Background: Stroke is one of the largest health concerns, and the number of stroke cases is increasing globally, especially in development countries. Stroke can lead to permanent disability or death, and physical therapy is vital in order to regain functions. Patients’ mental condition post-stroke is a strong predictor of the rehabilitation progress. Physical activity (PA) and exercise has shown positive effects on a biopsychosocial level and may improve patients’functionality. Objective: To investigate the level of PA, health related quality of life (HRQoL), and to clarify the relation between PA and HRQoL in people with stroke in Thailand. A secondary objective was to investigate the correlation between PA and depression in the same population. Method: PA was monitored objectively with accelerometer for 7 consecutive days, and subjectively with the Physical Activity Scale for People with Physical Disabilities. HRQoL and level of depression was assessed by index-score and Visual Analog Scale (EQ-VAS) from the EuroQoL 5-Dimension 5-Level questionnaire.  Results: The group was not physically active but experienced a high HRQoL. A significant positive correlation was found between HRQoL assessed with EQ-VAS and PA assessed both subjectively and objectively. No correlation was found between PA and depression. Conclusion: PA was associated with a higher HRQoL in stroke patients in Thailand. The participants showed an overall low PA compared to WHO guidelines, and an overall high HRQoL, including low depression. Stroke patients in Thailand should be encouraged to be more physically active, in order to gain the health benefits that PA can give. / Bakgrund: Stroke är ett av våra största hälsoproblem, och antalet strokefall ökar globalt sett,särskilt i utvecklingsländer. Stoke kan leda till permanent funktionsnedsättning eller död, och fysioterapi är avgörande för att återfå funktioner. Patientens mentala tillstånd efter en strokeincident är en stark faktor till hur effektiv rehabiliteringen blir. Fysisk aktivitet och träning har visat positiva biopsykosociala effekter och kan förbättra patientens funktion efter stroke. Syfte: Att undersöka graden av fysisk aktivitet, hälsorelaterad livskvalitet (HRQoL), och relationen mellan fysisk aktivitet och HRQoL hos strokeöverlevare i Thailand. Ett sekundärt syfte är att undersöka korrelationen mellan fysisk aktivitet och depression i samma population. Metod: Fysisk aktivitet mättes objektivt med accelerometer under sju konsekutiva dagar, och subjektivt med Physical Activity Scale for People with Physical Disabilities (PASIPD). HRQoL och depression mättes genom index-score samt Visual Analog Scale (EQ-VAS) från frågeformuläret EuroQoL 5-Dimension 5-Level (EQ-5D-5L). Resultat: Gruppen var inte fysiskt aktiv men upplevde en hög HRQoL. En signifikant positiv korrelation hittades mellan HRQoL bedömt med EQ-VAS och fysisk aktivitet genom både subjektiv och objektiv mätning. Ingen korrelation hittades mellan fysisk aktivitet och depression. Konklusion: Fysisk aktivitet var associerat med en högre HRQoL hos strokepatienter i Thailand. Deltagarna visade en övergripande låg fysisk aktivitetsgrad jämfört med WHO:s riktlinjer, och en övergripande hög hälsorelaterad livskvalité, inklusive låg depressions grad. Strokepatienter i Thailand bör bli uppmuntrade till att bli mer fysiskt aktiva, för att få de hälsofördelar som fysisk aktivitet kan ge.

Bakgrund:Njurtransplantation är den lämpligaste behandlingen vid kronisk njursvikt. Efter njurtransplantationen påverkas patienternas livskvalitet.   Syftet:Att undersöka upplevd livskvalitet hos patienter som genomgått njurtransplantation, vilka faktorer som påverkade livskvaliteten samt om det fanns någon skillnad i upplevd livskvalitet hos njurtransplanterade patienter jämfört med normalbefolkningen och dialyspatienter.   Metod:Litteraturöversikt där tio artiklar från databasen PubMed valdes ut, dessa artiklar kvalitetsgranskades och analyserades. Hälso-relaterad livskvalitet användes som teoretisk utgångspunkt.   Resultat:Studiens resultat kategoriserades i fysisk livskvalitet, psykisk livskvalitet, social livskvalitet samt läkemedlens påverkan på livskvaliteten. De njurtransplanterade rapporterade en förbättrad livskvalitet jämfört med innan transplantationen. Dock uppnådde de inte samma livskvalitet som normalbefolkningen då faktorer i samtliga kategorier påverkade de njurtransplanterades livskvalitet negativt. De njurtransplanterade upplevde sämre muskelstyrka, komplikationer efter transplantationen, högre grad av psykisk stress samt ett ökat behov av emotionellt stöd. De upplevde även biverkningar från den immunsuppressiva medicineringen vilket sänkte livskvaliteten. Njurtransplanterade patienter upplevde dock att deras livskvalitet förbättrades i hög grad jämfört med innan transplantation då de inte längre var i behov av dialys.   Slutsats:Trots att livskvaliteten inte uppnår normalbefolkningens upplevda livskvalitet ökar de njuransplanterades livskvalitet tillräckligt mycket för att en njurtransplantation ska förbättra livet för en patient med kronisk njursvikt. / Background: Kidney transplantation are the most suitable treatment for chronic kidney failure. The kidney transplantation affects the patients’ quality of life.   Aim:To investigate experienced quality of life amongst patients that has undergone kidney transplantation, which factors that affected quality of life as well as if there were any difference in experienced quality of life among kidney transplanted patients compared to the general public and dialysis patients.   Method: A literature review where ten articles from the database PubMed were selected, these articles were examined and analyzed. Health-related quality of life were used as a theoretical basis.   Results:The results of this study were categorized in physical quality of life, mental quality of life, social quality of life and pharmaceutical effects on quality of life. The kidney transplanted patients reported an improved quality of life compared to before the transplantation. However, the kidney transplanted patients did not achieve the same quality of life as the general public because of various factors that affected the quality of life negatively. The kidney transplanted patients experienced reduced muscle strength, complications related to the transplantation, a higher level of psychological stress and an increased need of emotional support. They did also experience side effects from the immunosuppressive treatment which affected the quality of life negatively. Kidney transplanted patients did however experience that their life quality improved to a great degree compared to before the transplantation, because they were no longer in a need of dialysis.   Conclusion:Although the quality of life doesn’t reach the general public's perceived quality of life, the kidney transplanted patients experience an improved life quality. A kidney transplantation therefore improves the life of a patient with chronic kidney failure.

Magister Chirurgiae Dentium (MChD) / An analysis of the oral health related quality of life (OHRQoL) of patients with orofacial clefts at the Wentworth Foundation in Durban, KZN is presented. Objectives: To assess whether the OHRQoL of orofacial cleft patients varies amongst different age groups, genders or cleft types as well as demographic factors. Method: 46 participants, aged 8- 18, completed a self-administered Child Oral Health Impact Profile (COHIP) questionnaire. Results: The most prevalent cleft type was the Unilateral Cleft Left, 45.7%. The COHIP mean score was 84.195 (SD 18.244) ranging from 35 to 110. The age related subscales which were statistically significant included Functional well-being (p value: 0.0456), School Environment (p value: 0.0145) and Treatment Expectancy. The subscale School Environment was statistically significant for: Transport (p value: 0.0267) and Place of accommodation (p value 0.028). The Oral Health subscale and the Educational level were statistically significant (p value 0.043). Conclusion: Statistically significant age-related differences and demographic factors were noted. The OHRQoL of cleft patients was low largely due to socioeconomic factors and difficulty accessing multidisciplinary care. Therefore, our findings highlight the importance of establishing a Cleft lip and palate multidisciplinary facility for these patients in the Wentworth foundation and subsidised transport to the Wentworth Foundation is recommended.

Masters of Science / Fifty percent of the world’s tuberculosis population is found in eight countries, one of which is South Africa. Of the eight countries, South Africa is said to be experiencing the highest burden of Tuberculosis, with an estimated incidence of three hundred and twenty-two thousand cases of active Tuberculosis. The Tuberculosis epidemic is driven by the following reasons, firstly poor living conditions which are a result of the wide gap between the rich and the poverty-stricken among some populations, and secondly late presentation to health facilities. Over the years, healthcare programs have made a meaningful impact in identifying patients presenting for Tuberculosis care, a global Tuberculosis report shows an estimated fifty-eight million lives were saved through Tuberculosis treatment and diagnosis, between the years 2000 and 2018. However, strategies to modify risk behaviour need to remain a main priority. In the South African context, it would be important to note the diversity of the individuals experience which is rooted in South African socio-political history and has resulted in high levels of social inequality and disparate socio-economic status groups, as a significant factor when considering the well-being of Tuberculosis infected South Africans. For policy makers to make data-driven decisions, with the aim of lessening the disease burden experienced by the populations they serve. They would require insights from an individual level, this way of measuring well-being requires the participants to rely on their own cognitive judgements and emotional reactions to characterize their well-being. Alatartseva and Barysheva in 2015 claim that subjective well-being is an internal evaluation of well-being, relating to one’s spiritual, personal characteristics and features. This approach is fitting since behavioural data is dynamic and relative as it tends to differ across populations and is often altered radically in short periods. Despite global advances in access to Tuberculosis treatment, Tuberculosis is the leading cause of death in adults with Human Immunodeficiency Virus and the main contributor to antimicrobial resistance. This gap can be bridged by an understanding of the behavioural aspects tied to Tuberculosis infection. There is a lack of adequate South African literature on Tuberculosis infection and health related well-being. The current study notes and compares, the diversity of life satisfaction experience between participants from different socio-demographic status groups across South Africa, bringing forth the most influential variables on well-being. This paper explored the possible factors of subjective well-being in the Tuberculosis infected South African population. Data from the National Income Dynamics Study 2017 was used, with a focus on the Tuberculosis diagnosed sub-population across all nine provinces in South Africa. The study sample consisted of forty-four individuals who were measured against the following variables: age; gender; population group; place of residence in 1994; labour market participation, education; health; emotional health and well-being and social cohesion. The study employed, Multiple Correspondence Analysis to identify significant variables associated with the well-being of Tuberculosis infected individuals. The results show that the participants of African lineage presented with the lowest level of subjective well-being, followed by the Coloured population which was more likely to have a smoking habit to further decrease their level of well-being. Gender was a significant contributor to well-being with female participants reporting an overall lower level of subjective well-being compared to their male counterpart. Furthermore, those co-infected with Tuberculosis and Human immunodeficiency Virus while poverty-stricken presented with the lowest possible level as they are likely to be depressed, have a weakened immune system and experiencing medication non-adherence.

Philosophiae Doctor - PhD / Rehabilitation of edentulous jaws without the option of osseointegrating implants will remain the only treatment option within reach of many older patients for the foreseeable future. Many routine prosthodontic procedures are based on dogmas, because no high-level scientific evidence exists to either accept or reject them, among these is the “neutral zone” (NZ) concept. In spite of paucity of evidence using approved patient-based outcome instruments, it is generally agreed that the NZ should be respected when constructing complete dentures. The purpose of this research project was to determine how shapes of conventional and NZ mandibular dentures differ, and if the two different types of dentures impact differently on oral health–related quality of life by using an accepted oral health-related quality of life instrument as a patient-based outcome. Thirty nine edentulous patients were selected for his prospective, randomised, cross-over, single-blinded clinical trial. Two sets of complete dentures were made for each patient. One denture set was made following conventional biometric guidelines for determining the position of the mandibular posterior denture teeth in relation to the ridge; another set was made following a functional impression of the potential denture space. Each set of dentures was worn for at least two months. A similar number of types of dentures were delivered first. Widths of residual ridges and mandibular denture arches were measured using digital measuring software. Position of denture teeth was related to the ridge. Denture dimensions were compared by means of analysis of variance using the mixed procedure. Using formula of parabola, arch-widths were compared using paired t-tests. Pre- and post-treatment patient feedback was obtained by means of the 20-item Oral Health Impact Profile (OHIP-20) and a preference score. Treatment effect size (ES) was established based on the OHIP-20 scores. Relevant associations among denture dimensions, OHIP-20 scores, preference, age, gender, marital status, education, income, period of edentulousness, and quality of denture-bearing tissue were done using the generalised linear model and correlation analysis. For all statistical analysis, level of significance was determined at p<0.05. The mean age of the sample was 62.3 years. Twenty four patients were female. Mean period of edentulousness was 31 years and mean number of denture sets worn prior to the trial was 2.5. Except for the canine region, NZ dentures were statistically wider than anatomic dentures. The difference in mean widths between the two types of dentures was larger for female patients. Older patients had smaller differences in denture dimensions. More unfavourable denture-bearing tissue was associated with a larger difference in the two types of dentures. Both types of mandibular dentures significantly improved the OHRQoL of patients. Both types of dentures had a high treatment ES. The OHIP-20 instrument could not distinguish a statistical difference in impact on OHRQoL between the two treatment options. There was a minute difference in treatment ES between the two types of treatment. The only domain representing a small clinical benefit between NZ and anatomic dentures was “physical pain”, with the NZ dentures scoring better. There was no correlation between pre- and post-treatment scores for both types of dentures. No significant associations were found between post-treatment OHIP- 20 scores on the one hand and tissue scores, gender, age, education, marital status, period of edentulousness and denture dimension differences on the other hand. Based on OHIP-20 scores, there was a significant association between denture preference and NZ dentures, but not for the other preferences. No significant associations were found between denture preferences on the one hand and tissue scores, gender, age, period of edentulousness and denture dimension differences on the other hand. Even though no significant relationship was found between preference and gender, the majority of female patients preferred the NZ denture and the majority of male patients did not express a preference.Providing new complete dentures improved OHRQoL of edentulous patients. The majority of female patients preferred the NZ compared over the ANA denture. The NZ technique appeared to have a higher positive impact on OHRQoL of female patients compared to male patients.

Introduktion: Levercirros är ett medicinskt tillstånd i slutskedet som är en följd av en leversjukdom och orsakas bland annat av missbruk av alkohol, kronisk hepatit B och C, och autoimmun hepatit. Enligt rapport från Världshälsoorganisationen lider cirka 10% av befolkningen i världen av kroniska leversjukdomar, och 20 miljoner människor drabbas av levercirros eller dess följd levercancer. Den registrerade mortaliteten av levercirros i Sverige är ca 600 personer per år. För många av dessa patienter innebär det ett stort lidande både fysiskt och psykiskt. Patienterna upplever inte alltid att deras lidande har kunnat lindras, och därför är det angeläget att kunskaper om och förståelse för denna patientgrupp utifrån deras egna upplevelser förbättras och fördjupas.   Syfte: Att beskriva patienters upplevelser av att leva med levercirros och deras självskattning av sin livskvalitet.   Metod: Litteraturöversikt med en systematisk ansats baserad på sex kvalitativa och nio kvantitativa originalartiklar publicerade på engelska under åren mellan 2003 och 2020.    Resultat: Resultatet innefattar tre huvudteman: fysiskt lidande, psykologiskt lidande, och försämrad hälsorelaterad livskvalité. Individer med levercirros upplever rent generellt ett lidande, dock på olika plan samt grader. Ett fysiskt lidande förekommer men även ett psykiskt, och ofta leder det till en försämrad livskvalité.   Slutsats: Forskning har visat att patienter med levercirros möjligen inte kan uttrycka sina åsikter på samma sätt som andra patienter på grund av stigmatisering och skam. Denna litteraturstudie kommer att hjälpa såväl närstående som vårdpersonal att förstå denna patientgrupp, och minska deras lidande på ett adekvat sätt. / Introduction: Liver cirrhosis is a medical condition in the final stages that is a consequence of a liver disease and is caused by, among other things, alcohol abuse, chronic hepatitis B and C, and autoimmune hepatitis. According to a report from the World Health Organization, about 10% of the world's population suffers from chronic liver disease, and 20 million people suffer from liver cirrhosis or its consequent liver cancer. The registered mortality from liver cirrhosis in Sweden is about 600 people per year. For many of these patients, it means great suffering both physically and mentally. Patients do not always feel that their suffering has been alleviated, and therefore it is important that knowledge of and understanding of this patient group based on their own experiences is improved and deepened.   Aim: To describe patients' experiences of living with liver cirrhosis and their self-esteem of their quality of life.   Method: Literature review with a systematic approach based on six qualitative and nine quantitative original articles published in English during the years between 2003 and 2020.   Results: The results include three main themes: physical suffering, psychological suffering, and deteriorating health-related quality of life. Individuals with liver cirrhosis generally experience suffering, however, on different levels and degrees. A physical suffering occurs but also a mental one, and often it leads to a deteriorating quality of life.   Conclusion: Research has shown that patients with liver cirrhosis may not be able to express their views in the same way as other patients due to stigma and shame. This literature review will help both relatives and caregivers understand this patient group, and reduce their suffering adequately.

Bakgrund: Narkolepsi är en kronisk neurologisk sjukdom som påverkar hjärnans förmåga att reglera hormonet hypokretin, vars uppgift är att reglera aptit, sömn och vakenhet. Narkolepsi delas in i två typer, Typ 1 och Typ 2. Fysisk inaktivitet har påvisat öka besvären med överväldigande dagtrötthet och personer med narkolepsi är mindre fysiskt aktiva än friska personer.  Syfte: Undersöka och kartlägga hälsorelaterad livskvalitet och fysisk aktivitet hos en grupp individer med narkolepsi, jämföra åldersskillnader samt undersöka om det finns ett samband mellan dessa variabler.  Metod: Tvärsnittsstudie med icke-experimentell design. Individer från 16 år inkluderades i undersökningsgruppen (n=70). Deltagarna rekryterades via Narkolepsiföreningen genom en sluten Facebook-grupp och ett mejlutskick från deras kansli.  Resultat: Lägre dimensionspoäng inom samtliga dimensioner från RAND-36 kunde påvisas för deltagarna jämfört med normalpopulationen samt att majoriteten av deltagarna uppnår rekommendationerna för fysisk aktivitet per vecka. Signifikant skillnad mellan åldersgrupperna kunde enbart påvisas inom dimensionerna Rollfunktion (emotionell) och Psykiskt välbefinnande. Det fanns en signifikant positiv låg korrelation mellan rapporterade aktivitetsminuter och dimensionen Fysisk funktion.  Konklusion: Resultatet i undersökningen visar på trots att majoriteten av deltagarna uppnår rekommendationerna för fysisk aktivitet skattade de lågt för dimensioner kopplade till psykologiska och sociala aspekter. Det behövs således vidare forskning för att undersöka olika fysiska interventioners effekt på den hälsorelaterade livskvaliteten hos individer med narkolepsi. Resultatet visar även på att det finns ett behov av multimodalt bemötande med fokus på bio-psyko-sociala aspekterna. / Background: Narcolepsy is a chronic neurological illness that effects the brain’s capacity to produce the hypocretin hormone, whose function is to regulate appetite, sleep and alertness. Narcolepsy is divided into two groups, Type 1 and Type 2. Physical inactivity has shown to increase the symptoms of excessive daytime sleepiness and individuals with narcolepsy is less physically active than healthy individuals.  Purpose: To study and chart health-related quality of life and physical activity level in a group of individuals with narcolepsy, to compare age-differences and also to explore whether there is a correlation between these variables.  Method: Cross-sectional study with a non-experimental design. Participants from 16 years old were included in the sample group (n=70). The participants were recruited by Narkolepsiföreningen through a closed Facebook-group and through e-mail from their chancellery.  Results: A lower score within all dimensions could be shown for the participants and that the majority of the participants reach the recommendation for physical activity each week. A significantly difference between the age-groups was disclosed within the dimensions Social functioning and Mental health. There was a significant positive low correlation between reported physical activity levels and the dimension Physical function.  Conclusion: The results in this study show that even though the majority of the participants reach the recommendations for physical activity, the dimensions that were related to psychological and social aspects were low. Thus, further research is needed to study the effect of different physical interventions on the health-related quality of life in individuals with narcolepsy. The results also show that there is a need for a multimodal approach with focus on the biological, psychological and social aspects.

Bakgrund Bäckenbottendysfunktion (BBD) är vanligt hos personer som genomgått förlossning, och kan påverka den hälsorelaterade livskvaliteten. Fysioterapeutisk behandling av BBD kan både symptomlindra och förbättra den hälsorelaterade livskvaliteten (HRQoL). Syfte Att beskriva hur personer 1-5 år postpartum skattar sina bäckenbottenbesvär och sin hälsorelaterade livskvalitet, samt att utreda sambandet mellan BBD och HRQoL. Att utreda hur många av deltagarna som fått behandling av fysioterapeut. Metod I tvärsnittsstudien deltog 205 personer med bäckenbottendysfunktion (medelålder 33,56 år, SD=±4,7). En webbenkät publicerades på fyra Facebooksidor. För korrelationerna användes icke-parametrisk statistik och beräknades med Spearmans korrelationskoefficient. Resultat Medianvärdet för deltagarnas skattade BBD med PFDI-20 var 95. Högst skattat av deltagarnas HRQoL mätt med RAND-36 var delskalan fysisk funktion med medianvärde 80, lägst var vitalitet med 35. Korrelationerna mellan BBD och olika delar av HRQoL varierade mellan delskalan smärta (r= -0,550) som högst, emotionell rollfunktion (r= -0,358) som lägst, och alla korrelationer hade p&lt;0.001. Starkast negativ korrelation mellan sexuell dysfunktion och HRQoL hittades inom dimensionen fysisk funktion (r= -0,517), och svagast för vitalitet (r=-0,235). Samtliga korrelationer hade p&lt;0,001. Av samtliga deltagare har 40% träffat fysioterapeut/sjukgymnast. Konklusion Deltagarna skattade sin BBD högre än en normalpopulation. Studien påvisar en negativ korrelation både mellan BBD mätt med PFDI-20, en egenformulerad fråga om sexuell dysfunktion och skattad HRQoL mätt med RAND-36. Trots upplevd BBD har enbart hälften av deltagarna fått vård för sina besvär. / Background Pelvic floor dysfunction (BBD) is common among people post partum, and it can affect the health-related quality of life (HRQoL). Physiotherapy for the pelvic floor can both ease symptoms and improve HRQoL. Purpose To describe how people 1-5 years postpartum estimate their BBD and their HRQoL, and to investigate the correlation between BBD and HRQoL. To investigate how many of the participants that have received treatment from a physiotherapist. Method In this cross-sectional study 205 people with BBD participated (mean age 33.56 years, SD=± 4.7). A web survey was published on four Facebook pages. Non-parametric statistics were used, and calculated with Spearman's correlation coefficient. Results The median value for the participants' estimated BBD with PFDI-20 was 95. The highest of the participants' HRQoL measured with RAND-36 was the subscale physical function with a median value of 80 and the lowest was vitality with 35. The correlations between BBD and the various subscales for HRQoL varied between pain (r = -0.550) as the highest, and emotional role function (r = -0.358) as the lowest, and all correlations had p &lt;0.001. The strongest negative correlation between sexual dysfunction and HRQoL was physical function (r = -0.517), and the weakest was vitality (r = -0.235). All correlations had p &lt;0.001. Of all participants, 40% have seen a physiotherapist. Conclusion The participants rated their BBD higher than an average population. The study shows a negative correlation between BBD measured with PFDI-20, a question about sexual dysfunction and estimated HRQoL measured with RAND-36. Despite perceived BBD, only half of the participants have received care for their problems.

No description available.

Objective: To quantitatively characterize change in health-related quality of life (HRQoL) in the context of behavioral (n = 16), surgical (n = 5), and pharmacological (n = 1) interventions for pediatric overweight and obesity. A secondary goal was to examine the relationship between change in HRQoL and change in body mass index (ΔBMI) by treatment type. The amount of weight loss necessary to observe a minimally clinically important difference (MCID) in HRQoL was determined. Method: Data were gathered from studies reporting on weight change and ΔHRQoL over the course of obesity interventions (N = 22) in youths (N = 1,332) with average ages between 7.4 and 16.5 years (M = 12.2). An overall effect size was calculated for ΔHRQoL. Moderation analyses were conducted using analysis of variance and weighted regression. MCID analyses were conducted by converting HRQoL data to standard error of measurement units. Results: The overall effect size for ΔHRQoL in the context of pediatric obesity interventions was medium (g = 0.51). A significant linear relationship was detected between ΔBMI and ΔHRQoL (R2 = 0.87). This relationship was moderated by treatment type, with medical (i.e., surgical) interventions demonstrating a stronger relationship. Results indicated that it takes a change of 0.998 BMI units to detect true change in HRQoL. Conclusion: This study provides the first known quantitative examination of changes in HRQoL associated with weight loss in pediatric interventions. Medical interventions appear to offer a more substantial increase in HRQoL per unit of BMI change. These results offer a concrete weight loss goal for noticing positive effects in daily life activities.