Die Therapie von Azetabulumfrakturen bei älteren Patienten bleibt ein kontrovers diskutiertes Thema, was aufgrund der steigenden Inzidenz zunehmend an Relevanz gewinnt. Richtlinien für die Therapie existieren vor allem für ein jüngeres Patientenkollektiv, was die Therapieentscheidung bei älteren Patienten erschwert. Trotzdem wurden in den letzten Jahren zunehmend auch ältere Patienten operativ versorgt. In der vorliegenden Arbeit wurde untersucht, ob ältere Patienten von einer operativen Therapie profitieren und ob ältere Patienten generell ein schlechteres Outcome aufweisen als jüngere. Es wurden 374 Patienten mit Azetabulumfraktur untersucht, welche zwischen 2005 und 2014 am Universitätsklinikum Leipzig operativ oder konservativ versorgt wurden. Zunächst wurden den krankenhausinternen Patientenakten allgemeine Patientendaten entnommen und anschließend eine Befragung mittels Fragbogen und eine klinische Nachuntersuchung durchgeführt. Schlechtere Ergebnisse im Outcome älterer Patienten traten zwar auf, erwiesen sich jedoch nur für die Items KÖFU und KÖRO des SF-36, den Parameter „Eigenständige Versorgung“ des EQ-5D sowie die Parameter „Hinken“ und die „Verwendung von Gehhilfen/Gehfähigkeit“ im Merle d’Aubigé und Harris Hip Score als statistisch signifikant. Auch zwischen den operativ oder konservativ versorgten Patienten wurden kaum signifikante Unterschiede im Outcome gefunden. Lediglich im psychischen Bereich des SF-36 (PSYC und psk) zeigten sich bei jüngeren konservativ versorgten Patienten signifikant bessere Ergebnisse. Ansonsten ließen sich keine signifikanten Unterschiede zwischen den Versorgungsgruppen, weder bei älteren noch bei jüngeren Patienten in den Scoresystemen feststellen. Insgesamt erwiesen sich die Unterschiede der Outcomeergebnisse zwischen den Alters- und Versorgungsgruppen als tendenziell und rücken unserer Meinung nach in den Hintergrund. Demnach schneiden ältere Patienten nach erfolgter Therapie unter Berücksichtigung des Allgemeinzustandes genauso gut ab wie jüngere Patienten. Die Gründe für die überraschend guten Ergebnisse im Outcome bei älteren und auch konservativ versorgten Patienten könnten Grundlage für weitere Arbeiten sein. Intentionen, welche möglicherweise die Therapieentscheidung künftig stärker beeinflussen könnten, sind der Anspruch an eine möglichst anatomische Reposition auch im hohen Alter und der damit verbundenen Langlebigkeit der angewendeten Therapie. Dadurch wäre die Senkung der Komplikationsrate sowie der Rate sekundär implantierter H-TEPs möglich. Diese sind aktuell bei operativ versorgten jüngeren und älteren Patienten deutlich höher als bei konservativ versorgten. Zwischen den Altersgruppen bestand kein statistisch signifikanter Unterschied. Um diese These zu untermauern sind weitere kontrollierte Beobachtungen des Outcomes sowie der Komplikationsraten nötig.:Inhaltsverzeichnis I Abbildungsverzeichnis III Tabellenverzeichnis IV 1 Einleitung  1 1.1 Einführung in die Thematik  1 1.2 Anatomie  2 1.2.1 Funktion und Bedeutung des Azetabulums  2 1.2.2 Anatomie des Azetabulums  2 1.2.3 Biomechanik des Hüftgelenkes  5 1.3 Pathologie  6 1.3.1 Pathomechanik der Azetabulumfraktur  6 1.3.2 Demographie und Epidemiologie  7 1.3.3 Frakturklassifkation  8 1.3.4 Diagnostik  9 1.3.5 Therapie  12 1.3.6 Komplikationen  14 1.4 Fragestellung  15 2 Patienten und Methoden  16 2.1 Patientenkollektiv  16 2.2 Methoden  17 2.2.1 Datenerhebung  17 2.2.2 Datenerfassung  17 2.2.3 Statistik  19 3 Ergebnisse  21 3.1 Patientenkollektiv  21 3.1.1 Allgemeine Merkmale  21 3.1.2 Unfallmechanismus und Trauma  22 3.1.3 Frakturklassifkation 24 3.1.4 Therapie  25 3.1.5 Komplikationen  26 3.1.6 Revisionen  29 3.2 Ergebnisse der Nachuntersuchung  30 3.2.1 Allgemeine Merkmale des Nachuntersuchten Patientenkollektivs  30 3.2.2 Ergebnisse im SF-36  30 3.2.3 Ergebnisse im EQ-5D  32 3.2.4 Ergebnisse im Merle d’Aubigné Score  33 3.2.5 Ergebnisse im Harris Hip Score  34 3.2.6 Vergleich der Scoreergebnisse  36 4 Diskussion  37 4.1 Allgemeine Gruppenmerkmale  37 4.2 Unfallmechanismus und Trauma  39 4.3 Klassifkation  40 4.4 Therapie  41 4.5 Komplikationen  43 4.6 Ergebnisse der Nachuntersuchung  44 5 Zusammenfassung der Arbeit 47 6 Quellen  49 7 Anlagen  A 7.1 Anlage A: AO-Klassifkation  A 7.2 Anlage B: Fragebogen zur Nachuntersuchung  C 7.3 Anlage C: Klinischer Nachuntersuchungsbogen  H 7.4 Anlage D: SF-36 Gesundheitskonzepte I 7.5 Anlage E: EQ-5D Bereiche  J 7.6 Anlage F: Modifizierter Merle d‘Aubigné Score K 7.7 Anlage G: modifizierter Merle d'Aubigné Score Auswertung L 7.8 Anlage H: Harris Hip Score Parameter. L 7.9 Anlage I: Harris Hip Score Auswertung N

No description available.

This purpose of the study is to examine the difference in the health-related quality of life (HRQOL) between individuals who suffer from physician-diagnosed arthritis compared with individuals who do not suffer from physician-diagnosed arthritis in a population of university students, faculty, and staff. The study sampled from a population of students, faculty, and staff at the University of Central Florida. Through the implantation of a cross-sectional ecological design, differences between the two groups were measured with a survey that measures health-related quality of life, such as the 36-Item Short Form Health Survey (SF-36). The SF-36 questionnaire was distributed to subjects through a campus-wide email system and was administered through Qualtrics, an online survey program. Literature suggests lower SF-36 scores for individuals suffering from arthritis, but is lacking in investigating the effect of arthritis on college-aged students, particularly within the 18-24 age group. The study aims to close this gap in the literature. SPSS software was used to analyze results through tests of association, like ANOVA, which measured differences in the SF-36 scores of subjects with physician-diagnosed arthritis and subjects without physician-diagnosed arthritis. Results showed a significant difference in the HR-QOL scores between individuals with arthritis and individuals without arthritis, as well as age, gender, ethnicity, and the presence of joint pain.

No description available.

No description available.

Bakgrund: Fysisk inaktivitet är ett av dagens största folkhälsoproblem där den fysiska aktiviteten är låg inom alla åldersgrupper. Rekommendationerna för fysisk aktivitet är 150-300 minuter med måttlig intensitet eller 75-150 minuter med hög intensitet per vecka. Betydelsen av att undersöka den äldre populationens fysiska aktivitet och mående är av yttersta vikt för att på en kommunal och regional nivå kunna sätta in lämpliga fysioterapeutiska åtgärder för att höja den egna skattade livskvaliteten och livsglädjen. Syftet: Syftet med denna studie var att undersöka självskattad fysisk aktivitet samt livskvalitet inom åldersgruppen 65+ år i Luleå kommun. Metod: En enkät bestående av FASTA samt SF-36 skickades ut via sociala nätverk till individer inom åldersgruppen 65+ år. 55 svar inkluderades varav 40 kvinnor och 15 män. Deltagarna delades in i grupper utefter ålder, kön samt aktivitetsnivå. Analys av data samt beräkningar av totalpoäng genomfördes i Google Sheets. Resultat: Det fanns könsskillnader vid självskattning av FASTA och SF-36. Män skattade något högre på alla kategorier jämfört med kvinnor. Självskattningen enligt FASTA sjönk desto äldre deltagarna blev med undantaget 65-70 år som skattade lägre på FASTA än de som var 70-75 år. Högre skattning på FASTA indikerar på en högre självskattning på SF-36 inom båda komponenterna. Ett undantag var åldersgruppen 80+ som hade högre självskattning på FASTA och SF-36, vilket kan bero på “healthy survivor effect”. Konklusion: Högre poäng på FASTA-skalan indikerar på högre självskattning på SF-36.

Health-related quality of life (HRQL) measures taken before and after coronary artery bypass grafting (CABG) aid in determining meaningful patient-perceived outcomes associated with alternative clinical interventions. This study compared performance of the Medical Outcomes Study Short Form-36 (MOS SF-36) subscales for Physical Functioning (PF), Role Physical (RP), Mental Health (MH), and Role Emotional (RE) against two other questionnaires, i.e. the Veteran's Specific Activity Questionnaire (VSAQ: self-efficacy for vigorous physical activity) and the Beck Depression Inventory (BDI-II: mental-emotional functioning). Seventy-one patients (59-M; 12-F; age, Mean + SD = 63 ± 8.6 years) were administered these three questionnaires just before and 3 months following CABG surgery. Score distributions were evaluated for the pre- and post-surgery measurements, as were change scores after CABG. All measures except the MOS SF-36 subscales for RP and RE showed statistically significant change after CABG (p<0.01). Only the subscales of RP and RE demonstrated substantial ceiling (21.0% and 56.3%) and floor effects (49.3% and 16.9%). Evaluation of individual change scores after CABG indicated that 59% and 62% of the patients, respectively, had clinically meaningful increases in the two measures of physical capability, i.e. PF and VSAQ. In contrast, 60% and 72% of patients, respectively, showed no clinically meaningful changes in the two measures of emotional functioning, i.e. RE and BDI-II scores. Chi-square analyses revealed that use of scales with similar definitional constructs resulted in significantly different surgical outcomes for the following: PF vs VSAQ (p<0.001), RP vs VSAQ (p<0.02); and MH vs BDI-II (p<0.0001). These findings illustrate the limitations in performance of the MOS SF-36 for assessing changes of importance in HRQL after CABG. The VSAQ and BDI-II, two simple measures of physical and emotional functioning that are fundamentally similar to those contained in the MOS SF-36, appear to be sensitive markers for detecting changes in these important outcomes after CABG surgery. / Master of Science

INTRODUÇÃO: Diversos ensaios clínicos randomizados (ECR) foram realizados nos últimos anos sobre a eficácia dos agentes biológicos no tratamento da artrite reumatóide (AR). Porém, as revisões sistemáticas sobre o tema ainda geram dúvidas sobre a real eficácia relacionada à capacidade funcional e qualidade de vida. MÉTODOS: O presente estudo sintetizou as evidências geradas pelas revisões sistemáticas que compararam o tratamento realizado com a utilização dos agentes biológicos e o tratamento convencional com a utilização das drogas anti-reumáticas modificadoras da doença de síntese química (DARMDq), considerando a capacidade funcional e qualidade de vida dos pacientes com AR, além de avaliar a qualidade metodológica das revisões sistemáticas recuperadas. Utilizamos as bases de dados PubMed (Medline), EMBASE e Cochrane para realizar o levantamento de revisões sistemáticas com ou sem meta-análises de ECR. Dois pesquisadores de maneira independente realizaram a seleção das revisões sistemáticas, avaliaram a qualidade metodológica utilizando a ferramenta AMSTAR e classificaram a qualidade das evidências pelo GRADE. RESULTADOS: Esta overview incluiu 10 revisões sistemáticas e meta-análises de ECR que avaliaram a capacidade funcional mensurada pelo HAQ e a qualidade de vida mensurada pelo SF-36 (PCF e PCM) em pacientes com AR que utilizaram a terapia com os agentes biológicos comparada a terapia convencional com a utilização das DARMDq. A maioria da revisões sistemáticas apresentaram alta qualidade metodológica avaliada pela ferramenta AMSTAR e a qualidade da evidência variou entre baixa a alta qualidade pelo GRADE. A melhora da capacidade funcional e qualidade de vida observada no período inicial do tratamento (24 semanas) com a terapia biológica, foi de pequena relevância clínica. Esta diferença entre os tratamentos não foi observada no longo prazo (52 semanas), principalmente com os agentes biológicos na forma de monoterapia. CONCLUSÃO: Evidências que variam entre baixa a alta qualidade mostraram que os agentes biológicos apresentaram melhora de baixa relevância clínica na capacidade funcional e qualidade de vida no período inicial do tratamento em comparação à terapia convencional com as DARMDq. Entretanto, não há diferenças entre a utilização da terapia biológica e da terapia convencional a longo prazo / INTRODUCTION: Several randomized clinical trials (RCTs) have been conducted in recent years on the efficacy of biological agents in the treatment of rheumatoid arthritis (RA). However, systematic reviews on this topic still raise doubts about the real efficacy related to functional capacity and quality of life. METHODS: This study synthesized the evidence generated by systematic reviews comparing the treatment with biological agents and the conventional treatment with disease-modifying antirheumatic drugs (DMARD), considering the functional capacity and quality of life of patients with RA, also evaluating the methodological quality of the systematic reviews retrieved. PubMed (Medline), EMBASE and Cochrane databases were searched for systematic reviews with or without RCT meta-analyzes. Two researchers independently carried out the selection of systematic reviews, assessed the methodological quality using the AMSTAR tool and classified the quality of the evidence by GRADE. RESULTS: This overview included 10 systematic reviews and meta-analyzes of RCTs that assessed functional capacity measured by HAQ and quality of life measured by SF-36 (PCS and MCS) in RA patients who used therapy with biological agents compared to conventional therapy with DMARDq. Most of the systematic reviews presented high methodological quality evaluated by the AMSTAR tool and the quality of the evidence ranged from low to high quality by GRADE. The improvement in functional capacity and quality of life observed in the initial period of treatment (24 weeks) with biological therapy presented low clinical relevance. This difference between the treatments was not observed in the long term (52 weeks), mainly with the biological agents in the form of monotherapy. CONCLUSION: Evidence that varied between low to high quality demonstrated that biological agents presented improvement with low clinical relevance of the functional capacity and quality of life during the initial period of treatment compared to conventional therapy with DMARDq. However, there are no differences in the long term between the use of biological therapy and conventional therapy

Made available in DSpace on 2016-01-26T12:51:16Z (GMT). No. of bitstreams: 1 marielza_dissert_parte 1.pdf: 600568 bytes, checksum: 0107e3e73118e6ec5de58894e7163c10 (MD5) Previous issue date: 2004-04-27 / Technological improvements in dialysis have contributed for the increased survival of chronic renal patients, however, undergoing dialysis treatment for an indeterminate time might interfere in the quality of life of these patients. This study was aimed at evaluating the quality of life of chronic renal patients undergoing hemodialysis and identifying the activities that might have a negative impact on their quality of life. This is a descriptive and exploratory study, including 125 chronic renal patients undergoing hemodialysis (74 men and 51 women), mean age 53.1±14.6 years, mean time on hemodialysis 28.5±23 months. The generic SF-36 quality of life questionnaire and a semi-structured interview were used as data collection instruments. Data was subject to a descriptive statistical analysis, the chi-squared test, Pearson s correlation coefficient and the proportion comparison test, with a significance level of 5%. The results showed impaired quality of life of the patients, with lower scores for physical aspects dimensions (32.3±11.3), emotional aspects (46.1±16.3) and vitality (48.7±7.3). Quality of life variables regarding genders did not have a significant difference. There was a negative correlation between time on hemodialysis and physical component (r=-0.75, p<0.001), indicating that the longer the time on hemodialysis the lower are the scores found for this component and there was no significant correlation between time on hemodialysis and mental component (r=-0.29). Physical and recreational activities were the most affected in the global sample and in the sample stratified by gender. There was a negative correlation between time on hemodialysis and daily activities: work (p=0.0014), domestic activities (p=0.0014) and practical activities (0.0459). Data have shown impairment in several of the analyzed quality of life aspects in chronic renal patients undergoing hemodialysis and have pointed out that daily physical and recreational activities were the most affected ones. Our results have allowed the conclusion that there were no evidences of statistically significant differences in quality of life compared to gender; time on hemodialysis correlated with quality of life and daily activities had a negative correlation with physical component and work, domestic and practical activities. These results are important predictive factors to improve quality of life parameters in these patients. / Os avanços tecnológicos na área de diálise contribuíram para o aumento da sobrevida dos renais crônicos, entretanto, a permanência por tempo indeterminado em tratamento dialítico pode interferir na qualidade de vida destes pacientes. Este estudo teve como objetivo avaliar a qualidade de vida de pacientes renais crônicos em tratamento de hemodiálise e identificar as atividades cotidianas, que podem comprometer na qualidade de vida. Trata-se de estudo descritivo e exploratório, onde foram pesquisados 125 pacientes renais crônicos em tratamento de hemodiálise (74 homens e 51 mulheres), com média de idade 53,114,6 anos, tempo médio de hemodiálise de 28,523 meses. Utilizou como instrumentos de coleta de dados o questionário genérico de qualidade de vida SF-36 e a entrevista semi-estruturada. Os dados foram submetidos a análise estatística descritiva, o teste qui-quadrado, o coeficiente de correlação de Pearson e o teste de comparação de proporções, efetuados ao nível de 5% de significância. Os resultados constataram prejuízo na qualidade de vida dos pacientes, demostrando menores escores nos domínios dos aspectos fisicos (32 3+11 3), aspectos emocionais (46,11 6,3) e vitalidade (48,77,3). As variáveis de qualidade de vida em relação ao sexo não apresentou diferença significante. Verificou-se correlação negativa entre tempo de hemodiálise e componente físico (r = -0,75, p< 0,001), indicando que quanto maior o tempo de hemodiálise mais baixos são os valores encontrados deste componente e não houve correlação sígnificante entre tempo de hemodiálise e componente mental (r = -0,29). As atividades corporais e recreativas foram as mais comprometidas tanto na amostra global quanto na estratificada por sexo. Observou-se correlação negativa entre tempo de hemodiálise e as atividades cotidianas: trabalho (p=0,001 4), atividades domésticas (p= 0,0014) e atividades práticas (0,0459). Nota de Resumo Os dados evidenciaram o comprometimento em vários domíníos analisados da qualidade de vida dos renais crônicos em hemodiálise e identificaram que as atividades cotidianas corporais e recreativas foram as mais afetadas. Os resultados permitiram concluir: que não houve evidências de diferença estatisticamente significantes da qualidade de vida em relação ao sexo; houve diferença estatisticamente significante quanto as atividades cotidianas; o tempo de hemodiálise correlacionado com a qualidade de vida e atividades cotidianas apresentou correlação negativa no componente físico e nas atividades do trabalho, domestica e prática respectivamente Estes valores são importantes fatores preditivos para a melhora dos parâmetros de qualidade de vida destes pacientes.

L’ostéopathie fonctionnelle est connue pour son action mécanique de rééquilibration des différentes structures du corps, action qui vient en renfort d’un processus permanent d’autoréparation de l’organisme. « Retracer la lésion sans irriter » dénoue les tensions myofasciales et produit des effets psychiques moins connus mais capitaux dans la clinique des troubles post-traumatiques. La prise en charge par ostéopathie fonctionnelle de patients « tout-venants » d’un cabinet privé a servi de pré-recherche qualitative pour repérer les mécanismes psychiques à l’œuvre. Puis la recherche quantitative AIVIO (Aide Intensive aux Victimes par Ostéopathie) a permis une prise en charge prospective randomisée sur plusieurs thérapeutes de victimes d’accident de la voie publique (AVP) recrutées dans un hôpital sur critère d’Etat de Stress Post-traumatique (ESPT) et/ou douleur. Cette recherche a montré l’efficacité d’une telle prise en charge par des résultats cliniques satisfaisants et statistiquement significatifs selon divers questionnaires (MOS SF-36, PCLS, DES, PPAG, BECK 21) Les résultats hautement significatifs concernent la douleur, la vie sociale et la santé psychique pour les victimes d’AVP. La taille des cohortes n’a pas permis de conclure sur l’impact du point de vue biologique, notamment sur l’évolution des taux bas de cortisol, pathognomoniques d’ESPT. L’évolution psychosomatique des patients, montrant trois différents destins, confortent les hypothèses de départ : 1/ Certains troubles anxieux post-traumatiques pourraient être soulagés par le soin du corps lui-même. Eliminer le whiplash et autres tensions myofasciales semble parfois réguler l’irritation neurovégétative et les troubles anxieux. 2/ Le cadre du soin ostéopathique produirait, en plus du travail somatique, un retour tridimensionnel (lieu-temps-niveau de conscience) sur la mémoire épisodique du traumatisme et ses affects liés. La part psychique du traumatisme s’éliminerait par réminiscence du traumatisme dans un état dissociatif paisible ou pendant un moment de sommeil. En cas de résistance au relâchement myofascial, induire délicatement ce processus habituellement spontané et inconscient relancerait le processus d’autoréparation psychique et somatique. L’induction ne parviendrait pourtant pas à diminuer les résistances lorsqu’elles reposent sur la colère, l’angoisse d’origine infantile et sur des difficultés affectives ou socio-économiques majeures. 3/ Dans d’autres cas enfin, le traumatisme corporel donnerait une occasion et un support somatique pour exprimer d’autres souffrances psychonévrotiques. Le symptôme douloureux post-traumatique serait alors maintenu par tension myofasciale. L’écoute active serait parfois suffisante pour libérer cette souffrance somatisée, surtout quand on connaît les mécanismes de défense spécifiques des différentes personnalités psychonévrotiques. Sinon l’approche psychothérapeutique conjointe serait conseillée en cas de névrose plus marquée ou de décompensation d’assises narcissiques fragiles. Du point de vue psychosomatique, nous n’avons pas observé de pensée opératoire ni de refoulement de l’imaginaire. Le symptôme étant déterminé par conservation d’énergie mécanique du traumatisme, il n’est pas métaphorique et ne devrait donc pas être interprété.