Thesis (doctoral)--Malmö University, Sweden, 2009. / Includes bibliographical references. Also available on World Wide Web.

Thesis (doctoral)--Malmö University, Sweden, 2009. / Includes bibliographical references. Also available on World Wide Web.

Thesis (doctoral)--Malmö University, Sweden, 2007. / Added t.p. with thesis statement inserted. Includes bibliographical references.

Thesis (doctoral)--Malmö University, Sweden, 2007. / Added t.p. with thesis statement inserted. Includes bibliographical references.

A tontura é considerada pela área médica, como um problema de saúde pública. Entender os distúrbios do equilíbrio corporal, como a limitação de um dos sistemas fundamentais para a sobrevivência do indivíduo, ajuda a compreender a importância e a necessidade de uma abordagem diagnóstica rápida e precisa. A valorização de sinais encontrados na avaliação vestibular, e da queixa do paciente, é fundamental para o diagnóstico, sendo de extrema importância o encaminhamento para avaliação exploratória do sistema vestibular, para que medidas terapêuticas personalizadas sejam adotadas. A reabilitação vestibular (RV) é um recurso terapêutico realizado por meio de exercícios que visam melhorar a interação vestíbulo-visual durante a movimentação cefálica, e ampliar a estabilidade postural estática e dinâmica nas condições que produzem informações sensoriais conflitantes. Objetivo: Verificar a eficácia de um protocolo de procedimentos terapêuticos de RV em grupo, aplicado em indivíduos com queixas vestibulares, considerando as variáveis: gênero, idade, presença de zumbido e influência da localização do comprometimento do sistema vestibular. Material e métodos: Estudo descritivo e retrospectivo, realizado a partir da análise de prontuários de 151 pacientes atendidos na DSA do HRAC-USP. A casuística foi delimitada a partir da análise de prontuários de pacientes de ambos os gêneros, com idade entre 10 a 88 anos. Os critérios de inclusão foram: queixas vestibulares, ter realizado a VENG pré RV em grupo, ter respondido ao Dizziness Handicap Inventory (DHI) e a Escala Visual Analógica (EVA), para os sintomas de tontura e zumbido, nas etapas pré e pós intervenção. A RV foi composta por 13 sessões de aproximadamente 60 minutos, seguindo protocolo especifico elaborado para a RV em grupo. O tratamento estatístico foi composto pelos testes Teste T, McNemar, Friedmann, Qui-Quadrado, Fisher, Binominal, Kolmogorov-Smirnov e Testes Wilcoxon. Foi adotado valor de significância (p) igual ou menor que 0,05. Resultados: Na comparação entre os resultados do DHI obtidos nas etapas pré e pós RV houve diferença para todos os aspectos, tanto a pontuação total como para a classificação por grau (p=0,001). Na análise do EVA houve diferença quanto ao desconforto da tontura (valor de p variou de 0,000 a 0,092), quanto ao desconforto relacionado ao zumbido (p=0,001). Houve diferença na comparação da avaliação vestibular por meio da VENG antes e depois da RV (p=0,003). Não houve correlação entre idade (p=0,610) e efetividade da RV porém houve correlação com o gênero (p=0,028). Houve diferença entre os resultados da VENG na comparação entre as etapas pré e pós RV em grupo (p=0,001). Na correlação da EVA com as variáveis, houve correlação com o gênero feminino (p=0,000), com todas as faixas etárias, exceto a de 10 a 20 anos (p=0,125) de 21 a 90 anos, e com o comprometimento vestibular periférico (p=0,000). Conclusão: O protocolo de RV em grupo, aplicados em pacientes com queixas vestibulares foi eficaz para a queixa de tontura e zumbido, independente da idade. O gênero feminino apresentou mais benefícios com a RV do que o gênero masculino. A RV foi eficaz para todos os tipos de comprometimento vestibular, inclusive nos achados identificados como normais. / Dizziness is considered by the medical field as a public health problem. Understanding body balance disorders, such as limiting one of the fundamental systems for individual survival, helps to understand the importance and necessity of a quick and accurate diagnostic approach. The evaluation of signs found in the vestibular evaluation, and the patient\'s complaint, is fundamental for the diagnosis, being extremely important the exploratory evaluation of the vestibular system, so that therapeutic therapeutic measures are adopted. Vestibular Rehabilitation (VR) is a therapeutic resource performed through exercises that aim to improve vestibulovisual interaction during head movement and to increase static and dynamic postural stability in conditions that produce conflicting sensory information. Aim: To verify the efficacy of a group VR therapeutic protocol, applied to individuals with vestibular complaints, considering the following variables: gender, age, tinnitus and influence of the location of vestibular system impairment identified by vectoelectronystagmography (VENG). Methods: Descriptive and retrospective study, based on the analysis of medical records of 151 patients seen in the DSA of HRACUSP. The casuistry was delimited from the analysis of medical records of patients of both genders, aged between 10 and 88 years. Inclusion criteria were: vestibular complaints, VENG pre VR in group, response to Dizziness Handicap Inventory (DHI) and Visual Analogue Scale (VAS) for the symptoms of dizziness and tinnitus, in the pre- and post-intervention stages. The VR was composed of 13 sessions of approximately 60 minutes, following a specific protocol elaborated for VR in a group. The statistical treatment was composed by the Test T, McNemar, Friedmann, Chi- Square, Fisher, Binominal and Kolmogorov-Smirnov tests. Significance (p) value was adopted equal to or less than 0.05. Results: The results obtained were compared with the results obtained for each classification level (p=0,001). In the analysis of VAS, there was a difference between the discount of dizziness (variance value = 0,000 to 0,092), or discomfort related to tinnitus (p=0,001). There was a difference in the evaluation of vestibular evaluation through VENG before and after VR (p=0,003). There was no correlation between age (p=0,610) and VR efficacy, with correlation with gender (p=0,028). There was a difference between the VENG results between the previous phases of the group (p=0,001). In the correlation between the VAS and the variables, there was a correlation with the female gender (p=0,000), with all age groups, except for 10 to 20 years (p=0,125) from 21 to 90 years and with peripheral vestibular impairment (p=0,000). Conclusion: The group VR protocol applied to patients with vestibular complaints was effective for complaint of dizziness and tinnitus, regardless of age. The female had more benefits with an VR than the male sex. VR was effective for all types of vestibular compromise, including findings identified as normal.

A tontura é considerada pela área médica, como um problema de saúde pública. Entender os distúrbios do equilíbrio corporal, como a limitação de um dos sistemas fundamentais para a sobrevivência do indivíduo, ajuda a compreender a importância e a necessidade de uma abordagem diagnóstica rápida e precisa. A valorização de sinais encontrados na avaliação vestibular, e da queixa do paciente, é fundamental para o diagnóstico, sendo de extrema importância o encaminhamento para avaliação exploratória do sistema vestibular, para que medidas terapêuticas personalizadas sejam adotadas. A reabilitação vestibular (RV) é um recurso terapêutico realizado por meio de exercícios que visam melhorar a interação vestíbulo-visual durante a movimentação cefálica, e ampliar a estabilidade postural estática e dinâmica nas condições que produzem informações sensoriais conflitantes. Objetivo: Verificar a eficácia de um protocolo de procedimentos terapêuticos de RV em grupo, aplicado em indivíduos com queixas vestibulares, considerando as variáveis: gênero, idade, presença de zumbido e influência da localização do comprometimento do sistema vestibular. Material e métodos: Estudo descritivo e retrospectivo, realizado a partir da análise de prontuários de 151 pacientes atendidos na DSA do HRAC-USP. A casuística foi delimitada a partir da análise de prontuários de pacientes de ambos os gêneros, com idade entre 10 a 88 anos. Os critérios de inclusão foram: queixas vestibulares, ter realizado a VENG pré RV em grupo, ter respondido ao Dizziness Handicap Inventory (DHI) e a Escala Visual Analógica (EVA), para os sintomas de tontura e zumbido, nas etapas pré e pós intervenção. A RV foi composta por 13 sessões de aproximadamente 60 minutos, seguindo protocolo especifico elaborado para a RV em grupo. O tratamento estatístico foi composto pelos testes Teste T, McNemar, Friedmann, Qui-Quadrado, Fisher, Binominal, Kolmogorov-Smirnov e Testes Wilcoxon. Foi adotado valor de significância (p) igual ou menor que 0,05. Resultados: Na comparação entre os resultados do DHI obtidos nas etapas pré e pós RV houve diferença para todos os aspectos, tanto a pontuação total como para a classificação por grau (p=0,001). Na análise do EVA houve diferença quanto ao desconforto da tontura (valor de p variou de 0,000 a 0,092), quanto ao desconforto relacionado ao zumbido (p=0,001). Houve diferença na comparação da avaliação vestibular por meio da VENG antes e depois da RV (p=0,003). Não houve correlação entre idade (p=0,610) e efetividade da RV porém houve correlação com o gênero (p=0,028). Houve diferença entre os resultados da VENG na comparação entre as etapas pré e pós RV em grupo (p=0,001). Na correlação da EVA com as variáveis, houve correlação com o gênero feminino (p=0,000), com todas as faixas etárias, exceto a de 10 a 20 anos (p=0,125) de 21 a 90 anos, e com o comprometimento vestibular periférico (p=0,000). Conclusão: O protocolo de RV em grupo, aplicados em pacientes com queixas vestibulares foi eficaz para a queixa de tontura e zumbido, independente da idade. O gênero feminino apresentou mais benefícios com a RV do que o gênero masculino. A RV foi eficaz para todos os tipos de comprometimento vestibular, inclusive nos achados identificados como normais. / Dizziness is considered by the medical field as a public health problem. Understanding body balance disorders, such as limiting one of the fundamental systems for individual survival, helps to understand the importance and necessity of a quick and accurate diagnostic approach. The evaluation of signs found in the vestibular evaluation, and the patient\'s complaint, is fundamental for the diagnosis, being extremely important the exploratory evaluation of the vestibular system, so that therapeutic therapeutic measures are adopted. Vestibular Rehabilitation (VR) is a therapeutic resource performed through exercises that aim to improve vestibulovisual interaction during head movement and to increase static and dynamic postural stability in conditions that produce conflicting sensory information. Aim: To verify the efficacy of a group VR therapeutic protocol, applied to individuals with vestibular complaints, considering the following variables: gender, age, tinnitus and influence of the location of vestibular system impairment identified by vectoelectronystagmography (VENG). Methods: Descriptive and retrospective study, based on the analysis of medical records of 151 patients seen in the DSA of HRACUSP. The casuistry was delimited from the analysis of medical records of patients of both genders, aged between 10 and 88 years. Inclusion criteria were: vestibular complaints, VENG pre VR in group, response to Dizziness Handicap Inventory (DHI) and Visual Analogue Scale (VAS) for the symptoms of dizziness and tinnitus, in the pre- and post-intervention stages. The VR was composed of 13 sessions of approximately 60 minutes, following a specific protocol elaborated for VR in a group. The statistical treatment was composed by the Test T, McNemar, Friedmann, Chi- Square, Fisher, Binominal and Kolmogorov-Smirnov tests. Significance (p) value was adopted equal to or less than 0.05. Results: The results obtained were compared with the results obtained for each classification level (p=0,001). In the analysis of VAS, there was a difference between the discount of dizziness (variance value = 0,000 to 0,092), or discomfort related to tinnitus (p=0,001). There was a difference in the evaluation of vestibular evaluation through VENG before and after VR (p=0,003). There was no correlation between age (p=0,610) and VR efficacy, with correlation with gender (p=0,028). There was a difference between the VENG results between the previous phases of the group (p=0,001). In the correlation between the VAS and the variables, there was a correlation with the female gender (p=0,000), with all age groups, except for 10 to 20 years (p=0,125) from 21 to 90 years and with peripheral vestibular impairment (p=0,000). Conclusion: The group VR protocol applied to patients with vestibular complaints was effective for complaint of dizziness and tinnitus, regardless of age. The female had more benefits with an VR than the male sex. VR was effective for all types of vestibular compromise, including findings identified as normal.

Research Objectives: Chronic obstructive pulmonary disease (COPD) is a major cause of disability and death worldwide. The prevalence of depression and anxiety in COPD patients is generally higher than those reported in other chronic illnesses, and these mental diseases significantly affect the health expenditures and the course of the diseases on elderly COPD patients. The COPD patients with co-morbid depression, anxiety or other chronic diseases are more impaired and have 50% to 100% higher medical costs than those without depression and anxiety. COPD affects approximately 1.8 million people in Taiwan every year, however, little studies have examined the impacts of mental diseases on elderly COPD patients. This study aims to investigate the depression and anxiety status on COPD patients¡¦ medical care utilizations and health outcomes. Study Design: This study analyzed the nationally representative research database from National Health Insurance program between 2002 and 2006 in Taiwan, by exploring outpatient visits, hospitalizations, and medical expenditures of COPD and its associated co-morbidities. The data analyses were carried out by Chi-square test, multiple linear regression and multivariate logistic regression. Population Studied: Patient aged over 65 with primary diagnosis of COPD and co-morbidity diseases based on ICD-9-CM in Taiwan. To investigate the complications in COPD patients, four diseases such as diabetes, hypertension, heart failure and ischemic heart disease were included in the analyses. Principle Findings: Among the 5,735 COPD patients (59.81%, male), most of them were aged over 80 (28.67%) , and lived in urban areas (62.28%) in northern Taiwan (43.71%). The results indicated that those who were suffered from depression or anxiety increased medical utilization and costs. Multiple linear regression model showed that age, and hospital level significantly affect the expenditures for medicine of COPD patients with depression or anxiety (p¡Õ0.001). Multivariate logistic regression model presented that number of complications significantly affect the probability of hospitalization among the COPD patients with mental diseases (p¡Õ0.001). Conclusions¡G COPD symptoms were usually getting worsen over time and depression or anxiety affect the COPD patients significantly, though the mental diseases are usually under-estimated. The study results demonstrated that COPD patients suffered from depression and anxiety increased the risks on longer length of stay, higher medical expenditures and more complications. WHO predicts that COPD will become the third leading cause of death worldwide by 2030. Since mental diseases may worsen elderly COPD patients¡¦ health outcomes, physicians are advised to pay more attention to these types of patients. With on time and appropriate treatments, thus may help to improve quality of care and reduce medical expenditures for these patients.

Thesis (Ph. D.)--University of Texas at Austin, 2005. / Vita. Includes bibliographical references.

<p>Kvalitet života u vezi sa zdravljem kod starih je najznačajniji aspekt kvaliteta života uop&scaron;te, a<br />merenje kvaliteta života ima značajno mesto u praksi zdravstvene za&scaron;tite i naučnoistraživačkom<br />radu. Cilj istraživanja je bio da se primenom modifikovanog McMaster Health Index Questionnaire<br />utvrde fizička, socijalna i emotivna dimenzija kvaliteta života starih, kao i da se defini&scaron;e validni<br />instrument za procenu kvaliteta života u vezi sa zdravljem kod starih u na&scaron;im uslovima. Istraživanje<br />je sprovedeno u periodu 1998-2000 u obliku studije preseka, putem anketnog upitnika na uzorku<br />stanovni&scaron;tva Novog Sada starosti 60 i vi&scaron;e godina (n=373). Inicijalni anketni upitnik je poslužio za<br />analizu pojedinih domena zdravlja a iz njega su korelacionim analizama izdvojeni ajtemi za &scaron;est<br />skala: fizičko funkcionisanje, samozbrinjavanje, osećanje u vezi korisnosti u dru&scaron;tvu, osećanja u<br />vezi života, socijalno funkcionisanje i samoprocena. Za svaku skalu i za ukupni indeks kvaliteta<br />života (QOL-OLD indeks) je izračunat transformisani skor (ranga 0-100) kao i uticaj pojedinih<br />skala na ukupni indeks kvaliteta života u odnosu na zdravlje. Indeks kvaliteta života QOL-OLD<br />(ranga 0-100) predstavlja sumarnu numeričku vrednost dobijenu iz svih &scaron;est domena. Za svaku<br />skalu kao i za sumarni Indeks utvrđena je pouzdanost i validnost pomoću svetski prihvaćenih<br />kriterijuma za Cronbach Alpha vrednost. Analizom je izdvojeno &scaron;est skala koje imaju uticaj na<br />kvalitet života starih i utvrđeno je da je uticaj fizičkog zdravlja, posmatran kroz skalu fizičkog<br />funkcionisanja i skalu samozbrinjavanja, dominantan i čini 39,3% u globalnom kreiranju indeksa<br />kvaliteta života. Svaki domen kao i ukupni QOL-OLD indeks je analiziran u odnosu na neke<br />sociodemografske determinante za koje se pokazalo da imaju uticaj na pojedine domene kao i na<br />ukupni kvalitet života u odnosu na zdravlje kod starih. Izdvajanjem ajtema iz modifikovanog<br />McMaster Health Index Questionnaire dobijen je skraćeni i validan upitnik za procenu kvaliteta<br />života starih u populaciji ali iza procenu kvaliteta života kod pojedinaca iste starosti.</p> / <p>Health related quality of life of the elderly is the most important aspect of quality of<br />life concept in general, and it&#39;s measurement has an important place in health care<br />practice and scientific work. The aim of this study was to determine physical, social<br />and emotional dimension of health related quality of life among elderly, using<br />modified McMaster Health Index questionnaire, as well as to construct valid<br />instrument for health related quality of life assessment among elderly for our<br />theritory. Cross sectional study was performed during 1998-2000. through poll, on the<br />Novi Sad population sample aged 60 and above (n=373). Initial questionnaire was<br />used for the purpose of analysis of certain health domains, and by using correlation<br />analysis to extract items for six scales: physical functioning, selfcare, social<br />usefulness, emotions about life, social functioning and self perception. Transformed<br />score (range 0-100) was calculated for each scale separatly and for total health related<br />quality of life index (QOL-OLD) as well as percentage influence of each scale on<br />QOL-OLD index. Health related quality of life index (QOL-OLD) presents summar<br />numeric value calculated from all six domains. For each scale and for QOL-OLD<br />validity and reliability was determined using Cronbach alpha value. Analysis<br />extracted six scales which influence quality of life among elderly, and results showed<br />that physical health, covered with physical functioning scale and selfcare scale, has<br />dominant influence (39,3%) in creating global QOL-OLD index. Each domain and<br />QOL-OLD index was analyzed considering some socio-demographic determinants<br />which showed impact on single domains and on total QOL-OLD index. Extracting<br />items from initial modified McMaster Health Index Questionnaire enabled<br />construction of shortened and valid questionnaire for assessment health related quality<br />of life among elderly in the population but also for individuals of same age.</p>

Sexualiteten och den sexuella hälsan är en grundpelare i att varje människas individualitet. Det finns ett fördomsfullt synsätt angående äldre och deras sexualitet där gruppen blir betraktade som asexuell. Ämnet är tabubelagt och det föreligger relativt lite kunskap kring det. Livskvalitet är en subjektiv upplevelse som förändras över tid. Åldrandet bidrar till flera riskfaktorer som kan leda till nedsatt livskvalitet. Denna litteraturstudies syfte var att undersöka hur sexualitet och sexuella hälsa bland äldre individer ≥ 50 år är kopplade till deras livskvalitet. En litteratursökning gjordes med hjälp av identifierade sökord som var relevanta för studiens syfte i databaserna PubMed och Google Scholar. Tretton artiklar användes i litteraturstudiens resultat. Resultatet visade att sexualiteten och den sexuella hälsan har betydelse för majoriteten av den äldre befolkningens livskvalitet då den bland annat främjar självförtroendet, självbilden och självkänslan. Sexuell aktivitet och sexuell tillfredsställelse har oftast en koppling till en bättre upplevd livskvalitet. Äldre med god sexuell hälsa har oftast ett gott psykiskt välbefinnande. Det finns också en del äldre som med åldern omprioriterar sexualiteten på grund av att andra behov anses som viktigare. En del äldre anser att deras sexualitet är i det förflutna. Vissa utvecklar en inre acceptans medan andra får en negativ påverkan på livskvaliteten. Kopplingen mellan sexualitet, sexuell hälsa och livskvalitet skiljer sig mellan äldre individer men för majoriteten har den en betydelse för deras fysiska och psykiska välbefinnande. / Sexuality and sexual health is a keystone of every person's individuality. There is a prejudiced view about the elderly and their sexuality that perceive the group as asexual. The subject is taboo and there is relatively little knowledge about it. Quality of life is a subjective experience that changes over time. Aging contributes to more risk factors that can lead to impaired quality of life. This study aimed to examine how older people; ≥50 years, sexuality and sexual health are linked to their quality of life. A systematic review was conducted using identified keywords relevant for the purpose of the study to search the databases PubMed and Google Scholar. Thirteen articles where selected and used in the systematic review. The results showed that sexuality and sexual health is important for the majority of the older population’s quality of life as it promotes self-esteem, self-image and self-reliance. Sexual activity and sexual satisfaction is often related to a better quality of life. Older people with a good sexual health usually experience a good mental well-being. In addition, there are older people from for whom the meaning of sexuality changes because other basics needs are considered more important. Some older people view their sexual activity is behind them. Some develop an inner acceptance towards this while others become adversely affected. The link between sexuality, sexual health and quality of life differ among older individuals but for the majority, it has an impact on their physical and mental well-being.