In der vorliegenden Untersuchung sollte ein möglicher Zusammenhang zwischen mundgesundheitsbezogener Lebensqualität (MLQ) und Depression untersucht und bei prothetischen Patienten und Personen der Allgemeinbevölkerung vergleichend betrachtet werden. Es handelt sich um eine Querschnittsstudie, in welche 311 zahnärztlich-prothetische Patienten und 811 erwachsene Probanden der Bundesrepublik Deutschland einbezogen wurden. Zur Erfassung von MLQ und Depression wurden als standardisierte Instrumente zum einen die deutsche Version des Oral Health Impact Profile (OHIP) und zum anderen das Vereinfachte-Beck-Depressions-Inventar (BDI-V) eingesetzt. Die statistischen Zusammenhänge der Konstrukte wurden mit Hilfe von Korrelationsanalysen sowie Strukturgleichungsmodellen ermittelt. Die konfundierenden Variablen Alter und Geschlecht wurden dabei kontrolliert. In beiden Populationen wurde ein signifikanter Zusammenhang zwischen Depression und MLQ festgestellt. Diese gegenseitige Beeinflussung zwischen MLQ sowie deren Dimensionen und der Depression war jedoch zwischen den beiden Probandengruppen signifikant unterschiedlich stark ausgeprägt. Bei den prothetischen Patienten war der Zusammenhang nur halb so stark ausgeprägt wie bei den Personen der Allgemeinbevölkerung. Die OHIP-Dimension „Psychosozialer Einfluss“ der MLQ korrelierte in beiden Probandengruppen signifikant stärker mit Depression als die anderen Dimensionen. Folglich könnte sie auf eine mögliche Depression hinweisen und als zahnärztliches Diagnostikum eingesetzt werden. Zudem legt diese Studie nahe, dass eine eingeschränkte MLQ möglicherweise erst zeitversetzt zu depressiven Symptomen führen kann.

Den föreliggande studien syftade till att utvärdera behandlingseffekten av den kognitiva beteendeterapin som bedrivs av terapeutkandidater vid psykoterapimottagningen på Karlstads universitet, med fokus på hälsorelaterad livskvalitet. Dessutom ämnade studien undersöka effekter på optimism och symptombild. Upprepad mätning användes och studien innefattade en behandlingsgrupp (n = 21), som erhöll kognitiv beteendeterapi under i genomsnitt 10,7 sessioner och en kontrollgrupp (n = 14), som stod på väntelista i genomsnitt 8,6 veckor. Resultatet av studien antyder en förbättring hos klienterna i behandlingsgruppen avseende delar av hälsorelaterad livskvalitet och optimism samt en minskning av ångestsymptom. Efter närmare 11 terapisessioner förbättrades klienterna i behandlingsgruppen signifikant avseende allmän hälsa (p = 0,028) och uppvisade en signifikant ökning gällande optimism (p = 0,027). Dessutom förbättrades klienterna beträffande flera områden inom psykisk hälsa samt uppvisade en minskning av ångestsymptom. Samtidigt pekar studien på att en viss förbättring sker även inom kontrollgruppen, vilket kan bero på den initiala terapeutiska kontakten, förväntanseffekt eller spontanremission. Studien indikerar att kognitiv beteendeterapi utförd av terapeutkandidater kan ha en positiv effekt på delar av HRQOL och optimism.

Introduction: Each year 1200-1300 patients are diagnosed with head neck cancer. Treatment that involves radiotherapy can cause severe side effects for example trismus that affects quality of life. Purpose: To study health-related quality of life in patients who have undergone radiation treatment for head and neck cancer and participated in a intervention group who received training intended to prevent trismus or in a control group who received standard treatment. Method: This is a prospective study in which data is collected from 66 patients participating in a randomized study aiming to evaluate a training program to prevent trismus. Thirty three participated in the intervention group and thirty three in the control group. Both patient groups assessed health related quality of life (HRQOL) with EORTC QLQ C30 and QLQ-H&N35, at start and end of the radiation treatment, and at 3 and 6-months after completing radiation treatment. Results: There is no difference between the intervention and control groups regarding symptoms, functional status and global health, except for intake of nutritional supplements.  For both groups almost all scales measuring HRQOL deteriorated under the radiation treatment. However, 3 and 6 months after end of radiotherapy HRQOL had improved and had returned to the baseline values. The only exceptions were dry mouth, sticky saliva, problems with social eating, senses and physical ability. Conclusion: Radiation therapy for head and neck cancer affects patients HRQOL both in the short and long term. Medical staff needs strategies to manage patients ' functional and symptomatic deterioration throughout the treatment period and try to prevent or relieve the symptoms that may still remain several months after radiotherapy.

Introduction: Chronic obstructive pulmonary disease (COPD) is a chronic disease that causes illness and death over the whole world. There are a little available data about COPD patients in Vietnam and how the disease affects their health related quality of life (HRQL). Aim: The aim of this study was to examine HRQL among patients with COPD in Ho Chi Minh City, Vietnam, and investigate differences in HRQL between men and women with COPD. Method: This was a descriptive study with a cross-sectional design. The method was quantitative by using a questionnaire. The study was performed at the respiratory department at Cho Ray Hospital in Ho Chi Minh City, Vietnam. The sampling was made through a consecutive sample. The questionnaire was based on Short Form 36 (SF-36) which is a widely used questionnaire to measure HRQL. The answers from the questionnaires were turned into a scale where 0 represent the lowest possible HRQL and 100 represent the highest possible HRQL. Results: The results showed that patients with COPD have a low HRQL. Mean value for HRQL in the total group of respondents was 22.42.The result also showed that women suffering from COPD have a significant lower HRQL than men concerning total HRQL (P-value= 0.04), general health (P-value= 0.02) and pain (P-value= 0.05). Conclusion: Patients suffering from COPD in Ho Chi Minh City have a low score of HRQL. Better routines and knowledge about the symptoms and caring for these patients are needed. Keywords: Chronic Obstructive Pulmonary Disease, Health related quality of life, Vietnam, SF-36

Measurement invariance (MI) is a prerequisite to conduct valid comparisons of Health-related quality of life (HRQOL) measures across distinct populations. This research investigated the performance of estimation methods for testing MI hypotheses in complex survey data using a simulation study, and demonstrates the application of these methods for a HRQOL measure. Four forms of MI were tested using confirmatory factory analysis. The simulation study showed that the maximum likelihood method for small sample size and low intraclass correlation (ICC) performed best, whereas the pseudomaximum likelihood with weights and clustering effects performed better for large sample sizes with high ICC to test configural invariance. Both methods performed similarly to test other forms of MI. In the numeric example, MI of one HRQOL measure in the Canadian Community Health Survey was investigated and established for Aboriginal and non-Aboriginal populations with chronic conditions, indicating that they had similar conceptualizations of quality of life.

Objective: Assess the changes in oral health-related quality of life (OHRQoL) of adolescents and their parents after overjet reduction. Materials and Methods: 53 patients between the ages of 11-18 years with increased dental overjet (≥ 6mm) and their parents were selected, of which 28 were pre- and 25 were post-treatment with dental overjet reduced to within normal limits. The data collection instrument was the Child Oral Health Quality of Life (COHQoL) Questionnaire. Results: Adolescents and their parents reported poorer quality of life before orthodontic treatment than after. The improvement in oral health-related quality of life was statistically significant for all health domains except for the social well-being domain. Parental reports on (OHRQoL) were in agreement with their children’s. No statistically significant differences were evident in (OHRQoL) between pre- and post-treatment groups. Conclusions: Adolescents with increased dental overjet ≥6mm experienced substantial psycho-social impacts. Adolescents with increased overjet can accurately recall the initial negative effects of the original malocclusion on their lives, even after a time lapse of five years. Orthodontic treatment significantly improves the perceived quality of life of orthodontic patients and their parents

Considering the increasing levels of unemployment and underemployment, and the limited evidence concerning the impact of underemployment on health, my study examines the relations between subjective, objective, and time-related underemployment and employees’ health-related quality of life, as manifested through self-rated health, activity limitations and work-related stress. The study compares an expanded model of work-health relations that, along with the factors addressed by control-demand, and social capital theories, includes characteristics of the physical work environment, and employees’ economic class. In addition to the commonly examined factors related to employment and health (control-demand and social capital), my study explores the impact of the work environment (hazards, discomfort and physical demands) and economic class to determine the specific effects of underemployment on an employee’s health-related quality of life. My main argument is that underemployment, in conjunction with lower economic class, higher exposure to a harmful work environment, lack of control over work, and lower social capital, contributes to increased work-related stress and diminishes health-related quality of life. The study applies a mixed methodological approach based on data from the Canadian Work and Lifelong Learning Survey and the US General Social Survey, and qualitative analysis of interviews from the Ontario Survey on Education-Job Requirements Matching. Evidence based on cross-sectional and qualitative data analysis provides consistent findings and confirms the main assumption that high levels of underemployment have a significant effect on employees’ health-related quality of life. The study shows that employees’ economic class, characteristics of work environment and control over work carry the highest associations with health-related quality of life, while underemployment has a significant additive association with health-related quality of life, most importantly with work-related stress.

Type 2 diabetes mellitus (T2DM) is now increasingly diagnosed in children and adolescents at an alarming rate, especially in youth from diverse ethnic backgrounds. Youth diagnosed with T2DM and their families face many challenges associated with the illness and its complications. Given that the prevalence of T2DM in youth is a recent trend, most of the studies examining T2DM have been conducted with adults. The current study expands the literature base of youth with T2DM by collecting demographic and clinical data of youth with T2DM and their families. Regression analyses were used to investigate the relationship among youth's executive function, their body mass index (BMI) and glycosylated hemoglobin (HbA1c) level. Furthermore, the study analyzed the relationship among depressive symptoms and health related quality of life (HRQOL) in youth, and the role of family members in sharing of tasks related to T2DM care and the youth's HRQOL. Results of this study demonstrated that executive function does not predict a youth's HbA1c, nor their BMI. Interestingly, one of the more significant findings to emerge from this study is that youth's rating of their ability to adjust to changes in routine or task demands and their ability to modulate emotions significantly correlated with their BMI. Results also demonstrated that HbA1c does not mediate the relationship between depressive symptoms and HRQOL, nor the relationship between the family sharing of responsibilities related to T2DM tasks and HRQOL. Future research examining the relationship among psychological and family characteristics can aid the development of diabetes prevention and treatment management.

In Australia, women with breast cancer comprise one of the largest groups of cancer survivors. As a consequence of this, and improved survival rates, the interest in programs to enhance the recovery of cancer survivors is growing. Exercise during and after treatment has been identified as a potential strategy to assist women throughout their treatment and positively influence the recovery and health-related quality of life (HRQoL) of breast cancer survivors. Through the use of an existing data source, this study investigated physical activity rates, explored the factors associated with low levels of physical activity participation, and assessed the relationship between levels of activity and HRQoL among women diagnosed with breast cancer. The population-based sample, obtained in 2002 was comprised of 287 women newly diagnosed with breast cancer, residing in South-East Queensland. Women were followed-up (via subjective questionnaire and objective physical testing) every three months over a 12-month period, from six months post-diagnosis. Physical activity was assessed using the Behavioural Risk Factor Surveillance System (BRFSS) while HRQoL was assessed using the Functional Assessment of Cancer Therapy for breast cancer (FACTB+4). Based on National Physical Activity Guidelines, women were categorised as being sufficiently active, insufficiently active or sedentary at each of the five testing phases (specifically at 6-, 9-, 12-, 15- and 18-months post-diagnosis). Rates of participation in physical activity were relatively stable over the testing period. At 18 months post-diagnosis, 44%, 43% and 13% of women, respectively, were categorised as being sufficiently active, insufficiently active or sedentary. The sedentary or insufficiently active women were more likely to be older, obese or overweight, lack private health insurance, and have received both chemotherapy and radiotherapy, compared with sufficiently active women. Sedentary women consistently reported a lower HRQoL compared to active women (sufficiently or insufficiently active) over the 12-month testing period. This was especially apparent amongst the group of younger women (aged less than 50 years at diagnosis) (p=0.02). This work is among the first to explore physical activity rates specifically among Australian breast cancer survivors, and highlights the potential importance of participating in physical activity to optimise HRQoL during recovery from breast cancer. Specific attention to promote physical activity to the identified group of sedentary and insufficiently active survivors is of particular importance.

Due to advances in detection and treatment, increasing numbers of women are diagnosed with, and surviving, breast cancer each year, making women with breast cancer one of the largest groups of cancer survivors. Hence, ensuring good healthrelated quality of life (HRQoL) following treatment has become a focal point of cancer research and clinical interest. While our understanding about the impact of breast cancer is improving, little is known about the HRQoL among survivors in non-urban areas. This is important locally, as 45% of breast cancer survivors in Queensland, Australia, live outside major metropolitan areas. Therefore, this study investigated the HRQoL and accompanying correlates among regional and rural breast cancer survivors, and made comparisons with urban breast cancer survivors as well as women from the general population without a history of breast cancer. Three population-based studies comprise this project. Original data were collected by way of self-administered questionnaire from 323 women, diagnosed with a first, primary, invasive, unilateral breast cancer during 2006/2007 and residing in regional or rural areas of Queensland, 12 months following diagnosis. HRQoL was assessed using the Functional Assessment of Cancer Therapy, Breast plus additional concerns (FACT-B+4) questionnaire. Data from two existing data sources were also utilised. Women diagnosed with a first, primary, invasive, unilateral breast cancer in 2002 and residing within 100kms of Brisbane provided information on HRQoL, measured by the FACT-B+4, via self-administered questionnaire at six (n=287), 12 (n=277) and 18 (n=272) months post-diagnosis. Data at 12 months post-diagnosis was utilised for comparison with region and rural women with breast cancer. General population data for HRQoL, collected by self-administered questionnaire in 2004 using the Functional Assessment of Cancer Therapy-General (FACT-G) questionnaire, were derived from a subgroup of female residents without a history of breast cancer from urban (n=675), regional (n=184) and rural (n=281) Queensland. The two studies involving women with breast cancer were recruited sequentially through the Queensland Cancer Registry, whereas the study involving the general population used telephone survey methods initially to identify participants. Women who participated in all studies were aged between 30 and 74 years. Raw scores for overall HRQoL (FACT-B+4, FACT-G) and subscales were computed. According to developers of the instrument, raw score differences of eight points between groups on the FACT-B+4 scale and five points on the FACT-G scale reflect a clinically meaningful differences in HRQoL. Age-adjusted, mean HRQoL was similar between regional and rural women with breast cancer 12 months following diagnosis (e.g., FACT-B+4: 122.9 versus 123.7, respectively, p=0.74). However, younger regional and rural survivors reported lower HRQoL scores compared with their older counterparts (e.g., FACT-B+4: 112.0 and 115.8 versus 129.3 and 126.2, respectively, p<0.05 for all). In addition to age, other important correlates of lower overall HRQoL (FACT-B+4) among regional/rural breast cancer survivors included: receiving chemotherapy, reporting complications post-surgery, poorer upper-body function than most, higher amounts of stress, reduced coping, being socially isolated, not having a confidante for social-emotional support, unmet healthcare needs, and low self-efficacy. Multiple linear regression analysis was used to address the hypothesis regarding similarity of HRQoL following breast cancer among women residing in regional and rural locations. After adjusting for the above factors, there was no statistically significant or clinically important difference in overall HRQoL (FACT-B+4) between regional and rural women with breast cancer 12 months following diagnosis (122.1 versus 125.1, respectively, p=0.07). Data from regional and rural women were pooled, based on the above analyses, and compared with urban women. Multiple linear regression analysis was used to test the hypothesis that HRQoL following breast cancer among women residing in regional/rural locations would be lower than that reported by women residing in urban locations. Potential confounders of the association between overall HRQoL (FACT-B+4) and place of residence included: marital status, upper-body function, amount of stress and perceived handling of stress. After adjusting for factors that differed between urban and regional/rural survivors, overall HRQoL (FACT-B+4) was lower among younger regional/rural survivors than their urban peers, and the findings were both statistically significant and clinically important (115.3 versus 123.7, respectively, p=0.001). Older women reported similar mean HRQoL, regardless of regional/rural or urban residence (128.2 versus 131.6, respectively, p=0.03). Further multiple linear regression analyses were undertaken to investigate whether women with breast cancer would report HRQoL equivalent to that reported by similarly-aged women in the general population. After adjusting for potential confounding factors that are known or suspected risk factors for breast cancer (age, marital status, education level, private health insurance, smoking status, physical activity, body mass index, co-morbidities), overall HRQoL (FACT-G) among breast cancer survivors was comparable to the general population 12 months following diagnosis (urban: 88.0 versus 86.9, respectively, p=0.28; regional/rural: 86.2 versus 85.8, respectively, p=0.79). However, 26% of survivors experienced worse overall HRQoL (FACT-G) compared with normative levels. HRQoL subscales contributing most to this deficit were physical well-being, with 29% of breast cancer survivors reporting scores below the norm, and emotional well-being among younger women, with 46% reporting scores below the norm. Logistic regression analysis was used to identify subgroups of breast cancer survivors who reported HRQoL below normative levels; reporting poorer upper-body function than most and not handling stress well increased the odds of reporting overall HRQoL (FACT-G: odds ratios (ORs) = 4.44 and 4.24, respectively, p<0.01 for both), physical well-being (ORs = 5.93 and 2.92, respectively, p<0.01 for both) and emotional well-being (among younger women: ORs = 2.81 and 5.90, respectively, p<0.01 for both) below normative levels. The cross-sectional nature of the study design for regional and rural breast cancer survivors, and the potential selection and response biases in all three studies, represent the main limitations of this work. The cross-sectional design precludes causal inference about observed associations, but even characterising relevant correlates allows for adjustment of potential confounding and provides insight into factors that may be important in contributing to HRQoL among breast cancer survivors. Moreover, the potential impact of the latter limitations is in the conservative direction, whereby differences in HRQoL between groups will be more difficult to identify. Since these biases are expected to be present to a similar degree across all study groups, the absolute difference in HRQoL by residence and cancer status observed are likely to exist. In contrast, the work is supported by a population based, state-wide sample of breast cancer survivors, comparisons with the general population, and use of standardised instruments. Therefore, the conclusions derived from this research are likely to be generalisable to the wider population of women in Queensland with unilateral breast cancer, aged 74 years or younger, and perhaps to similar women in other western countries, depending on variations in healthcare systems and the provision of oncology services. This research supports the initial supposition that while some findings may generalise to all breast cancer survivors, non-urban breast cancer survivors also have distinct experiences that influence their HRQoL. Results from this work highlight the HRQoL domains and characteristics of breast cancer survivors most in need of assistance to facilitate recovery following diagnosis and treatment. Characteristics include some already established and reconfirmed here, namely, emotional wellbeing among younger women, and other novel subgroups, including regional/rural survivors who receive chemotherapy or have a low self-efficacy and all survivors, regardless of residence, with upper-body problems or a low perception of handling stress. These results demonstrate the potential for identifying subgroups of women with breast cancer at risk for low HRQoL who may benefit from additional attention and possible tailored recovery interventions to increase their overall HRQoL. As such, researchers and clinicians need to consider the role of these factors when designing interventions to assist women as they deal with the challenges imposed upon them by their breast cancer. However, it was found here that the FACT-G instrument has ceiling effects. This means that positive changes reflecting improved status, such as those achieved through recovery interventions, will often fail to be measured appropriately if there is no room to indicate improvements. Overall HRQoL results indicated that there is room for improvement past 12 months following treatment, with a significant proportion of breast cancer survivors reporting HRQoL below normative levels. HRQoL concerns 12 months following diagnosis are likely to be distinct from the more acute issues reported earlier on in the literature. Therefore, the development of a cancer survivorship module to accompany the FACT-G would be useful to counteract the ceiling effects observed as well as to capture issues distinct to cancer survivorship. This is the first study to describe in detail the HRQoL of breast cancer survivors across all areas of Queensland and to compare it to the HRQoL reported by the general population of Queensland. Therefore, it represents a unique and substantial contribution to the existing knowledge on survivorship issues following diagnosis and treatment for breast cancer in Australia. Through this research, a number of questions remain that could be addressed by relevant investigations and which are likely to be important in the future to ultimately guide practice. Specifically, implementation of the concept of HRQoL in practice is the next important step forward. Furthermore, the development of a survivorship care plan that incorporates guidelines on HRQoL recovery could provide options for referral and support.