there was a difference in the following variables: leadership intelligence (emotional, rational and spiritual intelligence), self-esteem (basic, earning and performance-based) and personality traits, before and after participating in UGL. The leadership intelligence is a new leadership model (Ronthy, 2006), and a questionnaire based on this theory is in progress. An additional aim of this study was to investigate the construct validity of this instrument. The study included 125 participants (M = 38,5 years, SD = 7,8), whereof 82 women. Everyone participated in the leadership development program UGL in 2011. Three self-assessment forms were used in the study. Before and immediately after the leadership training all variables were evaluated, after six months only leadership intelligence was evaluated. The results showed significant differences before and after participation in emotional intelligence, rational intelligence, spiritual intelligence, basic self-esteem, embitterment, psychic trait anxiety, stress susceptibility and social desirability. The self-estimated increases in leadership intelligence were still at similar levels after six months. Results from correlation tests indicated theoretical plausible correlations. In the present study the self-rated emotional, the logical, as well as the spiritual intelligence measured higher after participation in UGL. This professional development program may have contributed in a positive direction to increase employees’ leadership intelligence.
36

Sociala och emotionella interventioner i skolans värld. : Vad händer med karaktären hos eleverna?

Samuelsson, Helen, Drugge, Anders, Storm, Ulrika January 2015 (has links)
The purpose was to investigate whether using two type of interventions (i.e., Four rooms of change in school and EQ- workshop) in addition to curriculum guidelines can affect character development in children 10-12 years of age. The data was collected using the test Junior Temperament and Character Inventory (J-TCI; Cloninger, CR, 1994) in three elementary schools among students in fifth grade who had been involved in any of the two interventions for the past two years or no intervention at all. The J-TCI scales were used to, besides the seven personality dimension it measures, create a self-constructed empathy scale. A total of 55 participants were included in the study (girls n = 26 and boys n = 29). Statistical testing with MANOVA showed no significant main effect on empathy or any personality trait. There was however an interaction effect between intervention and gender on the character traits. Girls in the Four Rooms of change in school, compared to boys, reported higher Self-directedness and Cooperativeness and girls in the EQ-workshop reported higher Self-transcendence. The interventions Four Rooms at school and EQ workshop seems to have different impact on boys and girls. / Syftet var att undersöka om användandet av två typer av interventioner (dvs, Fyrarummaren i skolan och EQ verkstan) utöver Läroplanens riktlinjer kan påverka karaktärsutveckling hos barn 10-12 år. Data samlades in med hjälp av testet Junior Temperament och Character Inventory (J-TCI, Cloninger, CR, 1994) i tre grundskolor bland elever i femte klass som hade varit inblandade i någon av de två insatserna under de senaste två åren alternativt ingen intervention alls. J-TCI skalorna användes för att, förutom de sju personlighetsdimensioner den mäter, skapa en egentillverkad empatiskala. Totalt 55 deltagare ingick i studien (flickor n = 26 och pojkar n = 29). Statistisk testning med MANOVA visade ingen signifikant huvudeffekt på empati eller något personlighetsdrag. Det fanns dock en interaktionseffekt mellan intervention och kön på karaktärsdrag. Flickor i  Fyrarummaren i skolan, jämfört med pojkar, rapporterade högre Self-directedness och Cooperativeness och flickor i EQ-verkstan  rapporterade högre Self-transcendence. Interventionerna Fyrarummaren i skolan och EQ-verkstan verkar ha olika påverkan på pojkar och flickor.
37

Emotionell Intelligens & Ledarskap

Daneshmir, Hanna January 2018 (has links)
Introduction: Leadership has been a core issue of organizations for decades, if not for centuries. However, the previously so strong confidence in leadership rationality begins to weaken and instead, it is increasingly becoming a picture of the dualism that leadership often involves. The view has changed, leaders no longer apply a rational and economically computational mindset, but in fact they have to a large extent an irrational, socially oriented and emotional mindset. The emotional aspect of leadership is on the rise and, in that sense, Emotional Intelligence (EI) will become increasingly important, especially as the leader's EI capability is considered crucial to how the organization will work. Nevertheless, there is not enough research that discusses the popularized concept of EI in relation to leadership, in addition, the discussion is almost non-existent in Sweden. Purpose: The aim of the study is to contribute to a deeper understanding of the Emotional Intelligence (EI) importance in organizational context from a leadership perspective by contributing knowledge about Emotional Intelligence (EI) impact on leadership within an organization. Method: The study has been conducted with a qualitative research method with an abductive research effort. The empirical material consists of eleven interviews from business leaders in the Swedish business community. To analyze the material, theories that describe leadership, communication, motivation and leadership styles are used in connection with EI. Conclusion: The study concludes that business leaders' understanding and interpretation of the EI concept has an influence on the leadership they exercise. The study also comes up to the fact that business leaders' views on leadership affect their application of EI. / Inledning: Ledarskap har varit en kärnfråga av organisationer i årtionden, om inte i århundraden. Men den tidigare så starka tilltron till ledarskapets rationalitet börjar försvagas och fram träder istället allt mer en bild av den dualism som ledarskapet ofta innefattar. Synen på att ledare inte längre tillämpar ett rationellt och ekonomiskt kalkylerande tankesätt, utan att de i själva verket i stor utsträckning har ett irrationellt, socialt inriktat och känslopräglat tankesätt. Den känslomässiga aspekten i ledarskap är på uppgång och i den meningen kommer den Emotionella Intelligensen (EI) bli allt viktigare, speciellt då ledarens EI förmåga anses vara avgörande för hur organisationen kommer att fungera. Trots det finns det inte tillräcklig forskning som diskuterar det populäriserade begreppet EI i relation till ledarskap, dessutom är diskussionen näst intil obefintlig i Sverige. Syfte: Studien syftar till att bidra till en djupare förståelse for den Emotionella Intelligensens (EI) betydelse i organisationskontext från ett ledarskapsperspektiv genom att bidra med kunskap om Emotionella intelligensens (EI) inverkan på ledarskap inom en organisation. Metod: Studien har utförts med en kvalitativ forskningsmetod med en abduktiv forskningsansats. Det empiriska materialet består av elva intervjuer från företagsledare inom det svenska näringslivet. För att analysera materialet används teorier som beskriver ledarskap, kommunikation, motivation och ledarskapstilar med koppling till EI. Slutsats: Studiens kommer fram till att företagsledares förståelse och tolkning av EI begreppet har en påverkan på ledarskapet de utövar. Studien kommer även fram till att företagsledarnas syn på ledarskap påverkar deras tillämpning av EI.
38

Mesure et interprétation du changement d'utilité dérivée d'instruments de qualité de vie psychométriques / Measurement and interpretation of change utility derived from psychometric instruments

Hosseini, Kossar 13 December 2013 (has links)
Dans le domaine de la santé, la mesure d'utilité permet d'exprimer la valeur que peut donner un individu à un état de santé, comprise généralement entre 0 (la mort) et 1 (meilleur état de santé envisageable). L'utilité permet de valoriser simultanément le résultat clinique et son impact sur l'état de santé du patient, et d'exprimer ainsi la qualité de vie liée à la santé. Nous nous sommes intéressés dans ce travail à l'approche indirecte d'estimation d'utilité, consistant à dériver une utilité à partir des échelles psychométriques de mesure de l'état de santé (questionnaires génériques). Cette approche permet de répéter la mesure de l'utilité dans le temps et ouvre des perspectives pour l'analyse du changement d'utilité. Les objectifs étaient de définir un seuil de changement pour l'utilité dérivée des instruments de mesure psychométrique de la qualité de vie, et de prendre en compte dans l'interprétation du seuil la présence des comorbidités ou d'un phénomène de response-shift. Afin de répondre à nos objectifs, nous avons étudié, d'une part, le changement d'utilité mesurée par le SF-6D dans une cohorte de patients atteints d'arthrose des membres inférieurs (cohorte KHOALA) et l'effet des comorbidités sur l'utilité et son changement. D'autre part, nous avons estimé l'utilité de donneur vivant de rein à partir des questionnaires EQ-5D et SF-6D avant et 3 mois après le prélèvement du rein. Un seuil de changement a été estimé et un phénomène de response-shift a été recherché. Les résultats ont montré l'effet délétère des comorbidités sur la mesure de l'utilité chez les patients atteints d'arthrose, et mis en évidence l'importance de la sévérité fonctionnelle de l'arthrose dans l'expression de l'utilité et son changement. Chez les donneurs vivants de rein nous avons mis en évidence une diminution significative de l'utilité à 3 mois, avec une proportion de plus de 30% de donneurs ayant atteint le seuil de détérioration significative. L'estimation du seuil de changement diffère selon la population étudiée, l'instrument de mesure de l'utilité, et la méthodologie appliquée pour définir ce seuil. En conclusion, l'évaluation du changement d'utilité doit tenir compte de l'existence des comorbidités ainsi que de l'adaptation du jugement de valeur que l'individu porte sur son état de santé lorsque celui-ci évolue. La complexité des méthodes psychométriques pour la mesure de l'utilité doit amener à être prudent sur leur prise en compte dans les modèles d'évaluation économique. L'identification d'un seuil pour l'interprétation du changement peut être un élément complémentaire utile dans la démarche d'analyse décisionnelle / In health economic, the concept of utility was used to describe a state of health in patients. The unit value of health state utility ranges between 0, representing "death" state, and 1 representing a "perfect" health state. It is possible to recover through the measurement of utility both the clinical outcome and their impact on the health of the patient, and thus express the quality of life related to health. In this work, we used the indirect approach for estimating utility that is derived from a generic utility scales (quality of life questionnaires). The objectives of this thesis were to define a threshold of change for the utility derived from psychometric instruments measuring quality of life, and to take into account for the change interpretation, the presence of comorbidities or a response-shift phenomenon. We used data from a cohort of patients with osteoarthritis of lower limbs (KHOALA cohort) for estimate the impact of comorbidities in utility measured by the SF-6D its change over 3 years. We are also interested in the particular case of living kidney donors. The utility was estimated by the EQ-5D and SF-6D before and 3 months after kidney donation. A threshold of significant deterioration has been estimated and the presence of a response-shift phenomenon was controlled. The results showed the deleterious effect of comorbidities on utility measurement for patients with lower limbs osteoarthritis, and highlighted the importance of the functional severity of osteoarthritis in the expression of utility and its change over time. Living kidney donors experienced a significant decrease in their utility score in the short term, and more than third of donors have reached the threshold of significant deterioration. The threshold of utility change varies depending on the population studied, the measurement instrument, and the methodology used to define the threshold. In conclusion, the assessment of utility change must take into account the existence of other diseases and the adaptation of the individual on his health state variation. The complexity of measuring individual preferences by psychometric instruments should lead to be careful about introducing them in the economic evaluation. The use of a threshold for the interpretation of utility change can be an additional element in the decision-making process
39

Trajectory Classes of Decline in Health-Related Quality of Life in Parkinson’s Disease: A Pilot Study

Klotsche, Jens, Reese, Jens Peter, Winter, Yaroslav, Oertel, Wolfgang H., Irving, Hyacinth, Wittchen, Hans-Ulrich, Rehm, Jürgen, Dodel, Richard January 2011 (has links)
Objective: To analyze the change in health-related quality-of-life (HRQoL) in patients with Parkinson’s disease (PD) and to identify different classes of HRQoL decline. Methods: A longitudinal cohort study was performed to assess clinical parameters (unified PD rating scale, Beck Depression Inventory) and HRQoL data (EuroQol, Parkinson’s Disease Questionnaire [PDQ]-39) at baseline, 3, 6, 12, 24, and 36 months. A total of 145 patients with PD were consecutively recruited in the county of Northern Hessia, Germany, between January and June 2000. A latent growth mixture model was applied to analyse the heterogeneity in HRQoL trajectories. Results: We successfully applied latent mixture growth modeling in order to identify different classes of HRQoL trajectories in PD. Three growth models were developed and each resulted in a four-class model of distinct patterns using the generic EuroQol instruments’ outcomes (EuroQol-5 Dimensions and visual analogue scale) and the disease-specific PDQ- 39. The four classes were defined by individual trajectory characteristics. Classes one and two represented trajectories with moderate declines over 36 months, but with different initial intercepts. Class three consisted mainly of patients who passed away during the observation period and therefore had a large HRQoL decline. Class four was characterized by a low level of HRQoL at baseline and a significant subsequent decline. Conclusions: The findings provide a more elaborate understanding of the variability in HRQoL reduction in PD over time. The classification of different HRQoL subgroups may help to explain the response of PD patients to the natural history of the disease. Future research will enable the identification of HRQoL responder subgroups on different treatment regimens.
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Effekten av intensivbehandling på HbA1c och hälsa hos individer med diabetes typ 1

Berntsen, Tom, Dahlbom, Emma January 2024 (has links)
Bakgrund: Glykemisk kontroll hos personer med typ 1 diabetes kräver stöd och utbildning av vårdpersonal inom diabetesvården. För att förbättra behandlingsresultat och livskvalitet samt minska risken för komplikationer kan intensiva behandlingsstrategier användas för att sträva efter optimal glykemisk kontroll och hälsa. Syfte: Syftet är att beskriva hur intensivbehandling påverkar HbA1c och hälsa hos personer med diabetes typ 1. Metod: En retrospektiv studie, deskriptiv design med kvantitativ ansats. Urvalet skedde från en diabetesmottagning och utgick från redan insamlade data från ett intensivbehandlingsprojekt. 42 patienter med diabetes typ 1 och HbA1c ≥70 mmol/mol inkluderades i intensivbehandlingsprojektet. De variabler som undersöktes var HbA1c och EQ-VAS, för att undersöka sambandet mellan glykemiskkontroll och skattad hälsa. Huvudresultat: Resultatet visade ett svagt samband mellan sjunkande HbA1c och stigande EQ-VAS vid uppföljningen. Det starkaste signifikanta sambandet sågs i kategorin kontakt med dietist, kopplat till HbA1c och EQ-VAS. I kategorierna patienter med flerdosbehandling av insulinpenna, behandling med insulinpump samt utebliven kontakt med dietist visade inget signifikant samband kopplat till sjunkande HbA1c och stigande EQ-VAS.  Slutsats: Studien visar betydande förbättringar i både HbA1c och EQ-VAS hos patienter med diabetes typ 1 efter intensivbehandling. Positiva samband observerades mellan insulinpumpbehandling och högre EQ-VAS, samt dietistkontakt och minskat HbA1c. Fynden tyder på att intensivbehandlingen, särskilt med dietistrådgivning, effektivt förbättrar glykemisk kontroll och livskvalitet. Ytterligare forskning behövs för att bekräfta dessa resultat. / Background: Glycemic control in individuals with type 1 diabetes requires support and education from diabetes care professionals. To improve treatment outcomes and quality of life while reducing the risk of complications, intensive treatment strategies can be employed to achieve optimal glycemic control and health. Purpose: The purpose is to describe how intensive treatment affects HbA1c and health in individuals with type 1 diabetes. Method: A retrospective study with a descriptive design using a quantitative approach. The sample was selected from a diabetes clinic and relied on previously reported data from an intensive treatment project. 42 patients with type 1 diabetes and HbA1c ≥70 mmol/mol were included in the intensive treatment project. Data were analyzed using Spearman's rank correlation analysis to identify relationships between HbA1c and health. Main Results: The results showed a weak correlation between decreasing HbA1c and increasing EQ-VAS scores at follow-up. The strongest significant correlation was observed in the category of contact with a dietitian, linked to HbA1c and EQ-VAS. In the categories of patients using multiple daily injections with insulin pens, insulin pump therapy, and lack of contact with a dietitian, no significant correlation was found related to decreasing HbA1c and increasing EQ-VAS. Conclusion: The study shows significant improvements in both HbA1c and EQ-VAS in patients with type 1 diabetes after intensive treatment. Positive correlations were observed between insulin pump therapy and higher EQ-VAS scores, as well as between dietitian contact and reduced HbA1c. The findings suggest that intensive treatment, especially with dietitian counseling, effectively enhances glycemic control and quality of life. Further research is needed to confirm these results.

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