Background: There is a lack of the generic data comparing the influence of different diseases on health-related quality of life (HrQoL) in a representative sample of primary care patients. Methods: Patient data were collected in the DETECT (Diabetes Cardiovascular Risk Evaluation: Targets and Essential Data for Commitment of Treatment) study including 55,000 patients. Results: 3,109 patients (33.3% female) with myocardial infarction (MI), stroke or both were compared to patients with a wide range of other diagnoses. Stroke and MI patients revealed a lower HrQoL as compared to patients with other diagnoses. Stroke was associated with strongest quality of life reduction. Multivariate analysis revealed several different determining factors. Conclusions: The reduction of HrQoL of patients with MI and stroke is primarily determined by the CNS insult. These data provide further evidence that early diagnosis and treatment of cardiovascular risk factors is essential to reduce subsequent stroke.

Bakgrund: Trots all forskning och kunskap om vikten av fysisk aktivitet ökar livsstilrelaterade sjukdomar. WHO (Världshälsoorganisationen) har klassificerat fysisk inaktivitet som en av fyra ohälsosamma levnadsvanor som vid minimering kan förebygga sjukdom och för tidig död. Fysisk aktivitet på recept (FaR) inkluderar hälsofrämjande hälso- och sjukvård och ökad fysisk aktivitet som är två av Sveriges elva folkhälsomål. Syftet med litteraturstudien var att undersöka hur fysisk aktivitet på recept påverkar den fysiska aktivitetsnivån. Metod: En litteraturstudie gjordes och sökning utfördes i LibHub och Academic Search Elite av artiklar publicerade mellan 2005 och 2012. Inklusionskriterier var artiklar som innefattade hälsofrämjande arbete och undersökte fysisk aktivitet på recept, ordinerad till vuxna. Av 60 lästa abstract och 19 lästa artiklar valdes tio ut vilka delades in efter studiedesign.  Inledningen av analysprocessen gjordes oberoende av forskarna därefter sammanställdes materialet och följande tema framkom: Motivation, Implementering, Hälsoekonomiska konsekvenser och Hälsovinster. Resultat: FaR kan leda till ökad fysisk aktivitet och ökad livskvalitet. Framgångsfaktorer var motivation, stöd, samarbete, kunskap samt delaktighet. Resultatet från de olika studiemetoderna visade ingen signifikant skillnad. Resultatet påvisade behov av ytterligare implementering och utveckling av metoden FaR. Slutsats: All typ av beteendeförändring kräver tid och tålamod. För att nå målet ”en mer fysisk aktiv befolkning”, krävs noggrann uppföljning av de som fått FaR utskrivet samt stöd genom motiverande samtal (MI). Utmaningen är att övertyga samhället att FaR är en kostnadseffektiv metod som främjar en god folkhälsa, vilket är en investering för framtiden. / Background: Despite all research and knowledge of the importance of being physically active sickness, related to lifestyle are increasing. WHO (World health organization) have ranged physic inactivity as one of the four unhealthy living habits which can with small effort prevent disease and early death. Physical activity on prescription (PaP) includes health promoted care and increased physical activity which is two of Sweden’s eleven great goals for the public health. Aim: The intention of the literature study was to review how physical activity was given as a prescription and the affects the physical level of activity. Methods: The systematic search was in LibHub and Academic Search Elite of articles published between 2005 and 2012. Inclusioncriteria were articles that included health promotion, physical activity on prescription and were ordained to adults. When 60 abstract and 19 articles were read, ten articles were selected and separated by the study design. The beginnings of the analysis process was done independently by the researchers then compiled the material and the following themes emerged: Motivation, Implantation, Health economic implications and Health benefits .Results: PaP may result to increased physical activity and improved quality of life. Success factors were motivation, collaboration, knowledge and participation. The results from the different study methods showed no significant difference. The results demonstrate a need for the implementation and development of the method PaP.  Conclusions: All sorts of behaviour change demands time and patience and support from the environment. To be able to reach the goal with “a more physical active population “, close monitoring is required thorough follow-up of those who have a prescription for PaP and support through Motivational Interviewing (MI). The challenge is to convince the public that the PaP  is a cost effective method to promote good public health, which is an investment in the future.

Normalt åldrande innebär förändringar hos individen som kan påverka tal, språk och sväljning. Ökad känslighet för inre och yttre påverkan hos den åldrande individen samt sjukdomsbild kan skapa problematik, vilken kan ge upphov till svårigheter med tal, språk och/eller sväljning, som i sin tur påverkar den upplevda livskvaliteten. Geriatriska patienter karaktäriseras av nedsatt funktionsnivå och kroniska sjukdomar, därför ställs krav på specialkompetens för vård och rehabilitering av dessa patienter. Syftet med föreliggande studie var att genom screening undersöka förekomst av tal-, språk- och sväljsvårigheter på geriatriska avdelningar i två städer i södra Sverige. Därtill undersöktes även orofacial påverkan och hälsorelaterad livskvalitet. Totalt 42 patienter från geriatriska avdelningar med inriktningarna allmängeriatrik, strokerehabilitering och ortopedi deltog. Screeninginstrument som användes var Nordiskt Orofacialt Test – Screening (NOT-S) för screening av orofaciala funktioner. Screening av tal baserades på delar ur NOT-S samt talade delar ur språklig screening. Delar ur Neurolingvistisk Afasi-undersökning (A-ning) valdes för screening av språk och Standardised Swallowing Assessment (SSA) användes för klinisk undersökning av sväljning. Hälsoenkäten the Short Form – 12 (SF-12) användes för skattning av hälsorelaterad livskvalitet. Identifierade svårigheter i patientgruppen var talsvårigheter hos 33 % (14 av 42), samt 40 % (16 av 40) och 37 % (15 av 41) språkliga svårigheter respektive sväljsvårigheter. Bland deltagarna hade 64 % svårigheter med en eller flera av de undersökta funktionerna. Förekomst av dessa svårigheter hade signifikant samband med nedsatt orofacial funktion. Lågt skattad hälsorelaterad livskvalitet hade signifikant samband med språkliga svårigheter och med orofacial dysfunktion. / Changes occur during the normal ageing process that can interfere with speech-, language- and swallowing functions. An increased occurrence of diseases increases the frailty in the ageing individual and may cause disordered speech, language and/or swallowing, in which case the health related quality of life may be negatively affected. The geriatric population is characterized by functional impairment and chronic diseases. This therefore poses special demands on specialist care and rehabilitation of these patients. The aim of this study was to examine the occurrence of speech, language and swallowing disorders in geriatric wards in two cities in the southern part ofSwedenusing screening. The orofacial influence on these functions and health related quality of life were also examined. In total 42 patients participated, from geriatric wards with general, stroke rehabilitation and orthopedic specialty. The instruments used for screening of orofacial functions was the Nordic Orofacial Test – Screening (NOT-S) and perceptual parameters for screening of speech based on speech parts from NOT-S and speech production from Neurolingvistisk Afasi-undersökning (A-ning). Parts of A-ning were also used for screening of language. Standardised Swallowing Assessment (SSA) was used for clinical examination of swallowing. The Short Form – 12 Health Survey (SF-12) was used to estimate the health related quality of life. Results showed that 33 % (14 of 42) had difficulties with speech, 40 % (16 of 40) and 37 % (15 of 41) showed difficulties with language and swallowing respectively. Of the participants, 64 % had difficulties with one or more of the examined functions. Occurrence of these difficulties associated significantly with impaired orofacial function. Language difficulties were associated with decreased mental health status and orofacial dysfunction with decreased physical health status, measured with the SF-12.

Introduktion: WHO betonar vikten av att integrera traditionell- och komplementärmedicin i nationella hälsovårdssystem. I Sverige förekommer integrativ medicin med antroposofisk inriktning på Vidarkliniken i Järna. Syfte: Att studera förändringar av självskattat hälsotillstånd hos patienter som erhållit antroposofisk vård på Vidarklinikens öppenvårdsmottagning i Norrköping. Metod: En kvantitativ metod med enkäter till 26 patienter på Vidarklinikens öppenvårdsmottagning i Norrköping, konsekutiv datainsamling. Hälsorelaterad livskvalitet skattades med hjälp av EQ-5D (rörlighet, hygien, aktivitet, smärta och oro) och EQ-VAS (totalt hälsotillstånd) samt två enkäter, konstruerade för denna studie, med VAS-skalor för sömnkvalitet, fysiskt tillstånd, psykiskt tillstånd och förutsättningar att hantera sin livssituation, samt patienternas beskrivning av måluppfyllelse. Därutöver undersöktes patienternas sjukskrivningsgrad och läkemedelsförbrukning. Resultat: Patienterna hade mycket varierande diagnoser och ofta sammansatt problematik. Vanligast var utmattning, fibromyalgi och smärta. Resultaten varierade mellan diagnosgrupperna. Huvuddelen av patienterna rapporterade stor tillfredsställelse med vård, behandling och bemötandet från personal, till hög grad uppnådda förväntningar och mål, samt att överlag ha fått bättre förutsättningar att hantera sin livssituation. Det fanns ingen signifikant skillnad i medelvärdet för EQ-5D index eller EQ-VAS, men trend till signifikant förbättring vad gäller sömnkvalitet och psykiskt tillstånd, samt signifikant förbättring av självskattat fysiskt tillstånd (p=0.021). Vid delanalys av de enskilda dimensionerna (EQ-5D) fann man förbättrat tillstånd i någon/några av dimensionerna hos 36 % av patienterna, oftast vad gäller rörlighet och minst vanligt vad gäller smärta. Slutsats: I denna grupp med omfattande och varierande och ofta mycket långvarig problematik påvisades stor uppskattning av vården, trender till förbättrade resultat vid sömnkvalitet och psykiskt tillstånd, samt signifikant förbättrade resultat vid självskattat fysiskt tillstånd. / Introduction: WHO stresses the importance of integrating traditional and complementary medicine into national health systems. In Sweden, integrative medicine with an anthroposophical focus is practised at Vidar Clinic in Järna. Purpose: To study changes in the self-rated health status of patients receiving anthroposophic care at Vidar Clinic outpatient facility in Norrköping. Method: A quantitative method using questionnaires to 26 patients at the Vidar Clinic outpatient facility in Norrköping, [using] consecutive data collection. Health-related quality of life was estimated using EQ-5D (mobility, hygiene, activity, pain and anxiety) and EQ-VAS (overall health status) along with two questionnaires specially designed for this study, with VAS scales for sleep quality, physical condition, mental condition and the ability to manage their lives, as well as the patients’ description of whether or not they felt fulfilled in their lives. In addition, the patients’ sickness absence rates and drug consumption were analysed. Results: The patients had extremely varying diagnoses and often complex problems. The most common were fatigue, fibromyalgia and pain. The results varied between the diagnostic groups. The majority of the patients reported great satisfaction with their care and treatment and how they were being cared for by the staff; to a large extent they felt that their expectations and goals had been achieved, and that in general they had been given better capabilities to manage their lives. There was no significant difference in the mean value for the EQ-5D index or EQ-VAS, but a tendency to significant improvement in sleep quality and mental condition, and a significant improvement in self-estimated physical condition (p=0.021). When a partial analysis was conducted of the individual dimensions (EQ-5D), improved conditions were found in one/some of the dimensions in 36 per cent of the patients, usually in terms of mobility and least common with regard to pain. Conclusion: In this group, with extensive and varied and often very long-term problems, great appreciation of the care was shown, there were tendencies to improved results in sleep quality and mental condition, and significantly improved results in self-estimated physical condition.

The purpose of this thesis was to identify fall risk individuals (+55) after stroke by validating a fall risk index and in post-stroke individuals with high risk of falls evaluate the impact of an intervention program on fall risk factors.A previously developed fall risk index was validated, modified and re-validated. The validation showed a sensitivity of 97% and a specificity of 26%. This result was not considered sufficiently accurate. Therefore a modified index was created in the Validation sample and re-validated back in the Model fit sample. The modified index was reduced to three items and included postural stability + visuospatial hemi-inattention + male sex.The randomized controlled trial contained an intervention program (IP) with High-Intensity Functional Exercises as well as implementation these exercises in to real life situations together with educational group discussions. The participants were enrolled and randomized three to six months after their stroke. The assessments were performed at the Clinical Research Center at Norrlands University Hospital. The Intervention Group (IG) received a program of 35 sessions (exercise and group discussions) and the Control Group (CG) received five group discussions.Performing daily activities at 6 months follow-up and falls-efficacy post-intervention and at the 3 months follow-up showed significant improvement in the IG compared with the CG (p<0.05). The IP did not have a statistically significant impact on Balance or Lifestyle activities. When evaluating gait, step time variability for the paretic leg and the variability in Cycle Time for the paretic and non-paretic leg were improved for the IG. The time spent on the non –paretic leg in the gait cycles’ most stable phase, Double Support, was reduced by almost half (0.9 sec to 0.4 sec) since baseline for the IG after the intervention and remained reduced to the three month follow-up. Quality of Life showed an improvement in the CG compared with the IG for the mental scales, Mental Component Scale and Mental Health subscale at the 3 month follow-up (p=.02).In conclusion, this intervention program significantly improved performance of everyday life activities, falls-efficacy and the variability in gait. These are three major fall risk factors and might in the long run have an impact on decreasing falls in persons that had a stroke.

No description available.

No description available.

Tyrimo tikslas – įvertinti kraujospūdžio kitimo ir su sveikata susijusios gyvenimo kokybės sąsajas tarp vyrų ir moterų, kuriems nustatytas padidėjęs kraujospūdis, dalyvavimo profilaktinėse kraujospūdžio reguliavimo grupėse laikotarpiu. Naudota metodika: Gyvenimo kokybės – 100 klausimynas (WHOQOL-100). Profilaktinėse grupėse dalyvavo 110 terapinės apylinkės pacientų. Visus keturis užsiėmimus lankė atitinkamai 80 pacientų. Pacientai buvo prašomi užpildyti GK-100 klausimyną, siekiant nustatyti kraujospūdžio kitimus užsiėmimų metu ir sąsajas su pacientų gyvenimo kokybės ypatumais. Tiriamieji dalyvavo keturiuose vienos valandos užsiėmimuose, kurie vyko kartą per savaitę vakare. Visoms keturioms pacientų grupėms vedami tie patys užsiėmimai taikant modifikuotą progresyvios raumenų relaksacijos metodą, diskusiją gyvenimo būdo keitimo klausimais ir abiejų šių metodų (raumenų relaksacijos ir diskusijos) derinį. Tyrimo rezultatai parodė, jog moterų ir vyrų grupėse statistiškai reikšmingas kraujo spaudimo sumažėjimas stebimas užsiėmimo pabaigoje. Aukštesni statistiškai reikšmingi arterinio kraujo spaudimo rodikliai susiję su vyresnio amžiaus ir žemesnio išsilavinimo rodikliais vyrų ir moterų grupėse. Aukšti statistiškai reikšmingi arterinio kraujo spaudimo rodikliai susiję su blogesne gyvenimo kokybe, o mažesni - su geresne gyvenimo kokybe. / Purpose of the survey is to assess the relations between blood pressure changes and health-related quality of life in men and women with high blood pressure during the period of blood pressure regulation in preventive groups. Methodology used: The Quality of Life - 100 Questionnaire (WHOQOL-100). Preventive groups involved 110 patients in the therapeutic environs. 80 patients attended all four workshops. Patients were asked to fill in WHOQOL-100 questionnaire to determine the associations with health – related quality of life and blood pressure variations in workshops. Patients participated in four one-hour classes, held once a week in the evening. All four groups of patients were involved in workshops using the modified progressive muscle relaxation method, the discussion on the changing of lifestyle and the combination of both of these methods (progressive muscle relaxation and discussion). The study showed that statistically significant decreased blood pressure was observed in men and women groups at the end of each workshop. Higher statistically significant arterial blood pressure was related to the older age and lower level of education in men and women groups. Higher statistically significant arterial blood pressure was related to poorer health – related quality of life, as lower arterial blood pressure was associated with better health – related quality of life.

Disertacijoje tiriant ligonių, ilgai gydytų intensyviosios terapijos skyriuje, su sveikata susijusios gyvenimo kokybės skirtumus iki gydymo ir praėjus 6 mėnesiams po gydymo vertinamos gyvenimo kokybės pablogėjimo priežastys bei gyvenimo kokybės ir mirštamumo po iškėlimo iš intensyviosios terapijos skyriaus ryšys. Jau anksčiau nustatyta, kad gyvenimo kokybė po gydymo intensyviosios terapijos skyriuje pablogėja. Tačiau neaišku, kokie veiksniai turi didžiausios įtakos intensyviosios terapijos skyriaus ligonių gyvenimo kokybei. Ypač mažai duomenų apie ligonių, ilgai gydytų intensyviosios terapijos skyriuje, gyvenimo kokybę po iškėlimo iš intensyviosios terapijos skyriaus. Tyrimo rezultatai patvirtino, kad ilgas gydymas intensyviosios terapijos skyriuje turi didžiausios įtakos fizinėms su sveikata susijusioms gyvenimo kokybės sritims. Tyrimo rezultatai įrodo, kad būklės sunkumas pirmą gydymo intensyviosios terapijos skyriuje parą, terapinių intervencijų skaičius iškėlimo iš intensyviosios terapijos skyriaus metu ir sunkus kritinių būklių neuroraumeninis pažeidimas susiję su pablogėjusia gyvenimo kokybe, o dirbtinės plaučių ventiliacijos trukmė – veiksnys turintis didžiausią įtaką gyvenimo kokybės blogėjimui. Taip pat nustatyta, kad įprastos sistemos būklės sunkumui įvertinti netinka numatyti ligonių mirštamumui po gydymo intensyviosios terapijos skyriuje, o nustačius fizinį aktyvumą iki gydymo intensyviosios terapijos skyriuje tai galima atlikti. / The doctoral dissertation investigates changes in health-related quality of life for long-term intensive care patients prior to ICU admission and 6 months after ICU discharge, exploring into the causes of impaired quality of life and the relationship between the quality of life and post-ICU mortality. It has already been established that the quality of life decreases after treatment in the intensive care unit. However, factors that have the strongest effect on the quality of life in ICU patients have not been identified. Information on post-ICU quality of life in long-term intensive care patients is particularly scarce. The findings of our research confirmed that long term treatment in the intensive care unit has major implications for the physical domains of health-related quality of life. The findings evidence that severity of illness on the first day in the ICU, number of therapeutic interventions upon ICU discharge and severe critical illness neuromuscular abnormalities are associated with impaired quality of life, while duration of mechanical ventilation is the factor with the strongest effect on reduced quality of life. Likewise, the findings demonstrate that usual systems for identification of severity of illness are not useful for predicting mortality in patients after discharge from the intensive care unit. Yet, identification of pre-ICU physical activity allows predicting post-ICU mortality.

The doctoral dissertation investigates changes in health-related quality of life for long-term intensive care patients prior to ICU admission and 6 months after ICU discharge, exploring into the causes of impaired quality of life and the relationship between the quality of life and post-ICU mortality. It has already been established that the quality of life decreases after treatment in the intensive care unit. However, factors that have the strongest effect on the quality of life in ICU patients have not been identified. Information on post-ICU quality of life in long-term intensive care patients is particularly scarce. The findings of our research confirmed that long term treatment in the intensive care unit has major implications for the physical domains of health-related quality of life. The findings evidence that severity of illness on the first day in the ICU, number of therapeutic interventions upon ICU discharge and severe critical illness neuromuscular abnormalities are associated with impaired quality of life, while duration of mechanical ventilation is the factor with the strongest effect on reduced quality of life. Likewise, the findings demonstrate that usual systems for identification of severity of illness are not useful for predicting mortality in patients after discharge from the intensive care unit. Yet, identification of pre-ICU physical activity allows predicting post-ICU mortality. / Disertacijoje tiriant ligonių, ilgai gydytų intensyviosios terapijos skyriuje, su sveikata susijusios gyvenimo kokybės skirtumus iki gydymo ir praėjus 6 mėnesiams po gydymo vertinamos gyvenimo kokybės pablogėjimo priežastys bei gyvenimo kokybės ir mirštamumo po iškėlimo iš intensyviosios terapijos skyriaus ryšys. Jau anksčiau nustatyta, kad gyvenimo kokybė po gydymo intensyviosios terapijos skyriuje pablogėja. Tačiau neaišku, kokie veiksniai turi didžiausios įtakos intensyviosios terapijos skyriaus ligonių gyvenimo kokybei. Ypač mažai duomenų apie ligonių, ilgai gydytų intensyviosios terapijos skyriuje, gyvenimo kokybę po iškėlimo iš intensyviosios terapijos skyriaus. Tyrimo rezultatai patvirtino, kad ilgas gydymas intensyviosios terapijos skyriuje turi didžiausios įtakos fizinėms su sveikata susijusioms gyvenimo kokybės sritims. Tyrimo rezultatai įrodo, kad būklės sunkumas pirmą gydymo intensyviosios terapijos skyriuje parą, terapinių intervencijų skaičius iškėlimo iš intensyviosios terapijos skyriaus metu ir sunkus kritinių būklių neuroraumeninis pažeidimas susiję su pablogėjusia gyvenimo kokybe, o dirbtinės plaučių ventiliacijos trukmė – veiksnys turintis didžiausią įtaką gyvenimo kokybės blogėjimui. Taip pat nustatyta, kad įprastos sistemos būklės sunkumui įvertinti netinka numatyti ligonių mirštamumui po gydymo intensyviosios terapijos skyriuje, o nustačius fizinį aktyvumą iki gydymo intensyviosios terapijos skyriuje tai galima atlikti.