A dor e o linfedema são as principais sequelas que acometem as pacientes com câncer de mama após o tratamento dessa doença, e essas sequelas acarretam alterações físicas e psicológicas que podem modificar a qualidade de vida relacionada à saúde (QVRS) dessas pacientes. Este estudo teve como objetivo verificar a presença da dor, do linfedema e da QVRS nas pacientes com câncer de mama. Foram realizadas avaliações da presença da dor com a EVA, da presença do linfedema com a perimetria e da QVRS com o EORTC QLQ C30. A amostra constituiu-se de 181 pacientes com câncer de mama que faziam acompanhamento médico da doença no Ambulatório de Mastologia do HCFMRP-USP e no Ambulatório de Fisioterapia da Fundação Pio XII - Hospital do Câncer de Barretos. A média da idade das pacientes variou de 52,81 (±11,68) a 54,09 (±11,39); a maioria das pacientes era casada, com baixo nível de escolaridade e desempenhavam atividade doméstica. A mama esquerda foi a mais acometida, o carcinoma ductal infiltrante foi o predominante e a mastectomia foi a técnica cirúrgica mais utilizada nas pacientes deste estudo. Constatou-se que 78 pacientes referiram sentir dor no membro superior homolateral à intervenção cirúrgica, em 52 pacientes constatou a presença do linfedema. A QVRS foi considerada como boa pelas pacientes. / The pain and lymphedema are the major consequences that affect patients with breast cancer after treatment of this disease, and these consequences cause physical and psychological changes that may alter the quality of life related to health of these patients (HRQOL). This study aimed to verify the presence of pain, lymphedema and HRQOL in patients with breast cancer. The presence of pain evaluated using visual anologue scale (VAS), perimetry was used to evaluate presence of lymphedema and HRQOL was measure with EORTC QLQ C30. The sample consisted of 181 patients with breast cancer who were monitoring the disease at the Mastology Outpatient of the Hospital das Clínicas of the University of São Paulo at Ribeirão Preto Medical School (HCRPFMRP/USP) and the Physiotherapy Outpatient of the Pius XII Foundation - Cancer Hospital of Barretos. The mean age of the patients ranged from 52,81 (±11,68) to 54,09 (±11,39). Most patients were married, with a low educational level and housewifes. The left breast was the most affected, the infiltrating ductal carcinoma was the most prevalent and mastectomy surgical technique was used in most patients in this study. 78 patients reported pain in the homolateral upper limb subsequent to surgery, in 52 patients had lymphedema. HRQOL was considered good for patients.

Objetivos: a) Investigar os efeitos de um programa de reabilitação pulmonar (RP) sobre os sintomas, a qualidade de vida relacionada à saúde (QV) e a capacidade de exercício medida pelo teste de caminhada de seis minutos (TC6m) e pelo teste de esforço cardiopulmonar (TECP) e b) estudar a associação entre estes efeitos em pacientes com doença pulmonar obstrutiva crônica (DPOC). Pacientes e Métodos: Estudamos 28 pacientes com DPOC moderada a grave, estáveis (idade 63,9±6,8 anos; volume expiratório forçado no primeiro segundo (VEF1) 0,97±0,28L) antes e depois da RP. As alterações nos desfechos clínicos como o questionário Saint George (Saint George’s Respiratory Questionnaire, SGRQ), a dispneia, o desconforto de membros inferiores (escala de BORG) e a capacidade de exercício com a RP foram examinados. A associação entre as mudanças nos parâmetros fisiológicos do TC6m e do TECP e as demais variáveis foram investigadas. Resultados: Observamos uma melhora significativa em parâmetros fisiológicos após a RP. Houve aumento da distância caminhada no TC6m (366±104 vs 442±78 m, p<0,0001), do consumo de oxigênio (VO2) de pico no TECP (857± 366 vs 1001±360 ml/min, p=0,02) e da carga máxima de trabalho (51±27 vs 79±38 Watts, p<0,0001) com a RP. Também foi observada melhora do desconforto em membros inferiores, da dispneia no final do TC6m (4 – 1,5 Borg, p<0,001) e durante o TECP (5 – 4 Borg, p<0,001), do escore total (56±20 vs 45±18, p<0,001) e dos domínios do SGRQ após a RP. A melhora nos escores de QV com a RP esteve associada com a variação da intensidade da dispneia no exercício durante a caminhada (r=0,43, p=0,025) e não se associou com a variação na capacidade de exercício. Não houve relação entre o incremento da distância percorrida e o aumento do VO2 com a RP. Conclusões: Houve melhora de todos os desfechos estudados com a RP. Apenas a variação da dispneia durante o TC6m se relacionou com as mudança da QV após a reabilitação em pacientes com DPOC. Não houve relação entre a variação da distância caminhada e do VO2 com a RP. Estes resultados sugerem que o TC6m e o TECP podem ter funções complementares na avaliação dos efeitos da RP. / Aims: a) To investigate the effects of a pulmonary rehabilitation (PR) program on the symptoms, health related quality of life (HRQL) and exercise capacity as measured by a six-minute walk test (6MWT) and a cardiopulmonary exercise test (CPET) and b) to study the association between these effects in patients with chronic obstructive pulmonary disease (COPD). Patients and Methods: We studied 28 patients with stable moderate to severe COPD (mean age, 63.9±6.8 years; forced expiratory volume in the first second (FEV1; 0.97±0.28 L) before and after PR. The changes in HRQL (Saint George's Respiratory Questionnaire scores, SGRQ), dyspnea, lower limb discomfort (Borg scale) and exercise capacity induced by PR were examined. The association between changes in physiological parameters of 6MWT and CPET and the other variables was also investigated. Results: We found an improvement in physiological variables after PR. There was an increase in 6MWT distance (366±104 vs 442±78 m, p<0.0001), peak oxygen uptake (VO2) measured by CPET (857±366 vs 1001±360 ml/min, p=0.02) and maximal work load (51±27 vs 79±38 Watts, p<0.0001). Improvement in leg fatigue and dyspnea at the end of the 6MWT (4 vs 1.5, p<0.001) and CPET (5 vs 4, p<0.001), in SGRQ total score (56±20 vs 45±18, p<0.001) and domains were also observed after PR. The improvement in HRQL scores after PR was related to the variation in the intensity of dyspnea at the end of the 6MWT (r=0.43, p=0.025) and was not associated with changes in exercise capacity. There was no relationship between the increase in walked distance and in VO2 after PR. Conclusions: PR induced an improvement in all outcomes studied. Only the change in dyspnea at the end of the 6MWT was associated with the change in HRQL induced by PR in COPD patients. There was no relationship between walked distance and peak VO2 changes. The results suggest that 6MWT and CPET can have complementary functions in the evaluation of PR outcomes.

Objetivos: Avaliar o desempenho no teste de caminhada de seis minutos (TC6M) em pacientes adultos com bronquiectasias não fibrocísticas, estabelecendo associações entre TC6M e qualidade de vida relacionada à saúde (QVRS). Secundariamente, determinar relações entre TC6M, achados clínicos e função pulmonar a fim de identificar preditores de tolerância ao exercíco. Métodos: Estudo transversal envolvendo pacientes com bronquiectasias não fibrocística, idade ≥ 18 anos, com pelo menos um sintoma respiratório por 2 ou mais anos e volume expiratório forçado no primeiro segundo (VEF1) ≤ 70% do previsto. Realizou-se avaliação clínica, função pulmonar, TC6M e QVRS pelo questionário Short-Form 36. Resultados: Foram incluídos 70 pacientes (48 mulheres; idade média 54,5±17,7 anos; VEF1 médio 44,9±14,5%). Desempenho alterado no TC6M foi observado em 23 pacientes (Grupo 1) e desempenho normal em 47 pacientes (Grupo 2). Em comparação aos pacientes do Grupo 2, os pacientes do Grupo 1 apresentaram menor idade (p<0,001), menor idade de diagnóstico das bronquiectasias (p=0,006), menor proporção de ex fumantes (p=0,048), menor índice de massa corporal (IMC) (p=0,003), pior VEF1 % previsto (p=0,041) e pior pressão expiratória máxima % previsto (p=0,021). Não houve diferença significante entre grupos nos escores de QVRS (p>0,05). No modelo de regressão logística, idade menor (p=0,002) e IMC menor (p=0,034) se associaram significantemente com desempenho precário no TC6M. Conclusão: Elevada proporção de pacientes com bronquiectasias não fibrocísticas apresenta desempenho precário no TC6M. O desempenho ao exercício não se relacionou com a QVRS. Idade e IMC se associaram com performance ao exercício. / Objective: To determine the performance in 6-minute walk test (6MWT) in adult patients with non-cystic fibrosis bronchiectasis, establishing the relationship between 6-MWT and health-related quality of life (HRQL). Secondarily, to determine the relationship between 6MWT, clinical findings and lung function in order to identify predictors for exercise tolerance. Methods: Cross-sectional study involving patients with non-cystic fibrosis bronchiectasis aged ≥ 18 years, with at least one respiratory symptom for 2 years or more, and with predicted forced expiratory volume in first second (FEV1) ≤ 70%. Patients were submitted to clinical evaluation, pulmonary function tests, 6MWT and HRQL using the Short-Form 36 Questionnaire. Results: Seventy patients were included (48 females; mean age, 54.5±17.7 years; mean FEV1, 44.9 ±14.5%). We observed poor performance in 6MWT in 23 patients (Group 1) and normal performance in 47 patients (Group 2). In comparison with Group 2 patients, Group 1 patients presented lower age (p<0.001), lower age at diagnosis of bronchiectasis (p=0.006), lower proportion of ex-smokers (p=0.048), lower body mass index (BMI) (p=0.003), worse FEV1 % predicted (p=0.041), and worse maximum expiratory pressure % predicted (p=0.021). There was no significant difference between groups on scores for HRQL (p>0.05). In a logistic regression model, lower age (p=0.002) and lower BMI (p=0.034) were significantly associated with poor performance in 6MWT. Conclusion: There is a high rate of poor performance in 6MWT in patients with non-cystic fibrosis bronchiectasis. The exercise performance was not related to HRQL. Age and BMI were associated with the exercise performance.

A sepse é uma condição importante dentre as complicações infecciosas da contemporaneidade, do ponto de vista clínico e da saúde pública, tanto pelo número de casos, quanto pela gravidade e potencial de evolução para óbito. Trabalhos mostraram que a taxa de mortalidade durante a internação é elevada e que permanece alta até cinco anos após a hospitalização. Além disso, estudos apontaram perdas nos aspectos físicos e cognitivos, o que resulta em prejuízos sociais e emocionais que afetam a Qualidade de Vida Relacionada à Saúde (QVRS) desses indivíduos. A partir da abordagem de pesquisa de desenho misto com estratégia de triangulação concomitante, utilizando-se do instrumento genérico para avaliação da QVRS Medical Outcomes Study 36 - Item Short-Form Health Survey (SF-36) (Versão dois) e de entrevista semiestruturada analisada sob o marco teórico da psicanálise de orientação lacaniana, à luz da técnica de análise de conteúdo indutivo, objetivou-se analisar as interpretações que cada participante faz sobre a experiência da sepse e relacioná-la com a QVRS dessas pessoas. A população estudada foi constituída por quatro indivíduos que passaram pelo evento da sepse no período de junho de 2013 a junho de 2015. Este estudo foi elaborado de acordo com as diretrizes contidas na Resolução CNS 466/2012 para o desenvolvimento de pesquisa com seres humanos e foi aprovado pelo Comitê de Ética em Pesquisa com Seres Humanos da Escola de Enfermagem de Ribeirão Preto-USP. Foi observado, a partir da análise dos resultados do SF-36 (Versão dois), mediana e baixa QVRS dos participantes deste estudo e, a partir da análise das entrevistas, pôde-se observar como cada um, a partir da sua subjetividade, pôde experienciar o evento da sepse, notadamente em aspectos que apontavam para o corpo e o adoecimento. Esses achados possibilitam uma compreensão ampliada que pode contribuir com a prática clínica da equipe de saúde multidisciplinar / The sepsis is an important condition between the infectious complication of contemporaneity, from a clinical point of view and public health, because of the number of cases, the severity and the potential progression to death. Studies showed that the mortality rate during hospitalization is high and remains high until five years after hospitalization. Authors showed losses in physical and cognitive aspects, resulting in social and emotional losses that affect the health-related quality of life (HRQOL) of these individuals. From the mixed research design approach with concurrent triangulation strategy, using the generic instrument to assess HRQOL Medical Outcomes Study 36 - Item Short-Form Health Survey (SF-36) (Version two) and the semi-structured interviews analyzed under the theoretical framework of Lacanian psychoanalysis in the light of inductive content analysis technique, this study aimed to analyze the interpretations that each participant makes about the experience of sepsis and relate it to the HRQOL of these people. The study population consisted of four individuals who have gone through sepsis event from June 2013 to June 2015. The study was prepared in accordance with the guidelines contained in Resolution CNS 466/2012 for the development of research with human beings it was approved by the Ethics Committee on Human Research of the Ribeirão Preto College of Nursing-USP. It was observed from the analysis of the results of the SF-36 (Version two), median and low HRQOL of the study participants and from the analysis of the interviews, it was observed how each one, from their subjectivity, could experience the event of sepsis, especially in ways that pointed to the body and illness. These findings allow a broader understanding that way contribute to the clinical practice of multidisciplinary health team

Objetivo. Este estudo diz respeito à mensuração da incapacitação funcional, e seu uso no cálculo de indicadores de saúde e qualidade de vida. O seu objetivo foi estimar o grau de incapacitação associado a diferentes níveis funcionais, através de um modelo baseado na lógica fuzzy. Métodos. Desenvolveu-se um modelo lingüístico fuzzy, baseado na opinião de especialistas. As variáveis de entrada do modelo foram, respectivamente, a mobilidade, a atividade física e a atividade social. Ao todo, foram definidas 100 regras fuzzy relacionando as variáveis de entrada, a partir das quais determinou-se o grau de incapacidade funcional. As avaliações dos diferentes funcionais foram feitas sobre uma escala de avaliação fuzzy. Para cada nível funcional, o modelo gera uma estimativa do grau de incapacitação, d, no intervalo entre 0 e 10, valores estes representantes da morte e do melhor estado de saúde imaginável, respectivamente. Resultados. Ao todo, foram avaliados 100 diferentes níveis funcionais. A título de exemplificação, para o nível funcional caracterizado por um adulto que trabalha, mas apresenta restrições para desenvolver outras atividades sociais, necessita auxílio para usar transporte público ou dirigir, e anda com limitações, a estimativa de d foi igual a 5,8, segundo um dos especialistas. Isto significa que um ano nesta condição equivale a 0,58 anos de vida com saúde, sem qualquer tipo de limitação funcional. Conclusões. O modelo fuzzy foi considerado uma alternativa consistente para a mensuração do grau de incapacitação. Ele emula o raciocínio humano, e provê uma estrutura adequada para lidar com incertezas e imprecisões, características inerentes ao processo de mensuração da incapacitação funcional. / Objective. This study is concerned with the measurement of disability, and its use in health and quality of life indicators. The aim was to estimate the degree of disability associated with varying functional levels, through a model based on fuzzy logic. Methods. A fuzzy linguistic model was developed, based on experts opinion. Three fuzzy input variables were considered according to: social activity, mobility and physical activity. A set with 100 fuzzy rules was derived and considered as consequent for each rule the functional disability. Functional levels were evaluated separately for each input variables on a fuzzy rating scale. The model provides a numerical estimate, d, of an individual\'s functional disability state, ranging from 0 to 10, which represent death and optimal function, respectively, obtained through defuzzification. Results. A total of 100 multidimensional functional levels were evaluated. As an example, for a functional level characterised by an individual who works but performs restrictively other social activities, needs help to use public transport and walks with physical limitations, d was estimated as 5,8, according to one of the experts. This means that one year in such a state is equivalent to 0.58 years of well life, in the absence of any kind of functional disability. Conclusions. The fuzzy model was considered a consistent alternative for the estimation of the degree of disability. It emulates human thinking, and provides an adequate framework to deal with uncertainty and imprecision, which are inherent in the measurement of functional disability.

O objetivo principal deste estudo foi avaliar a associação do enfrentamento religioso-espiritual na qualidade de vida relacionada à saúde (QVRS) dos pacientes em pré-operatório de cirurgia de câncer de cabeça e pescoço. Estudo descritivo, correlacional, transversal, desenvolvido em enfermaria de cabeça e pescoço de um hospital público do interior do estado de São Paulo. As entrevistas individuais foram realizadas pela pesquisadora após a internação do paciente em seu período pré-operatório. Foram utilizados os seguintes instrumentos para a coleta de dados: roteiro estruturado para caracterização da amostra; o Functional Assessment Câncer Therapy-Head and Neck (FACT-H&N), para avaliar a QVRS em pacientes com câncer de cabeça e pescoço; a Escala de Coping Religioso-Espiritual (CRE), para avaliação do enfrentamento e da espiritualidade. Os dados foram analisados de forma quantitativa, utilizando-se dos princípios da estatística descritiva e inferencial. Participaram da investigação 55 pacientes, predominantemente do sexo masculino, com idade média de 57,1 anos. Todos participantes acreditavam em Deus e, em sua maioria, consideravam-se católicos (87,3%). Com relação ao enfrentamento religioso-espiritual, as médias das variáveis da Escala CRE foram satisfatórias, assim como as variáveis do instrumento FACT H&N. No entanto, não foram encontradas diferenças estatisticamente significantes entre as médias de CRE Total comparadas com grupos etários, sexo e com as medianas dos domínios do FACT-H&N. Embora seja possível deduzir uma correlação entre os constructos CRE e QVRS, não detectamos associação entre a Escala CRE e FACT H&N. Não obstante, encontrou-se diferença estatisticamente significante entre as correlações nos grupos que apresentaram CRE Total Alto e Médio da Escala CRE e os altos e baixos escores nos domínios do instrumento FACT H&N, indicando que aquele que apresenta alta utilização do enfrentamento religioso-espiritual apresenta melhores índices nos domínios da qualidade de vida relacionada à saúde. Ressalta-se que tal correlação não implica em causa e efeito, ainda são complexas as relações entre a espiritualidade, religiosidade e seus benefícios para a saúde, mas este assunto tem merecido grande destaque em meios científicos. / The main goal of this study was to assess the association between religious-spiritual coping and the health-related quality of life (HRQoL) of patients in the preoperative phase of head and neck cancer surgery. A descriptive correlational and cross-sectional study was developed at a head and neck ward of a public hospital in the interior of São Paulo State, Brazil. The researcher held individual interviews after the patient\'s hospitalization in the preoperative phase. The following data collection instruments were used: structured script for sample characteristics; the Functional Assessment Cancer Therapy-Head and Neck (FACT-H&N), to assess the HRQoL in head and neck cancer patients; the Religious Spiritual Coping Scale (CRE), to assess coping and spirituality. The data were subject to quantitative analysis, using the principles of descriptive and inferential statistics. Research participants were 55 patients, predominantly male, with a mean age of 57.1 years. All participants believed in God and the majority considered they were Catholic (87.3%). Concerning religious-spiritual coping, the mean scores for the CRE Scale variables were satisfactory, as well as the FACT H&N variables. No statistically significant differences were found, though, between the mean scores of the Total CRE compared with age groups, gender and median scores for the FACT-H&N domains. Although a correlation can be deduced between the CRE and HRQoL constructs, we did not detect and association between the CRE and FACT H&N Scales. Nevertheless, a statistically significant difference was found between the groups with High and Medium total CRE on the CRE Scale and high and low scores in the FACT H&N domains, indicating that patients with high usage rates of religious-spiritual coping present better scores in the health-related quality of life domains. It is highlighted that this correlation does not imply cause and effect. Relations among spirituality, religiosity and their benefits for health remain complex, but this topic has received great attention in the scientific context.

Background: Little is known regarding the health-related quality of life among myocardial infarction (MI) survivors in the United States. The purpose of this population-based study was to identify differences in health-related quality of life domains between MI survivors and propensity score matched controls. Methods: This retrospective, cross-sectional matched case-control study examined differences in health-related quality of life (HRQoL) among MI survivors of myocardial infarction compared to propensity score matched controls using data from the 2015 Behavioral Risk Factor Surveillance System (BRFSS) survey. Propensity scores were generated via logistic regression for MI survivors and controls based on gender, race/ethnicity, age, body mass index (BMI), smoking status, and comorbidities. Chi-square tests were used to compare differences between MI survivors to controls for demographic variables. A multivariate analysis of HRQoL domains estimated odds ratios. Life satisfaction, sleep quality, and activity limitations were estimated using binary logistic regression. Social support, perceived general health, perceived physical health, and perceived mental health were estimated using multinomial logistic regression. Significance was set at p < 0.05. Results: The final sample consisted of 16,729 MI survivors matched to 50,187 controls (n = 66,916). Survivors were approximately 2.7 times more likely to report fair/poor general health compared to control (AOR = 2.72, 95% CI: 2. 43-3.05) and 1.5 times more likely to report limitations to daily activities (AOR = 1.46, 95% CI: 1.34-1.59). Survivors were more likely to report poor physical health > 15 days in the month (AOR = 1.63, 95% CI: 1.46-1.83) and poor mental health > 15 days in the month (AOR = 1.25, 95% CI: 1.07-1.46) compared to matched controls. There was no difference in survivors compared to controls in level of emotional support (rarely/never: AOR = 0.75, 95% CI: 0.48-1. 18; sometimes: AOR = 0.73, 95% CI: 0.41-1.28), hours of recommended sleep (AOR = 1.14, 95% CI: 0.94-1.38), or life satisfaction (AOR = 1.62, 95% CI: 0.99-2.63). Conclusion: MI survivors experienced lower HRQoL on domains of general health, physical health, daily activity, and mental health compared to the general population.

Epileptic seizures are usually stressful episodes for individuals, not least as they are often experienced in public. Most research into epilepsy has been conducted in Western cultures, and we know little about the experiences of people with epilepsy and living in Middle Eastern countries. This study aims to examine the influence of social comparison on the perception of quality of life for people with epilepsy in Iran and in the United Kingdom. Three studies were completed. Two studies were qualitative; exploring individuals’ experiences of living with epilepsy and investigating coping strategies, respectively, (UK = 10, Iran = 10), for each study. Thematic analysis was used for data analysis. The third quantitative study was examined to determine whether social comparison dimensions, (upward negative, upward positive, downward negative, downward positive), predict quality of life in both countries, (N = 100 for each country), and a hierarchical multiple regression was used to analyse data. The first study indicated people compare themselves to others and the unpredictable nature of a seizure causes individuals to perceive negative feelings and experience anxiety, furthermore urinary incontinence attached to seizures appeared to leave people feeling ashamed and anxious. Study two revealed that whilst Iranian people used emotion-focused coping strategies, individuals from the United Kingdom applied problem-focused coping strategies. In Iran religious coping strategies were used to cope with incontinency; however positive social comparison (downward) was used as a coping strategy for incontinency in the United Kingdom. Study three found that self-esteem was the main predictor for quality of life in Iran and the United Kingdom. Whilst a seizure’s severity negatively predicts quality of life in the United Kingdom, positive social comparison (upward) accounted for quality of life in Iran. This study suggests that providing positive role models can help Iranians have a better perception for their quality of life, whereas British people potentially maximise their quality of life through seizure management.

La maladie d’Alzheimer (MA) se caractérise par une détérioration progressive et continue des fonctions cognitives. Un des objectifs de la prise en charge d’un patient atteint de MA est le maintien d’une bonne qualité de vie liée à la santé (QDVLS) pour lui et son entourage. Les objectifs de l’étude étaient de rechercher les facteurs associés à la QDVLS des patients atteints de MA et d’identifier les facteurs associés au déclin cognitif rapide (DCR) des patients atteints de MA. Le Dementia Quality of Life (DQoL) et le Quality of life in Alzheimer Disease (QoL-AD) ont été administrés à 123 patients atteints de MA de stade léger à modéré. Des données sociodémographiques et cliniques (notamment les capacités cognitives, les troubles du comportement, les capacités fonctionnelles, la thymie, l’état nutritionnel et les comorbidités) ont été recueillies. La dépression et la polymédication étaient des facteurs influençant la QDVLS du patient, qu’elle soit évaluée par le DQoL ou par le QoL-AD. Concernant le questionnaire « aidant » du QoL-AD, le fardeau de l’aidant influençait l’évaluation de la QDVLS du patient faite par l’aidant. Le type de relation entre le patient et son aidant principal, la polymédication et l’existence d’un fardeau de l’aidant étaient des facteurs associés au DCR. L’importance de l’évaluation de la QDVLS chez les patients atteints de MA n’est plus à démontrer. Cette étude montre la nécessité de prendre en compte le couple patient/aidant pour définir au mieux les stratégies à mettre en place. Un suivi médical et psychologique régulier est nécessaire pour les aidants de patients atteints de MA, en plus d’une formation spécifique à ce rôle. / Alzheimer’s disease (AD) is characterised by progressive cognitive decline. Management of patients with AD is based on a multidisciplinary approach (medical, cognitive, psychological, social and functional), with the primary aim of maintaining the health related quality of life (HRQoL) of patient and his/her familyStudy’s aims were to identify factors associated with HRQoL in patients with AD and to determine predictive factors associated with rapid cognitive decline (RCD) in patients with AD.HRQoL was evaluated using Dementia Quality of Life (DQoL) and using Quality of life in Alzheimer Disease (QoL-AD) for 123 patients with AD. Sociodemographic and clinical (notably cognitive functions, behavioural troubles, level of patient dependence, depression, nutritional status and comorbidities) were recorded.Depression and polymedication were associated with HRQoL, whether assessed by DQoL or QoL-AD. Regarding to the QoL-AD caregiver score, presence of caregiver burden was factor associated with HRQoL. Type of relationship between the patient and the primary caregiver, polymedication and existence of a caregiver burden were factors associated with the RCD.The importance of HRQoL’s evaluation in patients with AD is no longer to be demonstrated. This study showed the need to take into account the couple patient/caregiver to define the strategies to be put in place. Regular medical and psychological follow-up is required for caregivers of patients with AD, in addition to training specific to this role.

Polycystic Ovary Syndrome (PCOS) is one of the most common endocrine disorders amongst women, estimated to affect one out of 10 women. Symptoms include infertility, obesity, alopecia, acne, hirsutism and menstrual irregularities. Women with the syndrome are also more likely to experience co-morbid physical and psychological conditions such as diabetes, heart disease, endometrial cancer and also depression and anxiety. PCOS has also been found to have a negative impact on quality of life. This thesis aimed to further understanding, and improve quality of life of women with PCOS in the UK. To achieve this, the thesis aimed to investigate and identify how women with PCOS in the UK perceive and define their quality of life and to further understanding of the day-to-day experience of living with PCOS. Moreover, in order to measure quality of life, it aimed to develop and validate a UK disease-specific quality of life measure for women with PCOS. It also aimed to identify, develop and test a pilot intervention to increase quality of life in women with PCOS. To achieve these aims a mixed-methods approach was taken employing a variety of data generation and collection methods including: photovoice, online Skype™ interviews; LimeSurvey and Qualtrics. The findings of this thesis emphasise that PCOS has a negative impact on quality of life; encompassing psychological, social, environmental, and physical domains of quality of life. Women with PCOS who experienced the symptoms of infertility, hirsutism, weight, alopecia, skin discolouration, skin tags and mood swings had significantly lower scores of overall quality of life than those women who did not experience the symptoms. In addition, those women with PCOS who had a diagnosis of anxiety and/or depression had reduced quality of life. The dissemination of these findings will enable health care professionals to better understand the experience of living with PCOS and its impact on quality of life. Moreover, this thesis identifies many areas for future research which will enable a better understanding of the impact of PCOS on quality of life. Finally, this thesis makes recommendations for clinical practice which include improvement of support from health care professionals for women with PCOS in order to help them better manage their symptoms, and therefore improve their overall quality of life.