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.

Bakgrund: En svår brännskada innebär en djup hudskada där kroppens underliggande organ kan komma att påverkas vilket kan resultera i ett kritiskt tillstånd. Skadan kan ge konsekvenser som berör den fysiska, psykiska, sociala och existentiella hälsan. Då en svår brännskada bedöms utifrån varje enskilt fall utgår sjuksköterskans omvårdnadsinsatser från de olika konsekvenser som brännskadan medfört. Med sjuksköterskans holistiska förhållningssätt i omvårdnaden kan det identifieras olika aspekter och faktorer i patientens hälsotillstånd som denne upplever vara av ett lidande. Det är då av vikt att sjuksköterskan ser till patientens hälsorelaterade livskvalitet, då detta beskrivs som ett subjektivt mått på hälsa och utgör således patientens unika upplevelser av sitt välbefinnande. Syfte: Att beskriva den hälsorelaterade livskvaliteten hos vuxna personer efter en svår brännskada. Metod: En litteraturöversikt har gjorts enligt Fribergs analysmetod. Tio vetenskapliga artiklar har valts ut med samtliga bestående av kvantitativ design. Artiklarna har sökts fram i databaserna CINAHL Complete och PubMed. Som en teoretisk utgångspunkt har Katie Erikssons omvårdnadsteori valts ut och använts som en referensram i resultatdiskussionen. Resultat: Tre huvudteman med underteman har identifierats: fysiska aspekter av livskvalitet med underteman ”smärta och rörelseförmåga” och “faktorer som påverkar den fysiska livskvaliteten”, psykosociala aspekter av livskvalitet med underteman “psykisk ohälsa” och “faktorer som påverkar den psykosociala livskvaliteten” samt generella aspekter av livskvalitet med underteman “sjukhustiden, vårdinsatser och tid sedan skadetillfället” och “ålder/kön”. Diskussion: I metoddiskussionen har författarna diskuterat för- och nackdelar med utförandet av denna litteraturöversikt. I resultatdiskussionen har det diskuterats de resultat som har varit mest intresseväckande hos författarna. Dessa har diskuterats utifrån Katie Erikssons omvårdnadsteori, litteraturöversiktens bakgrund och tidigare forskning. / Background: A severe burn is defined as a deep dermal damage in which the body's underlying organs can become affected and can result in a critical condition. The consequences of a burn can affect the physical, psychological, social and existential health. Since a severe burn is evaluated on a case to case basis, the nurse's caring interventions are based on the specific consequences from the burn. With the nurse's holistic approach on caring, he/she can identify different aspects and factors in the patient’s general health of which the patient experiences as suffering. Therefore it is of great importance that the nurse cares for the patient's health-related quality of life, since this is described as a subjective measurement of health and compounds the patient’s unique experiences of his/her wellbeing. Aim: To describe the health-related quality of life among adults with a severe burn injury. Method: A literature review was done in accordance with the Friberg analytical method. Ten scientific articles were selected, all of which consisted of a quantitative design. The articles were found in the CINAHL Complete and PubMed databases. As a theoretical base, Katie Eriksson’s caring theory was selected and used as framework in the results discussion. Results: Three main themes with subthemes were identified; physical aspects of quality of life with subthemes “pain and movement capability” and “factors that affect the physical quality of life”, psychosocial aspects of quality of life” with subthemes “psychological ill-health” and “factors that affect the psychosocial quality of life” and general aspects of quality of life with subthemes “length of hospital stay, caring interventions and time since injury” and “age/gender”. Discussion: In the method discussion the authors have discussed the pros and cons of the execution of this literature review. In the results discussion, the results that were of greater interest to the authors have been discussed, in accordance with Katie Eriksson's caring theory as well as the background in this literature review and previous research.

Abstract The aim of this 11-year retrospective study was to evaluate the impact of two spending patterns in glaucoma care on patient outcomes. Two cities were selected to the study because the statistics of Finnish Social Insurance Institution have repeatedly shown a difference in their mean costs of glaucoma medications per patient, i.e. Oulu spending more and Turku less than the national average. Patients with newly diagnosed open angle in 1994–96 were identified from the national register for reimbursement of medication costs. Patients were 45–74 years old when treatment was initiated after which they had consistently used glaucoma medication &#8805;&#160;10 years. For availability of cost data, their place of residence was required to remain unchanged during 1994–2006. In 2006 Social Insurance Institution sent invitations to 360 patients of whom 168 patients (47%) participated and completed the protocol (85 in Oulu and 83 patients in Turku). All patients underwent an ophthalmic examination (visual acuity, intraocular pressure, visual field test, retinal nerve fiber layer and optic disc photography). In addition, patients filled out the 15D health related quality of life questionnaire. All costs of glaucoma care during 11 years were collected for each patient individually. For each follow up year, the total cost was added up including medications, physician visits, diagnostic and follow-up tests as well as laser or surgical procedures. The total 11-year costs of glaucoma care per patient were 35% higher in Oulu (6010&#160;€) compared to Turku (4452&#160;€). Total costs increased with worsening of the disease. After 11 years on treatment, 40% of patients did not show any structural or functional damage. Medication costs accounted up to 73% of total costs. In addition to 29% higher medication costs in Oulu, other than medication costs were also 46% higher in Oulu. In different stages of glaucoma, more treatments (medication, laser and surgery) and more tests (photographs and visual fields) were taken in Oulu. In spite of the higher resource consumption, the 15D instrument did not indicate better quality of life in patients living in Oulu. There was actually a statistically significant counterintuitive difference in the early glaucoma group, i.e. patients using more resources reported worse quality of life. This is the first study evaluating the impact of high resource utilization on quality of life and reporting 15D utility values in different stages of glaucoma. Results from this study indicate that the higher resource allocation may not always lead to measurable benefits to the patients or society in terms of less glaucoma-induced visual disability and/or better quality of life. Further data from randomized trials with both unselected populations as well pragmatic randomized trials of ‘usual patients’ with large sample sizes are required. / Tiivistelmä Tämän 11 vuoden retrospektiivisen tutkimuksen tavoite oli arvioida kahta eri kuluttamismallia glaukooman hoidossa ja niiden vaikutusta hoitotuloksiin. Tutkimusalueiksi valitut kaksi kaupunkia ovat vuosia erottuneet toisistaan Kansaneläkelaitoksen (Kelan) tilastoissa glaukoomapotilaiden keskimääräisten vuosittaisten lääkekustannusten osalta. Oulussa kustannukset potilasta kohden vuodessa ovat olleet korkeammat kuin Turussa. Turussa vuosittaiset lääkekustannukset ovat vuosia jääneet alle kansallisen keskiarvon. Kelan lääkekorvausrekisteristä poimittiin potilaita, joilla oli todettu tuore avokulmaglaukooma ja aloitettu hoito vuosien 1994–96 välillä. Potilaat olivat 45–74-vuotiaita lääkityksen alkaessa. Tämän jälkeen he olivat käyttäneet lääkitystä yhtäjaksoisesti yli 10 vuotta. Kustannustietojen saatavuuden vuoksi potilaiden tuli olla asunut samalla paikkakunnalla 1994–2006 välisen ajan. Vuonna 2006 Kela lähetti kutsun tutkimukseen 360 potilaalle, joista 168 (47&#160;%) osallistui (85 Oulusta ja 83 Turusta). Kaikki potilaat kävivät silmätutkimuksessa (näöntarkkuus, silmänpaine, näkökentät, hermosäie- ja näköhermonpään valokuvaus). Lisäksi potilaat täyttivät 15D-kyselykaavakkeen elämänlaadusta. Kaikki glaukooman hoidosta aiheutuneet suorat kustannukset kerättiin potilaskohtaisesti 11 vuoden ajalta. Jokaisen seurantavuoden osalta määritettiin kokonaiskustannukset, sisältäen lääkityksen, lääkärikäynnit, näkökentät, valokuvat, laser- ja kirurgiset toimenpiteet. Kokonaiskustannukset 11 vuoden seurantajaksolla olivat 35&#160;% korkeammat Oulussa (6010&#160;€) verrattuna Turkuun (4452&#160;€). Kokonaiskustannukset nousivat glaukooman vaikeusasteen kasvaessa. 11 vuoden lääkehoidon jälkeen 40&#160;%:lla potilaista ei ollut glaukoomaan viittaavia vaurioita silmissään. Lääkekulujen osuus kokonaiskuluista oli jopa 73&#160;%. Oulussa lääkekustannukset olivat 29&#160;% ja muut hoitokustannukset 46&#160;% korkeammat kuin Turussa. Jokaisella glaukooman vaikeusasteella hoitoresursseja käytettiin Oulussa Turkua enemmän. 15D-mittarilla tutkittuna Oulussa elämänlaatu ei ollut parempi kuin Turussa suuremmasta resurssikulutuksesta huolimatta. Tutkimuksessa todettiin yhden alaryhmän (varhainen glaukooma) kohdalla jopa viitteitä siitä, että elämänlaatu on huonompi suuremman resurssikulutuksen alueella. Tämä on ensimmäinen tutkimus, joka arvioi suuremman resurssikulutuksen vaikutusta elämänlaatuun. Tutkimus myös raportoi 15D-arvot eri glaukooman vaikeusasteilla. Tulokset viittaavat siihen, että suurempi resurssikulutus ei aina johda mitattaviin hyötyihin potilaan tai yhteiskunnan kannalta, kun päätetapahtumana on glaukooman aiheuttama näkövammaisuus tai parempi elämänlaatu. Tarvitsemme lisää suuremmalla potilasmäärällä tehtyjä satunnaistettuja tutkimuksia.

Perceived availability or receipt of tangible or instrumental social support has generally been associated with favorable outcomes in kidney transplant recipients, yet there has been insufficient attention in the literature to other social relationship processes beyond support that may contribute to mental and physical health. The overall objective of the current study was to examine whether specific dimensions of relationship quality, such as emotional closeness, sexual relations, support transactions, respect/acceptance, and conflict/negative communication, within the context of a close interpersonal relationship, were associated with psychosocial and medical outcomes in kidney transplant recipients when accounting for the effects of global social support. Participants had received a living or deceased donor kidney transplant and were 6 months - 5 years post-surgery at the time of enrollment in the study. A total of 93 participants completed self-report measures and a semi-structured clinical interview via telephone that assessed each of the aforementioned dimensions with regard to a specified relationship. A subsample of 67 participants were married or involved in a committed dating relationship and responded to interview questions with their partner in mind; the remaining participants selected the person to whom they felt closest over the preceding 6 months (e.g., friend, sibling, parent). Structural equation modeling and linear regression were used to analyze the data. Results suggested that the distinct yet highly correlated dimensions reflected an underlying 'relationship quality' construct. Poorer relationship quality was associated with increased symptoms of depression, decreased feelings of well-being, and worse mental health-related quality of life for both the full sample and the subsample of participants in a romantic relationship. The path between relationship quality and depression remained significant for romantic relationship participants when global social support was included in the model, but global social support was more strongly associated with depression, well-being, and health-related quality of life for all participants. Relationship quality was not associated with adherence or graft function in this sample. However, interesting interaction effects were found, such that high conflict and lack of emotional intimacy were more strongly associated with poorer self-reported adherence in women. In addition, women who reported higher conflict in their relationship also endorsed increased depression, decreased well-being, and worse mental health-related functioning compared to men. These findings are consistent with previous research that has cited the importance of global social support for patients who have received a kidney transplant. The present study also provides novel evidence that other dimensions of relationship quality contribute to outcomes in this population. A comprehensive assessment of recipients' close relationships throughout the transplant process, particularly of conflict and emotional intimacy in women, would allow clinicians to recommend psychosocial interventions that could improve patient outcomes.

Bakgrund: Prevalens av fetma ökar i världen. Fetma har både fysisk och mentalpåverkan på individen och förknippas med samsjukdomar såsom diabetes, hjärtochkärlsjukdomar, depression och dåligt självförtroende. Livskvalitet påverkas avfetma.Syfte: Att sammanställa studier som har undersökt samband mellan fetma ochlivskvalitet.Metod: En systematisk litteraturstudie baserad på artiklar med kvantitativ ansats.Tre databaser användes till litteratursökningen; PubMed, CINAHL och PsycInfo.Efter kvalitetsgranskning sammanställdes resultat utifrån de fyra mestförekommande mätinstrumenten för livskvalitet; IWQOL-Lite, EQ-5D, HADSsamt SF-36/SF-12.Resultat: Personer med fetma upplever sämre livskvalitet, särskilt inom denfysiska komponenten av HRQOL. Inget uppenbart samband mellan den mentalakomponenten och fetma kunde påvisas. Prevalens av ångest och depression blandpersoner med fetma observerades.Konklusion: Det är viktigt för sjuksköterskan att vara uppmärksam på hurpersoner med fetma upplever livskvalitet för att kunna rikta sinaomvårdnadsåtgärder. / Background: Obesity is increasing on a global scale. Obesity has both physicaland mental consequences for the individual and is associated with co-morbiditiessuch as diabetes, coronary diseases, depression, and low self-esteem. Quality oflife is affected by obesity.Aim: To compile studies that have examined how obese people experience qualityof life.Method: A systematic review based on quantitative studies. Three databases wereused for the literature search; PubMed, CINAHL and PsycInfo. After qualitycontrol, results were compiled based on the four most commonquestionnaires/surveys; IWQOL-Lite, EQ-5D, HADS and SF-36/SF-12.Results: Obese people experience impaired quality of life, especially in thephysical component of HRQOL. No obvious relation between the mentalcomponent and obesity was found. Prevalence of anxiety and depression wasobserved in obese people.Conclusion: It is important for nurses to be aware of how obese people experiencequality of life, so they can tailor their nursing actions.

The goal of the current study was to evaluate the ways in which religious behaviors and perceived social support are associated with the relationship between depressive symptoms and health-related quality of life for this group. We hypothesized (1) that religious behaviors moderate the relationship between depressive symptoms and health-related quality of life, (2) perceived social support mediates the relationship between depressive symptoms and health-related quality of life and (3) that religious behaviors moderate the mediational indirect effect of perceived social support in the depression and health-related quality of life relationship. Findings from a sample of 244 HIV-positive individuals provided evidence to support direct, conditional, and indirect effects on the depressive symptoms and health-related quality of life relationship. A discussion of the findings, implications for future research and clinical practice are provided.

This research focused on the identification and description of predictors of pediatric and adult cochlear implantation outcomes in a South African cohort and the depiction of profound childhood hearing loss in terms of risk and intervention profiles. Study I described profound childhood hearing loss in a South African cohort of pediatric cochlear implant (CI) recipients in terms of risk profile and age of diagnosis and intervention. A retrospective review of patient files for 264 pediatric CI recipients from five CI programs was conducted. For all subjects, permanent congenital and early onset hearing loss (PCEHL) was confirmed under the age of five years old. The most prevalent risks for profound PCEHL were neonatal intesive care unit (NICU) admittance (28.1%), family history of childhood hearing loss (19.6%) and prematurity (15.1%). An associated syndrome was diagnosed in 10% of children and 23.5% had at least one additional developmental condition. Hearing loss for most (77.6%) children was confirmed as congenital or early onset, while 20.3% presented with postnatal onset of hearing loss. Auditory Neuropathy Spectrum Disorder (ANSD) was diagnosed in 5% of children, with admittance to NICU (80%) and hyperbilirubinemia (50%) being the most prevalent risk factors for these cases. Hearing loss was typically diagnosed late (15.3 months), resulting in delayed initial hearing aid fitting (18.8 months), enrollment in early intervention services (19.5 months), and eventual cochlear implantation (43.6 months). Delayed diagnosis and intervention predispose this population to poorer outcomes. / Thesis (DPhil)--University of Pretoria, 2016. / Speech-Language Pathology and Audiology / DPhil / Unrestricted