Širdies ir kraujagyslių sistemos ligos sudaro didžiąją dalį tarp sergamumo, mirtingumo ir neįgalumo priežasčių. Mirtingumo rodiklių vertinimas - tradicinis pirminis išeičių matavimas, tačiau ir pacientai, ir medikai vis labiau domisi ne vien tuo, kaip sumažinti mirtingumą, bet ir kaip sumažinti simptomus, padidinti funkcines galimybes, kitaip tariant, pagerinti su sveikata susijusią gyvenimo kokybę. Darbo tikslas – išnagrinėti sergančiųjų IŠL su sveikata susijusią gyvenimo kokybę bei jos pokyčius ilgalaikio stebėjimo metu. Uždaviniai: 1. Išnagrinėti sergančiųjų IŠL su sveikata susijusią gyvenimo kokybę priklausomai nuo sociodemografinių rodiklių (amžiaus, lyties, išsilavinimo, darbinės padėties). 2. Išnagrinėti sergančiųjų IŠL su sveikata susijusią gyvenimo kokybę priklausomai nuo pradinės funkcinės būklės (kardiovaskulinės, psichoemocinės, miego kokybės). 3. Įvertinti kardiovaskulinės, psichoemocinės būklės bei miego kokybės įtaką sergančiųjų IŠL su sveikata susijusiai gyvenimo kokybei. 4. Įvertinti sergančiųjų IŠL (po ūminio miokardo infarkto, perkutaninės transliuminalinės vainikinių arterijų angioplastikos ir aorto-vainikinių arterijų jungčių operacijos) su sveikata susijusios gyvenimo kokybės pokyčius ilgalaikio stebėjimo metu. Tyrimo kontingentas ir metodai. Tiriamąjį kontingentą sudarė KMU Psichofiziologijos ir reabilitacijos instituto kardiovaskulinės reabilitacijos klinikos pacientai, atvykę reabilitaciniam gydymui po ūmaus miokardo infarkto, perkutaninės... [toliau žr. visą tekstą] / Cardiovascular diseases including coronary artery disease (CAD) are very prevalent in Lithuania. The primary outcome interest has traditionally been mortality, but patients and researchers are increasingly interest in identifying interventions that not only improve mortality, but also reduce symptoms, increase functional ability; in other words, improve patients health-related quality of life. Health-related quality of life represents the effect of an illness and its treatment as perceived by the patient, that it is modified by impairments, functional stress, perceptions and social opportunities, and is influenced by disease, injury, treatment or policy. The aim of the study was to analyze health-related quality of life in CAD patients and to assess its changes during long-term period. The objectives of the study: 1. To evaluate health-related quality of life in CAD patients according to sociodemographic factors (gander, age, education level and employment status). 2. To evaluate health-related quality of life in CAD patients according to functional status ���� angina pectoris, heart failure, NYHA functional class, anxiety, depression and sleep quality. 3. To assess the impact of demographic factors, cardiovascular status, psycho-emotional status and sleep quality on health-related quality of life in CAD patients. 4. To assess the health-related quality of life changes during long-term period in CAD patients (after acute myocardial infarction (MI), percutaneous transluminal... [to full text]

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.

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The aim of research: to investigate the health related life quality subjective evaluation of the pedagogues of Rokiškis town and district. In the latter decade the topic and researches on life quality have become the underlying in the ranges of society health and health education. The quality of life by the most scientists is understood as the perception of subjective welfare, inclusive physical, psychological, social and inward levels. Scientists have created various expedients, designed to measure the subjective functional potential, the senses of state of health and the quality of life. The researches of quality of life may help to solve the most essential economic problems, related to the peoples’ welfare, the healthcare and social policy influence upon the society and its physical and psychological health. Though in Lithuania there have been made many valuable researches, analyzing various aspects upon quality of life, we have not succeeded in finding any researches on pedagogues’ quality of life, rather the analysis of quality of life according to their residence. Summarizing the country and town pedagogues’ comparison of health related life quality factors of evaluation, we can state, that the hypothesis of our research has partly proved – we can not unambiguously affirm, that the health related life quality subjective evaluation of country and town pedagogues’ is essentially different, because only two health related quality of life aspects are superiorly rated by... [to full text]

The overall aim of this thesis was to investigate the patients’ and their relatives’ perceived participation in discharge planning after stroke and the patients’ health-related quality of life, depressive symptoms, performance of personal daily activities and social activities in connection with discharge. Another aim was to evaluate the psychometric assumptions of the SF-36 for Swedish stroke patients. Prospective, descriptive and cross-sectional designs were used to study all patients with stroke admitted to the stroke unit at a hospital in southern Sweden from October 1, 2003 to November 30, 2005 each with one close relative. The total sample consisted of 188 patients (mean age=74.0 years) and 152 relatives (mean age=60.1 years). Data were collected during interviews, 2-3 weeks after discharge. The results showed that less depressive symptoms, more outdoor activities and performance of interests are important variables that related to higher HRQoL. SF-36 functions well as a measure of health related quality of life in Swedish stroke patients, but the two summary scales have shortcomings. Compared to a Swedish normal population, scores on all scales/components of the SF-36 were lower among stroke patients especially in the middle-aged group. Most of the patients perceived that they received information, but fewer perceived participation in the planning of medical treatment and needs of care/service/rehabilitation and goal setting. The relatives perceived that they need more information and they perceived low participation in goal setting and needs assessment. The professionals seem to lack effective practices for involving patients and their relatives to perceive participation in discharge planning. It is essential to develop and to implement methods for discharge planning, including sharing information, needs assessment with goal setting that facilitate patients’ and relatives’ perceived participation. The results suggest that ICF can be used in goal setting and needs assessment in discharge planning after acute stroke.

Syftet med studien var att jämföra skattad hanteringsförmåga och hälsorelateradlivskvalitet hos närstående till personer med kronisk hjärtsvikt och stroke. Ett annat syfte var också att studera om samband fanns mellan hanteringsförmågaoch hälsorelaterad livskvalitet.  Metod: En komparativ och korrelativdesign med kvantitativ ansats användes. För att mäta hanteringsförmåga ochhälsorelaterad livskvalitet användes Jalowiec Coping Scale (JCS) och Shortform- 36 (SF- 36). Urvalsgruppen för studien var närstående till patienter med kronisk hjärtsvikt och stroke (n = 46). Resultatet visade att båda närstående grupperna använde mer optimistisk-, självtillit och konfrontativ stil. Närstående till patienter med stroke skattar sitt psykiska välbefinnande högre än närstående till patienter med kronisk hjärtsvikt(p=0,024). Det framkom flera låga och moderata negativa statistiska signifikanta samband mellan hälsorelaterad livskvalitet och hanteringsförmåga. De psykiska skalorna (SF-36) hade fler statistiska samband med coping stilar(JCS) än de fysiska skalorna. Konklusionen visade att närstående till patienter med kronisk hjärtsvikt skattar sin hälsorelaterade livskvalitet lägre på den psykiska välbefinnande än närstående till patienter med stroke.  Generellt var att lägre användning av copingstilar hade mer samband med högre skattad hälsorelaterad livskvalitet. / The aims of the study were to compare handling ability and health-related quality of life in next of kin to patients with chronic heart failure and stroke, as well as study correlations between handling ability and health-related quality of life. Method: A comparative and correlative design with quantitative approach was used. To measure handling ability and health-related quality Jalowiec Coping Scale (JCS) and Short Form-36 (SF-36) were used. The study group was next of kin to patients with chronic heart failure and stroke (n = 46). The results showed that both groups use most optimistic, self- reliant and confrontative coping styles. Next of kin to patients with stroke estimated mental health significantly higher than next of kin to patients with chronic heart failure (p = 0.024). There were several significant negative low-and moderate correlations between health-related quality of life and handling ability. In SF-36, the mental scales were more significantly associated with coping strategies (JCS) than the physical scales. Conclusions: Next of kin to patients with chronic heart failure rated health-related quality of life lower in the scale mental health than next of patients with stroke. Lower use of coping styles were more associated with higher health- related quality of life. / Att leva med långvarig ohälsa- hanteringsförmåga/resurser och upplevd livskvalitet

Aims and Methods The overall aim was to evaluate methods of screening and assessment of distress, anxiety, and depression in cancer patients. Further, to evaluate effects of a psychosocial intervention and to explore changes of distress, anxiety, depression, and HRQoL during six months. Study I included 495 consecutive patients screened with the Hospital Anxiety and Depression Scale (HADS) at their first visit to an Oncology Department. Half of the patients with >7 on any of HADS subscales received standard care (SCG), and half received a psychosocial intervention (IG). To compare HADS with a thorough clinical assessment (CA), Study II included 171 identified patients representing both sexes, <65/≥65 years, and curative/palliative treatment intention. Results Screening with HADS identified anxiety or/and depression symptoms in 36% of the 495 patients. Thirty-six (43%) of 84 IG patients attended CA, resulting in support for 20 (24%) of them. There were no differences between SC and IG during follow-up, anxiety and depression decreased and HRQoL increased, although anxiety was still present and HRQoL impaired at six months. The Distress Thermometer (DT) ≥4 (sensitivity 87%, specificity 73%) is valid for screening of distress; its ability to measure changes over time is comparable to HADS. Of 319 patients screened with <8 on both HADS subscales, 196 (80%) were stable non-cases with HRQoL comparable to that of the general population and 49 (20%) patients were unstable non-cases, with deteriorated anxiety, depression, and HRQoL. >4 on HADS subscales may be useful for early detection of unstable non-cases. In Study II, HADS identified 49 (34%) and the CA 71 (49%) patients as having distress, anxiety or depression. CA identified more men and more young patients with distress than HADS did. Conclusion Screening and assessment identifies patients with persistent symptoms and increases access to CA and support. The DT may be used routinely in oncology care. When HADS is used, healthcare professionals should be aware of psychosocial problems perceived by patients but not covered by HADS. Most patients identified with distress seem to have resources to manage problems without needing additional support. Patients screened as non-cases indicate no need for re-assessment.

Objective The main objective of this thesis was to explore the effects of diet on gastrointestinal symptoms in prostate cancer patients treated with local curative radiotherapy, by evaluating dietary intake prior to treatment (Study I), the psychometric properties of a new questionnaire on patient-reported gastrointestinal side effects (Study II), and the effect of a dietary intervention on acute and long-term gastrointestinal symptoms up to 2 years after radiotherapy completion (Study III-IV). Methods A total of 130 men with localized prostate cancer referred to dose-escalated radiotherapy (ED2 87-102 Gy, α/β=3 Gy) were recruited to a dietary intervention trial. Patients were randomized to receive either standard care plus the dietary intervention of a fibre- and lactose-restricted diet (intervention group, IG; n=64) or standard care alone (standard care group, SCG; n=66). Data on gastrointestinal symptoms and dietary intake were collected pre-treatment and at seven time points during a follow-up period of 26 months. Results Prior to treatment, grain products and milk products were major sources of energy. Unbalanced fatty acid intake and low intake of selenium were observed (Study I). Validation of the Gastrointestinal Side Effects Questionnaire (GISEQ) revealed satisfactory internal consistency, moderate concurrent validity and adequate responsiveness (Study II). There were no significant effects of the intervention on acute or long-term gastrointestinal symptoms, but a tendency towards lower prevalence and severity of bloating and diarrhoea in the IG compared to the SCG during radiotherapy. Gastrointestinal symptoms were predominantly mild, and the frequency of clinically relevant symptoms was merely a few percent. Dietary adherence in the IG was initially good, but tended to decline beyond 12 months post-radiotherapy (Study III-IV). Conclusions A fibre- and lactose-restricted diet was not superior to the habitual diet in reducing gastrointestinal symptoms in patients undergoing high-dose, small-volume radiotherapy for localized prostate cancer. The GISEQ enables assessment of patient-perceived change in symptoms, but further work is needed to strengthen its psychometric qualities. It is suggested that continued research in this area target patient categories referred to irradiation of larger pelvic volumes with a higher risk of gastrointestinal symptoms, and that dietary interventions incorporate established strategies to enhance adherence and effectiveness.

Krūties vėžys yra dažniausia moterų liga, kuriai būdingi dideli sergamumo ir mirtingumo rodikliai. Visame pasaulyje krūties vėžys tarp moterų sudaro apie 23 proc. visų vėžio formų. Dėl mirčių nuo krūties vėžio visuomenė praranda daugybę gyvenimo metų: Ispanijos moterys dėl šio susirgimo per metus netenka 58 800, o Japonijos – 255 046 gyvenimo metų. Lietuvoje krūties vėžiu kasmet suserga apie 1500 moterų, iš jų – beveik pusė (46,4 proc.) – darbingo amžiaus, tačiau iki šiol nėra paskelbta sveikatos ekonomikos darbų, nagrinėjančių krūties vėžio kaštus ir išeitis. Atliktas tyrimas – pirmasis tokio pobūdžio tyrimas Lietuvoje, jo metu gauti rezultatai sudaro prielaidas sveikatos technologijų ekonominiam vertinimui, tolimesnei krūties vėžio stebėsenai, efektyvesniam išteklių paskirstymui bei sergančiųjų gyvenimo kokybės gerinimui. Tyrimo metu atliktas duomenų bazių sujungimo galimybių įvertinimas. Remiantis gautais rezultatais gali būti koreguojama mokėjimo už krūties vėžio gydymo paslaugas sistema. Taikant savalaikes modernias ankstyvosios diagnostikos priemones, galima diagnozuoti kuo daugiau ankstyvųjų krūties vėžio stadijų atvejų. / An estimated 180,000 new cases of breast cancer occur in Europe every year. According to WHO, BC causes about 77,000 deaths in the world every year. The disease accounts for 58,800 years of life lost per year in Spain and 255,046 years of life lost in Japan. It is the first research performed in Lithuania during which the evaluation of the possibility of pooling different databases has been performed; obtained results set preconditions for economic evaluation of health technologies, further monitoring of BC, more effective allocation of resources, and improvement health-related quality of life of patients. On the basis of these results, modifications in health care payment system can be developed. Considering clinical and molecular properties of tumour, effective treatment with fewer side effects might be administered – with the aim to help women to control the disease, return to active life, and enhance health-related quality of life.