Abstract The aim of this study was to evaluate the results of lumbar spine surgery and determine which factors modify outcome. A follow-up questionnaire, the Beck Depression Inventory (BDI, the Short Form 36 Health Survey (SF-36) and the Oswestry Low Back Disability Questionnaire (ODI) were sent to working-aged patients who had undergone lumbar spine surgery in the Oulu University Hospital between June, 2005 and May, 2008. Those with a BDI ≥ 10 were further classified into either non-melancholic (NmDS) or melancholic depression (MDS) groups. Potential spinal cord stimulation (SCS) candidates were interviewed via telephone. The postal survey was sent to 814 patients, of which 537 (66%) replied. Of these, 361 had undergone disc surgery, 85 stabilizing surgery and 91 decompression. Pain intensity was milder, the frequency of pain more rare, functional disability minimal and quality of life better after disc surgery compared to stabilizing surgery and decompression, which are technically more demanding operations and the patients’ condition are often more serious. Altogether, 213 patients presented with depressive symptoms (DS) defined as having a BDI ≥ 10, and these were further classified into NmDS (n = 153) and MDS (n = 60) subtypes. ODI differed between DS subtypes: those without DS had minimal, NmDS moderate and MDS severe functional disability. Pain was more frequent and more intense among DS patients. In particular, MDS patients suffered from pain, used more pain medication, but received less benefit from it. Disc surgery patients were divided according to body mass index (BMI): normal, pre-obese and obese. Pre-obese and obese patients gained weight during the follow-up. Obese patients had more DS and a worse functional outcome than normal-weighted or pre-obese patients. Of the entire cohort (n = 814), 21 patients received SCS. Eleven respondents underwent SCS treatment after they had replied. Features predicting SCS treatment were daily or continuous pain, higher pain intensity with predominant radicular pain, more severe pain-related functional disability, more DS and reduced benefit from pain medication. The time between lumbar surgery and implantation of a SCS device was extensive. Based on data from phone interviews, it appears that SCS was not offered to all potential candidates. In conclusion, the outcome of lumbar spine surgery was good after disc surgery but less favourable after more demanding stabilizing surgery or decompression. DS, especially of the MDS subtype, and obesity were more often seen in patients with a poorer surgical outcome. SCS treatment was used late and only for patients with very severe pain. / Tiivistelmä Tutkimuksen tarkoitus oli arvioida tuloksia lannerangan kirurgiassa ja kartoittaa tekijöitä, jotka vaikuttavat leikkaustulokseen. Seurantakysely, Beckin depressio¬kysely (BDI), SF-36 elämänlaatukysely ja Oswestryn toiminta¬kyky¬kysely (ODI), lähetettiin työikäisille Oulun yliopistollisessa sairaalassa kesäkuu 2005 - maaliskuu 2008 alaselkäleikatuille potilaille. Beckin depressioasteikko > 10 luokiteltiin ei-melankolisesti masentuneisiin (NmDS) ja melankolisesti masen¬tuneisiin (MDS). Mahdolliset takajuostestimulaatio (TJS) -ehdokkaat haastateltiin puhelimitse. Postikysely lähetettiin 814 potilaalle, joista 537 (66%) vastasi. Näistä 361:lle tehtiin välilevytyräleikkaus, 85:lle stabiloiva leikkaus ja 91:lle juurikanavan avarrusleikkaus. Välilevytyräleikatuilla kipu oli lievempää, harvemmin esiintyvää, toiminnallinen haitta vähäisempää ja elämänlaatu parempaa verrattuna potilaisiin, joille tehtiin vaativampi stabiloiva tai juurikanavan avarrusleikkaus. Kaikkiaan 213 potilaalla oli depressio-oireita (DS, BDI ≥ 10) ja nämä luokiteltiin edelleen NmDS (n = 153) ja MDS (n = 60) alaryhmiin. ODI erottui eri DS alatyyppien välillä: ei-DS-potilailla oli minimaalinen, NmDS-potilailla kohtuullinen ja MDS-potilailla vaikea toiminnallinen haitta. Kipua oli useammin ja voimakkaampana DS-potilailla. Erityisesti MDS-potilaat kärsivät kivuista, käyttivät enemmän kipulääkkeitä ja hyötyivät niistä vähemmän. Välilevytyräleikatut luokiteltiin painoindeksin (BMI) pohjalta normaaleihin, ylipainoisiin ja lihaviin. Ylipainoiset ja lihavat lihoivat seuranta-aikana. Lihavilla potilailla oli enemmän masennusta ja huonompi toiminnallinen tulos verrattuna normaaleihin ja ylipainoisiin. Koko tutkimusryhmässä (n = 814) 21 potilasta oli saanut TJS:n. Yksitoista vastaajaa sai TJS:n kyselytutkimuksen jälkeen. TJS:n saaneilla oli päivittäistä tai jatkuvaa, kovempaa ja pääasiassa jalkaan säteilevää kipua. Kipu aiheutti enemmän toiminnallista haittaa, enemmän masennusta ja nämä saivat vähemmän apua kipulääkityksestä. Aika leikkauksen ja TJS:n asennuksen välillä oli pitkä. Puhelinhaastattelun avulla saatu tieto osoittaa, ettei TJS-hoitoa tarjota kaikille potentiaalisille hyötyjille. Yhteenvetona voidaan todeta, että välilevytyräleikkauksen jälkeen tulos oli hyvä ja vaativampien stabiloivan ja juurikanavan avarrusleikkauksen jälkeen heikompi. DS, etenkin MDS ja lihavuus korostuivat huonommin toipuneissa. TJS-hoitoa käytettiin vain vaikeimmille tapauksille ja odotusajat olivat pitkät.

Background: Liver cirrhosis is a global health problem and a national health problem in Egypt. There is a lack of literature on Health-Related Quality of Life (HRQOL) and symptoms experience of liver disease and cirrhotic patients in Middle East, particularly in Egypt. Aims: This PhD had three major aims: First aim: To describe HRQOL of Egyptian liver cirrhotic patients and to identify and evaluate the factors associated with (HRQOL) physical and mental health domains. Second aim: To explore and describe experienced symptoms (prevalence, severity and hindrance) in Egyptian cirrhotic patients and to identify and evaluate factors associated with symptoms severity and symptoms hindrance (distress). Third aim: To explore and describe how cirrhotic patients in Egypt perceive social support from spouse, family and friends and to identify and evaluate factors associated with general perceived social support. Method: A cross-sectional study with a convenience sample of 401 patients from three hospitals in Cairo, Egypt, was conducted between June and August 2011. Patients were interviewed to complete a background data sheet, Short Form-36v2 (SF-36), the Liver Disease Symptom Index (LDSI)-2.0 and the Multidimensional Scale of Perceived Social Support (MSPSS). Results: Findings for first aim: The findings showed that all domains and component summary scores [Physical component summary score (PCS) and mental component summary score (MCS)] of the generic SF-36 were below the norm (cut-off score 50), suggesting that patients with liver cirrhosis in Egypt have poor HRQOL. About 87.2% of the patients rated their general health as poor or fair, which means the majority of these patients have low perceived general health. Many socio-demographic and medial factors were shown to be significantly associated with perceived HRQOL. Women, illiterate and unemployed people, and patients with frequent hospitalisation had poor PCS and MCS, while patients with advanced disease stage, increasing number of comorbidities and complications and those admitted to inpatients had significantly poorer PCS only. Perceived social support from a spouse had a statistically significant positive association with PCS and MCS, while perceived social support from family and friends had a statistically significant positive association with MCS only. Also, severity and hindrance of symptoms significantly correlated with PCS and MCS. Using stepwise multiple linear regression analysis, two models were developed to identify factors associated with PCS (Model 1) and MCS (Model 2) health. Model 1 could significantly explain 19% of the variation in PCS (R2 = 0.190, R2adj = 0.180, p = 0.0005), and four factors (symptoms severity, disease stage, comorbidities and employment status) were significantly (p ≤ 0.02) associated with PCS. Model 2 could significantly explain 31.7% of the variation in MCS (R2 = 0.317, R2adj = 0.308, p = 0.0005), and four factors (symptoms severity, employment status, perceived spouse support and perceived family support) were associated (p ≤ 0.04) with MCS. The key findings of this study were that severity of symptoms and social support from spouse and family were associated with HRQOL. Where patients with high symptoms severity were likely to report poor PCS and MCS; and patients with low perceived social support were likely to report poor MCS. Symptoms severity contributed significantly in explaining 28.7% of the variation in PCS and 43.6% of the variation in MCS. Findings for second aim: This study found that the majority of patients had one or more of a wide range of symptoms and social problems. Two-thirds of patients reported joint pain (78.3%), decreased appetite (75.6%) and memory problems (77.3%). Joint pain and depression were reported to have the biggest impact on daily life. Symptoms severity and distress were significantly higher among patients who were: female, illiterate, unemployed, and who had advanced cirrhosis with more complications and comorbidities (p ≤ 0.006). Symptoms severity (r=-0.206) and symptoms distress (r=-0.205) were negatively associated with perceived social support (p=0.005). Stepwise regression analysis showed that the regression model could significantly explain 19.6% of the variation in symptoms severity (R2 = 0.196, R2adj = 0.180, p = 0.0005), and 14% of the variation in hindrance of symptoms (R2 = 0.140, R2adj = 0.132, p = 0.0005). Being female, having an increasing number of liver disease complications, and having low perceived support from spouse were significantly associated with high-perceived symptoms severity and hindrance (p≤0.01). Findings for third aim: This study found that social support score was relatively high among patients with cirrhosis in Egypt (total score mean of MSPSS was 2.02± standard deviation (0.537), while perceived support from spouse was the highest source of support. 67.5% of the patients felt their spouse is around when they need him/her and 71.7% of them share their joys and sorrows with their spouse. Likewise, 64.9% of married people feel their spouse cares about their feelings. In relation to the perception of adequacy of family support, it was observed that 52.6% felt that their families do not really try to help them. At the same time, 52.1% reported that they got the emotional help and support that they needed from their families. Regarding perceived support from friends, more than half of the patients reported that their friends do not really try to help them (57.9%), they cannot count on their friends when things go wrong (65.6%) and they cannot talk about their problems with their friends (56.4%). There was a significantly positive association between the perception of social support and general health perception (GHP), suggesting that when social support decreases GHP also decreases or and vice versa (r= 0.208, p = 0.0005). Stepwise regression analysis showed that the regression model could significantly explain 10.9% of the variation in perceived social support (R2 = 0.109, R2adj = 0.100, p = 0.0005). Marital status, gender, age and employment status were significantly associated with general perceived social support (p ≤ 0.01), while unmarried, females, unemployed and elderly cirrhotic patients were vulnerable groups that were likely to perceive low social support. Overall discussion and conclusion: This is the first study to investigate HRQOL, symptoms experience and perceived social support in patients with liver cirrhosis in Egypt. All aspects of HRQOL of Egyptian cirrhotic patients were poor, and they were experiencing various symptoms that can affect their daily life. However, social support was found to be related to perceived symptoms severity and perceived poor mental health. Hence, social support may alleviate suffering for certain cirrhotic patients. Nurses have a responsibility to assess and treat symptoms that cirrhotic patients experience, particularly such treatable symptoms as depression, pain and decreased appetite. Also, nurses should involve the patient’s family in any plan of care. Future intervention studies that aim to develop programs to relieve treatable symptoms and enhance social support are also recommended.

Submitted by Cássio da Cruz Nogueira (cassionogueirakk@gmail.com) on 2017-09-11T18:38:59Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Tese_QualidadeVidaPacientes.pdf: 2921092 bytes, checksum: 9e31e5b8c539077daa663ef07bbb8ddd (MD5) / Approved for entry into archive by Irvana Coutinho (irvana@ufpa.br) on 2017-09-19T14:00:28Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Tese_QualidadeVidaPacientes.pdf: 2921092 bytes, checksum: 9e31e5b8c539077daa663ef07bbb8ddd (MD5) / Made available in DSpace on 2017-09-19T14:00:28Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Tese_QualidadeVidaPacientes.pdf: 2921092 bytes, checksum: 9e31e5b8c539077daa663ef07bbb8ddd (MD5) Previous issue date: 2014-11-20 / A Hanseníase é uma doença infecciosa que atinge pele, nervos periféricos, provoca dor, sequelas físicas e psicológicas. Pouco estudos descrevem a qualidade de vida (QV) em pacientes com dor neuropática hansênica (DNH), presente na doença. O objetivo desta pesquisa foi avaliar a QV de pacientes acometidos pela hanseníase utilizando os questionários WHOQOL-Bref e SF-36 e, investigar a influência da atividade física na QV de pacientes com DNH. Trata-se de um estudo Transversal e de Intervenção Self-control, em que foram selecionados 80 pacientes a partir de amostra de conveniência da Unidade Básica de Saúde da Vila Santo Antônio do Prata (Igarapé Açú/Pará) e Ambulatório de Dermatologia do Núcleo de Medicina Tropical da Universidade Federal do Pará (Belém/Pará). Os pacientes responderam aos questionários de avaliação de QV propostos e os casos diagnosticados com DNH participaram pelo período de 90 dias de um protocolo de Exercício Físico. No dia zero e após o período da intervenção, foram aferidas a força da preensão palmar e a flexibilidade de membros superiores e inferiores. Os resultados mostram maiores médias de QV em pacientes com ausência de DNH. Houve melhora significativa nos domínios da QV do grupo com DNH após o período de intervenção. O exercício físico deve ser incentivado enquanto proposta terapêutica para prevenção de sequelas físicas e de DNH crônica. A avaliação da QV relacionada à saúde de pacientes hansenianos pode ser uma estratégia preponderante para melhor prevenir, tratar e curar a doença nas regiões endêmicas do Brasil. / Leprosy is an infectious disease that affects the skin, peripheral nerves, causes pain, physical and psychological consequences. Some studies describe the quality of life (QOL) in patients with leprosy neuropathic pain (DNH) in this disease. The objective of this research was to evaluate the QL of patients affected by leprosy using the WHOQOL-Bref questionnaire and SF-36 and investigate the influence of physical activity on QL in patients with DNH. This is a Transversal study and intervention Self-control, in which 80 patients were selected from a convenience sample of Basic Health Unit of Vila Santo Antonio do Prata (Igarapé Açú / Pará) and the Dermatology Clinic of the Center for Tropical medicine, from Federal University of Pará (Belém / Pará). The patients answered evaluation questionnaires of QL proposed and diagnosed cases with DNH attended by 90 days of physical activity protocol. On zero day and after the intervention period were measured the power of palmar prehension and flexibility of upper and lower limbs. The results show higher averages of QL in patients with absence of DNH. There were significant improvements in the dominion of QL with DNH group after the intervention period. Physical activity should be encouraged as a therapeutic proposal for the prevention of chronic physical consequences and DNH and the evaluation of QL associated with health of leprosy patients can be a predominant strategy to better prevent, treat and cure the disease in endemic regions of this country.

<p>Abdominal aortic aneurysm (AAA) is a common problem with life-threatening consequences and was suspected to be a serious health problem in Norsjö, a municipality in northern Sweden. A screening study was undertaken to investigate the prevalence, risk factors associated with AAA and the effect of screening on quality of life (QoL). All men and women, aged 65-75 years, were invited to an ultrasonography (US) examination, 91% attended and 92 subjects were also evaluated with computed tomography (CT).</p><p>Depending on diagnostic criteria, the AAA prevalence was 3.6-16.9% in men and 0.8-9.4% in women. Seventy-five percent of the differences between US- and CT anteroposterior measurements were less than 5 mm. A decrease in mental health was observed among AAA patients with low baseline SF-36 scale scores. Elevated cholesterol at age 60 years were associated with screening detected AAA after 12 years of follow-up. Smoking, atherosclerosis and having a first degree relative with AAA were associated with AAA at screening. Compared to blood samples obtained 12 years prior to screening an elevation of hsCRP over time was observed among AAA patients. </p><p>Based on a systematic review of the literature, different screening strategies were analysed in a Markov cohort model. The cost per life year gained ranged from $8 309 to $14 084 and was estimated to $10 474 when 65 year old men were screened once.</p><p>Conclusions: The highest prevalence of AAA ever reported, in a population-based screening program, was found in Norsjö. The risk of having an AAA at screening showed a strong but complex association with atherosclerosis and its risk factors, genetic and inflammatory mechanisms may also be important. Screening 65-year-old men for AAA may be cost-effective, but QoL aspects on the cost-effectiveness of AAA screening merits further investigation.</p>

<p>The aim with this thesis was to study cardiovascular disease and hypertension, use of drugs and health from an epidemiological perspective. Various methods - self-rated health (SRH), health related quality of life (HRQL) - the 36-item short form questionnaire (SF-36) - and health utility measurements - the rating scale (RS) and the time-trade off (TTO) methods - were employed.</p><p>Data from the Swedish Adoption/Twin Study of Aging (SATSA) in 1984, 1987, 1990, and 1993 as well as a general population survey conducted in Uppsala County in 1995 were used.</p><p>Persons who have cardiovascular disease, both with and without drug treatment, were found to have a lower SRH as compared to others in the population. Longitudinal analyses showed that SRH was relatively stable over time among persons with cardiovascular disease. Both having a low SRH and having cardiovascular disease were associated with a higher mortality rate.</p><p>Hypertensives were found to have a lower HRQL than do others in the general population as measured by the SF-36. The lowest scoring was found in the general health perception scale (GH), whereas role emotional (RE) and mental health (MH) were the scales least affected by hypertension.</p><p>Nearly 20 percent of the antihypertensive drug users reported side effects.The pattern of side effects was similar to that reported in clinical trials. Both hypertension itself and the drug treatment were found to have an impact on the patient's health-state utility as measured by the RS. Comparative analyses showed that health utilities and psychometric quality-of-life instruments were only moderately correlated among hypertensives. </p><p>The results also showed that inequalities in HRQL were present with respect to several sociodemographic factors. </p><p>In summary, this thesis revealed that persons with cardiovascular disease and/or with hypertension experience poorer health than others in the population. The poor health may be caused both by the disease and/or the drug treatment. The results in this thesis also suggested that special attention and care should be directed to persons with cardiovascular disease and/or hypertension reporting ill health. This especially is important given that low HRQL can be a riskfactor for subsequent cardiovascular events or complications which in turn might result in higher mortality rate.</p>

The aim with this thesis was to study cardiovascular disease and hypertension, use of drugs and health from an epidemiological perspective. Various methods - self-rated health (SRH), health related quality of life (HRQL) - the 36-item short form questionnaire (SF-36) - and health utility measurements - the rating scale (RS) and the time-trade off (TTO) methods - were employed. Data from the Swedish Adoption/Twin Study of Aging (SATSA) in 1984, 1987, 1990, and 1993 as well as a general population survey conducted in Uppsala County in 1995 were used. Persons who have cardiovascular disease, both with and without drug treatment, were found to have a lower SRH as compared to others in the population. Longitudinal analyses showed that SRH was relatively stable over time among persons with cardiovascular disease. Both having a low SRH and having cardiovascular disease were associated with a higher mortality rate. Hypertensives were found to have a lower HRQL than do others in the general population as measured by the SF-36. The lowest scoring was found in the general health perception scale (GH), whereas role emotional (RE) and mental health (MH) were the scales least affected by hypertension. Nearly 20 percent of the antihypertensive drug users reported side effects.The pattern of side effects was similar to that reported in clinical trials. Both hypertension itself and the drug treatment were found to have an impact on the patient's health-state utility as measured by the RS. Comparative analyses showed that health utilities and psychometric quality-of-life instruments were only moderately correlated among hypertensives. The results also showed that inequalities in HRQL were present with respect to several sociodemographic factors. In summary, this thesis revealed that persons with cardiovascular disease and/or with hypertension experience poorer health than others in the population. The poor health may be caused both by the disease and/or the drug treatment. The results in this thesis also suggested that special attention and care should be directed to persons with cardiovascular disease and/or hypertension reporting ill health. This especially is important given that low HRQL can be a riskfactor for subsequent cardiovascular events or complications which in turn might result in higher mortality rate.

Abdominal aortic aneurysm (AAA) is a common problem with life-threatening consequences and was suspected to be a serious health problem in Norsjö, a municipality in northern Sweden. A screening study was undertaken to investigate the prevalence, risk factors associated with AAA and the effect of screening on quality of life (QoL). All men and women, aged 65-75 years, were invited to an ultrasonography (US) examination, 91% attended and 92 subjects were also evaluated with computed tomography (CT). Depending on diagnostic criteria, the AAA prevalence was 3.6-16.9% in men and 0.8-9.4% in women. Seventy-five percent of the differences between US- and CT anteroposterior measurements were less than 5 mm. A decrease in mental health was observed among AAA patients with low baseline SF-36 scale scores. Elevated cholesterol at age 60 years were associated with screening detected AAA after 12 years of follow-up. Smoking, atherosclerosis and having a first degree relative with AAA were associated with AAA at screening. Compared to blood samples obtained 12 years prior to screening an elevation of hsCRP over time was observed among AAA patients. Based on a systematic review of the literature, different screening strategies were analysed in a Markov cohort model. The cost per life year gained ranged from $8 309 to $14 084 and was estimated to $10 474 when 65 year old men were screened once. Conclusions: The highest prevalence of AAA ever reported, in a population-based screening program, was found in Norsjö. The risk of having an AAA at screening showed a strong but complex association with atherosclerosis and its risk factors, genetic and inflammatory mechanisms may also be important. Screening 65-year-old men for AAA may be cost-effective, but QoL aspects on the cost-effectiveness of AAA screening merits further investigation.

Coronary heart disease (CHD) is a leading cause of morbidity and mortality in the industrialised world, and places a heavy burden on society in terms of personal disability and health care costs. The first signs of CHD often present acutely as a myocardial infarction (AMI), commonly known as a heart attack. Survivors of a heart attack remain vulnerable to poor health-related quality of life (HRQOL), further cardiac events, and increased morbidity due to a progression of CHD. Thus, the implementation of interventions to reduce these risks is an important public health strategy. To date, secondary prevention and rehabilitation efforts post-AMI focus primarily on the patient. However, it is argued that recovery from AMI occurs within a social context, and that risk reduction strategies are likely to be enhanced if interventions take into account the impact of the event on the quality of life of patients and their partners. Evidence from a review of couple relationship literature indicates that a significant proportion of couples experiences poor HRQOL (i.e., physical and emotional wellbeing) when coping with stressful life events, and that interactive aspects of a couple relationship (i.e., dyadic functioning and behaviour) are associated with individual well-being at such a time. Information from studies of couples dealing with recovery from heart attack is sparse, but tends to reflect the findings from the broader literature. Further research is required with post-AMI couples, though, as there are a number of shortcomings associated with the existing evidence. For instance, it is derived from studies conducted with, mostly small, samples of convenience; many different instruments are used to collect the data; and no studies specifically measure HRQOL. Analytically, most evidence is obtained with univariate and bivariate statistics, and data are analysed as groups of patients or partners, as opposed to dyads. Where multivariable analyses are undertaken a number of bivariate relationships are no longer significant after accounting for covariates such as age and gender; and few researchers investigate predictive associations between dyadic functioning/behaviour and HRQOL outcomes. Finally, there is a paucity of information from comparative analyses. Thus, it is not known whether the well-being of post-AMI couples over time is better than, similar to, or worse than, for example, that in the general population. The research program underpinning this thesis, the QUT-AMI Project, comprised two studies designed to address these methodological issues. The first was an observational, cross-sectional, pilot study conducted in 1998 with 26 post-AMI couples. The main investigation was a prospective cohort study of 93 post-AMI couples undertaken in 1999-2000. In both studies the samples comprised a consecutive series of adult males younger than 75 years who had experienced a first AMI, and their female partners. The average couple in both studies was middle-aged, had been married for many years, and both members of the dyad were working at the time of the heart attack. Prospective participants were identified in major clinical centres that admit cardiac patients, and couples were recruited to the project soon after the patient's heart attack. Clinical data were collected in hospital. Further data were collected with self-administered questionnaires during a home visit at 1 month (pilot and main study), and by mailed questionnaire or during a home visit at 6 months(main study) after the heart attack. The pilot study was undertaken to test recruitment and data collection procedures in preparation for the second (main) study, measure couples' HRQOL at 1 month after the event using the SF-36, and qualitatively investigate life issues for couples coping with recovery from AMI. In the main study couples' HRQOL outcomes were measured at 1 and 6 months post-AMI using the SF-36, and examined for changes over that time. The outcomes were also compared with those from matched population norms to estimate the impact of a heart attack on couples' HRQOL during the early and later recovery period. Additionally, the following relationships were investigated to determine the extent to which:* patients' dyadic functioning (e.g. happiness/satisfaction with relationship, measured with the Marital Adjustment Scale) and use of dyadic behaviour (e.g., hiding concerns and negative feelings from the other member of the dyad, measured with the Protective Buffering Scale) at 1 month predicted patients' emotional well-being at 6 months post-AMI;* partners' dyadic functioning and behaviour at 1 month predicted partners' emotional well-being at 6 months post-AMI;* patients' and partners' dyadic functioning at 1 month predicted patients' or partners' emotional well-being at 6 months post-AMI; and* patients' and partners' dyadic behaviour at 1 month predicted patients' or partners' emotional well-being at 6 months post-AMI. Exploratory analyses were also undertaken to determine the effect of dyadic discrepancies in functioning and behaviour, at 1 month after the heart attack, on patients' and partners' emotional well-being at 6 months after the event. Important findings were as follows:* At 1 month after an AMI the HRQOL of couples is impaired. The major impact is on physical well-being for patients, and emotional well-being for their partners.* In general, couples' HRQOL improves between 1 and 6 months after an AMI.* At 6 months after an AMI, the HRQOL of average couples is similar to that of their peers in the normal population.* There are subgroup variations in the quality of life of post-AMI couples, and these are associated with age, clinically poor physical health, and depression.* The combination of patients' and partners' use of dyadic behaviour at 1 month after an AMI explains 7% of the variation in patients' emotional well-being at 6months after the event, after adjustment for patients' concurrent physical wellbeing and prior levels of emotional well-being, as well as duration of couple relationships.* The combination of partners' perceptions of dyadic functioning and use of dyadic behaviour at 1 month after an AMI explains 5% of the variation in partners' emotional well-being at 6 months after the event, after adjustment for partners' concurrent physical well-being and prior levels of emotional well-being, as well as duration of couples' relationships.* Patients have poorer emotional well-being at 6 months after an AMI if partners use dyadic behaviour infrequently at 1 month after the event.* Partners have poorer emotional well-being at 6 months after an AMI if they are not satisfied/unhappy with the functioning of their relationships at 1 month after the event. Adjusted exploratory analyses, undertaken to determine the extent to which dyadic discrepancies in perceptions of functioning or use of protective buffering behaviour, predict emotional well-being, show that patients who are less satisfied/unhappier with functioning than their partners at 1 month after an AMI have poor emotional wellbeing at 6 months after the event; patients who use the behaviour more frequently than their partners at 1 month after an AMI have poor emotional well-being at 6months after the event; and partners who are less satisfied/unhappier with functioning than their patients at 1 month after an AMI have poor emotional well-being at 6months after the event. The evidence from the QUT-AMI Project supports the proposition that the interaction that occurs within a couple relationship, combined with individual characteristics of members of a dyad, influences the extent to which a heart attack impacts on couples' HRQOL. It is argued that it is not enough to merely focus on implementing secondary prevention strategies with post-AMI patients. Given that poor emotional well-being is known to predict adverse cardiac events, and premature mortality due to cardiac disease, it is recommended that a couple-focused intervention designed to meet specific needs should be implemented with at-risk couples as a public health strategy to improve not only the patients' quality of life but also that of his partner. Further research is recommended to determine the extent to which such an intervention improves post-AMI couples' quality of life.

Background: Prostitution has been documented in most societies, although the context in which it occurs may vary greatly. In Queensland, Australia, sex workers can operate from legal brothels or privately but all other sectors of the sex industry are prohibited. It is assumed that regulation of the sex industry through legalization leads to better health and social outcomes for sex workers and their clients. However, this assumption has rarely been subjected to empirical scrutiny. Aims: This research examined the occupational health and safety of female sex workers in Queensland and explored the relationship between legislative change, workplace violence, mental health and job satisfaction. Sex workers interviewed in 2003 (after legalisation) were compared to a prior study of this population conducted in 1991 (before official regulation of the sex industry). Further, in-depth analysis of the 2003 cohort compared sex workers employed in legal and illegal sectors, to assess violence, health status and job satisfaction. Methods: Cross-sectional, convenience sampling was used to collect data from female sex workers in 2003. This data was compared with data collected earlier (in 1991) and explored differences in the two samples using bivariate analysis. Similar recruitment strategies on both occasions were used to recruit women from all known sectors of the Queensland sex industry. The 1991 comparison sample (Boyle et al. 1997) included 200 women (aged between 16 and 46 years), and in 2003, 247 women (aged 18 to 57) participated. The 2003 sample included workers from legal brothels (n=102), private sole-operators (n=103) and illegal street-based sex workers (n=42). Using data collected in 2003, this study assessed the relationship between physical and mental health and job satisfaction and two main independent variables, i.e., current work sector and recent workplace violence. Bivariate analysis of physical health and independent variables showed no significant relationships and therefore further analysis was not undertaken. However, analysis of mental health and job satisfaction showed complex interactions between multiple variables and therefore linear modeling was performed to adjust for confounding. Results: Analysis of the 1991 and 2003 samples showed little apparent change over time in self-reported sexually transmitted infections (STIs). There were substantial changes over time in the types of sexual services being provided to clients, with the 2003 sample more likely to provide 'exotic' services. Violence experienced ever in their lifetime differed; in 1991, 29% reported having ever been raped compared with 42% in 2003 (p= &lt0.01). In 2003, 50% of illegal sex workers reported having ever been raped by a client compared with 12% of private sex workers and 3% of brothel-based sex workers (p=&lt0.01). Overall, the sex workers reported roughly equivalent job satisfaction to Australian women. A desire to leave the sex industry was most strongly correlated with reduced job satisfaction (p=&lt0.01). Satisfaction was also relatively low among those whose family was not aware of their sex work (p=&lt0.01). Similarly, the mental and physical health of this sample was comparable to age-matched women from the general population. Wanting to leave the sex industry was most strongly associated with poor mental health (p=&lt0.01), as was recent sexual or physical assault by a client (p=0.06) and the woman's main work sector (p=0.05). Illegal sex workers reported substantially lower mental health scores than their counterparts in legal sex work. Conclusions: Self-reported STI diagnosis was high in these samples but the prevalence appears not to have changed over time. Comparing 2003 to 1991, there were trends towards safer and more diverse sexual practices. It is likely the sex industry has 'professionalized' and now includes more sex workers providing specialist, 'exotic' services. This sample of female sex workers reported high rates of violence, with those working illegally at greatest risk. Analysis suggests a complex interaction between variables contributing to mental health and job satisfaction. In general, it appears that the majority of sex workers enjoyed at least as much job satisfaction as women working in other occupations. It also appears that this sample had equivalent mental health to women from the general population, although the sub-group of illegal workers generally had poorer health. Job satisfaction and the extent of workplace hazards (especially risk of violence) were also strongly associated with different sectors of the sex industry. It is probable that legalisation has benefited some (perhaps most) but there are health and safety concerns for those outside the legal framework. Legislative reform should focus on violence prevention, promoting reporting of violent events to police, and further exploration of the impact of legislation on the health of workers in the sex industry.

Background Recently, Taiwan has been faced with the migration of numbers of women from Southeast Asian (SEA) countries. It was estimated that the aggregate number of SEA wives in Taiwan was more than 131,000 in 2007 (Ministry of Foreign Affairs, 2006).These women are often colloquially called, “foreign brides” or “alien brides”; most of them are seen as commodities of the marriage trade, whose marriages are arranged by marriage brokers. Some women can be regarded as being sold for profit by their families. These young Vietnamese immigrant women come to Taiwan alone, often with a single suitcase, and are culturally and geographically distinct from Taiwanese peoples; the changes in culture, interpersonal relationships, personal roles, language, value systems and attitudes exert many negative impacts on their health, so greater levels of acculturation stress can be expected. This particular group of immigrant women are highly susceptible and vulnerable to health problems, due to language barriers, cultural conflicts, social and interpersonal isolation, and lack of support systems. The aims of this study were to examine the relationships between acculturation and immigrantspecific distress and health outcomes among Vietnamese transnational married women in Taiwan. This study focuses on Vietnamese intermarriage immigrants, the largest immigrant group in the period from1994 through to 2007. Methodology The quantitative study was divided into two phases: the first was a pilot study and the second the main study. This study was conducted in a communitybased health centre in the south of Taiwan, targeting Taiwanese households with Vietnamese wives, including the Tanam, Kaohsiung, and Pentong areas. This involved convenience sampling with participants drawn from registration records at the Public Health Centre of Kaohsiung and used the snowball technique to recruit 213 participants. The instruments included the following measures: (1) Socio-demographic information (2) Acculturation Scale (3) Acculturative Distress Scale, and (4) HRQOL. Questions related to immigrant women’s acculturation level and health status were modified. Quantitative data was coded and entered into the SPSS and SAS program for statistical analysis. The data analysis process involved descriptive, bivariate, multivariate multiple regression, and classification and regression trees (CART). Results Six hypotheses of this study were validated. Demographic data was presented and it revealed that there are statically significant differences between levels of acculturation and years of residency in Taiwan, number of children, marital status, education, religion of spouse, employment status of spouse and Chinese ethnic background by Pearson correlation and Kendall’s Tau-b or Spearman test. The correlations of daily activity, language usage, social interaction, ethnic identity, and total of acculturation score with DI tend to be negatively significant. In addition, the result of the one-way ANOVA supported the hypothesis that the different types of acculturation had a differential effect on immigrant distress. The marginalized group showed a greater immigrant distresses in comparison with the integrated group. Furthermore, the comparison t-test revealed that the Vietnamese immigrant women showed a lower score than Taiwanese women in HRQOL. The result showed higher acculturative stress associated with lower score of HRQOL on bodily pain, vitality, social functioning, mental health, and mental component summary. The CART procedure to the conclusion that the predictive variables for the physical component of the SF-36 (PCS) were: alienation, occupation, loss, language, and discrimination (predicted 28.8% of the total variance explained). The predictive variables for the mental component of the SF-36 (MCS) were: alienation, occupation, loss, language, and novelty (predicted 28.4% of the total variance explained). Conclusion As these Vietnamese immigrant women become part of Taiwanese communities and society, the need becomes apparent to understand how they acculturate to Taiwan and to the health status they acquire. The findings have implications for nursing practice, research, and will assist the Taiwanese government to formulate appropriate immigrant health policies for these SEA immigrant women. Finally, the application of this research will positively contribute to the health and well being of thousands of immigrant women and their families.