No description available.

According to the American Cancer Society, breast cancer is the most commonly diagnosed cancer and is the second leading cause of cancer death in American women. Breast cancer screenings and improvement in treatments have resulted in the rising number of survivors in the recent decade. This urged the need for post-diagnosis lifestyle changes to improve breast cancer patients' quality of life. Many studies found soy food, the primary dietary source of phytoestrogens, has a protective effect against breast cancer recurrence and mortality. Dietary phytoestrogens can be classified into two groups: isoflavones and lignans. Daidzein and genistein were identified as the most common isoflavones. Due to their structural similarities to 17- beta estradiol, isoflavones exert agonistic and antagonistic effects. However, limited studies have evaluated the effect of phytoestrogen on health-related quality of life (HRQOL) among cancer survivors. This thesis examined the association between genistein levels and HRQOL and whether these associations are altered by menopausal status using data collected by a research team in South Korea. Women aged 21 to 81 years old, diagnosed with stage I – III primary breast cancer, and received breast cancer surgery at least six months prior were enrolled from five hospitals. Plasma genistein level was measured by orbitrap liquid chromatography-mass spectrometry at the University of Hawaii Cancer Center, Honolulu, Hawaii, U.S.A. HRQOL was self-reported using a validated Korean version of the SF-36 questionnaire. SF-36 has eight domain scores. The scores are summarized into physical (PCS) and mental (MCS) component summary scores, with a higher score indicating better HRQOL. The association between plasma genistein and HRQOL was assessed using a multiple linear regression model adjusting for potential confounders. Stratified analysis was conducted to examine whether menopause status modified this association. 407 women (mean age: 52.1 ± 8.3) with all available data were included in the analysis. The mean blood genistein concentration was 144.7 nM (range: 1.1- 2073.0 nM), and the PCS and MCS scores were 49.5 ± 7.1 and 49.2 ± 9.8, respectively. Analysis for the entire sample showed no significant associations between genistein level and HRQOL score across all domains. Further subgroup analysis by menopausal status revealed that only pre- menopausal women in the highest tertile level of genistein had a higher social function domain score (48.9 vs. 47.2) than those in the lowest tertile with a borderline statistical significance (p = 0.083). These findings suggest beneficial effects of genistein may depend on women's menopausal status, but further investigation is necessary.

No description available.

No description available.

Substance use disorders (SUDs) among community-based offenders are a significant challenge for criminal justice agencies. SUDs are linked with both adverse health risks and increased risk of recidivism. Given the consequences of SUDs, mandated substance use treatment is often required in community supervision. Unfortunately, relapse is extremely common regardless of whether treatment is a condition of supervision. Previous research has identified some factors that can influence treatment outcomes among offender populations, including demographic differences, substance use history, mental health conditions, and criminal history. This dissertation will argue that a more nuanced understanding of the role of health and well-being among community-based offenders is a necessary component in understanding treatment engagement. Health Related Quality of Life (HRQOL), a construct to gauge health and well-being, is often used among medical communities to better understand health impacts on a given population as well as decision-making in treatment compliance studies. However, HRQOL is rarely studied in criminal justice, and has almost never been examined in community offender populations. A robust understanding of health is needed for this population of vulnerable offenders, an understanding that includes multiple dimensions of health including HRQOL. This study sampled a total of 103 offenders from drug court and probation settings, who were mandated to participate in substance use treatment. The health and treatment experiences of this sample of offenders were examined using mixed methods, beginning with quantitative analyses including descriptive, bivariate, multivariate statistical models and structural equation models. The multivariate models and structural equation models examined two main treatment engagement outcomes: whether offenders stayed in treatment and the proportion of treatment sessions attended. These quantitative findings were followed by qualitative analysis of 10 interviews with a subsample of the survey participants who had experienced some level of health difficulty at their baseline survey. Qualitative analyses sought to elaborate on the quantitative findings to provide context for how and why participants were or were not engaging with their mandatory treatment. Results from the quantitative analysis indicate that although criminal history is the most consistent factor influencing treatment engagement, various aspects of health appear to influence treatment success to some extent. HRQOL may influence whether participants stay in treatment. Treatment experiences and health also appear to differ substantially depending on the offenders’ primary drug of use. Offenders who exclusively used marijuana were substantially healthier than their harder drug using peers, and they appear to stay in treatment more easily. Furthermore, both mental and physical health conditions appear to influence treatment attendance among participants who used drugs other than exclusively marijuana. Finally, there were differences in treatment retention depending on whether participants were supervised by drug court or probation, such that drug court participants were more likely to stay in treatment; however, supervision type did not influence proportion of treatment sessions attended. Qualitative findings both provided support for some of the quantitative findings and also illuminated the nuances of the treatment engagement experience of offenders with health difficulties. Interviewees who primarily used marijuana tended to have less severe health difficulties and many did not perceive their use as problematic. Treatment engagement among participants was influenced by their motivation for treatment, whether they had mental health and/or physical health difficulties and the severity of those health difficulties. Logistical factors also influenced treatment engagement, particularly conflicts between treatment requirements and employment and familial relationships. Many of the results presented herein are exploratory and thus require replication; however, some clear directions for future research arise. There is a need to examine the role of health among community based offenders and their ability to comply with mandated treatment with a larger sample. In particular, studies are needed, which include more participants who use ‘harder’ illicit drugs such as opioids and cocaine, as they appear to have more difficulties both with their health and with treatment engagement. Further research is needed on models for Treatment Engagement that include multiple dimensions of health and allow for recursive relationships between health dimensions. Regarding policy and practice implications, the correctional agencies involved should consider re-evaluating the means by which offenders are assigned to supervision and SUD treatment. In particular methods for screening and assessment of SUDs should be re-evaluated, with particular consideration given to the role of offenders’ primary drug of use. / Criminal Justice

The dissertation {\clq}qHealth Related Quality of Life (HRQoL) in Eating Disorders`` is divided into theoretical and practical part. In the theoretical part is analyzes the problems with eating disorders. It is especially focused on its two basics forms, anorexia nervosa and bulimia which are illnesses occasioned by hypothrepsia. The next part drala with history, symptoms, cause, medication, process, prognosis and complications resulting from these disorders, including the main diagnostic criteria and prevalence data. Women are affected by both diseases more frequently than man. Mental anorexia occurs mostly between the 14th and 15th year of the life, mental bulimia at the age of 13 to 20 years. The second part is practicaly aimed at evaluation of SF-36 forms, where I verify hypotheses how eating disorders influence quality of life of theirs carriers and how the changes in quality of life are dependant on the grade of education. The analysed results indicate the difference between the sick and the healthy individuals and also the fact the level of education is important too.

Abstract The aim of this thesis was to measure patient reported outcomes, such as health related quality of life and general diabetes knowledge of elderly diabetes mellitus type 2 (DMT2) patients in Slovenia. Patient reported outcomes demonstrate patient perspectives when evaluating the delivery of care. In Slovenia, a new, multidisciplinary model of chronic care was introduced in 2011, which yet needs to demonstrate the efficiency, care improvement and cost reduction. Thus, another aim of the study was to research if multidisciplinary teams in diabetes care are economically viable. To achieve the above, the study was divided into 4 subprojects. Firstly, the general level of diabetes knowledge of elderly DMT2 patients (n=179) was measured. Secondly, the reliability and validity of generic, European Quality of Life- 5 Dimensions (EQ-5D), and disease specific, Audit on Diabetes Dependent Quality of Life (ADDQoL ) instruments were examined. Thirdly, health related quality of life of elderly diabetic patients (n=285) was assessed. Fourthly, the systematic literature review on the cost-effectiveness of multidisciplinary teams was conducted. The data were collected during the period 2011–2012. The main contributions of the current thesis can be summarised as follows: This was the first study to measure general diabetes knowledge of elderly DMT2 patients in Slovenia. The results showed that the place of living does not have an impact neither on diabetes knowledge nor the health related quality of life of these patients. Secondly, a pioneering example of measuring health related quality of life (HRQoL) in elderly diabetic patients in Slovenia, using a validated and reliable instrument (ADDQoL) was provided. A study to evaluate the relationships between diabetic and other co-existing chronic medical conditions on health related quality of life was performed. As part of that study, the reliability and validity of the instruments (EQ-5D and ADDQoL) were measured, and the analysis showed that both instruments are reliable. Thirdly, a systematic way of finding evidence for understanding the cost-effectiveness of multidisciplinary teams was applied. The results of the literature review show weak improvements in the economic outcomes. In general, the thesis contributes to the improved understanding of patient reported outcomes in elderly diabetic patients, which can be a measure in assessing diabetes care program in Slovenia, and offers a basis for a national evaluation of the Model Practices. Furthermore, patient reported outcomes of elderly diabetic patients is important to Slovenian decision makers to identify and implement appropriate interventions for achieving better management of diabetes and ultimately improving the quality of life of diabetes patients. / Tiivistelmä Tutkimuksen tarkoitus oli mitata iäkkäiden tyypin 2 diabetespotilaiden itse ilmoittamia tuloksia, kuten terveyteen liittyvä elämänlaatu ja yleinen diabetekseen liittyvä tietämys Sloveniassa. Tulokset valottavat potilaiden näkökulmaa hoidon arvioinnissa. Sloveniassa otettiin 2011 käyttöön monitieteellinen hoitomalli, jonka tehoa sekä kykyä parantaa hoitoa ja vähentää hoitokustannuksia ei ole osoitettu. Toisena tavoitteena oli selvittää, onko moniammatillisten tiimien käyttö diabeteshoidossa taloudellisesti järkevää. Tutkimus jaettiin neljään osaprojektiin. Ensin mitattiin iäkkäiden tyypin 2 diabetespotilaiden (n=179) yleistä diabetestietämystä. Toiseksi selvitettiin geneerisen European Quality of Life- 5 Dimensions- (EQ-5D) ja diabeteskohtaisen ADDQoL -mittarin luotettavuus ja validiteetti. Kolmanneksi arvioitiin iäkkäiden diabetespotilaiden (n=285) terveyteen liittyvää elämänlaatua. Neljänneksi tehtiin moniammatillisten tiimien kustannus¬tehokkuutta koskeva systemaattinen kirjallisuuskatsaus. Tiedot kerättiin vuosina 2011–2012. Tulokset voidaan tiivistää seuraavasti: Kyseessä oli ensimmäinen tutkimus, jossa mitattiin iäkkäiden tyypin 2 diabetespotilaiden yleistä diabetestietämystä Sloveniassa. Tulosten mukaan asuinpaikka ei vaikuta potilaiden diabetestietämykseen tai terveyteen liittyvään elämänlaatuun. Toiseksi, Sloveniassa toteutettiin pioneerihanke, jossa mitattiin iäkkäiden potilaiden terveyteen liittyvää elämänlaatua (HRQoL) validoidun ja luotettavan instrumentin (ADDQoL) avulla. Tutkimuksessa selvitettiin diabeteksen ja muiden pitkäaikaissairauksien yhteisvaikutusta terveyteen liittyvään elämänlaatuun. Osana tutkimusta selvitettiin instrumenttien (EQ-5D ja ADDQoL) luotettavuus ja validiteetti. Molemmat osoittautuivat luotettaviksi. Kolmanneksi, tutkimuksessa etsittiin systemaattisesti näyttöä moniammatillisten tiimien kustannustehokkuuden arvioimiseksi. Kirjallisuuskatsauksen mukaan taloudellinen tulos paranee vain vähän. Tutkimus lisää tietoa potilaiden ilmoittamista tuloksista iäkkäiden diabetespotilaiden kohdalla, mitä voidaan käyttää diabeteshoito-ohjelman arvioinnissa Sloveniassa sekä mallikäytäntöjen kansallisen arvioinnin perustana. Diabetespotilaiden itse ilmoittava terveystieto on Slovenian päätöksentekijöille tärkeää sopivien interventioiden löytämisessä ja toteuttamisessa, kun halutaan parantaa diabeteshoitoa ja potilaiden elämänlaatua.

Canada’s population is aging rapidly, and understanding living arrangements and their determinants plays a critical role in supporting healthy aging. This thesis examined, using a population-based longitudinal survey, the Canadian Multicentre Osteoporosis Study, the effects of clinically-significant change in physical and mental health on future living arrangements, employing generalized estimating equations logistic regression models. Clinically-significant decline in SF-36 Physical Component Score (PCS) increased likelihood of not remaining community-dwelling, or “aging in place” over stable or improved scores by 41%. SF-36 Mental Component Score (MCS) did not show a statistically significant effect on aging in place. Older age and employment status of retired or unemployed increased likelihood of not aging in place, whereas living with a partner, pursuing moderate or vigorous physical activity, and having children increased the likelihood of aging in place. Study findings will inform social and health policy development to support aging in place in Canada and elsewhere.

The dissertation entitled ?Health Related Quality of Life (HRQoL) in Dialysed Patients with Respect to Age? contains a theoretical and practical part. The theoretical part describes chronic kidney disorder and the treatment of this disease. It mentions the causes, repercussions and complications of this disease. It also suggests the form of treatment as the method of replacing the function of the kidneys which includes haemodialysis, peritoneal dialysis and transplantation. I have attempted to elaborate their principle, history and current form, benefits, negative aspects and complications. The practical part describes the actual research. Health Related Quality of Life (HRQoL) was ascertained in a group of patients undergoing haemodialysis at one dialysis centre. Questionnaire SF 36 was used which allows for a quantified assessment of the quality of life in eight domains. The results were statistically assessed and clearly depicted using tables and graphs. The quality of life was compared in the monitored group with the general population and also based on age and gender. The results found show a reduced quality of life of dialysed patients compared with the standard population. A difference was also found in the assessment of the quality of life in some age groups. No difference in results was proved with regard to gender.

In Deutschland ist eine zunehmende Kinderlosigkeit zu beklagen (Statistisches Bundesamt 2009). Die Ursachen hierfür werden primär vor dem Hintergrund der Unvereinbarkeit von Berufstätigkeit und Mutterschaft diskutiert (Schrupp 2008). Aus lerntheoretischer Perspektive wären subjektiv empfundene gesundheitliche Ein-schränkungen von Frauen nach der Geburt eines Kindes als weitere Ursache denkbar. Über die subjektiven Gesundheitseinschätzungen von Frauen im geburtshilflichen Kontext ist jedoch nur wenig bekannt. Vereinzelt finden sich Hinweise, dass Frauen ihre subjektive Gesundheit (SGH) nach der Geburt ihres Kindes trotz bestehender Morbidität sehr positiv bewerten (Bauer 2011, Schytt et al. 2005, Borrmann 2005). Ziel der Studie ist es die subjektive Morbidität, die SGH sowie die gesundheitsbezogenen Lebensqualität (GHLQ) gesunder Frauen acht Wochen und sechs Monate nach der Geburt eines Kindes zu erfassen und die Faktoren zu ermitteln, die sich beeinflussend auf SGH und GHLQ auswirken. Methode: Retrospektive, longitudinale Kohortenstudie. Basis der Sekundäranalyse bilden Daten von 1029 Erst- und Mehrgebärenden, die im Rahmen einer multizentrisch angelegten, prospektiven Interventionsstudie zum Versorgungskonzept Hebammenkreißsaal an der Hochschule Osnabrück unter Förderung des Bundesministeri-ums für Bildung und Forschung (FKZ 01 GT 0616) zum Zeitpunkt der Geburt (t0) sowie acht Wochen (t1) und sechs Monate (t2) nach der Geburt erhoben wurden. Zur Ermittlung der SGH wurde der SF-1 angewendet. Die Operationalisierung der GHLQ erfolgte über die standardisierte körperliche und die standardisierte psychische Summenskala des SF-36. Ergebnisse: Gut die Hälfte der Studienteilnehmerinnen bewertete ihre SGH zu t1 und t2 besser als gut, wobei Erstgebärende gegenüber Mehrgebärenden signifikant häufiger diese positive Einschätzung vornahmen (p<.007). Neben einer Reihe von Faktoren, die in keinem unmittelbaren Zusammenhang mit der Geburt stehen, zeigten sich geburtsspezifische Aspekte als signifikante Einflussgrößen. In der Gruppe der Erstgebärenden er-höhte sich bei Vorliegen geburtsverletzungsbedingter Beschwerden die Chance auf eine beeinträchtigte SGH zu t1 signifikant (OR 1.68, [95% KI 1.04-2.71]; p=.035). In der Gruppe der Mehrgebärenden erwies sich ein nega-tives Geburtserleben zu t2 als signifikante Einflussgröße für eine beeinträchtigte SGH (OR 7.66, [95% KI 2.17-26.99]; p=.002). Hinsichtlich der GHLQ konnten ebenfalls geburtsspezifische Aspekte als Einflussgrößen ermit-telt werden. Zu t1 erhöhten in der Gruppe der Erstgebärenden geburtsverletzungsbedingte Beschwerden die Chance auf eine verminderte GHLQ um fast das Dreifache (OR 2.83, [95% KI 1.63-4.93]; p<.001). Ein negati-ves Geburtserleben verdoppelte die Chance auf eine verminderte GHLQ in dieser Gruppe (OR 2.09, [95% KI 1.19-3.65]; p=.010). In der Gruppe der Mehrgebärenden zeigte sich das negative Geburtserleben ebenfalls als signifikante Einflussgröße (OR 3.93, [95% KI 1.14-13.53]; p=.030). Dies allerdings erst zu t2. Insgesamt konn-ten in einzelnen Subskalen des SF-36 signifikante Abweichungen zwischen der landes-, alters- und geschlechts-spezifischen Normstichprobe und dem Studiensample festgestellt werden. Schlussfolgerung: Geburtsverletzungsbedingte Beschwerden und ein negatives Geburtserleben beeinflussen die SGH und GHLQ nachhaltig. Mit dem Anspruch einer qualitativ hochwertigen geburtshilflichen Versorgung gilt es die subjektiven Gesundheitseinschätzungen von Frauen nach der Geburt eines Kindes standardisiert zu evalu-ieren. Um Ceiling-effekte zu vermeiden müssen die in anderen Bereichen bisher üblichen Erhebungsverfahren für den geburtshilflichen Kontext modifiziert werden