Stigmatization involves the application of labels to individuals in social contexts, leading to impaired access to social, economic, and political power. Although actual stigmatizing beliefs that society holds about particular groups are important, the extent to which individuals themselves perceive stigma from others and internalize stigmatizing beliefs is being increasingly recognized as a cause of psychological and physical distress. Little research has been done on explanatory mechanisms of the relations between perceived stigma and health outcomes, particularly in the area of stigma related to finances. Two important dimensions of overall health include depressive symptoms and health-related quality of life. According to Self-Determination Theory feeling controlled by external forces decreases subjective vitality, a measure of energy that is available to self for engaging in life pursuits. Changes in subjective vitality may, in turn, affect health outcomes. Interpersonal variables including how connected one feels with others and whether or not one feels like a burden may affect the manner in which stigma relates to subjective vitality and health. In the current study a sample of 100 individuals receiving medical treatment from a primary clinic that targets the working uninsured population in a region of Appalachia completed questionnaires assessing for perceived stigma of finances, depressive symptoms, health-related quality of life, subjective vitality, thwarted belongingness, and perceived burdensomeness. Results confirmed that experienced and internalized perceived stigma were moderately associated with poorer health outcomes and lower subjective vitality. Thwarted belongingness and perceived burdensomeness were, likewise, associated with worse health outcomes. In mediation analyses subjective vitality significantly explained the relations between each dimension of stigma and each outcome. Subsequent conditional indirect effect analyses found that thwarted belongingness moderated the mediation effect for some of the models by impacting the relation between stigma and subjective vitality or by moderating the relation between subjective vitality and the dependent variable. The findings suggest the importance of subjective vitality and feelings of belongingness in understanding how perceived stigma negatively affects health. Results and implications are discussed along with considerations for future research and interventions.

Background: This systematic review evaluates the oral health-related quality of life (OHRQoL) of patients with chronic respiratory diseases. Methods: A systematic literature search was performed based on the PubMed, Medline, Web of Science, and Scopus, using the search terms: “oral health-related quality of life” and “respiratory disease” or “lung” and “oral health-related quality of life.” Full-text articles published until June 30, 2021 and reporting any OHRQoL measurement in children or adults with a chronic respiratory disease or condition were included and analyzed qualitatively. Results: A total of seven out of 44 studies were included, of which four studies examined adults and three studies investigated children. The respective diseases were chronic obstructive pulmonary disease (COPD) (n = 2), sleep apnea (n = 2), severe asthma (n = 1), cystic fibrosis (n = 1), and lung transplantation (n = 1). Four studies confirmed a worse OHRQoL in the respiratory diseased group compared to healthy controls. The overall OHRQoL was reduced in the included studies. Oral health, healthrelated quality of life, and disease-related parameters were rarely examined with regard to OHRQoL. Conclusion: Patients with chronic respiratory diseases show a reduced OHRQoL. Oral health should be fostered in these individuals to support their OHRQoL.

Syfte: Det övergripande syftet med denna licentiatavhandling är att beskriva resultat från en kartläggning av hälsosituationen hos nyanlända flyktingar som genomgår SFI studier samt att belysa den självskattade hälsorelaterade livskvalitet som arabisktalande deltagare i en specifik hälsofrämjande gruppaktivitet (Hälsoskola) beskriver före, efter samt vid en sexmånaders uppföljning av aktiviteten. Design, metod, urval: Urvalet deltagare i delstudie I var nyanlända arabisktalande flyktingar bosatta i Fosie stadsdel i Malmö och som deltog i SFI utbildning. Undersökningsgruppen bestod av sammanlagt 67 personer, 52 procent män och 48 procent kvinnor. Datainsamlingen genomfördes med hjälp av frågeformulär innehållande frågor om familj och anhöriga, nätverk och service, svenskundervisning och delaktighet, introduktion och hjälpbehov samt om sömn och återhämtning. I delstudie II bestod urvalet av arabisktalande nyanlända flyktingar som genomgick en sju veckors Hälsoskola som en del i sin introduktionsplanering. Dataunderlag bestod av kvalitativa data inhämtat vid deltagande observationer och muntliga grupputvärderingar med 65 kursdeltagare. Därutöver besvarades ett frågeformulär för självskattning av hälsorelaterad livskvalitet samt om sömn och återhämtning. Frågeformuläret besvarades vid kursstart, kursavslutning samt sex månader efter kursens slut. Respondenter i denna del var 39 kursdeltagare som besvarat samtliga tre frågeformulärsomgångar. Därutöver innehåller avhandlingen en artikel vars syfte är att beskriva kursen/metoden Hälsoskola, dess bakgrund och teoretiska kopplingar samt den samverkansprocess som utvecklats mellan professionella aktörer och brukare. Resultat: I delstudie I rapporterade respondenterna hög förekomst av sömn- och trötthetsbesvär. Sextioåtta procent av respondenterna hade sömnproblem motsvarande hälften av veckans dagar. Något färre 43 % rapporterade regelbundna besvär med sömnighet, till exempel att man nickade till under dagen. Fyrtioen procent (män 36 %, kvinnor 50 %) uppfyllde kraven för klinisk insomni baserat på att respondenterna hade både sömnbesvär och trötthetsbesvär under minst hälften av veckans dagar. Därutöver upplevde drygt 80 % av samtliga stor oro över sin familj eller andra anhöriga i hemlandet. Många kände sig isolerade och ensamma, hade svårt att få kontakter med föreningsliv, få tillgång till platser för kulturella aktiviteter, för religionsutövning och för sportaktivitet. Många upplevde också svårighet att få tillgång till hälso- och sjukvård samt tandvård. I utbildningssituationen upplevde drygt hälften stora svårigheter att förstå vad läraren sade och 68 % hade svårt att hinna med i tempot på lektioner. Drygt 64 % rapporterade koncentrationssvårigheter, de hade problem att förstå hemuppgifter liksom att kunna göra hemuppgifter i lugn miljö. För många respondenter rådde oklarhet om introduktionsplanen och cirka hälften av dem hade velat få mera hjälp av sin introduktionshandläggare med läkar- och sjukvårdskontakter samt med sin bostadssituation. I den kvalitativa delen av delstudie II vars syfte var att belysa de viktigaste frågorna från deltagarnas synvinkel, utkristalliserade sig fyra kategorier: 1) Fördjupningsfrågor beträffande innehåll i kursen/Hälsoskolan. 2) Kommentarer angående form och struktur på kursen/Hälsoskolan. 3) Vilka av kursdeltagarnas ”behovsområden” som kursen/Hälsoskolan täcker in och vilka områden som saknas? 4) Vad kursdeltagarna önskar få framfört till administratörer, beslutsfattare och politiker. I den kvantitativa uppföljningsstudien framkom att deltagarna upplevde en hög grad av sömn och koncentrationsproblematik vid kursstart. Denna problematik var betydligt mindre vid kursens avslutning och förändringen kvarstod vid uppföljning sex månader senare. Det framkom även att sömnproblematik var relaterad till de fem variablerna av hälsorelaterad livskvalitet;( rörlighet, aktivitet, egenvård, smärta och oro/depression) och till upplevelsen av det allmänna hälsotillståndet. Angående variablerna smärta och oro/depression kvarstod en signifikant förändring både vid uppföljning ett och vid uppföljning två sex månader efter kursavslut. Både män och kvinnor bedömde sitt allmänna hälsotillstånd som signifikant bättre vid båda uppföljningarna jämfört med vid kursstart, men förändringen var störst beträffande kvinnorna. Konklusion: De sammantagna resultaten visar att det finns en hög fysisk och psykisk ohälsoproblematik i den undersökta populationen med avseende på deras självskattade hälsa. Denna problematik har ett nära samband med sömn och koncentrationsproblem och får även konsekvenser för de nyanländas dagliga aktiviteter och etablering i det nya samhället. Det framkommer ett stort behov av hjälp från hälso- och sjukvården men också en brist på tillit till detsamma, bland annat beroende på svårtillgänglighet och brist på professionella tolkar. Å andra sidan visar resultaten i denna licentiatavhandling att mottagningssystemet med noga överlagda insatser kan åstadkomma betydande positiva förändringar för gruppen nyanlända flyktingar. Den självupplevda hälsorelaterade livskvaliteten för deltagare i kursen Hälsoskola visade på signifikanta förändringar inom de undersökta aspekterna för gruppen som helhet vid kursslut och vid senare uppföljning. De reella faktiska kunskaperna inom egenvård och om det svenska hälso- och sjukvårdssystemet hade ökat betydligt vid kursavslut. Nämnda effekter kan även få positiva följdverkningar för nästa generation och andra personer i kursdeltagarnas nära omgivning. / Aim: The overall aim of this thesis is to describe the results of a survey of the health situation of newly-arrived refugees attending a course in Swedish for Immigrants (SFI) (study I) and elucidate the self-rated health-related quality of life that Arabic-speaking participants in a spe-cific health-promoting group activity (Health School) report before, immediately after and at a six-month follow-up of that activity (study II). Design, method, sample: The sample in study I comprised newly-arrived Arabic-speaking refugees living in the Malmö district of Fosie who were attending a SFI course. A total of 67 persons participated, 52 per cent men, 48 per cent women. Data were collected with the aid of a questionnaire with both open-ended and closed alternative responses about family and relatives, networks and services, Swedish language lessons and participation, introduction and needs, sleep and recovery. In study II the sample comprised newly-arrived Arabic-speaking refu-gees who attended a seven-week Health School as a part of their intro-ductory planning. The study was based on qualitative data obtained by participatory observation and oral group evaluations with 65 course participants. In addition, we used a questionnaire with closed response alternatives for self-rating health-related quality of life, including sleep and recovery. The questionnaire was administered at the beginning and end of the group activity as well as six months after the end. This sam-ple comprised 39 participants in the group activity who responded to the questionnaire on all three occasions. Furthermore, the thesis contains an article describing the Health School group activity/method, its background and theoretical links, as well as the collaborative process that developed between professionals and re-cipients. Results: The respondents in study I reported a high frequency of sleep- and fatigue-related complaints. Sleep disturbances on the equivalent of every other day were reported by 68 per cent and somewhat fewer, 43 per cent, reported regular problems with drowsiness, for instance drop-ping off during the day. Criteria for clinical insomnia were met by 41 per cent (36 per cent of the men, 50 per cent of the women), based on the combination of sleep disturbance and complaints of fatigue at least every other day. In addition, over 80 per cent of the sample experienced great anxiety about their family or other relatives in their home country. Many felt isolated and lonely, found it hard to get in touch with associations, have access to places for cultural activities, practicing religion and participating in sports. Many also experienced difficulties in gaining access to health care and dental care. In the educational situation (SFI), more than half had great difficulty in understanding what the teacher said and 68 per cent found it hard to keep up with the pace of the lessons. More than 64 per cent reported difficulties with concentration, problems with understanding homework and being able to do homework in a calm environment. Many respondents were uncertain about the introductory plan and roughly half had wanted their introductory officer to be more helpful in contacts with health care, including doctors, and housing matters. The qualitative part of study II, which aimed to elucidate the most im-portant issues according to the participants, gave rise to four categories: 1) More in-depth issues concerning the content of the group activi-ty/Health School, 2) Comments on the form and structure of the group activity/Health School, 3) Which of the participants’ “needs” were cov-ered by and which were missing, and 4) What the participants wanted to convey to administrators, decision-makers and politicians. The quantitative follow-up study showed that when the group activity started, the participants experienced a high degree of problems with sleep and concentration. Such problems were considerably less frequent at the end of the activity and this change persisted six months later. Moreover, the sleep disturbances were related both to the five variables of the health-related quality of life (mobility, activity, self-care, pain and anxiety/depression) and to the perception of general health. The variables pain and anxiety/depression showed significant improvements at the end of the activity as well as six months later. Men as well as women rated their general health as significantly improved at both follow-ups compared with baseline; the change was greatest for women. Conclusions: Taken together, the results show that in terms of self-rated health, the studied population has a high degree of problems with physical and mental ill-health. These problems are closely related to problems with sleep and concentration, besides having consequences for the newly-arrived persons’ daily activities and for settling in the host country. A great need of assistance from health care emerges, as well as a lack of trust in this, partly due to difficulty of access and a lack of professional interpreters. At the same time, the findings in this thesis show that the reception sys-tem with evidence-based inputs can achieve considerable positive changes for newly-arrived refugees. The self-rated health-related quality of life for participants in the group activity/Health School showed that for the group as a whole, the studied aspects had improved significantly both by the end of the activity and at the six-month follow-up. Proper actual knowledge about self-care and the Swedish health care system had increased significantly by the end of the activity. These effects can also have positive consequences for the next generation and others close to the participant. The group activity needs to be tested with other language groups of newly-arrived in order to warrant general conclusions.

Bakgrund: Sepsis är ett globalt hälsoproblem som innefattar hög dödlighet. Tillståndet är livshotande och orsakas av ett stört systematiskt svar på en infektion. Personer som överlever sepsis kan drabbas av olika komplikationer. Det är av stor vikt att öka kunskapen och förståelsen kring hur personens livskvalitet kan påverkas av kvarstående komplikationer efter sepsis. Syfte: Studiens syfte var att belysa upplevd livskvalitet hos personer som har överlevt sepsis. Metod: En allmän litteraturstudie, där sex kvantitativa och fyra kvalitativa artiklar sammanställdes. Resultat: Resultatet i studien grundades på tio vetenskapliga artiklar där tre kategorier framkom: livskvalitet och försämrad hälsa, livskvalitet och förändrad livssituation och självbild samt livskvalitet och sociala relationer. Konklusion: Personer upplevde en lägre livskvalitet efter att ha överlevt sepsis. Främst berördes livskvaliteten gällande den förändrade livssituationen och självbilden negativt på grund av kvarstående besvär. Personer som överlevt sepsis upplevde att den hälsorelaterade livskvaliteten förbättrades av socialt stöd från anhöriga. Det finns ett behov av vidare kvalitativ forskning kring hur personer upplever sin livskvalitet efter sepsis. / Background: Sepsis is a global health problem involving high mortality. The condition is life-threatening and caused by a disrupted systemic response to an infection. People who survive sepsis can suffer from various complications. Therefore, increasing the knowledge and understanding of how sepsis survivors’ quality of life is affected is essential. Aim: To illustrate the quality of life in sepsis survivors. Method: A general literature study, where six quantitative and four qualitative articles were compiled. Results: The study's results were based on ten scientific articles. Three categories emerged: quality of life and deteriorating health,quality of life and changed life situation and self-image, quality of life and social relationships. Conclusion: People experienced a lower quality of life after surviving sepsis. The quality of life regarding the changed life situation and self-image was negatively affected due to remaining complaints. People who survived sepsis experienced that the health-related quality of life was improved by social support from relatives. There is a need for further qualitative research into how peopleexperience their quality of life after sepsis.

Förmaksflimmer är en av de vanligaste arytmierna i Sverige och västvärlden och förväntas öka bland befolkningen. Riskfaktorer som övervikt, stort alkoholintag, hypertoni och hög ålder har visat sig ha en stor påverkan på förmaksflimrets progression och därmed ökande morbiditet och mortalitet hos patienterna. Studiens syfte är att belysa påverkan av omvårdnadsinterventioner ledda av sjuksköterskor, hos patienter med förmaksflimmer. En allmän litteraturstudie med systematisk sökmetod har genomförts. Datainsamlingen gjordes via databaserna Cumulative Index to Nursing an Health Literature (CINAHL) och Public MEDLINE (PubMed). Totalt hittades femton artiklar, varav fjorton var kvantitativa och en artikel hade mixad metod. Artiklarna kvalitetsgranskades med stöd av en modifierad bedömningsunderlag. En integrerad dataanalys genomfördes för att sammanställa data. Resultatet blev sex kategorier: Riskfaktorer, Livsstil, Hälsorelaterad livskvalitet, Patientens sjukdomskännedom, Behandlingsrekommendationer och Sjukhusinläggningar. Resultatet påvisar att omvårdnadsinterventioner ledda av sjuksköterska har en god påverkan på patientens sjukdomstillstånd. Dock påvisar inte alla studier att det finns en signifikant skillnad. Litteraturöversikten visar behov av ett multidisciplinärt team, där en specialistsjuksköterska inom hjärtsjukvård kan göra en skillnad för patienten. Men även ett behov av mer forskning inom området för att identifiera kunskapsluckor för att ge patienter en bättre vård. / Atrial fibrillation is one of the most common arrhythmias both in Sweden and in the world and is expected to increase among the population. Risk factors such as obesity, large alcohol intake, hypertonia and age are shown to have great impact on atrial fibrillation progress hence rising mortality and morbidity among this group. The aim of this study is to illuminate the effect of nursing interventions on patients with Atrial Fibrillation. A general literature overview with a structural search method was conducted. The data was collected via CHINAHL and PubMed databases. The total of fifteen articles were selected, fourteen with quantitative and one with mixed method. All the articles were qualified via Caldwell scale design. An integrated data analysis was performed to compile the data. The result is presented in six categories: Risk factors, Lifestyle, Health related quality of life, Disease awareness, Treatment recommendation and Hospitalization. The results have shown that the nursing interventions having good effect on the patient's illness situation. However, not all studies show that there is a significant difference. The area studied requires further research and that studies be carried out in larger populations. This is to draw real conclusions that help to offer patients with atrial fibrillation better care. The literature review shows tendencies that patients are in need for a multidisciplinary team, where specialist nurses in cardiac care can make a difference for the patient. It also shows a need for further studies to identify knowledge gaps in order to a better healthcare to patients.

Bakgrund: Obesitas är en kronisk och komplex sjukdom som har en negativ effekt på både fysisk och psykisk livskvalitet jämfört med normalbefolkningen. Tidigare och nuvarande studier om obesitas och dess behandlingar har främst utvärderat viktminskning och förbättringar av obesitasrelaterade sjukdomar och ofta saknat patientperspektivet på hälsan. Därtill har forskning visat att personal inom hälso- och sjukvården är bristfälligt rustade för att stödja personer med obesitas vilket ökar patientgruppens lidande och försämrar dess livskvalitet. Syfte: Syftet var att undersöka om det finns vetenskapligt stöd för att kirurgisk obesitasbehandling är effektivare avseende fysisk och psykisk hälsorelaterad livskvalitet jämfört med medicinsk obesitasbehandling hos vuxna personer med obesitas. Metod: Studien genomfördes som en systematisk litteraturstudie baserad på SBU:s metod och utmynnade i totalt tre RCT-studier. Resultat: Litteraturöversiktens sammanvägda resultat visar på mycket låg vetenskapligt stöd. Därmed kan resultatet inte med säkerhet uttala sig om huruvida kirurgisk obesitasbehandling är mer effektiv jämfört med medicinsk obesitasbehandling avseende fysisk och psykisk hälsorelaterad livskvalitet. Resultatet indikerar att obesitaskirurgi kan förbättra fysisk livskvalitet i högre grad jämfört med medicinsk obesitasbehandling. Den psykiska livskvaliteten förbättras däremot inte i högre utsträckning efter obesitaskirurgi jämfört med kontrollbehandlingen. Konklusion: Där behövs fler RCT-studier som är större, baserade på samma livskvalitetsinstrument och vars mått är redovisade på ett enhetligt sätt. / Background: Obesity is a chronical and complex disease which has a negative impact on physical and mental health-related quality of life compared to the normal population. Previous and current studies on obesity and its treatments have mainly evaluated weight loss and improvements in obesity-related diseases and often lacked the patient perspective on health. In addition, research has shown that healthcare personnel are inadequately equipped to support people with obesity, which increases the patient  group´s suffering and impairs its quality of life. Aim: The aim was to investigate whether there is scientific support that surgical obesity treatment is more effective in terms of physical and mental health-related quality of life compared to medical obesity treatment in obese adults. Method: The study was conducted as a systematic review based on  SBU´s method and resulted in a total of three RCT studies. Results: The combined results of the literature review show very little scientific support. Thus, the result cannot state with certainty whether bariatric surgery is more effective compared to medical obesity treatment regarding physical and mental health-related quality of life. The result indicates that bariatric surgery can improve physical quality of life to a greater degree compared to medical obesity treatment. In contrast, the mental quality of life does not improve to a greater extent after bariatric surgery compared to the control treatment. Conclusion: There is a need for more RCT studies that are lager, based on the same quality of life instrument and whose measurements are reported in a uniform manner.

Background: Molar–incisor hypomineralization (MIH) has a strong negative effect on oralhealth-related quality of life (OHRQoL). Malformed teeth can be hypersensitive, and the discoloration might affect children’s appearances, reducing their well-being. The purpose of the study was to investigate how hypomineralized incisors and molars differ in children’s perceived OHRQoL. Materials and Methods: 252 children aged 7–10 years old were included and subdivided into three equal groups (n = 84). Group A included children with asymptomatic molars and affected incisors. Group B included children presenting only affected molars. Group C was the control group, with children showing no MIH. All participants were asked to complete the German version of the Child Perceptions Questionnaire (CPQ-G8-10) to measure OHRQoL. Results: Participants in the posterior group showed a median total CPQ of 13.4 (±1.7), which was significantly higher than scores in the anterior and control group, which showed a median total CPQ of 8.4 (±1.4) and 4.2 (±0.7), respectively. Children in the posterior group suffered more from oral symptoms and functional limitations, whereas the anterior group dealt more with social and emotional well-being problems. Conclusions: The position of the MIH-affected teeth causes different influences on perceived OHRQoL.

Bakgrund: Utöver hormonbaserade läkemedel har fysisk aktivitet visat effekt på klimakterierelaterade besvär men få studier har utförts om relationen mellan fysisk aktivitet, klimakteriebesvär och hälsorelaterad livskvalitet i en svensk population. Syfte: Syftet var att undersöka klimakteriebesvär, hälsorelaterad livskvalitet och fysisk aktivitetsnivå bland kvinnor i Sverige i klimakteriet samt att studera hur fysisk aktivitetsnivå relaterar till livskvalitet och klimakteriebesvär. Metod: Enkät med flervalsfrågor om klimakteriebesvär (Menopause Rating Scale), fysisk aktivitetsnivå (Socialstyrelsens screeningfrågor om fysisk aktivitet) och hälsorelaterad livskvalitet (RAND-36) skickades till två slutna Facebookgrupper för kvinnor i klimakteriet. Resultatsammanfattning: Enkätsvaren visade att kvinnorna (n=381) skattade sömn och fysisk/mental trötthet som de mest besvärande symtomen, var fysiskt aktiva i genomsnitt 315 minuter i veckan och hade lägst hälsorelaterad livskvalitet avseende energi/fatigue och högst hälsorelaterad livskvalitet avseende fysisk funktion. De som uppnådde rekommendationerna för fysisk aktivitet skattade både högre fysisk hälsa (p<0.001) och emotionell hälsa (p=0.004) jämfört med de som inte uppnådde rekommendationerna. Ett svagt men signifikant samband fanns mellan grad av klimakteriebesvär och totalt antal aktivitetsminuter (ρ=-0.156) respektive fysisk träning (ρ=-0.149). Konklusion: Resultaten tyder på en relation mellan tillräcklig fysisk aktivitet och högre hälsorelaterad livskvalitet, särskilt avseende dimensionerna fysisk och emotionell hälsa. Sambandet mellan klimakteriebesvär och fysisk aktivitet fanns men var svagt. Resultaten ger insikter i komplexa samband mellan klimakteriebesvär, fysisk aktivitet och hälsorelaterad livskvalitet men belyser betydelsen av fysisk aktivitet för denna grupp. / Background: Besides hormone-based treatments, physical activity has shown effectiveness in menopausal symptoms, but few studies have explored the relationship between physical activity, menopausal symptoms, and health related quality of life in a Swedish population. Objective: The objective was to examine menopausal symptoms, health related quality of life, and physical activity levels among menopausal women in Sweden, and to explore how physical activity levels correlates to health related quality of life, and menopausal symptoms. Method: A multiple-choice questionnaire about menopausal symptoms (Menopause Rating Scale), physical activity (Socialstyrelsens Screeningfrågor om Fysisk Aktivitet), and health related quality of life (RAND-36) was sent to two closed Facebook groups for menopausal women. Results: Survey responses from the women (n=381) reported sleep and physical/mental fatigue as the most severe symptoms. On average, they were physically active for 315 minutes per week and had the lowest heath related quality of life related to energy/fatigue and the highest heath related quality of life related to physical function. Those who met the recommendations for physical activity reported higher physical health (p<0.001) and emotional health (p=0.004) compared to those who did not meet the recommendations. A weak but significant relationship was found between the degree of menopausal symptoms and the total number of physical activity (ρ=-0.156) and physical exercise (ρ=-0.149). Conclusion: The results suggest a relationship between sufficient physical activity and higher health related quality of life, especially concerning the dimensions physical and emotional health. The association between menopausal symptoms and physical activity was present but weak. The findings provide insights into the complex relationships between menopausal symptoms, physical activity, and health related quality of life, highlighting the significance of physical activity for this group.

Laparoscopic liver resection (LLR) is an increasingly relevant treatment option for patients with resectable hepatocellular carcinoma (HCC). Orthotopic liver transplantation (OLT) has been considered optimal treatment for HCC in cirrhosis, but is challenged by rising organ scarcity. While health-related quality of life (HRQoL) and mental health are well-documented after OLT, little is known about HRQoL in HCC patients after LLR. We identified all HCC patients who underwent LLR at our hospital between 2014 and 2018. HRQoL and mental health were assessed using the Short Form 36 and the Hospital Anxiety and Depression Scale, respectively. Outcomes were compared to a historic cohort of HCC patients after OLT. Ninety-eight patients received LLR for HCC. Postoperative morbidity was 25% with 17% minor complications. LLR patients showed similar overall HRQoL and mental health to OLT recipients, except for lower General Health (p = 0.029) and higher anxiety scores (p = 0.010). We conclude that LLR can be safely performed in patients with HCC, with or without liver cirrhosis. The postoperative HRQoL and mental health are comparable to that of OLT recipients in most aspects. LLR should thus always be considered an alternative to OLT, especially in times of organ shortage.

Background: The present cross-sectional study assessed oral health, nutritional condition, and oral health-related quality of life (OHRQoL) in older German people in need of care. Methods: The participants were recruited from eight nursing homes (including three nursing homes with assisted living) and one mobile nursing service. Oral health, including dental status (decayed, missing and filled teeth (DMF-T), root caries), periodontal treatment needs, and prosthetic conditions, was recorded. Nutritional status was assessed using the screening of the “Mini Nutritional Assessment” (MNA). The OHRQoL was measured using the German short-form of the Oral Health Impact Profile (OHIP-G14) and summarized as a total sum score as well as the four dimensions “oral function”, “psychosocial impact”, “pain” and “orofacial appearance”. Statistics: Linear logistic regression analyses. Results: A total of 151 participants (age: 84.17 ± 7.8 years) were included. Most participants (60.3%) were nursing home residents. Nearly half of the individuals (47%) were edentulous and 75.4% of the dentate subjects required periodontal treatment. A total of 115 of the subjects had at least one denture. According to the MNA screening, 107 (70.9%) older people were at risk of malnutrition or already suffered from malnutrition. The median OHIP-G14 sum score was 3 (mean 5.7 ± 7.67). Regression analysis revealed MNA to be influenced by DMF-T, D-T, M-T and OHIP G14 sum score and root caries (pi < 0.01). Within the regression model, missing teeth (β: −11.9, CI95: −6.4–−1.9; p < 0.01) were the strongest influential factor on MNA, followed by DMF-T (β: 5.1, CI95: 1.7–6.2; p < 0.01). Conclusions: Older people in nursing settings show a high prevalence of oral diseases, risk of malnutrition and nearly unimpaired OHRQoL. Dental care should be fostered in these individuals, whereby OHRQoL might be a further hint for increased risk of malnutrition.