No description available.

Individuals with fibromyalgia report lower levels of health-related quality of life (HRQL) compared to other chronically ill populations and interpersonal factors (i.e., social support) may influence risk. What is less understood is how intrapersonal factors (i.e., self-compassion) may impact the social support-HRQL linkage. We examined the association between social support and HRQL in a sample of persons with fibromyalgia and tested the potential mediating role of self-compassion. Self-identified adults in the United States with fibromyalgia (N = 508) were recruited from state, regional, and national organizations and support groups and completed an online battery of self-report questionnaires including: Multidimensional Health Profile-Psychosocial Functioning Index, Short-Form 36 Health Survey, and Self-Compassion Scale-Short Form. Individuals with greater subjective social support reported higher levels of self-compassion and, in turn, higher mental HRQL. These findings provide greater information about psychosocial constructs and HRQL and extend our understanding of self-compassion among individuals living with fibromyalgia.

No description available.

No description available.

No description available.

Background: Tibial fractures are associated with prolonged recovery. The aim of this study was to identify predictors of long-term physical functioning after tibial shaft fracture. Methods: We used data from the Trial to Re-evaluate Ultrasound in the Treatment of Tibial Fractures (TRUST) to determine, in patients with unilateral, open or closed tibial shaft fracture, the association between baseline factors and physical functioning at 1-year. All fractures were fixed using intramedullary nails. Physical functioning was measured using the 100-point Short Form-36 (SF-36) Physical Component Summary (PCS) score; higher is better; minimally important difference is 2 to 5 points. Results: There were 299 tibial fracture patients with complete data available for analysis. In an adjusted analysis, the factors associated with lower physical functioning at 1-year were: (1) current smokers (mean difference [MD] -2.55, 95% confidence interval [95%CI] -4.63 to -0.46, p=0.017), (2) body mass index >30 kg/m² (MD -2.57, 95% CI -4.86, -0.27, p = 0.029), and (3) patients who were receiving disability benefits or involved in litigation, or planned to be (MD -2.65, 95% CI -4.58 to -0.72, p = 0.007). Patients who were employed at the time of their fracture reported significantly higher physical functioning at 1-year (MD 4.56, 95% CI 2.32 to 6.80, p= <0.001) and those who were allowed to partial or full weight-bear post-operatively (MD 1.98, 95% CI 0.13 to 3.82, p=0.036). Neither age, sex, fracture severity or receipt of physical therapy were associated with long-term physical functioning. Conclusions: Among patients undergoing surgical repair of tibial fractures, partial or full weight-bearing post-operatively and employment at the time of injury predict better long-term functioning, whereas smoking, obesity, and receipt of disability benefits or involvement in litigation (or plans to be) predict worse long-term functioning. / Thesis / Master of Science (MSc)

Yes / Loneliness in older people is associated with poor health-related quality of life (HRQoL). We undertook a parallel-group randomised controlled trial to evaluate the effectiveness and cost-effectiveness of telephone befriending for the maintenance of HRQoL in older people. An internal pilot tested the feasibility of the trial and intervention. Methods: Participants aged >74 years, with good cognitive function, living independently in one UK city were recruited through general practices and other sources, then randomised to: (1) 6 weeks of short one-to-one telephone calls, followed by 12 weeks of group telephone calls with up to six participants, led by a trained volunteer facilitator; or (2) a control group. The main trial required the recruitment of 248 participants in a 1-year accrual window, of whom 124 were to receive telephone befriending. The pilot specified three success criteria which had to be met in order to progress the main trial to completion: recruitment of 68 participants in 95 days; retention of 80% participants at 6 months; successful delivery of telephone befriending by local franchise of national charity. The primary clinical outcome was the Short Form (36) Health Instrument (SF-36) Mental Health (MH) dimension score collected by telephone 6 months following randomisation. Results: We informed 9,579 older people about the study. Seventy consenting participants were randomised to the pilot in 95 days, with 56 (80%) providing valid primary outcome data (26 intervention, 30 control). Twenty-four participants randomly allocated to the research arm actually received telephone befriending due to poor recruitment and retention of volunteer facilitators. The trial was closed early as a result. The mean 6-month SF-36 MH scores were 78 (SD 18) and 71 (SD 21) for the intervention and control groups, respectively (mean difference, 7; 95% CI, −3 to 16). Conclusions: Recruitment and retention of participants to a definitive trial with a recruitment window of 1 year is feasible. For the voluntary sector to recruit sufficient volunteers to match demand for telephone befriending created by trial recruitment would require the study to be run in more than one major population centre, and/or involve dedicated management of volunteers. Trial registration: ISRCTN28645428.

Background: The ability to measure health and the value of improving or declining health is crucial to the evaluation of health care interventions. Many generic and disease specific health status measures exist for use in patients with rheumatoid arthritis (RA). The Overall Status in Rheumatoid Arthritis (OSRA) measure is a new and simple measure with early evidence of construct validity. Generic health profiles with attached utility weights such as the EuroQol EQ-5D and the SF-6D (calculated from the Medical Outcome Study 36-item short-form health survey) allow the quantification of a patient's health relative to perfect health and death, and can be used to estimate quality adjusted life years (QALYs). The EQ-5D is extensively used in RA, but has potential limitations. The SF-6D appears to have potential, but needs further evaluation. The aim of this thesis was to assess the validity and responsiveness of the EQ5D, SF-6D and OSRA in UK RA patients, and compare the performance and implications of the use of the EQ-5D and SF-6D.Methods and subjects: Patient data were obtained from three sources; the Steroids in Very Early Arthritis (STIVEA) (n=256) and British Rheumatoid arthritis Outcome Study Group (BROSG) (n=466) randomised controlled trials, and the British Society for Rheumatology Biologics Register (BSRBR) (n=129). The data used included lifestyle and demographic factors, disease activity (DAS28), functional disability (HAQ), X-rays to assess erosive damage, the EQ-5D and the SF-6D. The OSRA was collected only in the BROSG trial. Visual analogue scales (VAS) of pain and fatigue were collected in BROSG and STIVEA. Construct validity was tested by correlating the EQ-5D, SF-6D and OSRA with a range of outcome measures for RA. Responsiveness to change was assessed using minimum important differences (MID), effect size (ES) and standardised response means (SRM), and compared using ratios. EQ-5D profiles placing arthritis patients in utility states 'worse than death' (negative scores) were described and assessed using linear and logistic regression. The implications of using the EQ-5D and SF-6D in economic evaluation were compared by cost-effectiveness analyses of the BROSG trial. Results: The correlation of the EQ-5D and SF-6D was moderate to high (0.67). Both measures had moderate to high correlations with disease activity, physical function, joint damage and fatigue. The OSRA Activity (OSRA-A) and Damage (OSRA-D) correlated strongly with measures of related aspects of disease. The EQ-5D, SF-6D and OSRA discriminated between known differences in health status across groups defined by social deprivation and disease activity. The EQ-5D MID was 0.04 for improvement and 0.10 for deterioration. The SF-6D MID was 0.04 in both directions. The SF-6D was more responsive to improvement (EQ-5D: SF-6D ES ratio 0.78-0.88) and the EQ-5D more responsive to deterioration (ES ratio 1.14) in health. The OSRA-A was the most sensitive disease specific measure in the BROSG trial, and the OSRA-D was more responsive than the HAQ. The factors associated with being in a 'worse than death' health state were male gender, the HAQ, SF-36 mental composite scale, pain VAS, and erythrocyte sedimentation rate (a marker of inflammation). Pain was the predominant factor and was scored at the most extreme level in every worse than death profile. The cost-effectiveness analyses (BROSG trial), found net quality adjusted life years (QALYs) were greater for the EQ-5D (0.07) than the SF-6D (0.05), but had higher variance than the SF-6D. Conclusions: The EQ-5D and SF-6D appear valid and responsive to changes in health in RA, but measure subtly different aspects of health. There are issues with both measures, and cost-effectiveness conclusions of a study could differ according to which measure was used. The EQ-5D may be more likely to demonstrate that an intervention is cost effective than the SF-6D, due to its larger mean change in response to change in health status. The OSRA is valid for use in RA and its responsiveness suggests potential for inclusion in clinical trials.

Bakgrund: Fetma och övervikt har blivit vanligare den senaste tiden och är idag ett stort hälsoproblem över hela världen. Många har svårt att gå ner i vikt på egen hand vilket har gjort att kirurgi har blivit allt vanligare de senaste åren. Gastric bypass är idag den vanligaste kirurgiska metoden för viktminskning och har visat goda resultat. Däremot kan den hälsorelaterade livskvalitén påverkas då operationen innebär en stor livsstilsförändring. Syfte: Syftet med denna studie var att beskriva vuxna personers upplevelse av hälsorelaterad livskvalité efter en gastric bypass operation. Metod: En litteraturöversikt med 11 kvantitativa och 3 kvalitativa vetenskapliga artiklar som ligger till grund för hur vuxna personer upplever sin hälsorelaterade livskvalité efter en gastric bypass operation. Resultat: Hälsorelaterad livskvalité (HRQOL) har visat en förbättring i samtliga studier efter en gastric bypass operation. HRQOL har haft sin topp efter 1 månad i samtliga skalor utifrån SF-36 frågeformulär. Slutsats: Den stora livsstilsförändringen som personer går igenom efter en gastric bypass operationen har visat förbättringar i HRQOL på både lång och kort sikt. Bidragande faktorer som kan påverka den förbättrade hälsorelaterade livskvalitén kan bland annat vara uppfyllda förväntningar av operationen och fysisk aktivitet. / Background: Obesity and overweight have become more frequent in recent years and is today a major health problem worldwide. A lot of people find it difficult to lose weight on their own which has made surgery become more common in recent years. Gastric bypass surgery is currently the most common surgical method of weight loss and have shown good results. However, the health-related quality of life is affected as the operation demand a major lifestyle change. Purpose: The purpose of this study was to describe adults’ experience of health-related quality of life after a gastric bypass surgery. Method: The study contains 11 quantitative and 3 qualitative scientific articles describing the adults’ experience of health-related quality of life after a gastric bypass surgery. Results: Health-related quality of life (HRQOL) has shown an improvement in all studies after a gastric bypass surgery. HRQOL has had its peak after 1 month in all scales based on the SF-36 questionnaire. Conclusion: The major lifestyle change that people go through after a gastric bypass surgery has shown improvements in HRQOL in both long and short term. Contributing factors that may affect the improved health-related quality of life can among other things be fulfilled expectations of the surgery and physical activity.

Prostate cancer (PCa) has been the leading cause of cancer death in men since1930. While studies pertaining to PCa have primarily focused on the disease and the subsequent side effects of treatment, psychological distress in this group has yet to be adequately addressed. The purpose of this dissertation was to: 1) conceptualize health related quality of life (HRQL) and health seeking behavior of men by describing lifestyle, cultural and health risks associated with being male, 2) evaluate the psychometric properties of the SF-12 Health Survey (SF-12) combined with the urinary and sexual portions of the UCLA PCa Index (UCLA-PCI), 3) investigate the psychological impact, coping styles and informational needs of a group of men diagnosed with PCa who have not yet undergone treatment. Men have been observed to underutilize health care services despite the fact that they are in poorer health, have higher mortality rates and lower life expectancies than women. Restricting emotions, being oriented toward success, having limited social networks and taking health risks are often associated with being male. Because incontinence and sexual dysfunction, the two most common side effects of PCa treatments impact men's quality of life, portions of the UCLA-PCI and the SF12 were analyzed. The psychometric analysis of the SF-12/UCLA-PCI and its three subcomponents confirmed the validity of the instrument. The SF-12 component had a Cronbach's alpha of 0.87, while the urinary and sexual subscales had a Cronbach's alpha of .86 and .91 respectively. All three scales were found to have good internal consistency. KEYWORDS: prostate cancer, health related quality of life, coping styles, psychological distress.