La qualité de vie liée à la santé (QdV) s’est imposée comme une préoccupation essentielle dans la prise en charge des patients. Elle est devenue un des objectifs majeurs des essais cliniques.Notre revue bibliographique a montré un réel manque de données sur la QdV de la femme enceinte, puisqu’entre 2005 et 2015, elle n’a identifié que 75 articles portant sur cette problématique. Nous avons donc voulu déterminer l’évolution de la QdV chez les femmes enceintes du premier trimestre au 9ème mois, à l’aide du questionnaire EQ5D-3L version française, en différenciant les grossesses physiologiques des grossesses pathologiques, et en comparant cette évolution inter et intra grossesse. A cette fin, nous avons suivi une cohorte de 500 femmes enceintes entre 2015 et 2017 au CHU de Toulouse qui ont complété mensuellement un cahier d’observation en ligne. Après avoir réalisé une régression par morceaux, entre le 4ème et le 8ème mois, la QdV était significativement plus basse pour les grossesses pathologiques et diminuait significativement pour chaque type de grossesse. Ces résultats nous ont amené à nous demander si la QdV de la femme enceinte pouvait avoir un impact sur le mode d’allaitement à la naissance (maternel ou artificiel). A partir de cette même cohorte, où nous avions également recueilli le mode d’allaitement à la naissance, nous n’avons pas montré de lien entre QdV au cours de la grossesse et mode d’allaitement à la naissance, que ce soit lors de l’analyse mensuelle ou lors de l’analyse catégorielle qui était fonction de la QdV au 3ème mois de grossesse et de son évolution au cours de la grossesse / Health Related Quality of life (HRQoL) has emerged as a major concern in the care of patients and has become a major objective of clinical trials.Our literature review showed us a real lack of data on the QoL of the pregnant woman, since between 2005 and 2015, she identified only 75 articles dealing with this problem.We therefore wanted to determine the evolution of QoL in pregnant women from the first trimester to the 9th month using the EQ5D-3L French version, by differentiating physiological pregnancies from pathological pregnancies and comparing this inter and intra pregnancy progression. . We therefore followed a cohort of 500 pregnant women between 2015 and 2017 at Toulouse University Hospital, who completed a monthly online observation form. After performing piecemeal regression, between the 4th and 8th month, QoL was significantly lower for pathological pregnancies and significantly decreased for each type of pregnancy.These results led us to question whether the QoL of the pregnant woman could have an impact on breastfeeding at birth (maternal or artificial). From this same cohort, where we also collected breastfeeding at birth, we did not show a link between QoL during pregnancy and breastfeeding at birth, whether at birth. monthly analysis or categorical analysis that was based on QoL at the 3rd month of pregnancy and its course during pregnancy

Made available in DSpace on 2016-04-28T20:38:46Z (GMT). No. of bitstreams: 1 Camila Souza Novaes.pdf: 5824337 bytes, checksum: 0e69f53b1ab8cf707be1f24ab68cd5a5 (MD5) Previous issue date: 2013-11-01 / This study aims to determine whether the Complementary Spiritist Therapy promotes improvement in quality of life and perceived health of the patient according to their selfreport. Based in Jungian Psychosomatic Model of diseases, this paper uses the method of qualitative and quantitative research, through the application of semi-structured interviews and The Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) before and after the participants undergo a spiritual healing treatment. The sample consists of thirtythree participants with various diseases, 34-81 years, of different religions, frequenters of a spiritist center of the city of São Paulo. The interview results showed that for the majority of the sample the treatment was effective because the respondents had a perception of improvement in their health status, reported a decrease in symptoms, acquired some kind of learning and changed their relationship with the disease itself. This way faith proved to be an important element of healing. For a minority of the sample, there has been little improvement in their perception of physical symptoms. However, they obtained psychological and spiritual gains. When comparing the average results of the participants in the first and second application of the SF-36, there was significant improvement in the mental component summary and in the following domains of quality of life: role-physical, bodily pain, general health, vitality, social functioning, role-emotional and mental health. The differences between the outcomes of the first and second application of the SF-36 of physical functioning and the physical component summary were not statistically significant / Este trabalho tem como objetivo verificar se a Terapia Complementar Espírita (TCE) promove melhora na qualidade de vida e na percepção de saúde do paciente segundo seu autorrelato. Fundamentada no Modelo Psicossomático Junguiano de doenças, esta dissertação utiliza o método qualitativo e quantitativo de pesquisa, através da aplicação de entrevistas e do Instrumento Genérico de Avaliação de Qualidade de Vida em Saúde (questionário SF-36) antes e depois dos participantes se submeterem a um tratamento de cura espiritual. A amostra é composta por trinta e três sujeitos com enfermidades diversas, de 34 a 81 anos, de distintas religiões, frequentadores de um centro espírita da cidade de São Paulo. Os resultados das entrevistas indicaram que para a maioria da amostra o tratamento foi eficaz, pois os entrevistados obtiveram uma percepção de melhora no estado de saúde, observaram uma diminuição dos sintomas apresentados, adquiriram algum tipo de aprendizado e modificaram a relação com a própria doença. A fé se mostrou assim um importante elemento de cura. Para uma minoria, houve percepção de pouca melhora nos sintomas físicos. Contudo, obtiveram ganhos de ordem psicológica e espiritual. Ao comparar as médias dos resultados dos participantes obtidos na primeira e na segunda aplicação do questionário, observaram-se resultados de melhora significativa no sumário de componentes mentais e nos seguintes domínios de qualidade de vida: aspectos físicos, dor, aspecto geral de saúde, vitalidade, aspectos sociais, aspectos emocionais, saúde mental. A diferença entre as médias da capacidade funcional e no sumário de componentes físicos não foi estatisticamente significativa

<p>Delirium is common among old patients admitted to hospital, but is often a neglected problem in patient care. The principal aim of this thesis was to evaluate aspects of delirium in relation to incidence, risk factors, behavioural changes, cognitive function and health-related quality of life (HRQOL). A further aim was to describe patients’ experiences of being delirious. The study was prospective, descriptive and comparative, with repeated measures (six-month follow up). The sample consisted of 225 consecutive patients, aged 65 years or older, who were to be operated on due to hip fracture or hip replacement. Exclusion criteria were serious cognitive disorder or delirium on admission. Data were collected via frequent daily observations, cognitive functioning tests (MMSE), HRQOL questionnaires (SF-36) and interviews. Delirium was assessed according to the DSM-IV criteria. A total of 45/225 became delirious, with an incidence of 24.3% among patients undergoing hip fracture surgery and 11.7% among those with hip replacement surgery. A predictive model for delirium included four factors: impaired hearing, passivity, low cognitive functioning, and waiting more than 18h for hip fracture surgery. Disorientation and urgent calls for attention were the most frequent behavioural changes in the prodromal phase prior to delirium. Delirium in connection with hip fracture revealed deteriorated HRQOL and cognitive functioning when measured at a six-month follow-up. The experience of being delirious was described by the patients as a sudden change of reality. Such an experience gave rise to strong emotional feelings, as did recovery from delirium. Nurses’ observations of behavioural changes in old patients with impaired cognitive function may be the first step in managing and reducing delirium. The predictive model of delirium ought to be tested further before use in clinical practice.</p>

<p>The aim the thesis was to investigate, the prevalence of Lower Urinary Tract Symptoms (LUTS). Moreover, we examine symptom severity and different levels of distress and describe how different symptoms from the lower urinary tract affect the self-assessed health, sadness, happiness and the quality of life in men. </p><p>The studies are based on two data collections. In the first data collection, all men aged 40 – 80 years (n=2571) living in the Swedish community received a postal questionnaire. Twelve months later, 504 men who had earlier reported LUTS and 504 who had not reported symptoms were asked to complete the DAN-PSS and the SF-36 questionnaires. </p><p>The overall prevalence of LUTS was 24%. Post-micturition dribbling (21%) was the most frequent symptom, and stress incontinence (2%) was the least frequent symptom. Urge incontinence, stress incontinence and “other” incontinence cause a high level of distress, even if the symptoms do not occur very often. Men experiencing mild, moderate or severe urge, stress or “other incontinence” had lower mean scores for all of the eight dimensions measured by the SF-36 than men without the same symptoms. Men experiencing a moderate/severe degree of weak stream or nocturia reported a poorer quality of life in all dimensions compared to men with a mild level of the same symptoms. The total burden of moderate/severe LUTS is related to self-assessed health, sadness and happiness. For each of the 12 specific LUTS, men with mild, moderate or severe symptoms had lower scores for self-assessed health and happiness, and higher scores for self-assessed sadness, than men without the same symptoms. </p><p>In conclusions, one of every four men reports LUTS. Urinary incontinence causes high level of distress even to men who experience this symptom rarely. LUTS have a negative impact on quality of life, health, sadness and happiness. </p>

Delirium is common among old patients admitted to hospital, but is often a neglected problem in patient care. The principal aim of this thesis was to evaluate aspects of delirium in relation to incidence, risk factors, behavioural changes, cognitive function and health-related quality of life (HRQOL). A further aim was to describe patients’ experiences of being delirious. The study was prospective, descriptive and comparative, with repeated measures (six-month follow up). The sample consisted of 225 consecutive patients, aged 65 years or older, who were to be operated on due to hip fracture or hip replacement. Exclusion criteria were serious cognitive disorder or delirium on admission. Data were collected via frequent daily observations, cognitive functioning tests (MMSE), HRQOL questionnaires (SF-36) and interviews. Delirium was assessed according to the DSM-IV criteria. A total of 45/225 became delirious, with an incidence of 24.3% among patients undergoing hip fracture surgery and 11.7% among those with hip replacement surgery. A predictive model for delirium included four factors: impaired hearing, passivity, low cognitive functioning, and waiting more than 18h for hip fracture surgery. Disorientation and urgent calls for attention were the most frequent behavioural changes in the prodromal phase prior to delirium. Delirium in connection with hip fracture revealed deteriorated HRQOL and cognitive functioning when measured at a six-month follow-up. The experience of being delirious was described by the patients as a sudden change of reality. Such an experience gave rise to strong emotional feelings, as did recovery from delirium. Nurses’ observations of behavioural changes in old patients with impaired cognitive function may be the first step in managing and reducing delirium. The predictive model of delirium ought to be tested further before use in clinical practice.

The aim the thesis was to investigate, the prevalence of Lower Urinary Tract Symptoms (LUTS). Moreover, we examine symptom severity and different levels of distress and describe how different symptoms from the lower urinary tract affect the self-assessed health, sadness, happiness and the quality of life in men. The studies are based on two data collections. In the first data collection, all men aged 40 – 80 years (n=2571) living in the Swedish community received a postal questionnaire. Twelve months later, 504 men who had earlier reported LUTS and 504 who had not reported symptoms were asked to complete the DAN-PSS and the SF-36 questionnaires. The overall prevalence of LUTS was 24%. Post-micturition dribbling (21%) was the most frequent symptom, and stress incontinence (2%) was the least frequent symptom. Urge incontinence, stress incontinence and “other” incontinence cause a high level of distress, even if the symptoms do not occur very often. Men experiencing mild, moderate or severe urge, stress or “other incontinence” had lower mean scores for all of the eight dimensions measured by the SF-36 than men without the same symptoms. Men experiencing a moderate/severe degree of weak stream or nocturia reported a poorer quality of life in all dimensions compared to men with a mild level of the same symptoms. The total burden of moderate/severe LUTS is related to self-assessed health, sadness and happiness. For each of the 12 specific LUTS, men with mild, moderate or severe symptoms had lower scores for self-assessed health and happiness, and higher scores for self-assessed sadness, than men without the same symptoms. In conclusions, one of every four men reports LUTS. Urinary incontinence causes high level of distress even to men who experience this symptom rarely. LUTS have a negative impact on quality of life, health, sadness and happiness.

Unilateral cleft lip and palate (UCLP) is a craniofacial malformation with functional and aesthetical impact on the face and the upper airways. The aims of the current thesis were to evaluate Quality of life (QoL) in adults treated for UCLP  (I), to objectively evaluate nasal form and function and to search for possible differences in residual nasal deformity and impairment of function between patients operated according to one-stage and two-stage palate closure (II) as well as to evaluate the relationship between professional and lay rating and patient satisfaction with nasolabial appearance (III) and to identify factors associated with lower levels of QoL and less satisfaction with nasal appearance among adults treated for UCLP (IV). Analyses of data from a homogenous population of UCLP patients treated at Uppsala University Hospital form the basis of this thesis. The mean follow-up time after primary surgery was 35 years (20-47 years) and participation rate was 79% (n=86). An age and gender matched control group of 68 people without clefts were evaluated according to the same protocol. The evaluation protocol included the Short Form 36 questionnaire (SF-36), rhinomanometry, acoustic rhinometry, odor test, peak nasal inspiratory flow test and photographies of faces. For the SF-36 data, age- and gender-matched norm data of 1385 people from the Swedish population were used. Unilateral cleft lip and palate affected QoL differently depending on gender and age of the patient. Younger patients were affected more negatively than older patients in several subscales. However, except for lower values in the Mental Health subscale, QoL was similar among UCLP patients and norm data. Objectively measured nasal function was extensively affected among adults treated for UCLP. No difference in impairment of nasal function was found between one-stage and two-stage palate closure protocols on the cleft side. Judgment of nasolabial appearance differed between professionals, lay people and patients. Large infant cleft width was associated with less satisfaction with nasal appearance and male gender was associated with lower levels of mental QoL. Correlation between high nasal breathing resistance and low levels of physical QoL was found. In conclusion, this thesis provides a platform for future research for optimal evaluation of cleft treatment outcome.

Background: RTW after work-related injuries is a multifactorial process. Factors affecting clinicians to make RTW-recommendations for patients with WRSEI have not been studied in the literature. Purpose: We investigated the associations between group of factors chosen from different domains (Personal/Environmental) and clinicians’ RTW-recommendations for patients with WRSEI. Methods: Study design was cross-sectional. Data were collected from self-reported surveys and clinical charts of 130 adult workers (not working at the time of visit and referred to WSIB-Shoulder & Elbow Specialty Clinic-Toronto) with chronic (≥6-months) injuries. Results: Population mean age was 43.5-years. 52% were female. The average time-since-injury was 20.4-months (45%>12-months). 70% received RTW-recommendations (regular/modified-job). 30% received a No-RTW-recommendation. 42% had education≥college-level. 18% had heavy (>20kg) job-demands. Higher MCS-scores had a significant association (p=0.0003) with clinicians’ RTW-recommendations. Conclusion: In patients with chronic WRSEI(s), poor general health-status and high disability, workers with better mental-health were more likely to receive a RTW-recommendation by clinicians.

Background: RTW after work-related injuries is a multifactorial process. Factors affecting clinicians to make RTW-recommendations for patients with WRSEI have not been studied in the literature. Purpose: We investigated the associations between group of factors chosen from different domains (Personal/Environmental) and clinicians’ RTW-recommendations for patients with WRSEI. Methods: Study design was cross-sectional. Data were collected from self-reported surveys and clinical charts of 130 adult workers (not working at the time of visit and referred to WSIB-Shoulder & Elbow Specialty Clinic-Toronto) with chronic (≥6-months) injuries. Results: Population mean age was 43.5-years. 52% were female. The average time-since-injury was 20.4-months (45%>12-months). 70% received RTW-recommendations (regular/modified-job). 30% received a No-RTW-recommendation. 42% had education≥college-level. 18% had heavy (>20kg) job-demands. Higher MCS-scores had a significant association (p=0.0003) with clinicians’ RTW-recommendations. Conclusion: In patients with chronic WRSEI(s), poor general health-status and high disability, workers with better mental-health were more likely to receive a RTW-recommendation by clinicians.

The purpose of this study was to understand the factors that encourage midlife women to make exercise and dietary changes, the prevalence of those changes, the process by which women make them, the factors that support or impede them, and how we can enhance women’s capacity to make health behaviour changes in midlife. Since the literature highlighted the importance of self-efficacy in changing health behaviour, and of health-related quality of life as a widely recognized measure of women’s mental and physical wellbeing, the study sought to understand the relationship between exercise and dietary self-efficacy, health behaviour change and health-related quality of life (SF-36), by testing a modified version of Bandura’s 1977 and 2002/2004b models of self-efficacy. The methodology involved postal surveys as well as semi-structured interviews with a subsample of the women who completed the survey. Surveys were sent to 866 women aged 51-66 years from rural and urban locations in Queensland, Australia. Five hundred and sixty-four (69%) were completed and returned. Survey data was analysed using descriptive and bivariate statistics and structural equation modeling. Thematic analysis was used to analyse interviews. The results confirmed that midlife is a significant time for women to make positive health behaviour changes. Almost 40% of women made a change to their exercise and around 60% made a dietary change since turning 40. The main exercise change was doing more walking and the most common dietary change was reducing fat intake. Self-efficacy was shown to be a key influence on whether women made positive changes to their health in midlife. In the relationship between health behaviour change and health-related quality of life, making a positive change to exercise was significantly related to physical but not mental health, and making a dietary change was not related to either physical or mental health. Body mass index was shown to be an important influence on both self-efficacy and health-related quality of life (particularly physical health). Interviews were conducted with 29 of the participants. Interview data reinforced that the main motivations to make a positive health behaviour change among midlife women were being overweight, having an injury or being diagnosed with an illness or health condition. Witnessing the hardship experienced by others with a degenerative disease could also prompt a positive behaviour change. Successful changes mainly involved modifying existing practices and repeating new behaviours until they became part of the daily routine. The main facilitators of health behaviour change were having positive role models, having more time due to retirement, and having support from significant others (such as husbands), health professionals and organizations such as Weight Watchers. The main obstacles to making changes were work, care giving, illness and injury. Bandura’s (1977, 2000/2004b) model was partially supported, but the cross-sectional nature of the study may have been a limitation in demonstrating all aspects of the self-efficacy process. In summary, women are willing to make positive health behaviour changes in midlife, but they need education and support to have those changes be effective. It is anticipated that this research will lead to a greater understanding of the significance of midlife as a time for making healthy lifestyle changes that have the potential to improve women’s health and quality of life in later years.