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.

A severe burn is a trauma associated with long lasting consequences, not only for the survivor but also for the family. Although it is recognized that family members are central in providing social support for the patients, previous research has not focused extensively on this group. The aims of this thesis were to increase knowledge about psychological symptoms and health-related quality of life (HRQoL) in family members of patients with burns, as well as to explore their experiences of burn care and rehabilitation. The research questions were approached using quantitative and qualitative methods. The results showed that most family members demonstrate normal to mild levels of psychological symptoms, while one third demonstrate moderate to severe symptoms during care. The symptoms decreased over time and could be predicted to a certain degree by early symptoms. Further, family members’ report of HRQoL is similar to that of the general population. An improvement is seen over time and HRQoL could be predicted in part by earlier life events and psychological symptoms. Family members’ experiences were explored in an interview study. Qualitative content analysis revealed that the time in hospital is stressful, although there were experiences of a positive character.  Family members might benefit from being cared for in a more individualized way. The communication between health care providers and the family members could be improved. Finally, a qualitative content analysis revealed that family members’ experiences and views concerning support is highly individual. There were experiences of sufficient support as well as lack of professional support. Treatment of family members should be modified according to personal circumstances, and it is important to actively include family members in the care process, both before and after discharge. In summary, being a family member of a burn survivor is a distressful experience, not only during care but in many cases also after discharge. The treatment of family members within burn care should be individualized. Some persons are more vulnerable than others and it might be possible to identify those in need of support while care is still ongoing.

The well-being of employees is an important issue. Researchers, policy makers and organisations are directing more resource into this field as the link between the health of people and their performance in the workplace becomes increasingly understood. This research programme examines how employee well-being can be measured. Having the right tools to successfully appraise well-being at the outset is judged to be imperative where any research or organisational programme to bring about change is under consideration. A review of existing methods indicates that the current provision of scales to assess the well-being of workers is limited and the construction techniques used in their development may be improved upon. At the core of this study is the testing of a new measurement framework which seeks to address these deficiencies. This innovative approach is taken from one established practice used to assess the well-being of patients using health related quality of life instruments. Three organisations participated in the study; a call centre operation, a police force and a county-based library service. Using qualitative and quantitative methodologies, three pilot questionnaires were constructed using Impact Analysis; an established procedure deployed in health related quality of life settings. Basic findings from each case study were analysed against conventional construction methods and against existing employee well-being scales. Results were also examined in respect of how they compared with the wider literature on employee well-being. ii The Impact Analysis method was critically appraised. Although weaknesses in respect of some of the qualitative phases of analyes were noted, the overall notion of transferring the practice of Impact Analysis to an occupational setting was assessed as cautiously encouraging. While this scale construction method lacks the statistical elegance of factor analytical methods, provisional indications suggest potential benefits in content validity over extant occupational scales where the assessment of a study population’s own experiences are critical to any well-being evaluation strategy. Based on the findings, a new operational definition for employee well-being is posited. A new, working model is also proposed. This emphasises for the first time, the need for specificity when researchers and organisations are seeking to evaluate a multi-dimensional, subjective construct that is employee well-being. Limitations regarding the study are noted. This means that the findings should be treated as tentative rather than conclusive. Nevertheless, it is hoped that this study will inject new thinking on how employee well-being may be evaluated using an alternative approach. By doing so, it is ventured that research communities and employers alike may take up the methods described in this study to conduct assessment programmes that could benefit not just the study teams or the employers, but importantly, the workers themselves.

This thesis explores treatment satisfaction and dissatisfaction in patients with chronic low back pain (CLBP). Chapters 1 and 2 provide background on CLBP, and treatment satisfaction and dissatisfaction. Chapter 3 presents study 1, the systematic review which identified research concerning treatment satisfaction and dissatisfaction in patients with CLBP. Findings indicated a need to define the concept, and establish appropriate measurement based on patient input and evidence to support the reliability and validity of items. Chapter 4 presents study 2, a qualitative study. Ten patients with CLBP taking medication and/or receiving physiotherapy were interviewed. A conceptual model of CLBP and a thematic map of treatment satisfaction and dissatisfaction were developed. Satisfaction was related to being 'happy' or 'pleased', and maintaining normal functioning. Treatment not working, causing discomfort, or negatively affecting health-related quality of life, as well as inconvenience of medication, lack of information, not feeling involved in treatment decisions, lack of trust and confidence in healthcare professionals, and being misdiagnosed or undiagnosed, were associated with dissatisfaction. Chapter 5 documents the development of the CLBP Treatment Satisfaction Questionnaire, based on patient input from study 2. Cognitive debriefing showed items were relevant and understood by patients. Chapter 6, study 3, explored the psychometric properties of the questionnaire. The longitudinal design involved data collection from 249 patients, some of whom participated in follow-ups. Results indicated that treatment satisfaction/dissatisfaction involves an appraisal of the following seven domains: 'Information Provided about Back Pain and Treatment', 'Burden of Back Pain', 'Impact of Back Pain and Treatment on Relationships', 'Satisfaction with the Treatment Process', 'Problems with Side Effects of Medication', 'Adherence to Physiotherapy', and 'Medication Acceptability'. Some evidence of reliability and validity are presented. This thesis concludes with Chapter 7, a discussion of the main findings of the studies, strengths and limitations, and recommendations for future research.

No description available.

Bakgrund: Humant immunbristvirus, HIV,är en obotlig virussjukdom som främst smittar som blodsmitta och sexuell kontaktsmitta. Behandlingen av HIV fokuserar på att bromsa sjukdomens förlopp och förlänga de symtomfria perioderna samt lindra symtom. Idag uppskattas det att cirka 6500 personer i Sverige lever med HIV och globalt sett lever cirka 30–35 miljoner människor med sjukdomen. De vanligaste symtomen som uppkommer vid en HIV-infektion är uppblåsthet, magsmärtor, diarré, aptitlöshet, illamående, kräkningar, viktnedgång, muskel- och ledvärk, trötthet, nedstämdhet, ångest, domningar och/eller smärta i fötterna samt sömnsvårigheter. Syfte: Att beskriva HIV-positiva patienters erfarenheter av sin hälsorelaterade livskvalité (HRLK) samt att beskriva de valda artiklarnas datainsamlingsmetod. Metod: Föreliggande studie är en beskrivande litteraturstudie där 14 vetenskapliga artiklar har granskats och kategoriserats, utifrån innehåll, för att besvara studiens syfte. Huvudresultat: Patienter med HIV hade lägre HRLK första året av behandling jämfört med innan behandlingsstart. Patienterna upplevde mer smärta, sämre fysisk aktivitet och mindre rörlighetsförmåga. Kunskap om HIV-diagnosen ledde till förbättringar inom den fysiska aspekten av HRLK, dock saknade många patienter denna kunskap. Socialt stöd hade ett positivt samband med både de psykiska och fysiska aspekterna av HRLK. Depression eller tecken på depression var något som, i varierande utsträckning, förekom bland patienter med HIV och som negativt påverkade HRLK. Datainsamlingsmetoden i samtliga artiklar bestod av enkäter. Slutsats: HIV påverkar samtliga aspekter av HRLK hos de drabbade patienterna. / Background: HIV is an incurable virus disease that mainly spreads through blood and sexual contact. The treatment of HIV focus on preventing disease progression, extend the symptom free periods, and relieve symptoms. Approximately 6500 people live with HIV in Sweden today. Globally, around 30-35 million people lives with the disease. The most common symptoms that occur during an HIV-infection is bloatedness, abdominal pain, diarrhea, loss of appetite, nausea, vomiting, weight loss, muscle and joint pain, fatigue, depression, anxiety, numbness and/or pain in the feet and sleeping difficulties. Aim: To describe HIV positive patients’experiences of their health-related quality of life (HRQL) and to describe the chosen article’s data collection. Method: The present study is a descriptive literature study based on 14 scientific article’s content, which have been reviewed and categorized based on common themes. Results: Patients with HIV experienced lower HRQL following the first year of treatment compared to before starting the treatment. The patient’s experiences more pain, worse physical activity, and more disability. Knowledge about HIV improved the physical aspect of HRQL, although many of the patients lacked this kind knowledge. Social support was positively associated with both physical and mental aspects of HRQL. Depression or depressive symptoms commonly occurred among patients with HIV and negatively affected HRQL. The data collection, in all articles, consisted of surveys. Conclusion: HIV affectsall aspects of HRQL among the effected patients.

Objectives We first sought to assess if bicyclist typology was associated with health. Second, we investigated whether bicyclist typology was related to health through physical activity and commute bicycling. Finally, we sought to develop profiles of disposition toward commute bicycling following proposed changes to a specific destination and the significance of pertinent covariates. Methods Data from the 2014 Georgia State University-Bicycling Survey were used. We first estimated the adjusted odds of worse health-related quality of life by bicyclist typology. A mediation model was then used to estimate the relative total and direct effects of bicyclist typology on health-related quality of life and relative indirect effects through physical activity and commute bicycling. A finite mixture modeling approach was used to identify latent classes of disposition toward whether proposed changes to a specific destination would increase likelihood of commute bicycling. The manual 3-Step protocol was used to assess the effect of covariates on the probability of latent class membership. Results Respondents who had never bicycled, were not motivated to commute bicycle, and who required greater bicycle facilities to feel comfortable commute bicycling had higher odds of worse health-related quality of life. Physical activity and, to a lesser extent, commute bicycling status mediated the effect of bicyclist typology on health-related quality of life. The seven-class solution was decided on as the “best” model for disposition toward whether proposed destination improvements would increase the likelihood of commute bicycling. Several covariates were identified that impact the probability of latent class assignment. Conclusions Initial evidence of a health disparity by bicyclist typology was revealed. Physical activity appears to serve as the primary means through which bicyclist typology has an effect on health. Urban environments that make physical activity, including commute bicycling, more comfortable for a larger proportion of the population may be a potential important health intervention. Understanding the patterns of disposition toward whether proposed destination improvements would increase the likelihood of commute bicycling may assist in targeting and prioritizing commute bicycling-related interventions toward subpopulations of interest.

The overall aim of this thesis is to explore experiences and self-reported outcomes from Transcatheter Aortic Valve Implantation, TAVI, among people with severe aortic stenosis. The thesis includes four studies. Study I-II are based on interviews performed the day before TAVI and Qualitative Concept Analysis was used for analysis. Study III is based on interviews at six months’ follow-up and Grounded Theory was used for analysis. Study IV is quantitative and based on questionnaires at baseline and at six months’ follow-up. Nonparametric, descriptive statistics were used for the analysis. Study I described the vulnerable situation for patients with severe aortic stenosis before TAVI. They were facing death and at the same time struggling to cope with their symptoms and to maintain independent. TAVI offered hope but also caused uncertainty about the new method. Study II focused on the patients’ decision-making process. Three patterns were identified; ambivalent, obedient, and reconciled. The ambivalent patient is unsure of the value of treatment and aware of the risks; the obedient patient is unsure of the value of one's own decision and wants to leave the decision to others; the reconciled patient has reached a point where there is no choice anymore and is always sure that the decision to undergo TAVI is right. Study III offered a deeper understanding of the TAVI trajectory. A journey of balancing between hope and life-struggle was the core category of the analysis. Before TAVI patients felt threatened, but also experienced hope. The rehabilitation phase was described as demanding and depressing or surprisingly simple. At the six months’ followup patients described being pleased to return to life, however, many were still struggling with limitations. Study IV focused on quantifying the symptom burden, function and health related quality of life before and after TAVI. The results were reflected against that of patients treated with open surgery. Self-rated function and health related quality of life increased and symptoms were reduced at follow-up, but breathlessness and fatigue were still common. Conclusively, TAVI patients are struggling with limitations, both because of their comorbidities and because of their valve disease which also poses a threat to their lives. TAVI gives an opportunity to survive, to stay independent and to increase quality of life. To feel and preserve hope is essential for patients’ wellbeing, both before and during the recovery process.

The aim of this study was to determine the relationship between HRQOL and adherence to an adolescent weight management program and identify variables predictive of increased adherence which are critical to motivating engagement in weight management. This study was a non-experimental, retrospective secondary analysis from aggregate data collected as part of the REWARD Teens program, a weight management program for overweight and obese adolescents. Data from 37 subjects were included in this study. Subject adherence to the program was the primary outcome variable. There was no significant relationship between baseline adolescent or parent-proxy sub-scale or total HRQOL scores with program adherence. A significant positive relationship for improved adherence was found only when change in BMI (p=.023), change of parent-proxy total PedsQL (p=.014), and change in child total PedsQL (p=.007) were present in the regression model. Body mass index and changes in both parent-proxy and child total HRQOL significantly affected attendance. Our findings suggest that baseline HRQOL does not affect program adherence. However, we identified a potentially novel interplay between variables predictive of program adherence. Future studies should focus on elucidating the mechanism by which these factors gained significance in the relationship with adherence when combined, perhaps as mediators or moderators, in order to identify interactions which may function as barriers or facilitators to adherence.

The study of immune status and biobehavioral measures is limited in professional nursing. The purpose of the pre-pilot study was to describe levels of cytokines prior to, during, and after dialysis, examine changes in cytokine levels from immediate pre-dialysis to immediate post-dialysis, and to compare cytokine patterns prior to and after dialysis. A within subject descriptive study was conducted as part of a larger pilot study to describe levels of cytokines prior to, during, and after dialysis, examine changes in cytokine levels from immediate pre-dialysis to immediate post-dialysis, and to compare cytokine patterns prior to and after dialysis. Serum cytokine samples were collected pre-dialysis and every 30 minutes during the dialysis treatment and immediately post-dialysis from a convenience sample of 10 patients. Mean age of subjects was 53.5 years and 60% were African American. The sample was equally divided between female and male. Statistical analysis using a nonparametric paired difference test showed that only MIP-1β showed a significant increase from pre-dialysis to post-dialysis. Based on the results of this study, a second descriptive study was conducted. The purpose of the second study was to examine the relationships among disease related factors, perceived stress, depressive symptoms, immune indicators, and HRQOL among patients requiring hemodialysis for ESRD using a PNI framework. Using a descriptive design, participants completed the Perceived Stress Scale (PSS), the Center for Epidemiologic Studies Depression Scale (CES-D), and one quality of life measure, the Functional Assessment of Cancer Therapy-General scale (FACT-G), during the first hour of the dialysis treatment. In addition, blood samples were collected immediately prior to dialysis for cytokine measurement and demographic information was collected from the medical record. The sample included 75 adults with ESRD requiring dialysis who consented and were enrolled in the study. Regression analysis showed significant correlations among the psychosocial variables (p = <0.0001, r = 0.65). Negative correlations were found between perceived stress and health-related quality of life (p = 0.024) and depressive symptoms with health-related quality of life (p = 0.0003). MIP-1 ß was the only cytokine significantly (and positively) correlated with health-related quality of life ( p = 0.0419). Principal component analysis of the cytokine data revealed three factors. A three-factor solution described the cytokine data; Factors 1 and 3 represented a pro-inflammatory response and Factor 2 represented a mixture of pro-inflammatory and anti-inflammatory responses. There was a significant correlation between Factor 1 and depressive symptoms (p = 0.0069). Significant differences in the distributions of Factors 2 and 3 were associated with the presence of cardiovascular disease (CVD) (Chi-square = 4.0, df = 1, p = 0.047), (Chi-square = 4.1, df = 1, p = 0.043), respectively, and Factor 3 with hypertension (HTN) (Chi-square = 7.6. df = 1, p = 0.006). However no relationships were found between the cytokine factors and QOL, PSS, and other variables. Findings suggest that there are relationships among psychosocial variables and possibly biological interactions that may affect perceptions of health-related quality of life among persons with ESRD on hemodialysis.