No / Most research on partners' experiences of living with a person with MND is questionnaire-based with no qualitative study focusing on the period between diagnosis and end-of-life care. This study aimed to provide an in-depth qualitative exploration of the experience of living with, and caring for, a partner with MND. Semi-structured interviews were conducted with eight individuals, and transcripts analysed from an interpretative phenomenological perspective. Two main themes were derived. 'Impact on life' included having concern for partner's safety, having social restrictions, being continually tired, struggling with anger and frustration, loss of intimacy and uncertainty around the future; while 'Adjusting to the situation' included trying to be strong, retaining a sense of normality, appreciation of specialist services, adopting a problem-solving approach, living day to day and ability to remain positive. In conclusion, experiences of stress and loss are illustrated in this sample of partners of those with MND, and it is suggested both these aspects should be integrated into understanding of carers' experiences. Carers appear to inhibit their grief in order to appear strong. Greater understanding of the consequences of this would help in providing appropriate emotional support.

African American women (AAW) are at a high risk for type 2 diabetes, a debilitating and potentially fatal disease for which there is no cure. The purpose of this study was to extend the research of Mosca et al. (2012) by examining the relationship between caregiver status and self-reported health status for AAW 18 years or older diagnosed with type 2 diabetes. The chronic care model (CCM) provided the theoretical framework for this study. The CCM promoted routine care for patients with chronic illnesses to migrate from acute care to proactive, planned, and risk-based protocols. A binomial logistic regression investigated the relationship between caregiver status, categorized as paid or unpaid, and self-reported health status, which was dichotomized as either good to excellent health or poor to fair health. There was a statistically significant relationship between primary caregiver status and self-reported health status among AAW diagnosed with Type 2 diabetes after controlling for age, education, and marital status (p < .004). Based on the fitted binomial logistic regression model, there were 186 cases of AAW with type 2 diabetes; having a paid caregiver was associated with a lower odds of having good to excellent health (OR = 0.294). About 12.3% of the variance in self-report health status was attributable to caregiver status. Overall, 82.6% of predictions were accurate. Nearly all participants required frequent assistance from a caregiver in the preceding 12 months. These findings suggest a critical need for healthcare service providers to educate caregivers as a means to deliver post-acute care to AAW diagnosed with type 2 diabetes, consistent with the CCM.

<p>Scaphoid fracture is most common in young individuals of working age. Without adequate diagnosis and treatment, long-term results are poor. Operative treatment is being recommended increasingly often instead of a long time in cast, although there is no evidence-based support for its superiority.</p><p>The present thesis focuses on diagnostic problems and therapeutic consequences of acute scaphoid fractures and of scaphoid reconstruction when other treatments have failed.</p><p>Simultaneous plain radiographs and computed tomography were done in 97 injured wrists. Structural assessments of plain radiography images were highly predictive with respect to the risk of having a displaced or comminute fracture as diagnosed on computed tomography. Any finding of a gap or step-off > 0.5 mm, the presence of an intermediate fragment or a dorsal lunate tilt of ≥ 15° identified 81 % of fractures that were displaced or comminuted when investigated with computed tomography.</p><p>Eighty-three patients were randomly allocated to and received either nonoperative treatment in cast or operative treatment with the aim of assessing long-term outcome of the two treatment options. Fifty-two of the patients were occupationally active. From an occupational perspective with an early return to work, surgical treatment was superior in individuals with manual employment, and from a health economic perspective conservative treatment was superior in non-manual workers.</p><p>Patients treated for scaphoid fractures generally do well up to 13 years after the injury based on limb-specific outcome scores. No benefits were identified with operative treatment compared to non-operative treatment in cast. On the contrary, there was an increased risk for osteoarthritis in the scaphotrapezial joint in those who were operated.</p><p>The patient-rated long-term results of silicone implant arthroplasty were good, with pain relief and reasonable hand function in many patients up to 20 years after surgery.</p>

PURPOSE: To evaluate whether the Amblyopia and Strabismus Questionnaire (A&SQ) is a suitable instrument for the assessment of vision-related quality-of life (VR-QoL) in individuals with strabismus and/or amblyopia. METHODS: The A&SQ was completed by 102 individuals, all of whom had amblyopia, strabismus, or both. Rasch analysis was used to evaluate the usefulness of individual questionnaire items (i.e., questions); the response-scale performance; how well the items targeted VR-QoL; whether individual items showed response bias, depending on factors such as whether strabismus was present; and dimensionality. RESULTS: Items relating to concerns about the appearance of the eyes were applicable only to those with strabismus, and many items showed large ceiling effects. The response scale showed disordered responses and underused response options, which improved after the number of response options was reduced from five to three. This change improved the discriminative ability of the questionnaire (person separation index increased from 1.98 to 2.11). Significant bias was found between strabismic and nonstrabismic respondents. Separate Rasch analyses conducted for subjects with and without strabismus indicated that all A&SQ items seemed appropriate for individuals with strabismus (Rasch infit values between 0.60 and 1.40), but several items fitted the model poorly in amblyopes without strabismus. The AS&Q was not found to be unidimensional. CONCLUSIONS: The findings highlight the limitations of the A&SQ instrument in the assessment of VR-QoL in subjects with strabismus and especially in those with amblyopia alone. The results suggest that separate instruments are needed to quantify VR-QoL in amblyopes with and without strabismus.

This study is a mixed-method study that seeks to develop a set of institutional dementia care indicators to evaluate quality of care and inform the improvement of quality of life (QOL) for Taiwanese people with dementia living in care homes. It also uses comparative analysis to compare the different features of policy and its delivery in dementia care between Scotland and Taiwan, a comparison designed to aid the development of dementia care policy, and the establishment of quality indicators for institutional dementia care, in Taiwan. This study employed the person-centred care approach at the micro perspective, and the total quality management (TQM) approach at the macro perspective, in order to inform a seamless care model for people with dementia living in care homes. Data were collected in two stages: comments from experts in dementia care were recorded in an exercise using “Delphi” methodology; subsequently the opinions of service receivers were recorded in a fieldwork exercise. The Delphi exercise (stage one) acted as the pre-test, involving 24 experts in dementia care in Scotland and Taiwan in evaluating the usefulness and applicability of proposed quality indicators for institutional dementia care. Quantitative and qualitative data from the Delphi panel were analyzed. The fieldwork (stage two) collected 237 questionnaires (from 122 residents with dementia and 115 family members) in 14 Taiwanese care homes for people with dementia (including special care units within care homes). The field test data were analyzed using reliability and item analysis, confirmatory factor analysis (CFA), and descriptive and inferential statistics. Initially, 43 proposed quality indicators for institutional dementia care were identified through literature review. However, after two Delphi rounds, only six key dimensions (41 quality indicators) were identified by consensus as the important items for use in measurement of quality of care for people with dementia living in Taiwanese care homes. Through reliability and item analysis, and CFA, this research developed a model which is a three-factor structure (social care, health and personal care, and environment) with 18 quality indicators. The 18 quality indicators have high reliability, validity, and credibility and load onto a second order factor which represents quality of care for people with dementia living in care homes. Further analysis was then conducted to explore how relative ratings on these three factors differed according to measured characteristics of the residents and their family members. In general, only a few strong patterns of difference emerged and multiple linear regression analysis suggested that differences in ratings could not be attributed to influences of socio-economic and socio-demographic differences between respondents. The study concludes that the Delphi method could be used as a methodology for health services research to integrate the opinions of multidisciplinary dementia experts and that CFA is an effective technique to study the empirical factor structure. The findings suggest that the 18 quality indicators could be suitable criteria for people with dementia and their family members to evaluate care quality and select an appropriate care home. The indicators also have important policy implications for the Taiwanese Government and regulations intended to ensure that care homes meet the requirements of service receivers.

Aims. This research investigated the health status (e. g. weight perception and BMI, mental health conditions and general health complaints), and the lifestyle behaviours (e. g. smoking, alcohol consumption, and dietary behaviour) of Libyan higher education students (HES). The objectives were to compare their health status and lifestyle behaviours in the different regions of Libya; and to compare Libyan HES with those from other countries. In addition to this, the study aimed to determine if any association existed between demographic and academic variables and health and lifestyle variables. Purpose. The purpose of the study was to provide baseline data required by university health programmes in Libya for planning related to the health needs of students. Methods. The sample consisted of 1300 higher education students from different higher education institutes and different disciplines. The self-administered health questionnaire used included questions on health and health-related behaviours and their associated social and economic factors. It was conducted during lecture time. Data were analysed with SPSS. Binary logistic regression analysis was used to identify sociodemographic variables associated with health and lifestyle variables. Results. In this sample of students, the prevalence of overweight was higher than the prevalence of underweight and obesity (14.5%, 18.2%, and 4.2% respectively), and 40% of students were trying to lose weight. High rates (45%) of depressive symptoms were found, however; overall 8.8% of respondents reported being diagnosed with anxiety, and 4.3% with depression. The findings of this study also indicated that students reported high levels of subjective health complaints. The majority of students reported that their physical activity levels were insufficient; only 5% of students met the international recommended levels of physical activity. Only one in ten students was found to be consuming an adequate amount of fruit and vegetables (at least five times a day). About 6% of the students self-identified themselves as current smokers, and the results revealed that smoking was a male phenomenon in Libya. Alcohol consumption is not very common among Libyan students, and only 3.5% reported drinking alcohol; overall, 1.6% reported using drugs, and all students who reported using drugs reported cannabis use. A gender difference was noticeable and consistent across types of complaints; depressive symptoms, dietary behaviour, physical activity, smoking and alcohol and drug consumption. Females reported significantly worse health status than males in terms of health complaints, and depressive symptoms. Males reported higher levels of physical activity and higher levels of smoking and alcohol and drug consumption than females. Students in North Libya showed the highest levels of physical activity, and also the highest levels of smoking, alcohol and drug consumption, whereas students in East Libya had the highest levels of fruit and vegetable consumption. Logistic regression analysis revealed substantial associations between females and depressive symptoms, dietary behaviour and higher levels of complaints, and also between social support and anxiety and depression. The comparisons with other survey data showed that the Libyan rates of overweight and obesity were similar to rates reported amongst students at Alexandria University in Egypt, and much higher than those reported in other countries such as Poland, Japan and Korea. Depressive symptom rates were similar to the rates reported among university students in Bulgaria and higher than those reported in Germany, Denmark and Poland with respect to male students, and Libyan HES reported lower rates of health complaints than students in certain other European countries. In addition, the levels of fruit and vegetable consumption amongst Libyan HES were lower than those reported amongst Australian students. The prevalence of physical activity levels was lower than that reported amongst university students in the United Arab Emirates. The results of this study clearly indicate that the prevalence of smoking and alcohol and drug consumption among students in Libya was " lower than among those from other Arabic countries such as the United Arab Emirates and Saudi Arabia. Conclusion. Efforts to promote a healthy lifestyle among students are needed and should place greater emphasis on physical activity and increased fruit and vegetable consumption, and on discouraging smoking and body dissatisfaction. There is a need for future research on student health, which should be carried out with a larger sample group to develop a national standardized instrument. Future research will be helpful for accurately identifying perceived barriers to, and recommending changes to enhance, physical activity among HES.

This study gives a platform to three old retired people who are constructed to be enjoying well-being and life satisfaction or going through life dissatisfaction after retirement. The epistemological framework was social constructionism. In-depth interviews with these three individuals were carried out. The premises of qualitative research were followed. The ‘case study approach’ was chosen as the most suitable method to gather information. Thematic content analysis was employed as a method of analysis of life stories of old retired people, which were reconstructed in terms of themes. Recurring themes in the life stories were then discussed and linked with the broader literature. The research allowed rich and informative information about life stories of three old retired people to emerge. Among the identified themes were financial status relating to adequate and appropriate sustenance after retirement; social networks and their effects on life satisfaction and dissatisfaction after retirement; health status; and cognitive functions in late adulthood. Everyone wishing to understand life in old age after retirement is encouraged to read this story. It is necessary to be sufficiently equipped in the event of an extended lifespan. / Psychology / M.A.(Psychology)

Health disparities among rural African Americans include disproportionately higher morbidity and mortality rates associated with cardiovascular disease. Interventions designed to decrease cardiovascular risk can potentially improve health outcomes among rural, underserved communities. The purpose of this study was to test the effect of a cardiovascular health promotion intervention among rural African Americans. An experimental study randomized by church clusters was done in two rural counties in northern Florida. A total of 229 participants, 114 in the intervention group and 115 in the control group, were recruited from twelve rural African American churches. The pretest-posttest design included instruments chosen to measure cardiovascular health habits and knowledge as well as changes in produce consumption, dietary fat intake, and exercise using the major components of the Integrated Model of Behavioral Prediction: intentions, norms, attitudes, and self-efficacy. Linear mixed model was the statistical test used to detect the program effects. Participants who received the intervention had significant increases in scores for the cardiovascular health habits (p < .01) and health knowledge (p < .01) variables compared with the control group. There were also significant group differences regarding intentions to increase produce consumption (p < .01) and reduce dietary fat intake (p < .01). The cardiovascular health program was associated with other statistically significant results including produce consumption attitudes (p = .01) and norms (p < .01), dietary fat attitudes (p = .04) and norms (p < .01), and exercise attitudes (p < .01). There were also significant results found for perceived behavioral control/self-efficacy regarding increasing produce consumption (p < .01), reducing dietary fat intake (p = .03), and increasing exercise (p = .01). Compared to the control group, the cardiovascular health promotion intervention was effective in fostering positive health effects for most of the variables measured. The findings supported the theoretical framework used for guiding the study, the Integrative Model of Behavioral Prediction Nurse-led health promotion interventions within church settings can be effective means for reducing overall cardiovascular risk and health disparities among rural African American populations. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2015. / FAU Electronic Theses and Dissertations Collection

O tratamento cirúrgico das neoplasias espinais intradurais primárias está indicado para conseguir ressecação completa, diminuir morbidade e aumentar a sobrevida livre de doença, em busca da cura. Há dúvidas sobre as consequências do tratamento cirúrgico influenciando a qualidade de vida. Entretanto, até o momento, não foram encontrados dados disponíveis na literatura especializada sobre a qualidade de vida dos pacientes que foram submetidos à cirurgia. Os objetivos foram avaliar a qualidade de vida e testar as propriedades psicométricas dos instrumentos utilizados, verificando a consistência interna e a confiabilidade. O estudo foi realizado no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, no período de 2009 a 2011, com aplicação do questionário genérico The Medical Outcomes Study 36-item Short-Form Health Survey (SF-36), e das escalas específicas de McCormick e de Aminoff-Logue para a avaliação da qualidade de vida sob o ponto de vista funcional. Todos os pacientes incluídos foram avaliados uma única vez e encontravam-se no período de, no mínimo, seis meses após a data da cirurgia. O banco de dados resultante foi analisado no Departamento de Medicina Preventiva da Faculdade de Medicina da Universidade de São Paulo. A série de casos constou de 148 pacientes, dos quais 48 foram excluídos por não completarem o protocolo. Dentre os 100 casos estudados, 55 eram do sexo feminino, com média de idade de 42,3 anos e tempo de acompanhamento pós-operatório de 20 meses. A pontuação global da qualidade de vida pelo SF-36 foi de 50,5, com resultado geral do componente físico de 46,8. A consistência interna foi demonstrada segundo a validade de construto e de critério, confirmando a hipótese da relação existente entre as pontuações do SF-36 e a escala de McCormick (p = 0,003), as escalas de Aminoff-Logue componente de marcha (p = 0,025), vesical (p = 0,013) e intestinal (p = 0,004). A confiabilidade foi demonstrada em todos os oito domínios do SF-36, alcançando em cada um o alpha Cronbach, satisfazendo o critério de Nunnally > 0,85. Estes resultados sugerem associação consistente entre a qualidade de vida e as funções medulares nesta série de casos, caracterizando melhor a percepção de saúde dos pacientes submetidos ao tratamento cirúrgico. O avanço do conhecimento aplicado à prática neurocirúrgica focada no paciente aponta para a necessidade de avaliação longitudinal da qualidade de vida para auxílio no planejamento terapêutico destas doenças. A qualidade de vida pode ser avaliada pelo questionário SF36, que se correlaciona bem com as escalas específicas de McCormick e Aminoff-Logue / The surgical treatment of intradural primary spinal tumors is indicated to obtain total ressection, decrease morbidity rate and increase survival rate, aiming at the cure. There are doubts about the consequences of surgical treatment influencing the quality of life. However, until now there have been no available data in specialized literature on the quality of life of patients who have undergone this surgery. The objectives of this study were to evaluate the patient´s quality of life and to test the psychometric properties of the instruments used, verifying consistency and reliability. The study was carried out at the Clinics Hospital of the University of São Paulo Medical School, between 2009 and 2011, by means of The Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) generic questionnaire and the McCormick and the Aminoff-Logue specific scales to assess the patient´s quality of life from the functional perspective. All patients included in the study were assessed only once, at least six months postoperatively. The resulting data were analyzed at the Department of Preventive Medicine of the University of São Paulo Medical School. The series of cases comprised 148 patients; 48 patients were excluded because they did not complete the protocol. The study was finally conducted with 100 patients. Fifty-five patients were women, the mean age was 42,3 years and the mean postoperative follow-up period was 20 months. The quality of life total score on the SF-36 was 50,5, and the Physical Component Summary (PCS) score was 46,8. Based upon construct validity and criterion, the internal consistency was demonstrated, confirming the hypothesized relationship between the scores of the SF-36 and the McCormick scale (p = 0.003), the Aminoff-Logue gait subscale (p = 0.025), the Aminoff-Logue micturition subscale (p = 0.013), and the AminoffLogue defecation subscale (p = 0.004). Reliability was demonstrated for all eight SF-36 domain scales and the Physical Component Summary and the Mental Component Summary of the SF-36, where in each the Cronbach alpha satisfied the Nunnally criterion of > 0,85. These results suggest a consistent relationship between the quality of life and the spinal cord functions in this series of cases, better characterizing the evaluation of the health of the patients who underwent surgical treatment. The advancement of knowledge applied to neurosurgery practice with a patient-focused approach shows the necessity of a longitudinal evaluation of the quality of life to help tailor a treatment plan for these diseases. The quality of life can be analyzed by the SF-36 questionnaire, which is well correlated with the McCormick and the Aminoff-Logue specific scales

Introdução - A partir dos estudos de Barker observou-se que o baixo peso ao nascer está associado ao desenvolvimento de doenças crônicas no adulto. Estudos sobre a composição corporal na infância também podem contribuir para a compreensão de seu papel no risco de desenvolvimento de doenças crônicas em etapas posteriores da vida. Objetivo - Analisar as relações entre o peso ao nascer, a composição corporal e o estado nutricional em crianças de 2 a 6 anos de idade. Métodos - Estudo de coorte histórica a partir de uma amostra aleatória probabilística, por conglomerados, das creches públicas de Taubaté - SP (2008 e 2009) compondo uma amostra de 950 crianças. As medidas antropométricas das crianças utilizadas ao nascimento foram peso e comprimento e as na idade pré-escolar foram peso, estatura, circunferência do braço (CB), circunferência da cintura (CC), dobra cutânea tricipital (DCT) e dobra cutânea subescapular (DCSE). Para avaliação do estado nutricional, utilizou-se o Índice de Massa Corpórea (IMC) em escore z e pontos de corte internacionalmente aceitos. Para a avaliação da composição corporal utilizouse a área muscular do braço (AMB) e a área gorda do braço (AGB) em escores z e a razão CC para estatura (CC/E). As análises foram realizadas a partir dos parâmetros de tendência central, dispersão e proporções, adotando-se um nível de significância de 5 por cento . Resultados - A média de peso ao nascer (PN) dos pré-escolares foi de 3150,1g com um desvio padrão (dp) de 487,7g e uma mediana de 3142,5g. As médias e os dp do escore z de estatura, peso e IMC foram: -0,05 (1,06), 0,27 (1,21), 0,43 (1,22), respectivamente. Nos préescolares nascidos com 3000g ou mais, a estatura atual correlacionou-se positivamente com o PN (r =0,16 e p<0,0001). Nos pré-escolares como um todo, quanto maior o PN, maior o IMC (r P =0,19 e p<0,0001). A mediana do escore z de IMC nos pré-escolares nascidos com mais de 3500g foi superior à observada nas demais faixas de PN. Pela regressão linear múltipla, cada aumento de 1kg no peso ao nascer corresponde um aumento de 0,45 escores z no IMC na idade pré-escolar. Observou-se uma correlação direta entre o PN e a AMB (r P =0,13 e p<0,0001) e a AGB (r =0,10 e p=0,003). Os pré-escolares com excesso de peso e que nasceram abaixo da mediana de PN apresentaram uma menor AMB em comparação com os nascidos acima da mediana. Não houve diferença para as medianas de AGB ou de CC entre esses grupos de peso ao nascer. A razão CC/E mostrou correlação direta com o IMC (r P =0,78), a AMB (r P =0,52), a AGB (r P =0,66) e com a proporção da AGB (r =0,54), p<0,0001. Já entre a razão CC/E e a proporção de AMB corrigida observou-se uma correlação inversa (r = -0,38), p<0,0001. Conclusões - Quanto maior o peso ao nascer das crianças, maior o seu IMC na idade pré-escolar. A massa magra e a massa gorda corporal também são maiores na idade pré-escolar nas crianças com maior peso de nascimento. O importante é que nos pré-escolares com excesso de peso a massa magra é menor nos que nasceram com menor peso, sem que se observe diferença para a massa gorda corporal em função do peso ao nascer. Quanto maior a razão CC/E também será maior a quantidade de massa magra e de massa gorda corporal, contudo o aumento da razão CC/E é acompanhado por um aumento desproporcionalmente maior da massa gorda em comparação com o da magra / Introduction - Barker studies evinced that low birth weight is a risk factor to develop chronic diseases in adults. Research about children body composition can also contribute to understand its role in the development of chronic diseases in later stages in life. Objective - To analyze the relationship among birth weight, body composition and nutritional status of 2 to 6 years old children. Methods - Historical cohort study of a probabilistic randomized sample by conglomerates, of public day care centers in Taubaté, SP (2008-2009) that resulted in a final sample of 950 children. The childrens anthropometric measures collected at preschool age were weight, height, upper arm circumference (AC), waist circumference (WC), triceps skinfold (TS), and subscapular skinfold (SS). Birth weight and length were retrospectively corrected. Body Mass Index (BMI) Z score was used to evaluate the children nutritional status based on cut-off points internationally accepted. Upper arm muscle area (UMA) and upper arm fat area (UFA) in Z-scores, and the waist-toheight ratio (WHtR) were used to evaluate the body composition. The analysis was carried out from measures of central tendency, dispersion and proportions, adopting a level of significance of 5%. Results - The mean birth weight (BW) of the preschool children was 3150.5g with a standard deviation (SD) of 487.7g and the median of BW was 3142.5g. The means and the SD of the Z-score of height, weight and BMI at pre-school age were respectively: -0.05(1.06), 0.27(1.21), 0.43(1.22). Height of preschool children born with 3000g or more showed a direct correlation with BW (r =0.16; p<0.0001). In the preschool sample as a whole, the higher the BW the higher the BMI (r P =0.19; p<0.0001). The median preschool children Z-score of BMI of the group born with more than 3500g was superior to the one observed in the group born with lower weight. By a multiple linear regression each increase of 1kg in the birth weight corresponds to an increase of 0,45 z scores in the BMI at preschool age. It was also observed a direct correlation between BW and the UMA (r P P =0.13; p<0.0001) and the UFA (r =0.10; p=0.003). The preschool children with excess of weight and that were born below the median of BW showed a lower UMA in comparison to those born with a weight above the median. There was no difference to the medians of UFA or WC according to birth weight. The WHtR showed a direct correlation with the BMI (r P P =0.78), the UMA (r =0.52), the UFA (r P =0.66) and the arm fat index (% fat area), r P P =0.54, p<0.0001. On the other hand it was observed an inverse correlation between the WHtR and the proportion of the UMA corrected (% muscle area), r = -0.38 and p<0.0001. Conclusions - The higher the childrens birth weight, the higher their BMI in preschool age. The lean and the fat body masses are also higher in the preschool age in children with a higher birth weight. The most relevant things observed is that in preschool children with excess of weight the lean mass is lower in the ones who were born with a lower weight, and that there were no correlation between UFA and birth weight. The higher the WHtR it will also be higher the amount of lean and fat mass; however the increase of the WHtR is followed by a disproportionately higher increase of the fat body mass when compared to that of the lean body mass.