Outcomes measurement is an important component of routine hemophilia care, clinical trials and economic evaluations. Assessing outcomes in patients living with hemophilia is challenging due to a lack of validated outcome measures. Conventional clinical outcomes, for instance, bleeding rate, structural changes of joints or functional joint scores may be less relevant for the decision-making process. Patient reported outcomes measures has been increasingly interested in routine medical care and clinical research. However, the available validated patients reported outcome measures for patients with hemophilia are not generally implemented in routine care or clinical trials. The Patent Reported Outcomes, Burdens, and Experiences (PROBE) study aims to develop a validated patient reported outcome measure for patients living with hemophilia. The PROBE questionnaire is organized in 4 sections, comprising 29 questions. Section I contains questions pertaining to demographic data. Section II contains questions pertaining to patient reported outcomes. Section III contains questions pertaining to hemophilia specific problems and treatments. Section IV contains the EuroQol five dimension 5-level instrument (EQ-5D-5L). The psychometric analysis of revealed that the PROBE questionnaire has a good internal consistency (Cronbach’s alpha coefficient=0.84). PROBE items showed moderate to strong correlations with corresponding EQ-5D-5L domains. The PROBE Score has a known group validity among known groups. The psychometric properties of the PROBE questionnaire demonstrated the validity of the instrument in both patients living with hemophilia and control population (participants without bleeding disorder). The test-retest reliability analysis demonstrated that the PROBE questionnaire has a substantial agreement when the questionnaire was repeatedly administrated. There were acceptable reliability properties between the paper-based and web-based questionnaires. The reliability properties of the PROBE questionnaire were established in both patients living with hemophilia and control population. The PROBE questionnaire was cross-cultural implemented in 21 countries. The results showed that the regions of participant contributed a trivial variability of the PROBE score, indicating that the PROBE questionnaire is valid for assessing the health status among hemophilia patients and participants without bleeding disorder across regions. Sexual health of patients living with hemophilia was evaluated using the PROBE questionnaire. The results showed that sexual difficulty was more prevalent in patients with hemophilia and associated with markers of disease severity. This finding warrants the sexual health assessment in routine hemophilia care. / Thesis / Doctor of Philosophy (PhD)

Background: Good health at community and individual levels are key policy priorities. These priorities can be shown through supporting parents about various different healthy lifestyle choices. In order to know where interventions are needed, it is of interest to study how parents generally feel and how they perceive their parenting. Aim: To study how parents rate their own health and parenting skills, and examine whether there is any correlation between perceived general health and perceived parental competence.  Further, this study will show whether there is a correlation between rate of perceived general health and rate of perceived parental competence when it comes to gender. Method: 64 questionnaires were collected at strategic open kindergartens in the municipality of Uppsala. The questionnaires were distributed to the parents present and who chose to participate in this study. Main result: The result of this study shows that parents have a high rate of general health. A weak correlation between rate of perceived general health and rate of perceived parental competence were found. However a clear correlation between rate of perceived general health and rate of perceived parental competence could be seen of fathers, while the mothers are unrelated. Conclusion:  Parents in Uppsala seems to feel generally well and believe they are capable parents. It also appears that these two factors are interrelated so that parents who are doing well also generally feel better in their parenting. More and major studies are needed to obtain a general and trustworthy result.

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Objective and Hypothesis The goals of this study are to address the following questions regarding shoulder arthroplasty (TSA): (a) Does restoring range of motion (ROM) lead to increased patient satisfaction? (b) How is ability to carry out activities of daily living (ADLs) influenced by ROM? (c) How does ADL performance correlate with patient satisfaction? We hypothesize that more “normal” ROM following TSA leads to increased patient satisfaction and better performance of ADLs. Methods Patients who underwent TSA, reverse TSA, hemiarthroplasty, or humeral head resurfacing were prospectively enrolled in a shoulder arthroplasty registry. 155 patients who had preoperative and 6 month postoperative data for ROM, patient satisfaction, and performance of ADLs were included in the study. Results Of these 155 shoulders, the response rate for patient satisfaction was only 82 (52.9%), with 96.8% reporting they were “satisfied or “very satisfied”. Postoperative ROM was associated with patient satisfaction for forward flexion, adduction, and external rotation. This association demonstrated a “dose;response” relationship, as higher percentage of normal ROM correlated with higher satisfaction. Mean ADL scores were higher for patients who achieved normal ROM in each plane of motion. The greatest improvement in mean ADL score occurred when a patient achieved normal ROM for at least 3 of 5 measurements. There was also a significant association between improved ADL and higher patient satisfaction. Significance Glenohumeral arthrosis causes considerable morbidity, and rates of shoulder arthroplasty are increasing. As the predominant goals of TSA are pain relief and restoration of ROM, it is important to assess postoperative patient satisfaction. While most historic studies have focused on measures of implant performance, interest is increasing in patient-centered outcomes. Both objective and subjective outcomes should be included in future large multicenter registries. Data collected from these registries has the potential to substantially improve success rates and longevity of shoulder arthroplasty.

Background: Globally, there are 10 million new cases of tuberculosis (TB) disease annually and 95% of cases occur in low- and middle-income countries (LMIC). More than 1 billion people use tobacco, and 80% of tobacco users reside in LMIC. Smoking approximately doubles the risk of TB disease and is associated with excess mortality during TB treatment. We aimed to estimate the proportion of annual incident TB cases and TB mortality attributable to tobacco smoking in high burden TB countries. Methods: To estimate population attributable fractions (PAF), we obtained country specific estimates of TB incidence and TB mortality rates from the WHO 2015 Global TB Report. Country specific smoking prevalence was estimated from WHO 2015 tobacco surveillance reports and the Tobacco Atlas. Risk ratios for the effect of smoking on TB incidence and TB mortality were obtained from previously published meta-analyses. Country specific PAF of smoking for TB disease were age and sex adjusted. Results: In high burden countries during 2014, an estimated 4.5 million adults developed TB disease and 163,000 people died from TB. An estimated 740 million adult smokers lived in those high burden countries in 2014. We estimated that tobacco smoking was attributable for 17.7% (95% confidence interval [CI] 8.6-21.9%) of TB cases and 15.0% (95% CI 1.9-31.6%) of TB mortality. Of the high burden countries, Russia had the highest proportion of smoking attributable TB disease (31.8%, 95% CI 16.0-37.8%) and death (28.1%, 95% CI 3.8-51.3%). India had the greatest absolute number of TB cases (233,000) and TB deaths (7,400) attributable to smoking. Men (30.5%, 95% CI 14.9%-36.9%) had a greater proportion of TB cases attributable to smoking than women (4.7%, 95% CI 1.9%-6.2%). Conclusion: In high-burden TB countries, nearly one-sixth of all TB cases and TB deaths were attributable to smoking. Our findings highlight the need for tobacco control in high TB burden regions and specifically among patients with TB. Reaching key populations and integrating smoking cessation efforts into TB programs will be essential to achieve global TB control goals.

Homelessness among unaccompanied youth is a unique, yet pervasive, social problem. Youth often become homeless through three central pathways: conflict with family, involvement in the foster system, and involvement in juvenile justice systems. As youth experience homelessness during important developmental period(s), vulnerability to mental illness may occur if not already present. The present study examined the type and prevalence of mental illness. Characteristics of homelessness, health and mental health service utilization, and pathways to homelessness were examined in relation to the occurrence of mental illness. Findings indicated that a variety of characteristics are associated with mental illness. Mental health service utilization was also evaluated.

No description available.

Objective: Patient-reported outcomes (PROs) are measures collected from a patient to determine how he/she feels or functions in regards to a health condition. Longitudinal PROs, which are collected at multiple occasions from the same individual, may be affected by response shift (RS). RS is a change in a person’s self-evaluation of a target construct. Latent variable models (LVMs) are statistical models that relate observed variables to latent variables (LV). LVMs are used to analyze PROs and detect RS. LVs are random variables whose realizations are not observable. Factor scores are estimates of LVs for each individual and can be estimated from parameter estimates of LVMs. Factor scoring methods to estimate factor scores include: Thurstone, Bartlett, and sum scores. This simulation study examines the effects of RS on factor scores used to test for change in the LV means and recommend a factor scoring method least affected by RS. Methods: Data from two time points were fit to three confirmatory factor analysis (CFA) models. CFA models are a type of LVM. Each CFA model had different sets of parameters that were invariant over time. The unconstrained (Uncon) CFA model had no invariant parameters, the constrained (Con) model had all the parameters invariant, and the partially constrained (Pcon) model had some of the parameters invariant over time. Factor scores were estimated and tested for change over time via paired t-test. The Type I error, power, and factor loading (the regression coefficient between an observed and LV) and factor score bias were estimated to determine if RS influenced the test of change over time and factor score estimation. Results: The results depended on the true LV mean. The Type I error and power were similar for all factor scoring methods and CFA models when the LV mean was 0 at time 1. For LV mean of 0.5 at time 1 the Type I error and power increased as RS increased for all factor scores except for scores estimated from the Uncon model and Bartlett method. The biases of the factor loadings were unaffected by RS when estimated from an Uncon model. The factor scores estimated from the Uncon model and the Bartlett and sum scores method had the smallest factor score biases. Conclusion: The factor scores estimated from the Uncon model and the Bartlett method was least affected by RS and performed best in all measures of Type I error, statistical power, factor loading and factor score bias. Estimating factor scores from PROs data that ignores RS may result in erroneous (or biased) estimates.

Self-reported health (SRH) tends to decline slower as people age compared to the decline of their objective health. If individuals believe they are in good health but actually are in poor health, their perceived susceptibility to disease may be low. Consequently, those individuals may feel less compelled to improve their health, which would make them a higher risk population. This project aims to examine the association of SRH and Metabolic Syndrome (MetS) in senior women, and whether personal and interpersonal dimensions help explain the degree to which SRH corresponds with MetS. Data are from the Kingston Senior Women Study (KSWS, n=100, 65 years of age and older). KSWS participants completed a questionnaire on their social background, psychosocial conditions, health behaviours, and SRH. Participants also provided physiological measures and medical information, so that MetS could be assessed, following the harmonized definition. MetS is a cluster of at least three of the following criteria: obesity, elevated blood pressure, low level of HDL cholesterol, raised triglycerides, and fasting plasma glucose. Two categories represented the correspondence between SRH and MetS: those who have a congruent perception of their health and those who overestimated it. Greater physical activity was associated with higher SRH (OR: 1.10; 95%CI: 1.01 – 1.20) and lower odds of MetS (OR: 0.64, 95%CI: 0.47 – 0.88) among the participants. However, only social network size was associated with lower odds of health overestimation (OR: 0.46, 95%CI: 0.26 – 0.80). Larger social networks may give access older women to a greater source of information about their own health, leading possibly to more accurate assessments of health. Such information can be conveyed as feedback from close ties. This information can also be conveyed as a more accurate perception of the health of their reference group when self-assessing their own health. Findings of this study may help identify women who are at greater risk of cardiovascular disease but who may be less likely to participate in health promotion programs. / Thesis (Master, Kinesiology & Health Studies) -- Queen's University, 2014-05-21 00:14:26.427

Class of 2015 Abstract / Objectives: Pharmacists’ level of training and experience in psychiatric pharmacy were compared for: 1) self-perceived preparedness to provide pharmacotherapy services; and 2) perceived barriers to providing services to individuals with psychiatric disorders. Methods: This study used data from an internet-based questionnaire. Respondents were divided into 2 groups: 1) completed the Arizona Pharmacy Association’s Psychiatric Certificate Program, and/or Board Certified in Psychiatric Pharmacy, and/or College of Psychiatric and Neurologic Pharmacists member, and/or completed a PGY2 psychiatric pharmacy residency; and 2) no specialized training/experience in psychiatric pharmacy. A Mann-Whitney U analysis was used to compare the scaled responses for each group. A Bonferroni alpha correction was use in the case of multiple tests. Results: Compared to pharmacists without training/experience in psychiatry (N = 235), respondents with specialized training/experience in psychiatry pharmacy (N = 38) reported more frequent interactions with psychiatric patients and provided more counseling/drug information, monitoring for adverse drug reactions, recommending non-pharmacological treatments, screening for treatment issues, and making therapeutic recommendations (p < 0.05). Trained pharmacists in psychiatry reported being more prepared to provide all pharmacotherapy services (p = 0.003), except in addressing non-adherence, utilizing online resources, and providing pharmacotherapy services to patients with attention deficit-hyperactivity disorder. They reported fewer barriers (α = 0.005) except for time to provide services, having a private consultation area, and reimbursement for patient care activities. Conclusions: This study found that responding pharmacists without psychiatric training/experience may need additional education/training post-graduation and that they perceive more barriers in providing services to this population.

Class of 2013 Abstract / Specific Aims: To assess the effect of a pharmacist-led education group on psychiatric patient-reported attitudes, knowledge, and confidence in self-managing medications. The reliability and validity of the questionnaire given to patients who attended a pharmacist-led medication education group was also evaluated. Methods: A retrospective pre-post questionnaire was distributed patients and collected variables collected including patient self-reported medication knowledge and attitudes, demographics, previous psychiatric hospitalizations, length of group attended, and outpatient pharmacist relationships. Knowledge and attitude items were measured on a 4-point Likert-type scale with response options ranging from “agree” to “disagree.” Rasch analysis was conducted to ensure all items measured the same construct and the probability of the person responding to an item was not dependent on other assessment items. Rasch measurement includes several diagnostic indices that allow item-specific and person-specific examinations of data reliability and measurement fit. In addition, the Rasch technique makes it possible to evaluate the contribution of each person’s measures on each item. A z-test was used to evaluate for instrument content gaps and a dependent t-test was performed to measure for statistical differences before and after the intervention. Main Results: Sixty patients responded to the Medication Attitude and Knowledge Questionnaire over a 16-week period. Gaps identified were not statistically significant (p=0.1064 and 0.5305) indicating that content validity is comprehensive. On a group level, no significant differences were identified in patient answers before and after the intervention (p=0.2162, p=0.8292). When each patient was analyzed separately, only one patient out of 60 showed a significant difference in answers after the intervention. Results also demonstrated that after attending a group, 100% of patients indicated they intended to adhere to their medication regimen post-discharge. Conclusion: This evaluation was unique because patient attitudes were explored before and after medication education group attendance. Medication Attitude and Knowledge items were valid and reliable.