Syfte: Syftet med denna enkätstudie var att kartlägga hur dental implantatbehandling påverkar livskvaliteten avseende upplevd tuggförmåga, smak, talet, utseendet och munhygienvanor samt själförtroendet. Material och metod: En empirisk enkätstudie med kvantitativ ansats utfördes på tre olika tandkliniker i Stockholm under perioden feb - april 2012. Enkät med följebrev och frankerat svarskuvert sändes ut genom konsekutivt urval till 83 patienter. Fyrtio patienter varav 15 män och 25 kvinnor, med medelåldrar 66,5 år (34 – 89 år), valde att delta i studien. Analys av svaren utfördes i statistikprogrammet IBM® SPSS® 19. Resultat: Andelen deltagare som upplevde en förbättring i upplevd tuggförmåga uppgick till 42,5 %, talet och smaken upplevdes inte ha förändrats av 85,0 % efter implantatbehandling. Vad gäller utseendet upplevde 27,5 % att det hade blivit bättre och 62,5 % att det inte var någon förändring. Det var 22,5 % som upplevde att självförtroendet hade blivit bättre, medan 75,0 % av deltagarna inte upplevde en förändring i självförtroendet efter implantatbehandlingen. Majoriteten (85,0 %) av deltagarna tyckte inte att deras sociala liv hade förändrats efter behandlingen, medan 7,5 % av patienterna rapporterade att det hade blivit bättre. I resultatet kunde noteras att 17,5 % av patienterna tyckte att det var enklare/lättare att utföra munhygienen medan 75,0 % upplevde ingen förändring med att utföra munhygien efter implantatbehandlingen. Konklusion: En förbättring i oral hälsorelaterad livskvalitet avseende alla studerade faktorer kunde ses hos en del patienter efter implantatbehandling. Flertalet patienter upplever dock ingen förändring i oral hälsorelaterad livskvalitet. / Purpose: The purpose of this survey study was to identify how dental implant treatment affects quality of life regarding chewing ability, taste, speech, appearance, oral hygiene habits, and self-confidence. Materials and methods: An empirical survey study with quantitative data was performed on three different dental clinics in Stockholm during the time period Feb - April 2012. Questionnaire with a covering letter and stamped envelope was sent to a consecutive sample of 83 patients. Participants, 40 patients, 15 men and 25 women, mean age 66.5 years (34 - 89), voluntarily chose to participate in the study. Analyses of responses were performed in statistical software IBM ® SPSS ® 19. Results: The proportion of participants who experienced an improvement in perceived chewing ability was 42,5 %, speech and the taste was perceived not to have changed by 85,0 % after dental implant treatment. Regarding the appearance, 27,5 % said it had improved and 62,5 % that there was no change. There were 22,5 % who felt that their self- confidence had improved, while 75,0 % of participants did not experience a change in self- confidence after dental implant treatment. The majority (85,0 %) of participants did not think their social life had changed after treatment, while 7,5 % of patients reported that it had become better. The result could be noted that 17,5 % of patients found it simpler/ easier to perform oral hygiene while 75,0 % experienced no change in the performance of oral hygiene after dental implant treatment. Conclusion: An improvement in oral health- related quality of life for all studied factors could be observed in some patients after dental implant treatment. Most patients experience no change in oral health- related quality of life after dental implant treatment.

The overall aim of this thesis was to develop knowledge about how to promote health in children treated for cancer and how health promotion interventions based on such knowledge can be evaluated. In this thesis, a descriptive and explorative design has been used, comprising both qualitative (Papers I-III) and quantitative (Papers I and IV) methods. A nationwide cohort of 144 childhood cancer survivors (24-42 years) answered a questionnaire about the support they had received from health care services (Paper I). Fifteen children (8-12years), with experience of cancer treatment, participated in five focus groups with two sessions per group (Paper II and III). The focus group methodology was combined with participatory and art-based techniques, such as draw and tell and photography. The children discussed what promotes health and what friendship is about. A methodological design was used to psychometrically test the Swedish version of the Minneapolis-Manchester Quality of Life instrument (MMQL) (Paper IV). The study included 950 pupils in grade 6 and 9 from seven primary schools. In addition to this, a comparison of the MMQL instrument with the health-promoting factors described by children in the focus groups was performed. The findings showed that there is a need for health-promoting factors, such as knowledge and psychosocial support, from health care services for childhood cancer survivors. Their family and friends may contribute with support and then serve as health-promoting factors. Health-promoting factors, according to children 8-12 years of age and with experience of cancer treatment, are meaningful relationships, recreational activities and a trustful environment. The children expressed a holistic view of what promotes their health. Friendship, from the perspective of the children, is a process of equal and mutual commitment that develops over time and with interactions occurring face-to-face and digitally. The MMQL instrument may be valid and reliable in a sample of healthy children. However, less than one-third of the items in the MMQL instrument could be linked to the health-promoting factors that the children participating in the focus groups highlighted. In conclusion, the findings in this thesis contribute knowledge from a participant perspective regarding the needs and the experiences of health-promoting factors for those who have received treatment for cancer. This knowledge could form a basis for development of health promotion interventions aimed at children who have received treatment for cancer. It is suggested that if the MMQL instrument is used to evaluate health promotion among children who have received treatment for cancer, the MMQL should be complemented with items that capture aspects of health that are important to the children.

Thesis (PhD)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: A comprehensive food frequency questionnaire (FFQ) was developed to assess the daily total flavonoid intake over the past fortnight within a 14-week intervention that consisted of four periods to determine the effect of rooibos consumption on oxidative stress in adults (n=40) at intermediate to high coronary heart disease (CHD) risk. Within the intervention the comprehensive FFQ validity (against six estimated dietary records and biomarkers), reproducibility (on administrations in the washout and control periods six weeks apart as these periods had similar flavonoid intake restrictions) and responsiveness (across the four intervention periods of changed dietary conditions) was evaluated. The baseline period dietary record and FFQ dietary sources found to contribute most to the participants’ daily total flavonoid intake, considering the percentage contribution, and the between-person variation in intake, considering the stepwise multiple regression analysis, formed the food list of the resultant abbreviated FFQ. The validity, reproducibility and responsiveness of the latter were also evaluated within the intervention and its validity (against dietary records) and reproducibility (on re-administration two weeks apart) in an additional group (n=90) being at low and intermediate CHD risk to evaluate its external strength. The validity and reproducibility evaluations of the comprehensive and abbreviated FFQs in the intervention and abbreviated FFQ within the additional group comprised paired difference tests (to establish the ability to estimate group intakes), correlation coefficients (to establish the ability to rank individual participants), category agreement and gross misclassification next to the weighted kappa statistic (to establish the ability to classify the participants into tertiles and quintiles of intake) and Bland-Altman plots (as representation of the limits of agreement between the two dietary assessment methods). Correlation coefficients were also used for biomarker validity evaluations in the baseline period. The repeated measures analysis of variance (ANOVA) (Bonferroni correction) was used for the responsiveness evaluations of the comprehensive and abbreviated FFQs across the intervention periods alongside that of the biomarkers as evidence for the changed dietary conditions. The study demonstrated that the comprehensive FFQ could be modified to a format with a brief food list as few items contributed appreciably to the total flavonoid intake and of which most also contributed to the between-person intake variability. The comprehensive and moreover the abbreviated FFQ in the validity evaluations provided sufficiently accurate daily total flavonoid intake estimates. They could determine the intake at group level in correspondence with that of the dietary records. The participant intakes could additionally be categorized and in particular ranked greatly alike to the dietary record intakes. The Bland-Altman plots revealed proportional bias regarding overestimation at the higher intake level. The reproducibility also appeared to be greatly satisfactory although seasonal fruit exclusions from the abbreviated FFQ food list may hamper its repeated administration. Both FFQs also confirmed the changed total flavonoid intakes across the intervention periods in relation to changes in the expected direction concerning the plasma total polyphenol, conjugated diene and thiobarbituric acid reactive substance concentrations. / AFRIKAANSE OPSOMMING: ‘n Omvattende voedsel frekwensie vraelys (VFV) is ontwikkel om die daaglikse totale flavonoïed inname oor twee agtereenvolgende weke te beraam te midde van ‘n 14-week intervensie. Die intervensie het uit vier periodes bestaan wat die effek van rooibosinname op oksidatiewe stres in volwassenes (n=40), met ‘n intermediêre tot hoë koronêre hartsiekte (KHS) risiko, bepaal het. Binne die intervensie is die geldigheid (teen ses geskatte dieetrekords en biochemiese merkers), herhaalbaarheid (op aanwending ses weke uitmekaar in die uitwas en kontrole intervensie periodes met dieselfde flavonoïed inname bepalings) en waarneembaarheid (oor vier intervensie periodes van veranderde dieet bepalings) van die omvattende VFV geëvalueer. Die dieetbronne in die basislyn periode dieetrekords en vraelyste wat die meeste tot die deelnemers se daaglikse totale flavonoïed inname (baseer op die persentasie bydrae) en die tussen-persoon variasie in inname (baseer op die stapsgewyse meervuldige regressie analise) bygedra het, het die voedsellys van die voortvloeiende verkorte VFV gevorm. Die geldigheid, herhaalbaarheid en waarneembaarheid van dié VFV is binne die intervensie geëvalueer en die geldigheid (teen dieetrekords) en herhaalbaarheid (heradministrasie twee weke later) daarvan in ‘n verdere groep (n=90) met lae en intermediêre KHS risiko as evaluasie van die eksterne vermoë van die VFV. Die geldigheid en herhaalbaarheid evaluasies van die omvattende en verkorte VFV in die intervensie en die verkorte VFV in die verdere groep het bestaan uit gepaarde verskil toetse (bepaling van die groepinname skattingsvermoë), korrelasie koëffisiënte (bepaling van individuele deelnemer rangorde skattingsvermoë), kategorie ooreenstemming en erge wanklassifikasie naas die aangepaste kappa statistiek (bepaling van die vermoë om die deelnemer innames in derdes en vyfdes te klassifiseer) en die Bland-Altman karterings (verteenwoordiging van ooreenstemmingslimiete tussen die twee dieetinname metodes). Korrelasie koëffisiënte is ook gebruik vir biochemiese merker geldigheid evaluasies in die basislyn periode. Die herhaalde metings analise van variansie (ANOVA) (Bonferroni regstelling) is gebruik om die waarneembaarheid evaluasies van die omvattende en verkorte VFV oor die intervensie periodes naas dit van die biochemiese merkers te evalueer as bewys van die veranderde dieet bepalings. Die studie het aangedui dat die omvattende VFV gewysig kon word tot ‘n formaat met ‘n verkorte voedsellys omdat slegs ‘n aantal items merkbaar tot die totale flavonoïed inname bygedra het en die meeste hiervan ook tot die tussen-persoon variasie in inname. Die omvattende en die verkorte VFV het in die geldigheid evaluasies daarvan voldoende akkurate daaglikse totale flavonoïed inname skattings opgelewer omdat groep innames bepaal kon word in ooreenstemming met dit verkry van die dieetrekords en die deelnemer innames bykomend kategoriseer en in besonder grootliks eenders rangeer kon word as met hul dieetrekord innames. ‘n Proporsionele oorskatting by die hoër inname vlakke is wel vir al twee getoon in die Bland-Altman karterings. Die herhaalbaarheid was ook grootliks aanvaarbaar, alhoewel seisoenale vrugte uitsluitings in die verkorte VFV voedsellys die heruitvoering kan bemoeilik. Al twee vraelyste kon ook die veranderinge in die daaglikse totale flavonoïed inname oor die intervensie periodes bevestig in ooreenstemming met veranderinge in die verwagte rigting van die plasma totale polifenool, konjugaat diëne en tiobarbituursuur reaktiewe stof konsentrasies.

INTRODUCTION: Child maltreatment is a significant public health problem that affects all countries and cultures alike. Child maltreatment, which includes neglect, physical abuse, emotional abuse and sexual abuse, can result in negative consequences that are lifelong and irreversible. Previous studies have shown the prevalence of all forms of child abuse in India, which is also home to one fifth of the world’s children. However, adequate resources and efforts are not being made to understand the true scope of this problem. AIM: The present study utilized an existing measure, the Childhood Trauma Questionnaire (CTQ), to understand how parents from the South Indian culture defined acceptable child rearing practices and physical and emotional child abuse. The items from the physical and emotional abuse subscales on the CTQ were also tested for validity and reliability. It was hypothesized that fathers would report higher scores on the physical abuse subscale and mothers would report higher scores on the emotional abuse subscale. It was also hypothesized that parents would find spanking to be an acceptable form of discipline and note that both child physical and emotional abuse are not prevalent in the South Indian community residing in the United States. METHODS: This study recruited 41 participants (21 mothers and 20 fathers) to complete the CTQ. Of the total number of participants, ten were randomly assigned to participate in an in-depth interview, which focused on how parents in the South Indian community in Georgia interpreted the items on the CTQ and how parents defined child physical and emotional abuse. Reliability and validity testing was conducted using data analysis software SPSS 23.0. Qualitative analysis of the interviews involved Consensual Qualitative Research, identifying common themes among all ten interviews. RESULTS: Quantitative analysis revealed low to moderate internal consistency for the emotional abuse scale (α = 0.65) and moderate to high internal consistency for the physical abuse scale (α = 0.88). Independent t-test results showed that fathers reported higher scores on both the physical and emotional abuse subscale; however, these results were not significant. Using the Consensual Qualitative Research method, six domains were determined from the interviews. These included: (a) parent perspectives on child rearing practices, (b) spanking as a discipline practice, (c) country differences between India and the United States regarding discipline, (d) prevalence of abuse among the South Indian community in the United States, (e) reporting child abuse, and (f) parents’ awareness of resources to develop parenting skills. A majority of participants reported spanking as an acceptable form of discipline and believed that neither child physical nor emotional abuse was prevalent in the South Indian community in the United States. CONCLUSION: This study serves as formative research and encourages further investigation of different forms of child abuse in Indian populations, specifically child physical and emotional abuse. Understanding how a culture views children and child rearing practices is important in determining how abuse is defined within said culture. Societies that are more lenient and accepting of violence in general are at a greater risk for perpetrating the maltreatment of children. Establishing a concise definition of child abuse will aid in the development of valid measures that will determine the actual scope of the problem and create solutions, such as laws and policies that will shift a society’s view on appropriate interactions with children.

Sleep is essential for survival but a significant minority of the adult population are dissatisfied with their sleep, and 6-10% meet the criteria for insomnia disorder, characterised by difficulties falling asleep at bedtime, waking up in the middle of the night or too early in the morning, and daytime symptoms. Cognitive behavioural therapy for insomnia (CBT-I), an evidence-based sleep-focused intervention, has been suggested as the treatment of choice for chronic insomnia. However, access to specialised sleep therapists is sparse, and a service delivery model based on the principles of ‘stepped care’ has been proposed. Even though CBT-I is shown to be effective, there is a need to continue the development of cognitive behavioural treatments for insomnia. As a complement to traditional interventions, the potential value of acceptance, that is, to make an active choice of openness towards psychological experiences, has been recognized. However, it has not yet been systematically investigated, and specific instruments for studying acceptance in insomnia are lacking. The present thesis is based on three studies: Study I showed that manual-guided CBT for insomnia delivered by ordinary primary care personnel has a significant effect on perceived insomnia severity, sleep onset latency and wake time after sleep onset. Study II demonstrated that non-responders in Study I reported shorter sleep time at baseline than did responders, a notion that may help select patients for this type of low-end intervention in a stepped care treatment approach. Study III aimed to develop a new assessment instrument for studying acceptance of insomnia, the Sleep Problem Acceptance Questionnaire (SPAQ), resulting in an eight-item questionnaire with two factors; the first being Activity Engagement, persisting with normal activities even when sleep is unsatisfactory, and the second involving Willingness, avoiding fighting and trying to control sleep problems. In conclusion, the present thesis demonstrates that it is feasible to treat patients with insomnia using CBT-I administrated by ordinary primary care personnel in general practice, and that those with relatively longer initial sleep duration benefit most from treatment, enabling allocation to relevant treatment intensity. In addition, acceptance of sleep difficulties may be quantified using the SPAQ.

<p>Vardagslivets belastning har en stark påverkan på människors välbefinnande, men utbudet av reliabla och valida mätinstrument är inte tillräckligt stort. Syftet med föreliggande studie är att göra en systematisk utvärdering av Life Content Questionnaire (LCQ), en enkät baserad på Krav-Kontroll-Stöd-modellen avsedd att mäta generell belastning i vardagen. Undersökningsdeltagarna var 272 föräldrar; kvinnor och män boende i Stockholms kommun med minst ett barn 0-16 år. LCQs psykometriska egenskaper mättes både genom en kvantitativ och med en kvalitativ studie. Inledningsvis genomfördes reliabilitetsberäkningar och en jämförande statistisk analys mot andra stress- och utbrändhetsmått. Därefter utfördes semistrukturerade metodorienterade intervjuer kring var och en av skalans frågor. Tematisk analys användes i databearbetningen av intervjuerna. Resultatet visade att LCQ är ett reliabelt och valitt instrument. LCQ var approximativt normalfördelat och korrelerade signifikant med ett stress- och ett utbrändhetsmått. Kontrolldelskalan föll ut i två komponenter och respondenterna uppfattade fråga 5 (angående motstridiga krav) väldigt olika samt påpekade att de påståenden som mäter socialt stöd var svåra att skilja åt.</p>

本文的主要目的是為使用者建立一個方便使用及減少成本的網路問卷模型，以模糊統計為基礎，主要探討梯形隸屬度函數的統計量，讓使用者能透過系統，從事問卷調查。 網站共有5個部份,分成(1)問卷調查(2)威克生等級檢定(3)離散型模糊資料統計量(4)連續型模糊資料統計量(5)模糊迴歸；網頁使用ASP.NET2.0撰寫，並在其中加入資料庫語法，連結資料庫，讓使用者可以在線上輸入資料，並獲得統計結果。 / The main purpose of this paper is to build up a questionnaire model, which is convenient to use and can reduce cost for the users. With the foundation of the fuzzy statistics, the main study is about the statistical quantity of trapezoid membership function, and let them work on a questionnaire through system. The website totally has 5 parts and is divided into (1) A questionnaire, (2) Wilcoxon Signed-Rank Test, (3) The statistical quantity with discrete fuzzy data, (4) The statistical quantity with continuous fuzzy data, (5) Fuzzy regression equation. The web page is composed of ASP.NET2.0, and database phrasing is added therein to link database. Let users input data on line, and get the results of statistics.

This thesis explores treatment satisfaction and dissatisfaction in patients with chronic low back pain (CLBP). Chapters 1 and 2 provide background on CLBP, and treatment satisfaction and dissatisfaction. Chapter 3 presents study 1, the systematic review which identified research concerning treatment satisfaction and dissatisfaction in patients with CLBP. Findings indicated a need to define the concept, and establish appropriate measurement based on patient input and evidence to support the reliability and validity of items. Chapter 4 presents study 2, a qualitative study. Ten patients with CLBP taking medication and/or receiving physiotherapy were interviewed. A conceptual model of CLBP and a thematic map of treatment satisfaction and dissatisfaction were developed. Satisfaction was related to being 'happy' or 'pleased', and maintaining normal functioning. Treatment not working, causing discomfort, or negatively affecting health-related quality of life, as well as inconvenience of medication, lack of information, not feeling involved in treatment decisions, lack of trust and confidence in healthcare professionals, and being misdiagnosed or undiagnosed, were associated with dissatisfaction. Chapter 5 documents the development of the CLBP Treatment Satisfaction Questionnaire, based on patient input from study 2. Cognitive debriefing showed items were relevant and understood by patients. Chapter 6, study 3, explored the psychometric properties of the questionnaire. The longitudinal design involved data collection from 249 patients, some of whom participated in follow-ups. Results indicated that treatment satisfaction/dissatisfaction involves an appraisal of the following seven domains: 'Information Provided about Back Pain and Treatment', 'Burden of Back Pain', 'Impact of Back Pain and Treatment on Relationships', 'Satisfaction with the Treatment Process', 'Problems with Side Effects of Medication', 'Adherence to Physiotherapy', and 'Medication Acceptability'. Some evidence of reliability and validity are presented. This thesis concludes with Chapter 7, a discussion of the main findings of the studies, strengths and limitations, and recommendations for future research.

Background: Clinical and physiotherapy professional guidelines advocate enquiry into, and documentation of the impact of musculoskeletal pain on a range of psychosocial and functional aspects of life. However, there is no clinical tool to assist this process. The Impact of Symptoms Questionnaire (IoSQ) is patient-completed and was developed to meet the needs of outpatient physiotherapists. It explores the impact of health conditions on patients’ beliefs/concerns and their ability to undertake work/caring responsibilities and activities of daily living; and to enjoy their usual hobbies or activities. It also enquires into the impact on mood and relationships. It comprises a “Yes” or “No” response for each of the five domains with the option of providing written comments. There are also four numerical rating scales. A discharge version determines if patients’ needs and expectations have been addressed. However, the acceptability and usefulness of the IoSQ has not been explored in a department naive to its development. Project purpose Two studies were undertaken, to explore: the role of the IoSQ for enhancing documentation of psychosocial and functional assessment; and the perceptions of staff and patients regarding the acceptability and clinical value of the IoSQ Research questions Enquiry into the primary research question, “Is the introduction of the Impact of Symptoms Questionnaire to a physiotherapy outpatient department acceptable and clinically useful for patients and staff?” was undertaken through secondary questions which explored: patients’ experiences of psychosocial and functional assessment before and after the introduction of the IoSQ; the role of the IoSQ for the provision of documentation; evidence for staff and patients engaging with the IoSQ; and staff and patients’ experiences of using the IoSQ. Project design and methods: A pragmatic mixed model project was undertaken in a department comprising predominantly post-surgical orthopaedic patients. Study 1 explored current practice; study 2 explored the impact of introducing the IoSQ, with minimal training as to its role or use. Methods for both studies comprised sequential audits of patients’ notes, and surveys and focus groups for patients and staff. Results: The audits (study 1, n=60; study 2, n=55) highlighted that documentation by physiotherapists for assessing the impact across all five domains remained low at about 20%, with 40% of the notes in both studies not providing evidence of enquiry into any of the domains. Only one set of notes provided physiotherapist evidence that a domain was still affected at discharge. Study 2 showed that patients consistently completed the IoSQ with 62.6% of the domains being affected at assessment and 19% of the domains being unresolved at discharge, affecting 64.1% of the patients. Survey feedback (study 1, n=19/60; study 2, n=33/55) identified that patients felt it was important to assess the broader impact of a health problem and staff and patients indicated that the IoSQ was relevant to the presenting conditions and was easy to use. This was further explored in the three focus groups (patients, n=3 studies 1 and 2; physiotherapists n=8, study 2) where frustration with validated outcome questionnaires in current use was expressed. However, patients felt they took responsibility for raising issues, even when the IoSQ was provided. Patients and staff felt that if physiotherapists were able to engage with the IoSQ better, it could help to provide structure and prompts to identify patients’ questions or concerns about their condition and the functional impact. The potential for patients to describe the impact in their own words was particularly valued as well as its potential, to improve rapport and more effectively match expectations It was also demonstrated that the IoSQ can enhance documentation of the impact of health problem - from the patient’s perspective. Conclusion: Patients engaged well with the IoSQ and it has potential to be a useful tool to facilitate identification and discussion of the broader psychological, social and functional impact of a health problem. However, staff would need additional training to facilitate discussion with the completed forms and patients, and further research would be required to determine its impact on patient outcomes.

This thesis aimed to develop a measure to investigate the perceived motivational climate in individual sports. In particular, it aimed to address some of the knowledge gaps in the current literature examining motivational climates: by developing a measure whose intended population participate in individual sports; that incorporates the perceived motivational climate created by multiple significant others; and that incorporates the 'impact' or salience of each of these perceptions of the motivational climate. In order to achieve this, the thesis is comprised of four studies.