<p><strong>Background</strong>: Health-related quality of life (HRQL) studies have inconsistently identified a burden of pain in survivors of brain tumours in childhood, with limited exploration of this morbidity.</p> <p><strong>Objective: </strong>To explore the HRQL, with a focus on pain, in survivors greater than 10 years from diagnosis of a primary brain tumour in childhood or adolescence.</p> <p><strong>Methods:</strong> A cross-sectional study was undertaken using Health Utilities Index (HUI) questionnaires. Location of pain was queried using a homunculus and a colour-analog scale facilitated the reporting of severity. Single-attribute HRQL scores for participants with and without pain were compared. Stability of pain over a decade was established using available HUI2/3 data from the same cohort with imputation for missing variables.</p> <p><strong>Results:</strong> Twelve males and 13 females out of 37 eligible subjects participated in this study. Participants (mean time from diagnosis of 19.7 years) had mean multi-attribute HRQL scores of 0.79 (SD of 0.23) for HUI2 and 0.69 (SD of 0.29) for HUI3. Thirteen (52%) participants reported pain, with ranges in severity and location of the discomfort. Participants with pain had considerably greater burdens of morbidity in sensation and emotion than those without pain. Pain also increased from the initial interview (10 years prior) to the final interview.</p> <p><strong>Conclusion:</strong> As a group, long-term survivors of brain tumours in childhood have diminished overall HRQL. However there is variability between subjects. Pain appeared to be a persistent and significant burden in a subset of individuals, with those experiencing pain reporting greater severity of morbidities in other attributes.</p> / Master of Science (MSc)

<p>Air pollution and a general concern for lack of physical activity in North America have motivated governments to encourage non-motorized modes of transportation. A key infrastructure component for these forms of transportation is sidewalks. The City of Saskatoon has identified the need to formalize sidewalk management policies to demonstrate diligence for community protection regarding sidewalk safety. Prioritization of sidewalk maintenance and rehabilitation actions must be objective and minimize risk to the community. Most research on prioritization of pedestrian facilities involved new construction projects. This research proposes a decision model that prioritizes a given list of existing unsafe sidewalk locations needing maintenance or rehabilitation using a direct measure of pedestrian safety, namely, quality-adjusted life years lost per year. </p><p>A decision model was developed for prioritizing a given list of unsafe sidewalk locations, aiding maintenance and rehabilitation decisions by providing the associated risk to pedestrian safety. The model used data mostly from high quality sources that had already been collected and validated. Probabilities and estimations were used to produce value-added decision policy.</p> <p>The decision analysis framework applied probability and multi-attribute utility theories. This study differed from other research due to the inclusion of age and gender groups. Total average daily population of the city was estimated. This population was distributed to sidewalk locations using probabilities for trip purposes and a locations ability to attract people relative to the city total. Then trip injury events were predicted. Age and gender distribution and trip injury type estimations were used to determine the impact of those injuries on quality of life.</p><p>There exist much observable high quality data that can be used as indicators of unknown or unobserved events. A decision policy was developed that prioritizes unsafe sidewalk locations based on the direct safety impact on pedestrians. Results showed that quality-adjusted life years lost per year sufficiently prioritized a given list of unsafe sidewalk locations. It was demonstrated that the use of conditional probabilities (n=594) allowed for the ability to abstract data representing a different source population to another. Average daily population confined and distributed within the city boundary minimized problems of accuracy. Gender-age distribution was important for differentiating the risk at unsafe sidewalk locations. Concepts from this research provide for possible extension to the development of sidewalk service levels and sidewalk priority maps and for risk assessment of other public services.</p>

<p>Air pollution and a general concern for lack of physical activity in North America have motivated governments to encourage non-motorized modes of transportation. A key infrastructure component for these forms of transportation is sidewalks. The City of Saskatoon has identified the need to formalize sidewalk management policies to demonstrate diligence for community protection regarding sidewalk safety. Prioritization of sidewalk maintenance and rehabilitation actions must be objective and minimize risk to the community. Most research on prioritization of pedestrian facilities involved new construction projects. This research proposes a decision model that prioritizes a given list of existing unsafe sidewalk locations needing maintenance or rehabilitation using a direct measure of pedestrian safety, namely, quality-adjusted life years lost per year. </p><p>A decision model was developed for prioritizing a given list of unsafe sidewalk locations, aiding maintenance and rehabilitation decisions by providing the associated risk to pedestrian safety. The model used data mostly from high quality sources that had already been collected and validated. Probabilities and estimations were used to produce value-added decision policy.</p> <p>The decision analysis framework applied probability and multi-attribute utility theories. This study differed from other research due to the inclusion of age and gender groups. Total average daily population of the city was estimated. This population was distributed to sidewalk locations using probabilities for trip purposes and a locations ability to attract people relative to the city total. Then trip injury events were predicted. Age and gender distribution and trip injury type estimations were used to determine the impact of those injuries on quality of life.</p><p>There exist much observable high quality data that can be used as indicators of unknown or unobserved events. A decision policy was developed that prioritizes unsafe sidewalk locations based on the direct safety impact on pedestrians. Results showed that quality-adjusted life years lost per year sufficiently prioritized a given list of unsafe sidewalk locations. It was demonstrated that the use of conditional probabilities (n=594) allowed for the ability to abstract data representing a different source population to another. Average daily population confined and distributed within the city boundary minimized problems of accuracy. Gender-age distribution was important for differentiating the risk at unsafe sidewalk locations. Concepts from this research provide for possible extension to the development of sidewalk service levels and sidewalk priority maps and for risk assessment of other public services.</p>

Background Chronic low back pain (LBP) is a common health problem, with a large potential for primary prevention. Health utilities (HU) reflect which proportion of their expected remaining life time individuals would hypothetically trade to be alleviated of a health condition of interest. A value of 0 means “prefer to die immediately”, a value of 1 means “not willing to trade any life time”. The aim of this cross-sectional study was to assess HU for LBP patients and for healthy participants and to examine whether HU for LBP are useful indicators to substantiate preventive and therapeutic decision making. Methods Healthy participants (n = 126) and LBP patients (n = 32) were recruited mainly among the employees of a tertiary care hospital in Germany. Standardized LBP scenarios were presented to all participants and HU values were assessed using the time-trade-off method. Results Median HU for LBP were 0.90 (IQR 0.31) for participants and 0.93 (IQR 0.10) for LBP patients. Measurements were consistent across illness severity ratings with HU and with a visual analogue scale (VAS); in the healthy sample the intraclass correlation coefficient (ICC) was 0.61 (95% CI 0.23–1.00, F(1125) = 190, p < .001), in the patient sample the ICC was 0.66 (95% CI = 0.24–1.00, F(1,31) = 62, p < .001). 8% of participants reported HU of 1. There was no statistically significant relation between HU and age, income, or gender. Conclusion On average, participants chose a 7 to 10% shorter life expectancy to avoid LBP, but almost 1 in 10 participants were not willing to trade any life years. The results indicate a certain stability of HU due to the comparability of HU ratings across patients and healthy participants, the measurement consistency when comparing VAS and HU ratings, and the lack of association between demographic variables and HU. This underlines the usefulness of HU for measuring illness severity in comparative health economics evaluations of preventive and therapeutic measures that address chronic LBP or other pain-characterized diseases. Future studies should focus on different LBP intensities and derive stratified HU that reflect the distribution of pain intensity in the population.

Background Chronic low back pain (LBP) is a common health problem, with a large potential for primary prevention. Health utilities (HU) reflect which proportion of their expected remaining life time individuals would hypothetically trade to be alleviated of a health condition of interest. A value of 0 means “prefer to die immediately”, a value of 1 means “not willing to trade any life time”. The aim of this cross-sectional study was to assess HU for LBP patients and for healthy participants and to examine whether HU for LBP are useful indicators to substantiate preventive and therapeutic decision making. Methods Healthy participants (n = 126) and LBP patients (n = 32) were recruited mainly among the employees of a tertiary care hospital in Germany. Standardized LBP scenarios were presented to all participants and HU values were assessed using the time-trade-off method. Results Median HU for LBP were 0.90 (IQR 0.31) for participants and 0.93 (IQR 0.10) for LBP patients. Measurements were consistent across illness severity ratings with HU and with a visual analogue scale (VAS); in the healthy sample the intraclass correlation coefficient (ICC) was 0.61 (95% CI 0.23–1.00, F(1125) = 190, p < .001), in the patient sample the ICC was 0.66 (95% CI = 0.24–1.00, F(1,31) = 62, p < .001). 8% of participants reported HU of 1. There was no statistically significant relation between HU and age, income, or gender. Conclusion On average, participants chose a 7 to 10% shorter life expectancy to avoid LBP, but almost 1 in 10 participants were not willing to trade any life years. The results indicate a certain stability of HU due to the comparability of HU ratings across patients and healthy participants, the measurement consistency when comparing VAS and HU ratings, and the lack of association between demographic variables and HU. This underlines the usefulness of HU for measuring illness severity in comparative health economics evaluations of preventive and therapeutic measures that address chronic LBP or other pain-characterized diseases. Future studies should focus on different LBP intensities and derive stratified HU that reflect the distribution of pain intensity in the population.