Bakgrund: Tyreoideacancer drabbar cirka 400 personer årligen i Sverige varav kvinnor är överrepresenterade. Insjuknandet sker vanligen efter 50 års ålder men förekommer även i yngre åldrar. Syfte: Att få kunskap om omvårdnadsbehov och livskvalitet hos patienter med tyreoideacancer under och efter den medicinska behandlingen mot cancer. Metod: En litteraturstudie där 9 artiklar båda kvalitativa och kvantitativa artiklar har analyserats. Resultat: Resultatet pekar på att det finns omvårdnadsbehov under och efter avslutad cancerbehandling. Analysen visar att patienterna upplever en försämrad livskvalitet efter avslutad behandling och att detta påverkade patienternas förmåga att återgå till ett vanligt liv. Slutsats: Konsekvenserna av sjukdomen och behandling tyder på att patienterna bör erbjudas psykologiskt stöd, samtalsstöd i grupp och enskilt under en längre tid samt att en uppföljning behövs efter avslutad medicinsk behandling. Detta för att se hur patienten bibehåller sin livskvalitet och sin förmåga att klara av det vanliga livets krav och utmaningar. / Background: Thyroid cancer affects about 400 people annually in Sweden, of which women are overrepresented. The onset is usually after age 50 but also occurs in younger ages. Purpose: To ascertain the needs of care and quality of life in patients with thyroid cancer during and after medical treatment for cancer. Method: A literature review where 9 articles, both qualitative and quantitative articles were analyzed. Results: The results indicate that there is need for care during and after cancer treatment. The analysis show that patients experience a decreased quality of life after treatment and that this affected patients’ ability to return to a normal life. Conclusion: The consequences of the disease and treatment indicates that patients should be offered psychological support, counseling in groups and individually for a long time and that a follow-up is needed after medical treatment. This is to ensure that the patient maintain their quality of life and their ability to cope with the ordinary demands and challenges of life.

Background: Food allergy, an abnormal immunologic response to food protein, has an estimated prevalence of 6% in young children and 3.7% in adults in the U.S. The only proven therapy for food allergy is strict elimination of the offending allergens. As a result, caregivers and patients could experience constant anxiety and stress that affects their quality of life. Additionally, food allergy can lead to significant economic impact on the health care system, since severe reactions often lead to ED visits and hospitalizations. Objectives: The first major objective was to determine the economic burden of Food Allergy and Anaphylaxis (FAA) patients in the U.S. by estimating the direct medical and indirect costs. The second principal objective involved assessing the Health Related Quality of Life (HRQL) of food allergic patients by measuring their health utilities and disease specific quality of life. Methods: Economic burden was estimated by measuring certain direct medical and indirect costs from a societal perspective. Costs were estimated using a bottom-up approach -- calculating the average cost of illness per patient and multiplying it by reported prevalence estimates. FAA patients with an emergency department (ED) visit, office based physician visit, outpatient department visit, and hospital admission were identified from a list of federally administered databases using ICD-9 codes. Sensitivity analyses were conducted to measure the robustness of the estimates. The cross-sectional HRQL study measured health utilities in food allergic adults and children, and quality of life in allergic adults using EQ-5D and FAQL-AF questionnaires respectively. These questionnaires were administered in an online survey format. Regression models were specified to explore the deviations in HRQL scores between patients with different disease related characteristics. Results: The findings reveal that for a given year (2007), direct medical costs worth $225 million and indirect costs worth $115 million were incurred. Owing to the irregularities in the reporting and diagnosis of food allergy, these values might be an underestimation. Simulations from probabilistic sensitivity analysis generated mean direct medical costs of $307 million and indirect costs of $203 million. Survey responses were collected online for eight months, during which 45 adults and 94 parents (acting as proxy for their food allergic child) responded. Adults reported a mean utility of 0.874 compared to 0.918 for children. Gender, number of food allergies and frequency of carrying epinephrine device had significant impacts on HRQL scores. An effect size of 0.003 was estimated comparing health utilities of food allergic adults with the general U.S. population. Conclusions: This was the first research to examine economic burden of FAA, and elucidate health utilities for food allergic patients. A large proportion of costs were incurred due to ambulatory visits. Effect size calculation revealed that health utilities of food allergic patients were very similar to the general U.S. population.

The adverse effects of cancer treatment on health-related quality of life (HRQL) are the primary concern of elderly women diagnosed with breast cancer. The interplay of transient and progressive functional impairments caused by cancer therapies, alongside the accelerated physical declines associated with the normal aging process, are all negatively correlated to HRQL. This study compared the HRQL trajectories between cases and controls for ten years after diagnosis. The cancer group included 1467 women (age ≥ 65), diagnosed with primary breast cancer, registered in the Surveillance Epidemiology and End Results (SEER) cancer registry, and completed the Medicare Health Outcomes Survey (MHOS) before and after diagnosis. Controls were frequency-matched to cases with a 1:1 ratio on age and socio-economic variables. Participants reported their HRQL using SF-36/VR12 questionnaire, which was summarized into two summary scores (physical component summary (PCS) and mental component summary (MCS) and eight domain scores: physical functioning (PF), general health (GH), bodily pain (BP), role-limitation physical (RP), social functioning (SF), mental health (MH), role-limitation emotional (RE), and vitality (VT). Hierarchical Linear Modelling was utilized to assess the fixed effects of time, group, and the interaction between time and group (Time*Group) on HRQL trajectories. At the time of cancer diagnosis, cases fared worse than controls in all of the HRQL domains and summary scores. Group and time were majorly significant for PCS, PF, GH, BP, and RP, while only group was predominantly significant for mental domains (MCS, SF, MH, RE, VT). Time was also significant for SF and VT, while Time*Group was only significant for RE. Cases showed remarkable gains over controls across time in MCS, RE, MH, VT, SF, and PF. The need for intervention in improving physical health iii HRQL among older women is validated. On the other hand, the remarkable gains of cases over controls on mental domains of HRQL provoke future research to explore further patient perception on benefit-finding caused by the diagnosis and experience of cancer.

No description available.

Objetivo: Asociar la calidad de vida relacionada a la salud oral con la pérdida prematura de dientes deciduos en preescolares de 3 a 5 años de una institución privada en Lima, Perú. Materiales y métodos: El diseño del estudio fue de tipo transversal. La muestra estuvo constituida por 142 alumnos entre las edades de 3 a 5 años. Para el análisis de la calidad de vida relacionada a la salud oral (CVRSO), se utilizó el cuestionario Early Childhood Oral Health Impact Scale (ECOHIS) desarrollado por los padres de familia. Asimismo, para determinar la pérdida prematura de dientes deciduos, se usaron los parámetros de la American Dental Association (ADA) y las características de la gingiva. Para la asociación de CVRSO y pérdida prematura se empleó el análisis multivariado mediante la regresión binomial negativa. Se estableció el nivel de significancia como p<0.05 y un IC 95%. Resultados: Se encontró un promedio de 7.70 ± 8.43 al analizar la CVRSO, y la prevalencia de pérdida prematura fue de 10.56 %. Con respecto a la pérdida prematura de dientes deciduos, no existe probabilidad de que la calidad de vida se vea afectada, ya que a su presencia, la puntuación de la CVRSO aumenta en RTI 0.75 (IC 95% 0.26 -2.15). Conclusiones: Se observó que la CVRSO no se encuentra asociada con la pérdida prematura. Sin embargo, si existen diferencias en los puntajes de CVRSO al comparar los grupos de presencia y ausencia de pérdida prematura. / Objective: To associate the quality of life related to oral health with the premature loss of deciduous teeth in pre-schoolers from 3 to 5 years from a private institution in Lima, Peru. Materials and methods: The study design was cross-sectional. 142 students between the ages of 3 to 5 years were evaluated. For the analysis of Oral Health-related Quality of Life (OHRQL), the questionnaire Early Childhood Oral Health Impact Scale (ECOHIS) developed by the parents was used. Similarly, the parameters of the American Dental Association (ADA) and the characteristics of the gums were used to determine the premature loss of deciduous teeth. For the association of CVRSO and premature loss, the multivariate analysis, binomial negative regression, was used. The level of significance was established as p <0.05 and a IC 95%. Results: An average of 7.70 ± 8.43 was found when analysing the OHRQL, and the prevalence of premature loss was 10.56%. Regarding the premature loss of deciduous teeth, there is no probability that the quality of life will be affected, since in its presence, the CVRSO score increases by IRR 0.75 (95% CI 0.26 -2.15). Conclusions: It was observed that the OHRQL was not associated with the premature loss of deciduous teeth. However, there is a difference in the OHRQL scores when comparing the groups of presence and absence of premature loss. / Tesis

BACKGROUND: Prolonged mechanical ventilation for acute medical conditions increases the risk of chronic critical illness (CCI). Close family members are confronted with the life-threatening condition of the CCI patients and are prone to develop posttraumatic stress disorder affecting their health-related quality of life (HRQL). Main aim of the present study was to investigate patient- and family-related risk factors for posttraumatic stress and decreased HRQL in family members of CCI patients. METHODS: In a cross-sectional design nested within a prospective longitudinal cohort study, posttraumatic stress symptoms and quality of life were assessed in family members of CCI patients (n = 83, aged between 18 and 72 years) up to 6 months after transfer from ICU at acute care hospital to post-acute rehabilitation. Patients admitted a large rehabilitation hospital for ventilator weaning. The Posttraumatic Stress Scale-10 and the Euro-Quality of life-5D-3L were applied in both patients and their family members via telephone interview. RESULTS: A significant proportion of CCI patients and their family members (14.5 and 15.7 %, respectively) showed clinically relevant scores of posttraumatic stress. Both CCI patients and family members reported poorer HRQL than a normative sample. Factors independently associated with posttraumatic stress in family members were the time following ICU discharge (β = .256, 95 % confidence interval .053-.470) and the patients\' diagnosis of PTSD (β = .264, 95 % confidence interval .045-.453). Perceived satisfaction with the relationship turned out to be a protective factor for posttraumatic stress in family members of CCI patients (β = -.231, 95 % confidence interval -.423 to -.015). Regarding HRQL in family members, patients\' acute posttraumatic stress at ICU (β = -.290, 95 % confidence interval -.360 to -.088) and their own posttraumatic stress 3 to 6 months post-transfer (β = -.622, 95 % confidence interval -.640 to -.358) turned out to be significant predictors. CONCLUSIONS: Posttraumatic stress and HRQL should be routinely assessed in family members of CCI patients at regular intervals starting early at ICU. Preventive family-centered interventions are needed to improve posttraumatic stress and HRQL in both patients and their family members.

BACKGROUND: Prolonged mechanical ventilation for acute medical conditions increases the risk of chronic critical illness (CCI). Close family members are confronted with the life-threatening condition of the CCI patients and are prone to develop posttraumatic stress disorder affecting their health-related quality of life (HRQL). Main aim of the present study was to investigate patient- and family-related risk factors for posttraumatic stress and decreased HRQL in family members of CCI patients. METHODS: In a cross-sectional design nested within a prospective longitudinal cohort study, posttraumatic stress symptoms and quality of life were assessed in family members of CCI patients (n = 83, aged between 18 and 72 years) up to 6 months after transfer from ICU at acute care hospital to post-acute rehabilitation. Patients admitted a large rehabilitation hospital for ventilator weaning. The Posttraumatic Stress Scale-10 and the Euro-Quality of life-5D-3L were applied in both patients and their family members via telephone interview. RESULTS: A significant proportion of CCI patients and their family members (14.5 and 15.7 %, respectively) showed clinically relevant scores of posttraumatic stress. Both CCI patients and family members reported poorer HRQL than a normative sample. Factors independently associated with posttraumatic stress in family members were the time following ICU discharge (β = .256, 95 % confidence interval .053-.470) and the patients\' diagnosis of PTSD (β = .264, 95 % confidence interval .045-.453). Perceived satisfaction with the relationship turned out to be a protective factor for posttraumatic stress in family members of CCI patients (β = -.231, 95 % confidence interval -.423 to -.015). Regarding HRQL in family members, patients\' acute posttraumatic stress at ICU (β = -.290, 95 % confidence interval -.360 to -.088) and their own posttraumatic stress 3 to 6 months post-transfer (β = -.622, 95 % confidence interval -.640 to -.358) turned out to be significant predictors. CONCLUSIONS: Posttraumatic stress and HRQL should be routinely assessed in family members of CCI patients at regular intervals starting early at ICU. Preventive family-centered interventions are needed to improve posttraumatic stress and HRQL in both patients and their family members.

Untersuchungsziel: Untersucht wurden Auswirkungen einer ambulanten orthopädischen Rehabilitation nach der Implantation einer Hüft- bzw. Knieendoprothese auf die individuelle Lebensqualität. Um zu erkennen, ob Zusammenhänge von individuellen Parametern wie Geschlecht, Alter, Bildungsstand und dem Rehabilitationsverlauf bzw. –ergebnis bestehen, wurden medizinisch-funktionelle und psychosoziale Daten erhoben, sowie ergänzende Variablen durch Schichtenindices und mittels eines strukturierten Interviews erfasst. Methode: Systematische Datenerhebung von medizinisch funktionellen (Gelenkbeweglichkeit, Muskelkraft) und psychosozialen (Aktivitäten des täglichen Lebens) Daten von n=60 Pat. mit Knie-TEP und n=61 Pat. mit Hüft-TEP zu vier Messzeitpunkten (Anfang Reha=t0, Ende Reha=t1, 6 Monate nach Reha= t2 und 24 Monate nach Reha= t3) und strukturiertes Interview zur Erfassung von soziodemographischen Merkmalen, Motivation und Behandlungszuversicht. Analysemethoden: Signifikanzanalyse und Berechnung der Effektstärke (Cohens d) der Veränderungen zwischen t0 – t1 für abhängige Stichproben (getrennt nach Indikation), Längsschnittdarstellung der funktionellen und psychosozialen Parameter mit deskriptivstatistischen Analysen getrennt nach Indikation und Geschlecht. Ergebnisse: Für beide Indikationen ergaben sich hohe Effekte für Verbesserungen der funktionellen Parameter und mittlere (teilhabebezogen) bzw. hohe (aktivitätsbezogen) Effekte bei den psychosozialen Parametern am Ende der Rehabilitation. Die teilstandardisierten Rehabilitationsmaßnahmen wirken sich indikations- und geschlechtsbezogen unterschiedlich aus. Unter Beachtung der psychophysischen Leistungsvoraussetzungen und sozialen Rahmenbedingungen ist die ambulante Rehabilitation gut geeignet für Patienten im höheren Lebensalter. / Study objective: Effects of an outpatient orthopedic rehabilitation after the implantation of a hip or knee replacement on the individual quality of life were studied. In order to analyze the existence of significant relationships between individual parameters such as gender, age, education and the rehabilitation outcome medical-functional and psychosocial data were collected, and additional layers of indices and variables by using a structured interview were applied. Method: Systematic data collection from medical functional (joint mobility, muscle strength) and psychosocial (activities of daily living) data of n = 60 patient with total knee replacement and n = 61 patient with total hip replacement to four time points (beginning of rehabilitation = t0, end rehab = t1, t2 = 6 months after rehabilitation and 24 months after discharge = t3) and structured interview for socio-demographic characteristics, motivation and confidence in treatment Analysis: Significance analysis and calculation of effect size (Cohen''s d) of the changes between t0 and t1 for dependent samples (separated by indication), longitudinal section view of the functional and psychosocial parameters with descriptive-statistical analyses apart from indication and sex Results: For both indications high effects of improvement in functional parameters, mean effects (participatory based) and high (activity-related) effects on the psycho-social parameters at the end of rehabilitation could be identified. The semi-standardized rehabilitation measures had shown differences by indication just like gender. In accordance with the psychophysical performance conditions and social environment outpatient rehabilitation is well suited for patients in advanced age.

Mit der vorliegenden Arbeit werden aktuelle Anwendungsbereiche der Lebensqualitätsforschung innerhalb der klinischen Medizin dargestellt. Besonderes Gewicht wurde dabei auf die Erläuterung der Grundlagen der Lebensqualitätsforschung und der derzeit verbreiteten Konzepte, die Diskussion aktueller und zukünftiger Messmethoden sowie die Darstellung einiger typischer Anwendungen gelegt. Der letzte Teil der Arbeit weist auf die bereits erkennbaren Grenzen und ethischen Konsequenzen dieser Forschungsrichtung hin. In der Habilitationsschrift werden verschiedene Originalarbeiten zusammengefasst, denen jeweils eine allgemeine Einführung zur leichteren thematische Einordnung vorangestellt ist. / This volume demonstrates the present scope of 'Quality of Life' research within a clinical context. Different chapters describe the foundations and the development of 'Quality of Life' research, presently used concepts, discussions about appropriate measurement models and some perspectives for an improvement of psychometric methods. Further, different applications and purposes to use 'Quality of Life' instruments in a clinical context are demonstrated. The last part discusses particular ethical consequences and other limitations of 'Quality of Life' research. All chapters combine introductory sections with published original works.