Le lupus érythémateux disséminé (LES) est une maladie systémique auto-immune chronique dont le retentissement sur la vie des patients est très lourd. Au cours de la décennie écoulée, des échelles de qualité de vie spécifique du lupus systémique ont été développées pour compléter les données obtenues avec les questionnaires génériques. Dans une première partie de ce travail, nous exposons la définition du concept de qualité de vie et les différentes manières de la mesurer. Nous présentons ensuite l’état des connaissances sur les facteurs influençant la qualité de vie au cours du LES. Dans une seconde partie, nous exposons les résultats obtenus sur une cohorte de 182 patients atteints de LES (étude FRESHQOLA) ayant pour but de valider la version française du questionnaire spécifique LupusQoL. La validité et la fiabilité du questionnaire étaient satisfaisantes. Dans une seconde partie, nous présentons les résultats de la sensibilité au changement du même questionnaire, et nous montrons que le LupusQoL permet de capter un changement dans l’état de santé des patients, et qu’il serait plus sensible au changement que le questionnaire générique SF-36 pour mesurer une amélioration de leur état de santé. Dans une troisième partie, nous présentons les résultats de l’étude EQUAL sur 330 patients ayant pour objectif la validation du questionnaire SLEQOL. Outre la fiabilité et la validité du questionnaire, nous avons réalisé une analyse de fonctionnement différentiel d’item entre les patients de notre cohorte et un échantillon de patients issus de la cohorte de développement de l’échantillon à Singapour. Le SLEQOL était fiable et valide malgré 4 items montrant un fonctionnement différentiel modéré. Dans une quatrième partie, nous présentons l’analyse des facteurs associés à la qualité de vie mesurée par les questionnaires spécifiques LupusQoL, SLEQOL et les questionnaires génériques SF-36 et WHOQOL dans cette même cohorte de 330 patients. La qualité de vie dans les domaines physique, mental et social était fortement associée aux facteurs socio-économiques et en particulier la précarité sociale, telle que mesurée par le score EPICES. Les femmes avaient une altération de la qualité de vie spécifique, tandis que le surpoids et le tabagisme influençaient les questionnaires génériques mais pas les questionnaires spécifiques, suggérant que dans ces situations, les patients n’attribuent pas la gêne à leur lupus. Enfin, l’atteinte articulaire était la manifestation clinique de la maladie la plus fortement associée à une diminution de la qualité de vie. Ces résultats ouvrent donc des perspectives dans la compréhension du retentissement du lupus systémique sur le quotidien des patients et nous permettront de mieux comprendre les résultats des essais cliniques et études épidémiologiques à venir. / Systemic Lupus Erythematosus (SLE) is a chronic systemic auto-immune disease that considerably impairs patients’ daily living. During the past 10 years, disease-specific health related quality of life questionnaires have been developed in order to complete the information obtained using generic questionnaires in SLE patients. In the first part of our work, we present the definition of the concept of quality of life and the different way to measure it. In the second part, we present the results of a cohort study of 182 SLE patients that aimed to validate the French version of the SLE-specific questionnaire LupusQoL. Validity and reliability of the questionnaire were found to be satisfactory. In the second part, we present the results concerning responsiveness of the same questionnaire. We showed that LupusQol was able to capture a change in patients’ health state, and that it could be more responsive than the generic SF-36 questionnaire in patients with improving symptoms. In the third part, we present the results of a study involving 330 patients that aimed to validate the SLEQOL questionnaire. Besides determining the validity and reliability of the questionnaire, we conducted a differential item functioning analysis between patients of our cohort and patients from the development cohort of the SLEQOL in Singapore. The SLEQOL was found to be reliable and valid despite 4 items showing a moderate differential item functioning. In the fourth part, we present the results of the analysis of factors associated with quality of life in SLE patients, as measured by SLEQOL and LupusQoL specific questionnaires, and WHOQOL and SF-36 generic questionnaires in the same cohort of 330 patients. Quality of life in physical, mental and social domains was strongly associated with socio-economic factors, especially the social precariousness, as measured by the EPICES score. Women had a lower generic quality of life, whereas overweight and smoking influenced the generic questionnaires but not the specific ones, suggesting that in those situation, patients did not attribute their problem to lupus. Finally, articular involvement of the disease was the clinical symptom with the strongest association with quality of life impairment. This study opens up new areas of research that will lead to better understanding of SLE burden and improve the interpretation of results from future clinical trials and epidemiological studies.

Dans le domaine de la santé, la mesure d'utilité permet d'exprimer la valeur que peut donner un individu à un état de santé, comprise généralement entre 0 (la mort) et 1 (meilleur état de santé envisageable). L'utilité permet de valoriser simultanément le résultat clinique et son impact sur l'état de santé du patient, et d'exprimer ainsi la qualité de vie liée à la santé. Nous nous sommes intéressés dans ce travail à l'approche indirecte d'estimation d'utilité, consistant à dériver une utilité à partir des échelles psychométriques de mesure de l'état de santé (questionnaires génériques). Cette approche permet de répéter la mesure de l'utilité dans le temps et ouvre des perspectives pour l'analyse du changement d'utilité. Les objectifs étaient de définir un seuil de changement pour l'utilité dérivée des instruments de mesure psychométrique de la qualité de vie, et de prendre en compte dans l'interprétation du seuil la présence des comorbidités ou d'un phénomène de response-shift. Afin de répondre à nos objectifs, nous avons étudié, d'une part, le changement d'utilité mesurée par le SF-6D dans une cohorte de patients atteints d'arthrose des membres inférieurs (cohorte KHOALA) et l'effet des comorbidités sur l'utilité et son changement. D'autre part, nous avons estimé l'utilité de donneur vivant de rein à partir des questionnaires EQ-5D et SF-6D avant et 3 mois après le prélèvement du rein. Un seuil de changement a été estimé et un phénomène de response-shift a été recherché. Les résultats ont montré l'effet délétère des comorbidités sur la mesure de l'utilité chez les patients atteints d'arthrose, et mis en évidence l'importance de la sévérité fonctionnelle de l'arthrose dans l'expression de l'utilité et son changement. Chez les donneurs vivants de rein nous avons mis en évidence une diminution significative de l'utilité à 3 mois, avec une proportion de plus de 30% de donneurs ayant atteint le seuil de détérioration significative. L'estimation du seuil de changement diffère selon la population étudiée, l'instrument de mesure de l'utilité, et la méthodologie appliquée pour définir ce seuil. En conclusion, l'évaluation du changement d'utilité doit tenir compte de l'existence des comorbidités ainsi que de l'adaptation du jugement de valeur que l'individu porte sur son état de santé lorsque celui-ci évolue. La complexité des méthodes psychométriques pour la mesure de l'utilité doit amener à être prudent sur leur prise en compte dans les modèles d'évaluation économique. L'identification d'un seuil pour l'interprétation du changement peut être un élément complémentaire utile dans la démarche d'analyse décisionnelle / In health economic, the concept of utility was used to describe a state of health in patients. The unit value of health state utility ranges between 0, representing "death" state, and 1 representing a "perfect" health state. It is possible to recover through the measurement of utility both the clinical outcome and their impact on the health of the patient, and thus express the quality of life related to health. In this work, we used the indirect approach for estimating utility that is derived from a generic utility scales (quality of life questionnaires). The objectives of this thesis were to define a threshold of change for the utility derived from psychometric instruments measuring quality of life, and to take into account for the change interpretation, the presence of comorbidities or a response-shift phenomenon. We used data from a cohort of patients with osteoarthritis of lower limbs (KHOALA cohort) for estimate the impact of comorbidities in utility measured by the SF-6D its change over 3 years. We are also interested in the particular case of living kidney donors. The utility was estimated by the EQ-5D and SF-6D before and 3 months after kidney donation. A threshold of significant deterioration has been estimated and the presence of a response-shift phenomenon was controlled. The results showed the deleterious effect of comorbidities on utility measurement for patients with lower limbs osteoarthritis, and highlighted the importance of the functional severity of osteoarthritis in the expression of utility and its change over time. Living kidney donors experienced a significant decrease in their utility score in the short term, and more than third of donors have reached the threshold of significant deterioration. The threshold of utility change varies depending on the population studied, the measurement instrument, and the methodology used to define the threshold. In conclusion, the assessment of utility change must take into account the existence of other diseases and the adaptation of the individual on his health state variation. The complexity of measuring individual preferences by psychometric instruments should lead to be careful about introducing them in the economic evaluation. The use of a threshold for the interpretation of utility change can be an additional element in the decision-making process

Nach Operationen am Schultergelenk ist die Rehabilitation von entscheidender Bedeutung, um das operative Ergebnis zu sichern und die Schulterfunktion wiederherzustellen. Die dafür erforderliche funktionelle Kraft, Mobilität, Stabilität und Schmerzfreiheit soll mittels adäquater Maßnahmen im Therapieprozess entwickelt werden. Einen Untersuchungsschwerpunkt dieser Arbeit stellte die Erhebung von indikationsspezifischen isokinetischen Referenzwerten dar, die als schädigungsfrei erreichbare Steigerungsraten der Kraft innerhalb eines definierten Rehabilitationsprogrammes anzusehen sind. Dafür wurden jeweils 30 Patienten mit ventraler Schulterstabilisierung, arthroskopisch subakromialer Dekompression und Rekonstruktion der Rotatorenmanschette unter Verwendung des Seilzugisokinetikgerätes „Moflex®“ für die Bewegungen Adduktion, Innen- und Außenrotation untersucht. Zusätzlich galten die tägliche Schmerzquantifizierung, die Erfassung der aktiven Beweglichkeit und die subjektive Einschätzung mittels Fragebögen zum Gesundheitszustand (SF-36-Health-Survey) und zur Schulterfunktion (DASH-Score) zu definierten Zeitpunkten der Rehabilitation als obligate Bestandteile der Untersuchung. Auf der Grundlage der ermittelten Referenzwerte werden Empfehlungen für die praktische Anwendung eines therapeutischen Aufbautrainings mit dem Therapieband und dem Seilzugsystem abgeleitet. Einen weiteren Schwerpunkt der Arbeit bildete die Leistungsdiagnostik mit der Überprüfung der körperlichen Leistungsfähigkeit und der kardiopulmonalen Belastung während einer orthopädisch ausgerichteten Rehabilitation. Dafür absolvierten 20 männliche Patienten nach einer Operation am Schultergelenk zu Beginn und zum Abschluss der Rehabilitation einen Spiroergometrietest auf dem Fahrradergometer und eine Spirometrieuntersuchung mit dem „K4b2“ während der Krankengymnastik und der Medizinischen Trainingstherapie. Mit den Resultaten ist erstmalig eine Beurteilung der kardiopulmonalen Belastung von Patienten bei differenten Therapiemaßnahmen möglich. Die Ergebnisse können als Handlungsanleitung für die Belastungsgestaltung im Rahmen der postoperativen Rehabilitation von Schulterpatienten betrachtet werden.

Emotionell intelligens (EI) handlar om hur man identifierar emotioner, dvs. förmågan att uppskatta, reglera och uttrycka sina egna samt andras emotioner. EI handlar också om hur man använder informationen om andras eller egna emotioner för att förbättra sina handlingar och sitt tänkande. Trait EI består av fyra faktorer: välmående, självkontroll, emotionalitet samt sociabilitet och den totala sammanräkningen av dessa kallas för global trait EI. Syftet med denna studie var att undersöka om medelålders män och kvinnor skiljer sig åt i EI. För att besvara syftet och frågeställningarna användes TEIQue-SF, vilket är ett självskattningsformulär med 30 påståenden. Det distribuerades via sociala medier. Deltagarna i studien var 169 personer varav 50 män och 119 kvinnor. Studiens främsta resultat var att män fick ett signifikant högre värde för självkontroll. Slutsatserna för studien är att resultaten tyder på att män och kvinnors EI inte skiljer sig åt förutom gällande självkontroll. / Emotional intelligence (EI) regards how a person identifies emotions, one's ability to estimate, regulate, and express one's own and others’ emotions. EI also regards how to use information about others’ or one's own emotions to enhance one's actions and thinking. Trait EI consists of four factors: well-being, self-control, emotionality, and sociability. The total score of these comprises global trait EI. The purpose of this study was to examine whether middle aged men and women differ regarding EI. To answer the purpose and the questions the TEIQue-SF was used. It's A self-assessment form with 30 statements. It was distributed via social media. The participants in the study were 169 people, 50 men and 119 women. The main result of the study was that men received a significantly higher value for self-control. The conclusions of the study are that the results imply men and women’s EI don’t differ except regarding self-control.

Introduction: Approximately 10 000 people suffer each year from out-of-hospital cardiac arrest in Sweden. At the turn of the millennia the survival rate for out-of-hospital cardiac arrest was circa three precent and in 2022 the survival rate had increased to around eleven percent. Survivors face cognitive, psychological, and motor problems post arrest which impacts their health-related quality of life (HRQoL) – ie. their perception of their own social and physical environment and health. The research regarding HRQoL following cardiac arrest is limited. With increasing survival rates comes an increasing need for extensive research mapping the HRQoL of cardiac arrest survivors. Aim: The aim of this study was to investigate patients’ perceived health-related quality of life after surviving cardiac arrest.   Method: This study was conducted as a quantitative general literature review with an inductive content analysis. This study used articles that included the SF-36 instrument to measure the HRQoL in cardiac arrest survivors. Main- and subcategories were created based on the data extracted from the included articles. Result: Cardiac arrest patients generally experience their health-related quality of life as worse compared to the general population. Physical, psychological and social factors were identified as the main components whose effect on HRQoL was found to be the greatest. Conclusion: Cardiac arrest survivors experience a reduced HRQoL compared to the general population. The HRQoL is affected in both the psychological and physical dimensions with long term consequences. These results create a foundation for the nurse in the work to improve the HRQoL for the patient.

Skrivprojektet Tillfälligheter består av sju texter som på olika sätt binds ihop av tematiken i ordet tillfälligheter. Jag har haft intentionen att utforska hur jag i mitt skrivande kan närma mig genren science fiction. Genren är bred och ger stora möjligheter till variation och användning av fantasin utan begränsningar. Eftersom man gärna skriver det man själv gillar att läsa är det mjuk sf, alternativa världar, tidsresor och dystopier samt så kallad New Weird jag främst har fokuserat på. Science fiction försöker ofta besvara frågan "What if?" och jag har anammat den utgångspunkten i mitt arbete med projektet och utgått från att det är just tillfälligheter som har fått styra händelserna i de sju berättelserna. De sju texternas genreanpassning och stil kan kortfattat beskrivas som följer: Equinox – tidsresor; uppbyggd som en vetenskaplig uppsats och med ett retrospektivt berättande utifrån ett förstapersonsperspektiv Kalejdoskop – New Weird; hur namnens betydelser får personifiera karaktärerna 22:43 – en alternativ värld; skriven endast med dialog utan sägeverb Brunnen – dystopisk saga med stark verklighetsförankring och några stänk av skräck CCTV – teknologi, AI; om ett inanimat objekts upplevelse och tolkning av mänskligt beteende Tom Taylor – dystopi, mjuk sf (psykologi, ekologi) och samhällskritik; retrospektivt blandat med rak kronologi och cirkelrörelse Eschatos – en dystopisk omvänd travesti på Första Moseboks skapelseberättelse skriven som en dikt

Bakgrund: Fetma är ett allvarligt folkhälsoproblem då fetma ökar risken att drabbas av följdsjukdomar, samt att patienter med fetma visat sig ha lägre genomsnittlig hälsorelaterad livskvalitet (HRQoL) jämfört med befolkningen i allmänhet. Syfte: med denna litteraturöversikt var att beskriva hälsorelaterad livskvalitet bland personer som genomgått fetmakirurgi. Metod: Litteraturöversikt baserad på 8 kvantitativa interventionsstudier med uppföljningar mellan 9 månader - 10 år efter genomförd behandling. Litteratursökning skedde i databaserna PubMed och Cinahl. Analys av studierna skedde genom att studierna sammanställdes baserat på redovisning av frågeformulär SF-36 för index fysisk och mental hälsa och dess åtta dimensioner. Resultat: Samtliga studier indikerar att den fysiska hälsan i genomsnitt ökar efter fetmakirurgi. Samtliga utom en studie indikerar att hälsoindex för mental hälsa i genomsnitt ökar efter fetmakirurgi. Studier som sträcker sig över flera uppföljningsperioder visar att den initiala ökningen av hälsoindex minskar med tiden och effekten är som högst 1–2 år efter fetmakirurgi. Konklusion: Resultaten pekar på att fetmakirurgi initialt leder till en förbättring av fysisk och mental HRQoL med en tydlig topp efter 1–2 år. Studier med högt deltagande och uppföljning över tid är för få för att dra slutsatser kring effekten av fetmakirurgi på HRQoL på längre sikt. Utbildning av vårdpersonal och uppföljningsprogram kan bidra till ökat uppföljningsdeltagande, och minska risken för bortfall till följd av brister i vårdpersonalens bemötande. / Background: Obesity is a serious public health problem as it increases the risk of secondary diseases. Patients with obesity have been shown to have lower average health-related quality of life (HRQoL) compared to the general population. Aim: of this literature review was to describe health-related quality of life among people who have undergone bariatric surgery. Methods: Literature review of eight quantitative intervention studies with follow-ups between 9 months to 10 years. Literature search took place in the databases PuBMed and Cinahl. Analysis of the studies was done by summarizing the studies based on the reported result of the SF-36 questionnaire for physical and mental health and its eight dimensions. Results: All studies indicate that physical health increases on average after bariatric surgery. All but one study indicate that the mental health index increases, on average, after bariatric surgery. Studies that extend over several follow-up periods show that the initial increase in mental health decreases over time and the effect is highest 1–2 years after bariatric surgery. Conclusion: The results indicate that bariatric surgery initially leads to an improvement in physical and mental HRQoL with a clear peak after 1–2 years. Studies with high participation and follow-up over time are too few to draw conclusions about the effect of bariatric surgery on HRQoL in the longer term. Training of healthcare professionals and follow-up programs can contribute to increased follow-up participation, and reduce the risk of non-response.

Met und der korrespondierende Ligand HGF/SF sind im hyperproliferativen Epithelium von Hautwunden exprimiert. Aus diesem Grund ist es wahrscheinlich, dass der Rezeptor und sein Ligand in autokriner Weise wechselwirken und wichtige Funktionen für den Heilungsprozess der Haut besitzen. Unter Verwendung der Keratin 14 Cre-Rekombinase konnte ein „Knockout“ des Met-Rezeptors spezifisch in der Epidermis erzielt werden. In der Tat zeigten die Ergebnisse, dass Met für die Re-epithelisierung in Wundschlussprozessen essentiell ist, da in den an der Wundheilung beteiligten Keratinozyten keine Rekombination des Met-Gens stattgefunden hat. In Met-Mausmutanten war der Wundschlussprozess verlangsamt, denn er erfolgte ausschließlich durch wenige Keratinozyten, in denen die Cre-Rekombinase keine Rekombination bewirkte. Met konnte als erstes Gen identifiziert werden, das absolut erforderlich für Re epithelisierungsprozesse von Wunden ist. Diese Arbeit trägt daher wesentlich zum Verständnis der Regulation von Wundheilungsprozessen bei. / Met and its ligand, HGF/SF are expressed in the hyperproliferative epithelium of the wound. This suggests that receptor and ligand may act in an autocrine manner to promote wound healing in the skin. Using Keratin 14 cre recombinase, Met receptor was specifically knockout in the epidermis. In this way, it was demonstrated that Met receptor is essential for wound healing process and that keratinocytes, which contributed to the wound closure were Met-postitive. In the Met mutant mice, wound closure was slightly attenuated, but occurred exclusively by a few keratinocytes that had escaped recombination. Met is therefore the fist gene, which is absolutely required for re-epithelialization of the wound. This finding is fundamental for understanding the regulation of wound healing process.

Feline Osteoarthritis (OA) is a pathological change of a diarthrodial articulation which primarily occurs in older cats. The aims of this study were:- 1) to define the radiographic features of OA in the cat for each individual appendicular joint; 2) to relate the radiographic features to the gross pathologic and histopathologic features; 3) to explore underlying causes of OA in cats, 4) to identify the presence of Protease Activated Receptor-2 (PAR-2) and matriptase in feline articular cartilage and synovial membrane and to determine their role in OA pathogenesis. The present study has defined five radiographic features of OA for each appendicular joint:- presence of osteophytes, enthesiophytes, areas of abnormal mineralisation,synovial effusion and joint remodelling. The study furthermore suggested that increases in radio-opacity beneath the semilunar notch, along the femoral trochlea, beneath the tibial plateau and on the femoral head/neck are also important radiographic features. The radiographic prevalence was highest in the elbow (23.9%, 93/389) and stifle (23.9%,93/389) joints, followed by the hip (21.1%, 82/389), tarsal (17.7%, 69/389), shoulder(6.7%, 27/389) and carpal (6.4%, 25/389) joints. The results from this study demonstrate that the presence of a radiographically apparent supinator sesamoid bone(SSB), meniscal mineralisation (MM) and two fabellae are related to cartilage pathology and can be indicators of OA. Prevalence rates for gross pathology changes were highest in the elbow (20.2%,102/506) joint, followed by the stifle (19.6%, 99/506), hip (18.4%, 93/506), shoulder (17.8%, 90/506), tarsal (15.0%, 76/506), and carpal (9.1%, 46/506) joints. Eight key gross pathologic features were identified- cartilage discolouration, cartilage fibrillation,cartilage ulceration, cartilage erosion, osteophytes, thickening of joint capsule, synovium discolouration and joint remodelling. The radiographic and gross pathologic total scores were positively correlated in each appendicular joint and the joint most likely to have cartilage damage without radiographic evidence of OA is the shoulder (71.1%, 64/90) followed by the elbow (39.1%, 9/23), hip (32.4%, 11/34), stifle (26.1%,6/23), carpal (23.1%, 21/91) and tarsal (14.9%, 7/47) joints. Four possible underlying conditions that lead to secondary OA were identified:- radioulnar incongruity, hip dysplasia (HD), cranial cruciate ligament (CCL) disease and primary meniscal mineralisation. The identification of PAR-2 and matriptase proteins and gene expression in feline articular tissues is a novel and important finding supporting the hypothesis that serine proteases are involved in the articular cartilage degradation seen in feline OA.

Examining patient records is a useful way to identify common conditions and treatment outcomes in veterinary practice and data gathered can be fed back to the profession to assist with clinical decision making. This research aimed to develop a method to extract clinical data from veterinary electronic patient records (EPRs) and to assess the value of the data extracted for use in practice-based research. The transfer of new research from continuing professional development (CPD) into practice was also considered. An extensible mark-up language (XML) schema was designed to extract information from a veterinary EPR. The analysis of free text was performed using a content analysis program and a clinical terms dictionary was created to mine the extracted data. Data collected by direct observation was compared to the extracted data. A review of research published in the proceedings of a popular veterinary CPD event, British Small Animal Veterinary Association (BSAVA) Congress, was appraised for evidence quality. All animal records were extracted and validation confirmed 100% accuracy. The content analysis produced results with a high specificity (100%) and the mined data analysis was successful in assessing the prevalence of a specific disease. On comparison, the data extracted from the EPR contained only 65% of all data recorded by direct observation. The review of BSAVA Congress abstracts found the majority of the clinical research abstracts (CRAs) presented to be case reports and case series, with differences in focus between CRAs and veterinary lecture stream abstracts. This study has demonstrated that data extraction using an XML schema is a viable method for the capture of patient data from veterinary EPRs. The next step will be to understand the differences found between data collected by observation and extraction, and to investigate how research presented as CPD is received, appraised and applied by the veterinary profession.