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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
301

The Relationship Between Sickle Cell Support Group Status and Barriers to Care as Perceived by Parents of Children with Sickle Cell Disease

Nwachuku, Goldie Okechi Nwaru 01 January 2016 (has links)
By examining barriers to care, health professionals can better understand what disparities exist between groups and who may be at greater risk for poor primary care. Researchers have highlighted the need for additional research that focuses on the extent of unmet needs for U.S. children with sickle cell disease (SCD). The purpose of this quantitative study was to compare the differences between parents who are in a SCD support group and those who are not. The theoretical framework of this study is based on the chronic care model and social support theory. A total of 128 parents of children with SCD completed the study survey. The sampling occurred by e-mail, phone, and face-to-face conversations. Selection criteria for potential participants in both groups were based on their children being diagnosed with SCD. Seventy-four participants (57.8%) were members of a SCD support group, and 54 participants (42.4%) were not members of a SCD support group. In this study, the independent variables were parents attending or not a SCD support group. The t test and MANCOVA was used to assessed the association between perceptions of barriers to care and support group status. However, statistical analysis showed no significant results. The null hypothesis was not rejected. Therefore, the positive social change implication is to further explore potential factors that may shape perceptions of barriers to care for those with SCD so that perceived barriers to care can be overcome.
302

EXPLORING BIOPSYCHOSOCIAL (BPS) FACETS OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) IN PATIENTS IN AN ACUTE INPATIENT PHYSICAL REHABILITATION FACILITY (IRF)

Williams, Ronnetta 01 January 2013 (has links)
From a BPS perspective, COPD and other chronic diseases may have a significant negative impact on those living with them and may be associated with higher rates of depression and anxiety and lower levels of health-related quality of life (HRQOL). Certain factors, such as spirituality, may influence the negative impact of chronic disease on the relationship between mood and functional independence and HRQOL. Also, gender may influence the relationship between mood, spirituality, and HRQOL for men and women living with chronic diseases. The current study included 136 patients undergoing physical rehabilitation at an IRF. Anxiety, depression, spirituality, HRQOL, and functional independence were evaluated for all. Mediation models were tested to determine the impact of spirituality on the relationships between mood and HRQOL and functional independence, and moderation models were tested to evaluate the impact of gender on the relationships between mood, spirituality, functional independence, and HRQOL. The current study yielded some inconclusive results but did evidence that COPD patients in acute inpatient physical rehabilitation facilities (IRF) have higher levels of anxiety than patients without COPD and also revealed that men with COPD have better HRQOL than do women with COPD. Spirituality was found to partially mediate the relationship between depression and HRQOL in IRF patients with COPD, but gender did not appear to moderate the relationships between mood, spirituality, functional independence, or HRQOL in IRF patients. As few studies on IRF patients with chronic diseases exist, continuing to evaluate patients in IRFs is important to enhance our BPS understanding of chronic disease.
303

Oral Health Care and Humanitarian Health Praxis / Munhälsa och humanitärt hälsoarbete

Liebe-Harkort, Carola January 2016 (has links)
Background: Oral and dental diseases is a major part of the global disease burden. Poor oral health has a significant impact on the general well-being of people. In contrast with prior decades high rates of oral diseases may be found in low- and middle income countries. Populations that are particularly vulnerable are more likely to develop poor oral health. As a consequence of human distress related to war, poverty and natural disasters the accomplishments of humanitarian aid organizations has a direct impact on people´s health and well-being. Purpose: The aim of the present study is to examine the International Red Cross and Red Crescent Movement as well as Doctors without borders concerning documents and guidelines on oral health. A further aim is to explore the knowledge of oral health related topics of delegates from the International Federation of the Red Cross and Red Crescent Societies (IFRC). Method: The study is designed as a literature review and a questionnaire survey. Results: Within the International Red Cross and Red Crescent Movement and Doctors Without Borders there are a limited number of guidelines on oral health and they are rarely mentioned in the same documents as non-communicable diseases (NCDs). The responses of the study revealed that the participants generally have a limited knowledge about measures on oral health in the IFRC. Conclusion: Both the literature review and the questionnaire survey study confirms that there is an absence of clear and specific guidelines on oral health care related activities within IFRC. / Bakgrund: Mun- och tandsjukdomar utgör en stor del av den globala sjukdomsbördan. Dålig mun- och tandhälsa har en stark påverkan på det allmänna välbefinnandet. I motsats till tidigare, ses idag höga frekvenser av karies även i låg- och medelinkomstländer. Populationer vilka befinner sig i extra utsatta kontexter löper större risk att utveckla dålig munhälsa. Som en följd av mänskligt lidande i form av händelser relaterade till krig, fattigdom och naturkatastrofer har aktiviteter utförda av humanitära hjälporganisationer en direkt inverkan på hälsa och välbefinnande. Syfte: Syftet med föreliggande studie är att studera dokument och riktlinjer rörande munhälsa inom Internationella Röda korset och Röda halvmånen och Läkare utan gränser. Ett ytterligare syfte är att undersöka kunskapen om hälsorelaterade frågor kring munhälsa hos delegater från Internationella federationen för Röda Korset och Röda Halvmånen (IFRC). Metod: Studien är utförd som en litteratur-sammanställning och som en enkätundersökning. Resultat: Inom Internationella Röda korset och Röda halvmånen samt Läkare utan gränser återfinns begränsat antal riktlinjer rörande oral hälsa vilka dock sällan nämns i samma dokument som icke-smittsamma sjukdomar (NCDs). Av enkätsvaren i studien framgår det att de medverkande generellt har en begränsad kunskap kring åtgärder rörande munhälsa inom IFRC. Konklusion: Deltagarna i denna studie bekräftar resultaten i litteraturstudien om en avsaknad av tydliga och konkreta riktlinjer för munhygienrelaterade aktiviteter inom IFRC.
304

Prevention of type 2 diabetes : modeling the cost-effectiveness of diabetes prevention

Neumann, Anne January 2016 (has links)
Background: Diabetes is a common and costly disease that is expected to continue even to grow in prevalence and health expenditures over the coming decades. Type 2 diabetes is the most common diabetes type and is characterized by insulin resistance and relative insulin deficiency. Type 2 diabetes develops over a long period and is often undetected over years. During this time, people almost always first develop any of the pre-diabetic states, i.e. impaired fasting glucose (IFG), impaired glucose tolerance (IGT) or a combination of both (IFG&IGT). This thesis focuses on type 2 diabetes only. In the following, the term diabetes is used to refer to type 2 diabetes only. Diabetes is associated with a sedentary lifestyle and obesity. While those are not the only factors contributing to the development and maintenance of diabetes, several studies have shown that prevention of diabetes among individuals at high risk through lifestyle change is possible, effective and cost-effective, especially targeting diet and exercise to reduce weight. No previous study had, however, estimated the cost-effectiveness of diabetes prevention strategies from a population-based perspective including healthy individuals and also considered IFG and IGT as two distinct pre-diabetic states. Objective: The overall objective of this thesis was to establish, describe and evaluate a model that can assess the cost-effectiveness of lifestyle intervention programs to prevent diabetes. Methods: First, a Markov Model was established using data from the literature. The cost of a German diabetes prevention program was estimated. Second, risk equations for change to worsened glucose states were estimated using factor analysis and logistic regression based on consecutive data from the Västerbotten Intervention Program (VIP). The risk equations described transition probabilities in the final model and were based on several risk factors such as age, sex, physical activity and smoking status. Third, information on the Short-Form 36 questionnaire from the VIP population was transformed into Short-Form 6D. Health utility weights (HUW) by glucose group and four risk factors were estimated using beta regression. Fourth, an updated Markov model was established using an updated model structure compared to the one in Paper I, program costs of Paper I, risk equations of Paper II, health utility weights of Paper III and updated cost and mortality estimates. Results: The first model in Paper I showed that lifestyle intervention programs have the potential to be cost-effective with a high degree of uncertainty. The risk equations in Paper II indicated that the impact of each risk factor depended on the starting and ending pre-diabetes state, where high levels of triglyceride, hypertension, and high body mass index were the strongest risk factors to transit to a worsened glucose state. The overall mean HUW in Paper III was 0.764 with healthy individuals having the highest HUW, those with diabetes the lowest and those in pre-diabetic states ranging in between. The intervention described in Paper IV was cost-effective for all sex and age scenarios ranging from 3,833 EUR/QALY gained (women, 30 years) to 9,215 EUR/QALY gained (men, 70 years). The probability that the intervention is cost-effective was high (85.0-91.1%). Conclusion: We established a model that can estimate the cost-effectiveness of different scenarios of initiatives to prevent diabetes. The prevention or the delay of the onset of diabetes is feasible and cost-effective. A small investment in a healthy lifestyle with the change in physical activity and diet together with weight loss can have a decent, cost-effective result. The full range of possibilities this model offers has not been evaluated so far. We have, however, shown that implementing a lifestyle intervention program like the Västerbotten Intervention Programme would be cost-effective.
305

Quantification of standing balance in survivors of childhood posterior fossa brain tumours

Turner, Melissa 12 1900 (has links)
Malgré un intérêt grandissant pour la question du devenir des survivants de tumeur cérébrale pédiatrique, l’évaluation de leur équilibre est souvent négligée. Les objectifs de nos travaux étaient de 1) examiner les écrits portant sur l’équilibre chez les survivants de tumeur cérébrale pédiatrique; 2) comparer l'équilibre debout et la qualité de vie entre les survivants et un groupe d’enfants témoins; et 3) examiner l'association entre l'équilibre debout et qualité de vie chez les survivants. Notre recension des écrits démontra que les survivants de tumeur cérébrale présentent des troubles de l’équilibre, mais les limites méthodologiques des études nous empêchent de conclure de manière définitive. Ensuite, nous avons recruté un groupe d’enfants survivants d’une tumeur cérébrale de la fosse postérieure et un groupe d’enfants sains. Leur équilibre était évalué à l’aide du Bruininks-Oseretsky Test of Motor Proficiency-2nd edition (BOT-2) et du Pediatric Balance Scale (PBS). Certains participants ont aussi été évalués avec une plate-forme de force où les limites de stabilité étaient documentées. Finalement, tous les enfants et leurs parents remplissaient le Pediatric Quality of Life Inventory (PedsQL4.0). Nos résultats démontrent que les survivants présentent une diminution de l’équilibre mise en évidence par le BOT-2, mais que leur qualité de vie est similaire aux enfants sains. La performance au BOT-2 est associée à la dimension physique du PedsQL4.0, suggérant une relation entre l’équilibre et la qualité de vie. Nos résultats suggèrent qu’une évaluation de l’équilibre pourrait être bénéfique chez cette clientèle afin de mieux cerner ses besoins de réadaptation. / There is growing interest in studying outcomes in survivors of pediatric brain tumours. Physical outcomes, especially balance abilities, are less investigated. Objectives of this thesis are to: 1) examine the literature for balance outcomes in survivors of pediatric brain tumours, 2) compare standing balance and health-related quality of life (HRQOL) between survivors of pediatric posterior fossa brain tumours (PFBT) and typically-developing controls and 3) explore the association between balance and HRQOL. A comprehensive review demonstrated that although the literature suggests that survivors of pediatric brain tumours display ongoing balance deficits, studies have limitations, emphasizing the need for further research. Survivors of pediatric PFBT and typically-developing children were recruited and their balance assessed with the Bruininks-Oseretsky Test of Motor Proficiency-2nd edition (BOT-2) and Pediatric Balance Scale (PBS). Dynamic balance was also evaluated for some participants using a force platform. The Pediatric Quality of Life Inventory measured HRQOL. Statistical analyses included Mann-Whitney U tests to compare results between groups and Spearman's rank correlation coefficient to determine the association between balance and HRQOL. Balance abilities were significantly worse in survivors as measured by the BOT-2. The PBS displayed a ceiling effect. Certain laboratory outcome measures suggested balance difficulties. All participants’ HRQOL scores were within normative values. In survivors, an association was found between BOT-2 scores and the physical dimension of HRQOL. Survivors of PFBT demonstrate persistent balance difficulties, best assessed by the BOT-2; however, they report normal HRQOL. Future research should be collaborative and focus upon the best ways to manage balance deficits.
306

An Examination of Spiritual and Religious Coping and Well-Being and their Impact on the Health-Related Quality of Life for Patients with Mechanical Circulatory Support

Hardy-Duncan, Angela 10 November 2011 (has links)
Mechanical Circulatory Support (MCS) improves the health-related quality of life (HRQOL) for patients with end-stage heart failure (HF) (Friedrich & Bohm, 2007). Religious and spiritual practices positively influence health and well-being for cardiac patients (Ai, Park, Huang, Rodgers, & Tice, 2007; Blackhall, & Koenig, 1998). The purpose of this study was to examine the impact of spiritual well-being (SWB) and religious well-being (RWB) and coping styles and methods (CSM) on health related quality of life (HRQOL) of patients with MCS. This exploratory repeated measures study used Spearmans’ rho and Wilcoxons’ Signed Rank tests for correlation and comparison analyses. The study population included patients with left ventricular assist devices (HMII) and total artificial hearts (TAH). Patients were assessed pre and post MCS implant. Patients reported an increase in the use of faith practices for coping (prayer and meditation), providing evidence for spiritual growth after MCS. SWB, RWB, and CSM, and their corresponding subscales were positively related to HRQOL revealing medium to large correlation coefficients and variances. Post MCS, the TAH patients’ mean scores decreased for SWB and RWB (religious comfort) and increased for RWB (religious strain), indicating some spiritual distress. The internal locus of control for TAH patients increased with significance. HMII patients reported a significant increase in adaptive coping and “God” locus of control. The results suggest that early spiritual assessment with MCS patients may promote more timely and effective responses to maladaptive and dysfunctional coping. Patients who use their faith to cope (in distress or not) may also benefit from an increase in emotional and spiritual attention. Spiritual care providers who are knowledgeable about the MCS assessment, surgery, and recovery process could then provide interventions that build resilience and mediate improved outcomes through supportive and directed counseling. The results of this study inform the future development of interdisciplinary plans of spiritual and emotional care for this patient population and for other chronic illness populations. Further examination may reveal how SWB, RWB and CSM improve HRQOL as well as highlight the unique support needs of HMII and TAH patients.
307

Analyse de la qualité de vie dans une cohorte de patients transplantés rénaux / Quality of life analysis in a cohort of Kidney Transplant Recipients 'KTR)

Mouelhi, Yosra 18 October 2018 (has links)
Quand elle est possible, la greffe de rein est le meilleur traitement de l’insuffisance rénale chronique terminale. La qualité de vie des patients joue un rôle essentiel dans la réussite de la transplantation. Dans ce contexte, notre objectif était d’analyser la qualité de vie dans une cohorte de patients transplantés rénaux en France. Dans un premier temps, nous avons analysé la qualité de vie des patients au moment de leur inclusion dans l’étude dans le but de déterminer les facteurs associés à la qualité de vie. Nous avons retrouvé des caractéristiques socio-démographiques et cliniques connues dans la littérature et de nouvelles variables psycho-sociales ont été identifiées. Ce travail nous a ensuite amené à analyser le profil des patients qui utilisent l’Internet et les réseaux sociaux : près de 80% de patients utilisent Internet et la plupart d’entre eux ont besoin de soutien informatif. Nous avons pu montrer, dans un deuxième temps, une faible concordance de l’évolution de l’état de santé du patient du point de vue du patient et du médecin. Enfin, pour interpréter les scores de qualité de vie dans cette cohorte, nous avons calculé la différence minimale cliniquement significative par la méthode des courbes ROC, en utilisant le changement d’état de santé du point de vue du patient comme critère de changement (anchor). Cette analyse a montré que l’évolution de la qualité de vie de ces patients n’est pas liée au changement d’état de santé des patients. Cette thèse fournit une analyse approfondie sur la qualité de vie des patients transplantés rénaux francophones. / Kidney transplant is the best treatment for chronic end-stage renal failure. The quality of life of the patient plays a vital role in the success of the transplantation. In this context, our objective was to analyze the quality of life in a cohort of kidney transplanted patients in France. As a first step, we analyzed the quality of life of patients at the time of their inclusion in the study in order to determine the factors associated with the quality of life. Socio-demographic and clinical characteristics known in literature were found and new psycho-social variables were identified. This work then led us to analyze the profile of patients using the Internet and social networks: nearly 80% of the patients use Internet and the majority need an informative support. We were able to show, in a second time, a weak concordance of the evolution of the state of health of the patient from the patient and the doctor point of view. Finally, to interpret the quality of life scores in this cohort, we calculated the minimal clinically significant difference, by the ROC curve method and using the change in health status from the patient's point of view as a criteria for change. This analysis showed that the quality of life of these patients is not related to the patient's state of health, and no clinical changes could be detected for the quality of life scores of the two questionnaires. This thesis provides an in-depth analysis of the quality of life of French kidney transplanted patients.
308

Qualidade de vida, imagem corporal e ajustamento psicossocial de pacientes estomizados devido câncer colorretal / Quality of life, body image and psychosocial adjustment to ostomy patients due to colorectal cancer.

Rezende, Fabiana Faria 11 August 2015 (has links)
O Câncer Colorretal (CCR) consiste no terceiro tipo de câncer mais comum em homens e o segundo em mulheres. O tratamento, na maioria dos casos, implica na cirurgia geradora de estoma, que constitui um procedimento invasivo, com grande impacto em todas as áreas na vida da pessoa. O presente estudo teve por objetivos investigar prospectivamente variáveis relacionadas à imagem corporal, sintomas ansiosos e depressivos, domínios da Qualidade de Vida Relacionada a Saúde (QVRS) e as cognições, emoções e comportamentos diante do processo de adaptação ao estoma. Trata-se de um estudo exploratório, longitudinal e de abordagem quanti qualitativa. A amostra foi composta por pacientes adultos (n=122), de ambos os sexos, atendidos no Ambulatório de Estomaterapia do Hospital de Câncer de Barretos (SP). A avaliação quantitativa foi realizada em todos os pacientes e a qualitativa em 26 dos pacientes, sorteados aleatoriamente. Os participantes foram avaliados em quatro momentos (pré-operatório, três, seis e quinze meses após a cirurgia) e foram subdivididos de acordo com o tipo de procedimento cirúrgico realizado (Anastomose Primária, Estomia Intestinal Temporária e Estomia Intestinal Definitiva). Para a coleta de dados, foram utilizados os instrumentos: questionário de dados sociodemográficos; Critério de Classificação Econômica Brasil; ficha de condições clínicas; Escala de Figura de Silhuetas (EFS); Escala de Ansiedade e Depressão para Hospital Geral (HADS); Questionários para avaliação da QVRS (EORTC QLQ-C30/ QLQ-CR38); Medida subjetiva de pensamentos e emoções e Roteiro de entrevista semiestruturada. Os resultados demonstraram que a amostra foi constituída por pacientes mais velhos, de baixa renda e escolaridade. Os valores médios encontrados na avaliação da imagem corporal indicaram uma superestimação desta. Apesar dos participantes não terem apresentado sintomatologias graves para ansiedade e depressão, de acordo com a escala HADS, as comparações estatísticas infere-se que, quanto pior a sintomatologia para ansiedade e depressão, pior a saúde global. Segundo o EORTC QLQ-C30 e QLQ-CR38 a maioria dos domínios de QVRS apresentaram níveis moderados, sendo que os piores sintomas foram os sexuais. A depressão influenciou de forma direta e negativa na saúde global, assim como na acurácia da imagem corporal. Foram encontradas diferenças significantes entre os grupos na comparação das variáveis nos diversos momentos de avaliação, sugerindo que o nível dos sintomas variou de acordo com o tempo. Não foram encontradas altas frequências para as distorções cognitivas nesses pacientes, entretanto, observou-se pela entrevista semiestruturada que na primeira avaliação existia grande preocupação quanto às limitações ocasionadas pela estomia intestinal em detrimento da percepção de normalidade, frequentemente reportada na última avaliação. Conclui-se que a entrevista qualitativa complementou os resultados encontrados na abordagem quantitativa, sendo que a análise de conteúdo reforçou que os pacientes, em geral, apresentaram boa adaptação à estomia. O suporte social foi apontado como uma das principais estratégias utilizadas no processo de adaptação. Neste sentido, orientações psicoeducativas aos pacientes e familiares devem ser realizadas desde o diagnóstico, a fim de contribuir para adaptação ao estoma. / The Colorectal Cancer (CRC) is the third most common type in men and the second in women. The treatment in most cases implies a surgery with a stoma, which is an invasive procedure, with a great impact in all areas in a person\'s life. This study aimed to prospectively investigate variables related to body image, depression and anxiety symptoms, areas of Health Related Quality of Life (HRQoL) and cognitions, emotions and behaviors related to the adaptation process to the stoma. It is an exploratory study, longitudinal, with quantitative and qualitative approach. The sample consisted of adult patients (n = 122), of both sexes, attended in Stomatherapy Clinic of Barretos Cancer Hospital. The quantitative evaluation was performed in all patients and the qualitative evaluation was performed in 26 patients randomly selected. Participants were assessed at four time points (preoperative, three, six and fifteen months after surgery) and were subdivided according to the type of surgical procedure performed (Primary Anastomosis, Temporary Intestinal Ostomy and Definitive Intestinal Ostomy). For data collection, the follow instruments were used: socio-demographic questionnaire; Brazilian Economic Classification Criteria; clinical conditions record; Figures of Silhouettes Scale (FSS); Hospital Anxiety and Depression Scale (HADS); Questionnaires to assess the HRQoL (EORTC QoL-C30 / QoL-CR38); Subjective measure of thoughts and emotions and Semi-structured interviews. The results showed that the sample was composed of older patients, with low income and low education level. The mean values found in the evaluation of body image showed an overestimation of it. Although the participants did not show servere symptomatology for anxiety and depression, according to the HADS, statistical comparisons inferred that, the worse the symptoms for anxiety and depression, worse overall health. According to the EORTC QoL-C30 and QoL-CR38 most HRQoL domains showed moderate levels in which the worst symptoms were sexual. Depression had a direct and negative impact on global health, as well as the accuracy of body image. Significant differences were found between groups when comparing the variables in the different time points, suggesting that the level of symptoms varied according to the time. There were no high frequencies for cognitive distortions in these patients; however, the semi-structured interview shows that in the first assessment there was great concern about the limitations caused by intestinal ostomy at the expense of perceived \"normal\" often reported in the last assessment. We conclude that the qualitative interview complemented the findings in quantitative approach, and the content analysis emphasized that patients generally showed good adaptation to the stoma. Social support was considered one of the main strategies used in the adjustment process. In this sense, psychoeducational guidance to patients and their families must be carried out from diagnosis, in order to contribute to the adaptation to the stoma.
309

Avaliação da qualidade de vida relacionada à saúde: percepção sobre as condições de trabalho e de vida entre profissionais de enfermagem, de hospital universitário no município de São Paulo / Health-related quality of life: perception on living and working conditions among nursing professionals of an university hospital of São Paulo

Silva, Amanda Aparecida 02 March 2009 (has links)
Introdução - O ambiente psicossocial do trabalho em enfermagem influencia diretamente a qualidade de vida dos trabalhadores desta área. Diferenças entre as categorias profissionais nesta profissão podem se traduzir em diferenças na percepção de saúde e de condições de trabalho. Objetivo - Avaliar as associações entre condições de trabalho e qualidade de vida relacionada à saúde (QVRS) de enfermeiros, técnicos e auxiliares de enfermagem. Métodos Foram coletados dados em um hospital universitário no município de São Paulo, de uma população de 696 enfermeiros, técnicos e auxiliares de enfermagem, população predominantemente feminina (87,8%) e que trabalhava em turnos diurno e noturno. Os dados coletados a partir de questionário correspondiam a informações sobre aspectos sóciodemográficos, condições de trabalho e de vida, hábitos de vida e sintomas de saúde referidos desta população. Foram também utilizados os questionários: Questionário Genérico de Avaliação de Qualidade de Vida (SF-36), Escala de Estresse no Trabalho e Desequilíbrio Esforço-Recompensa (ERI). Foram ajustados modelos de regressão logística ordinal de chances proporcionais para cada dimensão do SF-36. Resultados Aproximadamente 22% da população foi classificada como trabalhando em condições de alto desgaste e 8% em desequilíbrio desfavorável entre esforços e recompensa no trabalho. Vitalidade, dor e saúde mental foram as dimensões do SF-36 com pior avaliação. Os modelos de regressão múltipla 5 demonstraram: alto comprometimento associado a todas as dimensões do SF-36, e ERI desfavorável associado a todas as dimensões relacionadas à saúde mental. Alto desgaste no trabalho, ERI desfavorável, alto comprometimento e ser enfermeira associaram-se de maneira independente aos resultados desfavoráveis da dimensão de aspectos emocionais. Conclusões As dimensões relacionadas à saúde mental foram as que mais sofreram influência dos fatores psicossociais do trabalho. ERI desfavorável e alto comprometimento mostraram-se mais significativos à saúde desta população comparados com altas demandas e baixo controle. Os resultados indicam que a análise conjunta dos modelos de desequilíbrio esforço-recompensa e demandacontrole contribui para a discussão sobre os papéis profissionais, condições de trabalho e QVRS de profissionais de enfermagem. / Introduction- The psychosocial work environment influences the quality of life of nursing professionals. Differences among job titles may lead to distinct perceptions of working conditions and health status. Aim-To evaluate working and living conditions and quality of life associated with health (HRQL) among nursing professionals. Methods- Six hundred ninety six nursing professionals, registered nurses and nurse assistants, predominantly females (87.8%), working day or night shifts, participated in a study carried out in an university hospital of São Paulo, Brazil. Data collection took place during 2004-2005 and included a comprehensive questionnaire including sociodemographic characteristics, life styles, working and living conditions, and health outcomes. HRQL was evaluated using the short form questionnaire of quality of life (SF-36). Working conditions included the job stress scale, effort-reward imbalance (ERI), and other environmental and occupational stressors. Ordinal logistic regression of proportional ratios was used to evaluate each of SF-36 dimensions. Results- Imbalance of the effort-reward ratio and high work strain were mentioned by 7.8% and 22.1% of the participants, respectively. Vitality, pain and (poor) mental health were the SF-36 worse perceived outcomes. The multiple regression models showed: over commitment associated with all SF-36 dimensions, and unfavorable ERI associated with mental health dimensions. High 7 job strain, unfavorable ERI, over commitment, and being a registered nurse were independently associated with negative emotional outcomes. Conclusions- The dimensions associated with mental health were significantly influenced by psychosocial factors at work. Unfavorable ERI and over commitment were more significantly associated with health compared to high demands and low control. These results show the importance to jointly evaluate ERI and demand- control models to discuss professional roles, working conditions and HRQL of nursing professionals.
310

Avaliação dos resultados de um programa educativo para pacientes submetidos à intervenção coronária percutânea, um ano após a intervenção / Evaluation of the result of an educative program for patients submitted to percutaneous coronary intervention one year after the intervention

Arantes, Eliana de Cássia 14 August 2015 (has links)
As doenças cardíacas estão entre as condições crônicas consideradas como desafio para o setor saúde deste século e, nas próximas décadas, continuarão sendo a principal causa de morte global. Dentre as doenças cardiovasculares, a Doença Arterial Coronariana (DAC) é uma das mais importantes causas de morbimortalidade na população adulta. A Intervenção Coronária Percutânea (ICP) é uma das formas de tratamento da DAC. Deve ser acompanhada de medidas terapêuticas farmacológicas e não farmacológicas com o intuito de controlar a sua progressão e melhorar a qualidade de vida relacionada à saúde (QVRS). Objetivo. Comparar as medidas de QVRS e de sintomas de ansiedade e de depressão um ano após à ICP, de acordo com o tipo de intervenção recebida (rotina do serviço ou programa educativo com seguimento por telefone). Método. Estudo observacional, de delineamento longitudinal no qual acompanhamos a evolução dessas variáveis de interesse em pacientes submetidos à primeira ICP, entre agosto/2011 e junho/2012, atendidos em um hospital universitário do interior do Estado de São Paulo e que participaram de um estudo clínico aleatorizado. No estudo de intervenção, 30 pacientes participaram de um Programa Educativo com seguimento por telefone (grupo intervenção-GI) e outros 30 receberam informações de acordo com a rotina do serviço (grupo controle-GC) antes da realização da ICP. Doze meses após a intervenção, avaliamos 56 desses pacientes, sendo 29 do GI e 27 do GC. Os dados foram coletados por entrevistas individuais realizadas durante os retornos ambulatoriais ou nas residências dos participantes A QVRS foi avaliada pelo Medical Outcomes Study: 36-Item Short Form Survey (MOS-SF-36) e os sintomas de ansiedade e depressão pela Hospital Anxiety and Depression Scale (HADS), em suas versões validadas para o português. O teste T de Student para amostras independentes foi utilizado para comparar as medidas obtidas pelos instrumentos, segundo a participação ou não no Programa Educativo. O nível de significância adotado foi de 0,05. Resultados. Assim, como na avaliação feita antes da ICP, os grupos continuaram homogêneos nas caracterizações sociodemográficas obtidas, um ano após a intervenção. No GI, 58,6% eram homens, a média de idade foi de 64,6 anos e a maioria era casada (72,4%). No GC, 51,9% eram do sexo masculino, a média de idade foi 61,3 anos e 70,4% estavam casados. A avaliação da QVRS, 12 meses após a ICP, não mostrou diferenças estatisticamente significantes entre os dois grupos aos compararmos as médias dos oito domínios do SF-36. Em ambos os grupos, o domínio melhor avaliado foi Aspectos Sociais (M= 81,9 GI e M=72,7 GC; p=0,169) e o pior avaliado foi Aspectos Físicos (M= 55,2 GI e M=51,87 GC; p=0,777). Não constatamos diferenças entre os dois grupos também para as medidas de ansiedade (M= 6,33 GI e M=6,31 GC; p=0,981) e de depressão (M= 5,89 GI e M=5,31 GC; p=0,578). Conclusão. A participação em um programa educativo antes da ICP não teve efeito na determinação de uma melhor QVRS e menor presença de sintomas de ansiedade e de depressão, doze meses após a realização da intervenção / Cardiac illnesses figure among the chronic conditions that are considered challenging for this century\'s health sector and, in the upcoming decades, they will continue as the main global cause of death. Among the cardiovascular illnesses, Coronary Artery Disease (CAD) is one of the most important causes of morbidity and mortality in the adult population. Percutaneous Coronary Intervention (PCI) is one way to treat CAD. It should come with pharmacological and non-pharmacological measures to control its progression and improve the health-related quality of life (HRQoL). Objective. To compare the HRQoL measures and anxiety and depression symptoms one year after the PCI, according to the type of intervention received (usual care or educational program with telephone monitoring). Method. Observational study with longitudinal design, in which the evolution of these variables of interest was monitored in patients submitted to the first PCI between August/2011 and June/2012, who were attended at a university hospital in the interior of the State of São Paulo and who participated in a randomized clinical study. In the intervention study, 30 patients participated in an Educative Program with telephone monitoring (intervention group-IG) and 30 others received information according to the usual care (control group-CG) before the PCI. Twelve months after the intervention, 56 of these patients were assessed (being 29 from IG and 27 from CG). The data were collected through individual interviews, held during the outpatient return appointments or at the participants\' homes. The HRQoL was assessed using the Medical Outcomes Study: 36-Item Short Form Survey (MOS-SF-36) and the anxiety and depression symptoms using the Hospital Anxiety and Depression Scale (HADS), in its versions validated for Portuguese. Student\'s t-test for independent samples was used to compare the instrument measures according to the participation or not in the Educative Program. Significance was set at 0.05. Results. Like in the assessment preceding the PCI, the groups remained homogeneous in terms of sociodemographic characteristics one year after the intervention. In IG, 58.6% were male, the mean age was 64.6 years and the majority was married (72.4%). In CG, 51.9% were male, the mean age was 61.3 years and 70.4% were married. The HRQoL assessment 12 months after the PCI did not show statistically significant differences between the two groups when the means on the eight SF-36 domains were compared. In both groups, the best domain was Social Functioning (M= 81.9 IG and M=72.7 CG; p=0.169), while the worst was Physical Functioning (M= 55.2 IG and M=51.87 CG; p=0.777). No differences between the two groups were found for the anxiety (M= 6.33 IG and M=6.31 CG; p=0.981) and depression measures either (M= 5.89 IG and M=5.31 CG; p=0.578). Conclusion. The participation in an educative program before the PCI did not affect the determination of a better HRQoL and the lesser presence of anxiety and depression symptoms twelve months after the interview

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