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Objectives. To compare four diverse approaches to measuring patient perceptions about health outcomes; the SF-36 Health Survey; clinically derived condition specific instruments; daily time trade-off (DTTO); patient generated index (PGI). The relationship between the instruments and their responsiveness to changes in Health Related Quality of Life (HRQL) was assessed. Results. The response rate exceeded 75% (1327 respondents). The SF-36 had Cronbach's Alpha values above the criterion of 0.7. Test-retest estimates were above 0.7 for al but the role-limitations scales which were above the criterion of 0.5. The specific instruments produced Alpha values and test-retest estimates above 0.7. The DTTO and PGI produced estimates of reliability above 0.5. Evidence for the construct validity of the SF-36 was demonstrated by the differences in scale scores between the general population and four condition-specific groups. Evidence for the construct validity of the specific instruments and PGI was demonstrated by the significant moderate levels of correlation with the SF-36. Evidence for the validity of all four approaches was demonstrated by patient scores behaving as predicted in relation to condition-specific and sociodemographic variables. Comparisons of the four approaches show that the relationship between them is condition dependent. Score changes for the SF-36, specific instruments and PGI were significantly related to self reported health transition. The SRMs for the specific instruments were significantly greater than those for the SF-36. Conclusions. These results demonstrate that the SF-36 has similar properties in United Kingdom patient populations as those in the United States and is satisfactory for comparisons of groups. The clinically derived approach is recommended for constructing instruments where no suitable condition-specific instrument exists. These two approaches are recommended for use as part of a package of instruments for assessing health outcomes.

Yes / Hypertension remains a public health challenge worldwide however, the prevention, detection, treatment and management of this condition are not highly prioritized. Health knowledge has an important impact on individual's health. The ability to actively participate in screening, diagnosis and management of hypertension are influenced by patient's knowledge of hypertension. To understand why hypertension is so difficult to control, it may be of benefit to gain an understanding of the patient's perspective. Hence, the aim of the study is to explore the perceptions of patients on prevention and diagnosis of hypertension in Fiji. The study used a qualitative method approach. The study was conducted at the four purposively selected health centers in the Lautoka/ Yasawa medical subdivision. A purposive sampling was used which included all the patients who attended the SOPD, age more than 18 years and above, diagnosed with hypertension for 6 months or more and attended clinic at one of the 4 selected health centers. Semi-structured open-ended interview guide were used to collect data among patients through in-depth interviews. Thematic analysis was used manually to analyze the data using four steps that is immersion in the data, coding the data, creating categories and identifying themes / subthemes. Twenty-five SOPD patients took part in the in-depth interview and the responses were grouped into two themes. The themes emerged included hypertension knowledge and diagnosis of hypertension in a closed family and self. Subthemes derived from the hypertension knowledge were measures of awareness, hypertension aetiology, risk perception, origin of information and concept of prevention. Sub themes derived from the diagnosis of hypertension in a closed family were perception when first diagnosed, hypertension in relation and hypertension impact. Patients' knowledge on etiologies and risk factors of hypertension were generally poor. Majority of the participants learnt about hypertension in hospitals and few over radios and television. Diagnosis in a closed family triggered worrisome, fear and fright on some patients. Majority of the patients have less knowledge about various risk factors of hypertension. Worrisome, fearful, frightful, frustration and sadness were some of the reactions and emotions highlighted by the patients. It is important to design culturally tailored interventions that address the psychological and behavioral needs of the patients. Recommendation to conduct further studies to understand the perception of hypertension among the general public.

Background: Approximately 2,8 million surgical procedures were performed in Sweden 2016. After surgery, patients experienced different degrees of postoperative pain. Under treated postoperative pain created great suffering for patients, delayed the recovery after surgery and could increase the risk of complications. Therefore, it is of importance to explore and describe patients’ experiences regarding pain in conjunction with surgery, in order to improve postoperative pain relief from a nursing perspective. Aim: To describe how patients experience postoperative pain and pain relief. Method: A literature review was conducted in which four qualitative studies and three quantitative studies were included. The studies were subjected to assurance of quality and Friberg’s three-step analysis was used. Results: Two categories and eight subcategories emerged. The two categories were (1) The time before surgery and (2) The time after surgery. The categories illustrated how patients experienced postoperative pain and pain relief before and after surgical procedures. Conclusion: Patients had previous experiences, expectations, knowledge and beliefs about postoperative pain and pain relief that affected their experiences before surgery. After the procedure, patients' difficulty in communicating, their participation, the attitudes of healthcare professionals and the degree of attendance of the nurse were important experiences related to postoperative pain and pain relief.

Bakgrund: MRSA är i dagens samhälle ett globalt problem. Denna bakterie producerar ett enzym, vilket gör en del antibiotiska läkemedel verkningslösa. Flertalet MRSA-infekterade patienter upplever negativa känslor till följd av infektionen. Dessa tros orsakas av bristande kunskap hos både sjuksköterskor och patienter.Syfte: Syftet med denna litteraturstudie var att belysa patienters upplevelser och erfarenheter av att vara MRSA-infekterad.Metod: I litteraturstudiens resultat har 9 artiklar med kvalitativ ansats sammanställts. Dessa har analyserats med inspiration från det beskrivande metasyntestänkandet. Databaserna Cinahl, Medline, Pubmed och Scopus användes vid sökning av artiklar.Resultat: Patienternas upplevelser vid en MRSA-infektion var komplexa. Känslor av skuld, stigmatisering och att vara smittsam återkom upprepade gånger. Varierande kunskapsnivåer beträffande MRSA påvisades också hos patienterna. Anpassningen till infektionen upplevdes ofördelaktigt påverka möjligheten till ett normalt liv. Information erhållen från vården ansågs otillräcklig och vårdpersonalen upplevdes även agera oprofessionellt i vissa situationer. Konklusion: Ökad kunskap och förståelse för MRSA-infekterade patienter kan bidra till att en god omvårdnad möjliggörs. För att understödja en mer personcentrerad omvårdnad bör eventuellt upplevda skillnader i relation till genus och ålder beforskas. / Background: MRSA is a global problem in today's society. This bacterium produces an enzyme, making some antibiotic drugs ineffective. Most patients infected with MRSA experience negative emotions as a result of the infection. The lack of knowledge of both nurses and patients are believed to be causing these emotions. Aim: The purpose of this literature review was to illuminate patients' perceptions and experiences of being infected with MRSA. Method: 9 articles with a qualitative approach have been compiled in this review. These have been analyzed with inspiration from descriptive meta-synthesis method. The search for articles was performed in the databases of Cinahl, Medline, PubMed and Scopus. Results: The result shows that patients' perceived the MRSA infection as complex. Feelings of guilt, stigma and being contagious recurred repeatedly. Varying levels of knowledge regarding MRSA were also detected. Adaptation to the infection was perceived as an unfavorably affect to the possibility of a normal life. Information obtained from the care was considered inadequate and nursing staff were experienced to act unprofessional.Conclusion: Increased knowledge and understanding of patients' infected with MRSA can make a good healthcare possible. Any perceived differences in relation to gender and age should be further studied in order to contribute a more person-centered healthcare.

Introdução: A percepção do paciente sobre a relação com seu psicoterapeuta é determinante para a sua permanência em tratamento e para o sucesso da psicoterapia. Entretanto, pouco se tem investigado sobre quais fatores disponíveis na fase de avaliação para uma psicoterapia psicanalítica são indicadores de melhor aliança entre terapeuta e paciente. Objetivo: Investigar se há associação entre fatores sociodemográficos e clínicos e a aliança terapêutica, na percepção do paciente. Método: Trata-se de um estudo transversal que avaliou a qualidade da aliança terapêutica em pacientes adultos atendidos em psicoterapia psicanalítica em um ambulatório de saúde mental em Porto Alegre, Rio Grande do Sul, Brasil. A amostra foi constituída por 118 pacientes que chegaram até a quarta ou quinta sessão de psicoterapia psicanalítica e foram avaliados pela escala Calpas – P. Resultados: O estudo mostrou que pacientes do sexo masculino tiverem média (6.44) significativamente menor (p=0.036) a das mulheres (6.66) na escala de avaliação e percepção do trabalho do terapeuta. Encontrou também que quanto maior a intensidade dos sintomas de psicoticismo menor a percepção de aliança na escala de comprometimento com o processo de psicoterapia (r=0.231, p=0.05). Conclusões: Os resultados mostraram que, no início da psicoterapia, gênero e severidade dos sintomas interferem na percepção da aliança terapêutica. Identificou-se que os pacientes homens percebem, em media, menor aliança na dimensão que se refere à compreensão e ao envolvimento do psicoterapeuta, independente do sexo deste. Isso indica, possivelmente, que homens tendem a considerar seus terapeutas com menor capacidade de entender seu ponto de vista e sofrimento, demonstrar aceitação sem julgamentos, dirigir-se ao ponto central de dificuldade, intervir com tato e no tempo certo, e mostrar real compromisso em ajudar e vencer os problemas. Pacientes com sintomas de psicoticismo mais severos apresentaram menor aliança na dimensão que avalia esforço do paciente em empreender uma mudança, boa vontade em fazer sacrifícios em relação ao tempo e ao dinheiro; visão da terapia como uma experiência importante; confiança na terapia e no terapeuta; participação na terapia, apesar de momentos de sofrimento; e compromisso de completar o processo terapêutico. Devido à complexidade do conceito de aliança terapêutica, mais pesquisas são necessárias, a fim de reforçar e demonstrar a influência de variáveis objetivas em seu desenvolvimento (fatores do paciente, do terapeuta e da interação da dupla). Os achados agregam importância à preparação técnica dos terapeutas, para poderem desenvolver melhores alianças com esse tipo de paciente, propiciando maior aderência ao tratamento. / Introduction: The patient's perception of the relationship with their therapist is determinant for their treatment adherence and for the success of psychotherapy. However, little has been investigated about which factors available at the evaluation stage for psychoanalytic psychotherapy are indicators of a better alliance between therapist and patient. Objective: To investigate whether there is an association between sociodemographic and clinical factors and the therapeutic alliance in the patient's perception. Method: This work consists of a crosssectional study that evaluated the quality of the therapeutic alliance in adult patients receiving psychoanalytic psychotherapy in a mental health outpatient clinic in Porto Alegre, state of Rio Grande do Sul, Brazil. The sample was made up of 118 patients who had at least four or five sessions of psychoanalytic psychotherapy and were evaluated using the Calpas – P scale. Results: The study showed that male patients have average (6.44) significantly lower (p=0.036) than women (6.66) in the scale of evaluation scale and perception of the therapist‟s work. He also find that the intensity of the symptoms of psychoticism present lesser alliance in the scale of commitment with the psychotherapy process (r=0.231, p=0.05). Conclusions: The results showed that, at beginning of psychotherapy, gender and severity of the patient‟s symptoms interfere with the perception of therapeutic alliance. It was identified that male patient‟s are, on average, worse at perceiving the alliance in the dimension that refers to therapist understanding and involvement regardless of gender this. This indicate, perhaps, that men tend to consider their therapists with less capacity to understand their point of view and suffering, show acceptance without judgment, address the key point of difficulty, intervene tactfully and timely and show commitment to helping and overcome the problems. Patients with more severe symptoms of psychoticism had lower alliance in the dimension that assess patient‟s effort in undertaking change, willingness to make sacrifices regarding time and money; having a vision of therapy as an important experience; confidence in therapy and in the therapist; engagement in therapy, despite moments of suffering; commitment to completing the therapeutic process. The alliance is a complex concept. This is why more research is necessary in order to reinforce and show the influence of objective variables on its development. Factors related to patient, therapist, and the interaction of the duo are worthy of attention. The findings add to the importance of therapists' technical preparation, so as to enable them to develop better alliances with this type of patient, thus allowing for a better adherence to treatment.

Introdução: A percepção do paciente sobre a relação com seu psicoterapeuta é determinante para a sua permanência em tratamento e para o sucesso da psicoterapia. Entretanto, pouco se tem investigado sobre quais fatores disponíveis na fase de avaliação para uma psicoterapia psicanalítica são indicadores de melhor aliança entre terapeuta e paciente. Objetivo: Investigar se há associação entre fatores sociodemográficos e clínicos e a aliança terapêutica, na percepção do paciente. Método: Trata-se de um estudo transversal que avaliou a qualidade da aliança terapêutica em pacientes adultos atendidos em psicoterapia psicanalítica em um ambulatório de saúde mental em Porto Alegre, Rio Grande do Sul, Brasil. A amostra foi constituída por 118 pacientes que chegaram até a quarta ou quinta sessão de psicoterapia psicanalítica e foram avaliados pela escala Calpas – P. Resultados: O estudo mostrou que pacientes do sexo masculino tiverem média (6.44) significativamente menor (p=0.036) a das mulheres (6.66) na escala de avaliação e percepção do trabalho do terapeuta. Encontrou também que quanto maior a intensidade dos sintomas de psicoticismo menor a percepção de aliança na escala de comprometimento com o processo de psicoterapia (r=0.231, p=0.05). Conclusões: Os resultados mostraram que, no início da psicoterapia, gênero e severidade dos sintomas interferem na percepção da aliança terapêutica. Identificou-se que os pacientes homens percebem, em media, menor aliança na dimensão que se refere à compreensão e ao envolvimento do psicoterapeuta, independente do sexo deste. Isso indica, possivelmente, que homens tendem a considerar seus terapeutas com menor capacidade de entender seu ponto de vista e sofrimento, demonstrar aceitação sem julgamentos, dirigir-se ao ponto central de dificuldade, intervir com tato e no tempo certo, e mostrar real compromisso em ajudar e vencer os problemas. Pacientes com sintomas de psicoticismo mais severos apresentaram menor aliança na dimensão que avalia esforço do paciente em empreender uma mudança, boa vontade em fazer sacrifícios em relação ao tempo e ao dinheiro; visão da terapia como uma experiência importante; confiança na terapia e no terapeuta; participação na terapia, apesar de momentos de sofrimento; e compromisso de completar o processo terapêutico. Devido à complexidade do conceito de aliança terapêutica, mais pesquisas são necessárias, a fim de reforçar e demonstrar a influência de variáveis objetivas em seu desenvolvimento (fatores do paciente, do terapeuta e da interação da dupla). Os achados agregam importância à preparação técnica dos terapeutas, para poderem desenvolver melhores alianças com esse tipo de paciente, propiciando maior aderência ao tratamento. / Introduction: The patient's perception of the relationship with their therapist is determinant for their treatment adherence and for the success of psychotherapy. However, little has been investigated about which factors available at the evaluation stage for psychoanalytic psychotherapy are indicators of a better alliance between therapist and patient. Objective: To investigate whether there is an association between sociodemographic and clinical factors and the therapeutic alliance in the patient's perception. Method: This work consists of a crosssectional study that evaluated the quality of the therapeutic alliance in adult patients receiving psychoanalytic psychotherapy in a mental health outpatient clinic in Porto Alegre, state of Rio Grande do Sul, Brazil. The sample was made up of 118 patients who had at least four or five sessions of psychoanalytic psychotherapy and were evaluated using the Calpas – P scale. Results: The study showed that male patients have average (6.44) significantly lower (p=0.036) than women (6.66) in the scale of evaluation scale and perception of the therapist‟s work. He also find that the intensity of the symptoms of psychoticism present lesser alliance in the scale of commitment with the psychotherapy process (r=0.231, p=0.05). Conclusions: The results showed that, at beginning of psychotherapy, gender and severity of the patient‟s symptoms interfere with the perception of therapeutic alliance. It was identified that male patient‟s are, on average, worse at perceiving the alliance in the dimension that refers to therapist understanding and involvement regardless of gender this. This indicate, perhaps, that men tend to consider their therapists with less capacity to understand their point of view and suffering, show acceptance without judgment, address the key point of difficulty, intervene tactfully and timely and show commitment to helping and overcome the problems. Patients with more severe symptoms of psychoticism had lower alliance in the dimension that assess patient‟s effort in undertaking change, willingness to make sacrifices regarding time and money; having a vision of therapy as an important experience; confidence in therapy and in the therapist; engagement in therapy, despite moments of suffering; commitment to completing the therapeutic process. The alliance is a complex concept. This is why more research is necessary in order to reinforce and show the influence of objective variables on its development. Factors related to patient, therapist, and the interaction of the duo are worthy of attention. The findings add to the importance of therapists' technical preparation, so as to enable them to develop better alliances with this type of patient, thus allowing for a better adherence to treatment.

Introdução: A percepção do paciente sobre a relação com seu psicoterapeuta é determinante para a sua permanência em tratamento e para o sucesso da psicoterapia. Entretanto, pouco se tem investigado sobre quais fatores disponíveis na fase de avaliação para uma psicoterapia psicanalítica são indicadores de melhor aliança entre terapeuta e paciente. Objetivo: Investigar se há associação entre fatores sociodemográficos e clínicos e a aliança terapêutica, na percepção do paciente. Método: Trata-se de um estudo transversal que avaliou a qualidade da aliança terapêutica em pacientes adultos atendidos em psicoterapia psicanalítica em um ambulatório de saúde mental em Porto Alegre, Rio Grande do Sul, Brasil. A amostra foi constituída por 118 pacientes que chegaram até a quarta ou quinta sessão de psicoterapia psicanalítica e foram avaliados pela escala Calpas – P. Resultados: O estudo mostrou que pacientes do sexo masculino tiverem média (6.44) significativamente menor (p=0.036) a das mulheres (6.66) na escala de avaliação e percepção do trabalho do terapeuta. Encontrou também que quanto maior a intensidade dos sintomas de psicoticismo menor a percepção de aliança na escala de comprometimento com o processo de psicoterapia (r=0.231, p=0.05). Conclusões: Os resultados mostraram que, no início da psicoterapia, gênero e severidade dos sintomas interferem na percepção da aliança terapêutica. Identificou-se que os pacientes homens percebem, em media, menor aliança na dimensão que se refere à compreensão e ao envolvimento do psicoterapeuta, independente do sexo deste. Isso indica, possivelmente, que homens tendem a considerar seus terapeutas com menor capacidade de entender seu ponto de vista e sofrimento, demonstrar aceitação sem julgamentos, dirigir-se ao ponto central de dificuldade, intervir com tato e no tempo certo, e mostrar real compromisso em ajudar e vencer os problemas. Pacientes com sintomas de psicoticismo mais severos apresentaram menor aliança na dimensão que avalia esforço do paciente em empreender uma mudança, boa vontade em fazer sacrifícios em relação ao tempo e ao dinheiro; visão da terapia como uma experiência importante; confiança na terapia e no terapeuta; participação na terapia, apesar de momentos de sofrimento; e compromisso de completar o processo terapêutico. Devido à complexidade do conceito de aliança terapêutica, mais pesquisas são necessárias, a fim de reforçar e demonstrar a influência de variáveis objetivas em seu desenvolvimento (fatores do paciente, do terapeuta e da interação da dupla). Os achados agregam importância à preparação técnica dos terapeutas, para poderem desenvolver melhores alianças com esse tipo de paciente, propiciando maior aderência ao tratamento. / Introduction: The patient's perception of the relationship with their therapist is determinant for their treatment adherence and for the success of psychotherapy. However, little has been investigated about which factors available at the evaluation stage for psychoanalytic psychotherapy are indicators of a better alliance between therapist and patient. Objective: To investigate whether there is an association between sociodemographic and clinical factors and the therapeutic alliance in the patient's perception. Method: This work consists of a crosssectional study that evaluated the quality of the therapeutic alliance in adult patients receiving psychoanalytic psychotherapy in a mental health outpatient clinic in Porto Alegre, state of Rio Grande do Sul, Brazil. The sample was made up of 118 patients who had at least four or five sessions of psychoanalytic psychotherapy and were evaluated using the Calpas – P scale. Results: The study showed that male patients have average (6.44) significantly lower (p=0.036) than women (6.66) in the scale of evaluation scale and perception of the therapist‟s work. He also find that the intensity of the symptoms of psychoticism present lesser alliance in the scale of commitment with the psychotherapy process (r=0.231, p=0.05). Conclusions: The results showed that, at beginning of psychotherapy, gender and severity of the patient‟s symptoms interfere with the perception of therapeutic alliance. It was identified that male patient‟s are, on average, worse at perceiving the alliance in the dimension that refers to therapist understanding and involvement regardless of gender this. This indicate, perhaps, that men tend to consider their therapists with less capacity to understand their point of view and suffering, show acceptance without judgment, address the key point of difficulty, intervene tactfully and timely and show commitment to helping and overcome the problems. Patients with more severe symptoms of psychoticism had lower alliance in the dimension that assess patient‟s effort in undertaking change, willingness to make sacrifices regarding time and money; having a vision of therapy as an important experience; confidence in therapy and in the therapist; engagement in therapy, despite moments of suffering; commitment to completing the therapeutic process. The alliance is a complex concept. This is why more research is necessary in order to reinforce and show the influence of objective variables on its development. Factors related to patient, therapist, and the interaction of the duo are worthy of attention. The findings add to the importance of therapists' technical preparation, so as to enable them to develop better alliances with this type of patient, thus allowing for a better adherence to treatment.

Background: Obesity has exploaded in the last decades and an ongoing increase is to be seen. The disease is rated as a huge epidemia of times and has developed to an economic social problem. Today more people die from obesity and it´s complications than from nutritional diseases and malnutrition. Gastric Bypass has proved to enable a new life including an improved health and quality of life but has also been critized for being a quick solution not resulting in a long term perspective weight loss. Aim: The aim of this study was to describe people´s experiences from going through Gastric Bypass surgery. Method: The method used was a literature study based on qualitative research. The articles were analysed according to Fribergs five step model and resulted in three main themes and nine sub-themes. Results: The main themes were- The last way out, The battle against oneself and On a new adventure. In order to be able to support these people keeping their new life style and weight reduction the nurse must have insight in people´s experiences of having undergone a Gastric Bypass surgery. Conclusion: The result showed that Gastric Bypass can be a last alternative for hope about a better future and a chance to an improved health and quality of life. Though the surgery has to be combined with individually created coping strategies and a genuine, strong will to make a change in order to become a successful action in a long term perspective.

Introduction: Orthodontics has clinical benefits, however, the psychosocial outcomes are not well understood. These soft benefits are often classified as aesthetic, functional, and psychosocial, however, there is limited work understanding these outcomes as reported directly from the patient. By better understanding the patient’s perspectives, we can continually refine our clinical model to be patient-centric and more appropriately manage the patient’s expectations and experiences. Materials and Methods: This is a cross-sectional qualitative study of 20 parents of 24 children ages 8-11 years. Participants were remotely interviewed using a semi-structured chronologically based line of questioning to elucidate their perceived outcomes of early orthodontic treatment or phase one. A content thematic analysis using a framework approach was used to analyze the resulting data. Results: The thematic analysis uncovered four major themes and associated subthemes as follows (1) dental health including functional changes, aesthetic improvement, and improved cleansability; (2) opportunity cost: meaning harnessing growth for lasting change, avoidance of future orthodontic treatment, avoidance of future dental treatment, and supervision of growth; (3) social outcomes: encompassing external perception and acceptance, self-perception, parental perception, and reduced dental anxiety; and (4) behavioral changes: including the correction of bad habits, development of good oral hygiene, and an increase in responsibility of the patient. Conclusions:This study highlights the depth of psychosocial benefit perceived by patients undergoing early orthodontic treatment, with the main outcome being functional improvement, followed by an advantage to treatment at a young age, and an improvement in aesthetics. Patients did not recognize an increase in self-perception which is contrary to outcomes previously found in other age groups.