The overall purpose of this thesis was to identify determinants of quality of life in adults with diabetes mellitus. This thesis consists of two studies. The first study tested a comprehensive model which comprised of personal, medical and lifestyle factors to explain quality of life in adults with type 2 diabetes. The model was tested with two concepts of quality of life: health-related quality of life and life satisfaction. The second study (1) tested the comprehensive model in adults with type 1 diabetes; and, (2) examined the interaction effects of diabetes type (i.e., type 1 diabetes /type 2 diabetes) on significant determinants of quality of life in the combined type 1 and type 2 diabetes group. The findings of this study identified subgroups that may be at risk for impaired quality of life and topics that require further investigation.

Quality of life and productivity are two important measures in health outcomes that usually require the use of self-reported surveys for accurate assessment. Measuring health-related quality of life (HRQOL) has been established as an important field in the past century, and many psychometrically validated instruments exist for both general and specific population use. Another health measure that has attracted a significant amount of attention in recent years, although there is no gold standard, is that of workforce productivity. Most productivity studies measure the amount of work loss incurred by employees in the form of absenteeism and presenteeism. A new survey that combines questions from existing HRQOL and workforce productivity surveys, the Health-Related Quality of Life and Work Productivity Questionnaire (HQWP), was constructed and tested using a descriptive, cross-sectional study of faculty and staff at a major research university. As expected, HRQOL and work loss were found to be negatively correlated. In addition, staff were found to have statistically higher levels of absenteeism than faculty, but faculty had higher levels of presenteeism. Using multivariate regression models on several measures of productivity, including both absenteeism and presenteeism, we concluded that mental health measures were stronger predictors of productivity than physical health measures for our overall sample, as well as faculty and staff groups separately. In addition, those who work extra hours to make up for lost production had significantly lower social function scores compared to those who do not. Other statistical analyses performed include PCA factor analyses on presenteeism covariates. Lastly, we performed economics analyses on the cost savings that could be achieved through health management programs to reduce absenteeism and presenteeism levels. A better understanding of reasons for absenteeism and presenteeism could help inform targeted workplace programs to reduce employer indirect costs related to lost productivity. Moreover, such programs could reduce rates of turnover due to increased employee satisfaction, as well as improve both quantity and quality of life years.

The aim of this thesis was to investigate in a (RCT) the effect of support group intervention in women with primary breast cancer in the short term, and with a long-term follow-up. Women with primary breast cancer were randomized between April 2002 and November 2007 and stratified according to adjuvant treatment with chemotherapy. Of 382 eligible patients, 191+191 patients were randomized to intervention and control groups respectively. Control patients were subjected to standard follow-up procedures. Patients in the intervention group received support intervention at the Foundation of Lustgården Mälardalen during one week followed by four days of follow-up two months later. Patients in intervention and control groups filled in questionnaires at baseline, after 2, 6 and 12 months and in the long-term follow-up after a mean of 6.5 years. In paper I, we studied the effect of the intervention on anxiety and depression measured by the HAD scale and we could show that a significantly lower proportion of women in the intervention group had high anxiety scores compared with women in the control group after 12 months; however, the proportion of women with high depression scores were unaffected. In paper II, we studied the effect of the intervention on fatigue and health-related quality of life (HRQoL) measured by the Norwegian version of the fatigue questionnaire (FQ) and EORTC-QLQ 30 and BR 23.We could not demonstrate any significant effect of the intervention. In paper III, we studied the effect of the intervention on sick-leave, healthcare utilization and the effect of the intervention in economic terms. We used a specially formulated questionnaire. There was a trend towards longer sick leave and more health-care utilization in the intervention group. The difference in total costs was statistically significantly higher in the intervention group after 12 months (p= 0.0036). In paper IV, we studied the long-term effects of the support intervention on anxiety, depression, fatigue and HRQoL. We could show a significant effect of the intervention on cognitive function, body image, future perspective and fatigue, the largest effect was seen among women who received chemotherapy; however, no effects on anxiety and depression were demonstrated.

Breast cancer is a common disease in Australia and exerts a sizable burden to individuals, families, and health care resources. Studies that assess healthrelated quality-of-life (HRQoL) are particularly relevant as survivors must learn to live with breast cancer, undergo prolonged treatment, use new pharmacological agents, monitor and adjust to a serious condition. Relatively little published evidence exists on the effects of rehabilitation programs for breast cancer survivors but those published demonstrate positive health benefits that alleviate both physical and psychological problems. This study aimed to partly fill this gap and had the objectives of: a) estimating the effectiveness of two rehabilitation interventions for breast cancer survivors over time compared to a non-intervention comparison group; and b) ascertaining which option was cost-effective when taking a societal perspective. Effectiveness was described in terms of HRQoL and functional status and there was a particular focus on upperbody morbidity since the two interventions primarily addressed this aspect of rehabilitation. The study participants comprised three groups: one group received a physiotherapy home-visits service (DAART), the second attended a gentleexercise group program (STRETCH), while the third represented a nonintervention comparison group for later analyses only. Data collection was primarily by way of postal questionnaires while medical and cost data abstraction was also necessary. Reliable and validated instruments were used to collect HRQoL and utility data. The Functional Assessment of Cancer Therapy - Breast Cancer plus the Arm Morbidity module (FACT-B+4), Disabilities of the Arm, Shoulder and Hand (DASH), and the Subjective Health Estimation (SHE) instruments were chosen for their high psychometric performance with various populations, their brevity, quick administration and relevance to a breast cancer sample. Missing data was a small concern overall, however, baseline differences were present and mixed across the three participant groups indicating selection bias was present. DAART showed poorer demographic indicators of socioeconomic status and were older, STRETCH participants had poorer disease and treatment profile, while the non-intervention women had poorer general health characteristics. Based on bivariate analyses, age, presence of comorbidities, chemotherapy, high blood pressure, work status (unpaid/paid), hormone therapy were determined to be factors requiring control for in the multivariate analyses. Benefits were found for multiple dimensions of HRQoL for the DAART intervention. On average, HRQoL levels were fairly high across the three alternative participant groups and no significant group differences were found. However, approximately one-third of the women experienced declining HRQoL between 6- to 12-months and their scores were significantly poorer than other participants. STRETCH incurred higher overall costs per participant (on average) than DAART and the non-intervention groups. This was driven by higher leisure time forgone, travel and higher community costs. DAART experienced the highest program costs (or health system costs). Therefore, by taking a societal perspective, and incorporating the estimated value of more intangible or indirect costs (e.g., volunteers, travel costs etc.) the STRETCH program was more costly. The greatest influence on higher costs incurred by the STRETCH participants was the average out-of-pocket expenses for health care services purchased during the previous 12 months for breast cancer-related problems. Although an exploratory finding, the DAART group emerged as the cost-effective option, that is, the incremental cost per QALY gained was $1,344 compared to STRETCH $14,478. The key drivers in the cost-effectiveness modelling were utility values and health service expenditure. When uncertainty was quantified by way of Monte Carlo modelling, DAART remained the cost-effective choice. This project has highlighted that while many women seem to breeze through their breast cancer diagnosis and treatment, there are a substantial number of women who do not. Therefore, it is quite mistaken to generalise the favourable levels of HRQoL and expect that all women will get back to 'normal'. Given that HRQoL is a very complex concept, it was important to use validated tools that had undergone extensive testing with sound psychometric properties. Health care activities observed in their natural 'real world' setting are preferable to minimise biases that may cause more favourable results than truly occur and allow a better assessment on the impact of the service. The project findings have been interpreted while respecting a number of limitations. These have included potential selection and response bias, missing data, and small numbers of intervention women and defined socio-demographic profiles. Taken together, these are likely to overestimate the true outcomes. Arguably, selection bias and the timing of the interventions are likely to be the strongest factors affecting the generalisability of these findings. Given the caveats of this research, the following recommendations were made: 1. Greater awareness and/or screening of adjustment problems among survivors needs to be considered during recovery from breast cancer surgery. 2. Early physiotherapy should be given to all breast cancer survivors after surgery due to the potential functional, physical and overall HRQoL benefits that may arise. 3. Professionally-led group exercise therapy with psychosocial care appears to have a neutral effect on upper-body recovery and improving HRQoL. However, it provides advantages for attendees in the form of peersupport, education, a holistic focus and the potential for addressing previously unrecognised psychological problems in a caring and acceptable environment. This program, with large community resources (provided voluntarily), represents a very low-cost outlay for health services and should be given support and consideration during follow-up care after breast surgery. 4. From a societal perspective, a home-visiting physiotherapy service represents a cost-effective means to provide rehabilitative care for breast cancer patients and represents an excellent public health investment. Several topics for further research are likely to be important in the future including, among others, other modes and settings of rehabilitation service delivery, barriers to psychosocial care and the indirect financial and work consequences of having breast cancer.

The development of major commercial airports promotes the air transport industry and generates positive economic benefits to the airport and to its host economy. However, external costs are associated with these benefits. Any increase in aircraft movement causes negative environmental impacts, especially noise pollution. Governments have reduced aircraft noise levels at their sources, or introduced aircraft noise management strategies (ANMS); however the problems have never been satisfactorily resolved. This research aims at developing a better understanding of the impacts of aircraft noise on community health and well-being by exploring two core research questions: (1) ???Is health related quality of life worse in communities chronically exposed to aircraft noise than in communities not exposed????; and (2) ???Does long-term aircraft noise exposure associate with adult high blood pressure level via noise stress as a mediating factor????. The Sydney (Kingsford Smith) Airport has been selected as a case study. The health survey instruments have been developed and piloted, and then translated from English into Greek and Arabic. A postal self-administrative health survey (with follow-up letters) has been implemented in the areas surrounding Sydney Airport (called ???aircraft noise exposure group???) and in the matched control group. The total sample size was 1,500 with 47% response rate. This thesis has developed a ???new??? noise index (named Noise Gap Index, NGI) to describe and assess aircraft noise in such a way that is easily understood by the layperson. Factorial analysis of covariance revealed that ???Health related quality of life, in term of physical functioning, general health, vitality, and mental health, of community chronically exposed to high aircraft noise level were worse than the matched control area???. Binary logistic regression analysis found that ???Subjects (aged 15 ??? 87) who have been chronically exposed to high aircraft noise level have the odds of 2.61 of having chronic noise stress. In addition person who have chronic noise stress have the odds of 2.74 of having hypertension compared with those without chronic noise stress???. Finally, the robust hypotheses of effects of aircraft noise on community health and well-being for future experimental study were proposed.

A carcinomatose peritoneal (CP), secundária ao avanço neoplásico maligno na cavidade abdominal, causa grande morbidade e tem como recomendação terapêutica atual um tratamento multimodal, que consiste na combinação de cirurgia citorredutora (CCR) agressiva e quimioterapia hipertérmica intraperitoneal (HIPEC). O objetivo do presente estudo é caracterizar a função respiratória desse grupo de pacientes, potencialmente candidatos à abordagem de tratamento multimodal e a relação da função respiratória com a capacidade de exercício e qualidade de vida relacionada à saúde (QVRS). Nesse estudo transversal, 25 pacientes com CP candidatos à abordagem de tratamento multimodal, foram avaliados em um centro terciário de saúde, entre maio de 2013 e abril de 2014. Foram avaliados o performance status (PS), espirometria, pressões respiratórias máximas, capacidade de exercício pelo teste de caminhada de seis minutos (TC6m) e um questionário de QVRS (QQVRS) específico para portadores de câncer. Os valores médios da avaliação de força muscular respiratória e da espirometria estavam dentro dos limites de normalidade. Todavia, foram encontrados valores reduzidos na pressão inspiratória máxima (PImax), na pressão expiratória máxima (PEmax) e na distância percorrida no TC6m em 6/25 (24%), 4/25 (16%), e 9/20 (45%), respectivamente. A PImax se associou com o PS, enquanto que a PEmax se associou com a capacidade de exercício, escala funcional do QQVRS e PS. Em conclusão, uma significativa proporção de pacientes apresentava fraqueza muscular respiratória e redução da capacidade de exercício. A força muscular respiratória mostrou associação significativa com PS, enquanto que a PEmax se relacionou com a capacidade de exercício e escala funcional do questionário de QVRS. / Peritoneal carcinomatosis (PC), secondary to advanced abdominal malignancies, causes great morbidity and is currently treated using multimodal approaches combining aggressive cytoreductive surgery (CRS) and intraperitoneal hyperthermic chemotherapy (HIPEC). The aim of the present study is to characterize the respiratory functional status of patients with PC potentially candidates to multimodal treatment approaches and the relationship of respiratory function with exercise capacity and health related quality of life (HRQL). In a cross-sectional study, 25 patients with PC referred for CRS plus HIPEC treatment approach at a tertiary care center between May 2013 and April 2014 were evaluated. Performance status, spirometry, maximal respiratory pressure measures,6-minute walk test (6MWT) and cancer specific HRQL questionnaire were assessed. Mean values of spirometry and respiratory muscle strength were above normal limits. However, reduced maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP) and 6MWT distance was found in 6/25 (24%), 4/25 (16%), and 9/20 (45%), respectively. MIP was associated with performance status while MEP was associated with exercise capacity, functional scale of HRQL questionnaire and performance status. A significant proportion of patients presented respiratory muscle weakness and impaired exercise capacity. MEP and MIP were related with performance status while MEP was additionally associated with exercise capacity and functional scale of HRQL.

O transplante de células tronco hematopoéticas(TCTH) consiste na infusão intravenosa de células tronco hematopoéticas, destinadas a restabelecer a função medular e imune em pacientes com uma série de doenças malignas e não malignas, herdadas ou adquiridas, sendo considerado um procedimento de alta complexidade, alto custo financeiro e alta morbi-mortalidade . O sucesso do TCTH resultou em um grande número de pacientes sobreviventes livres de doença, trazendo como grande questão colocada pelos candidatos a essa terapêutica como será sua qualidade de vida após o procedimento. O objetivo desse estudo longitudinal consistiu em avaliar a qualidade de vida relacionada à saúde (QVRS) de pacientes submetidos ao TCTH autólogo e alogênico em três momentos distintos: no pré, após 30 e 180 dias pós TCTH e correlacionar com dados clínicos e sócio-demográficos. Para a coleta de dados foram utilizados dois questionários: o primeiro para obtenção de dados clínicos e sócio-demográficos, e o segundo uma escala específica traduzida e validada para o português o Functional Assessment Cancer Therapy (FACT-BMT). A amostra inicial foi constituída por 30 pacientes, 26 avaliados nos três momentos. O conjunto de resultados permitiu visualizar um impacto positivo da QVRS em pacientes com neoplasias e doenças hematológicas submetidos ao TCTH, ao final dos seis meses pós TCTH, apesar de algumas funções se apresentarem mais prejudicadas como a função física, funcional e preocupações adicionais com 30 dias pós TCTH, houve melhora nos escores do FACT-BMT em todos os componentes quando comparado ao do pré TCTH, especialmente nos aspectos físicos, emocionais e relacionamento com o médico.Conhecer essas implicações auxiliam a equipe interdisciplinar e o paciente na decisão de submeter-se a esse procedimento e auxiliam no planejamento de uma assistência que visa a melhora da QVRS desses pacientes. / The Hematopoietic Stem Cells Transplantation (HSCT) consists of infusing stem cells intravenously, aiming to reestablish the spinal cord and immune functions in patients with a series of, inherent or acquired, malignant and nonmalignant diseases. It is considered a highly complex procedure, with high financial costs and morbidity and mortality. The HSCT success resulted in a large number of patients who survived and were healed, which in turn lead potential candidates to question how good quality of life can be after the procedure. This study evaluates the Health- Related Quality of Life (HRQoL) of patients submitted to the autologous and allogenic HSCT in three different points in time: before, 30 and 180 days after the HSCT and correlated clinical and socio-demographic data. Two questionnaires were used for data collection: the first addressed clinical and socio-demographic data and the second was the Functional Assessment Cancer Therapy (FACT-BMT) translated and validated to Portuguese. The initial sample was composed of 30 patients; 26 were evaluated in the three points. The set of results indicated a positive impact on HRQoL in patients with neoplasias and hematologic diseases six months after the HSCT. Despite the fact there were additional concerns and some functions, such as physical and functional, were affected 30 days after the HSCT, the FACT-BMT scores improved in all components reaching levels above those pre HSCT, especially in physical and emotional aspects and relationship with the physician. Knowledge concerning these implications helps patients to decide whether to submit to the procedure and the interdisciplinary team to plan care with a view to improve the HRQoL of these patients.

Made available in DSpace on 2014-06-11T19:29:05Z (GMT). No. of bitstreams: 0 Previous issue date: 2013-04-25Bitstream added on 2014-06-13T18:38:42Z : No. of bitstreams: 1 pellegrino_la_me_botfm.pdf: 2258976 bytes, checksum: 13535dd0280b816f0448e374b34401b8 (MD5) / Paralisia cerebral (PC) descreve um grupo de anormalidades permanentes do desenvolvimento, do movimento e da postura, causando limitação da atividade, que são atribuídas a um distúrbio não progressivo que ocorreu no cérebro em desenvolvimento do feto ou do bebê. As alterações motoras da paralisia cerebral são frequentemente acompanhadas de distúrbios da sensação, percepção, cognição, comunicação, comportamento e por problemas musculoesqueléticos secundários1. A paralisia cerebral está entre as causas mais comuns de incapacidade crônica na infância, com uma incidência entre 2 e 2,5 por 1000 nascidos vivos nos países desenvolvidos 2-4. Embora a lesão cerebral primária seja não-progressiva, a patologia é permanente e muitas das manifestações clínicas, incluindo as consequências musculoesqueléticas, são adquiridas e progressivas com o tempo. Entre 25% e 35% dessas crianças são gravemente comprometidas e apresentam dificuldades com suas atividades da vida diária (AVD), comunicação, mobilidade, e consequentemente com sua saúde, e por isso são dependentes de seus cuidadores para a maioria das suas necessidades. Essas condições têm um impacto significativo durante toda a vida dessas crianças, de seus cuidadores e familiares, e para as instituições responsáveis pelos seus cuidados e bem estar 5-7 / The consideration of quality of life related to health is crucial for planning and maintaining a system of patient-centered care. Until recently there have been no sutiable instruments to assess health related quality of life (HRQoL) of children and adolescents with severe, non-ambulant cerebral palsy (GMFCS functional levels IV and V). The “Caregiver Priorities and Child Health Index of Life with Disabilities Questionnaire” (CPCHILD©) was developed in English specifically for this population, and has been validated in Canada. The aim of this study was to translate and adapt the CPCHILD© Questionnaire into Portuguese of Brazil, allowing researchers in Brazil to have this important tool in measuring health related quality of life in this population, besides the possibility of comparison with other studies that used the same questionnaire in other languages. The cross-cultural adaptation included two forward and back translations by independent translators, an assessment of the two versions by an expert committee, and the development of a pre-final version which was tested on 30 caregivers of children (5 -18) with severe CP (GMFCS IV & V). The caregivers’ comments about the pre-final version were assessed by the expert committee and incorporated in the development of the final version. Despite the relative equivalence between the two translations, some items required adaptations for the synthesized version. Certain modifications were necessary in the pre-final version to achieve idiomatic equivalence. The modifications accounted for the socioeconomic and cultural levels of the target population. Following the pre-test, we modified language that was difficult to understand, and certain items were adapted for the final version

The dissertation entitled ?Health Related Quality of Life (HRQoL) in Dialysed Patients with Respect to Age? contains a theoretical and practical part. The theoretical part describes chronic kidney disorder and the treatment of this disease. It mentions the causes, repercussions and complications of this disease. It also suggests the form of treatment as the method of replacing the function of the kidneys which includes haemodialysis, peritoneal dialysis and transplantation. I have attempted to elaborate their principle, history and current form, benefits, negative aspects and complications. The practical part describes the actual research. Health Related Quality of Life (HRQoL) was ascertained in a group of patients undergoing haemodialysis at one dialysis centre. Questionnaire SF 36 was used which allows for a quantified assessment of the quality of life in eight domains. The results were statistically assessed and clearly depicted using tables and graphs. The quality of life was compared in the monitored group with the general population and also based on age and gender. The results found show a reduced quality of life of dialysed patients compared with the standard population. A difference was also found in the assessment of the quality of life in some age groups. No difference in results was proved with regard to gender.

A carcinomatose peritoneal (CP), secundária ao avanço neoplásico maligno na cavidade abdominal, causa grande morbidade e tem como recomendação terapêutica atual um tratamento multimodal, que consiste na combinação de cirurgia citorredutora (CCR) agressiva e quimioterapia hipertérmica intraperitoneal (HIPEC). O objetivo do presente estudo é caracterizar a função respiratória desse grupo de pacientes, potencialmente candidatos à abordagem de tratamento multimodal e a relação da função respiratória com a capacidade de exercício e qualidade de vida relacionada à saúde (QVRS). Nesse estudo transversal, 25 pacientes com CP candidatos à abordagem de tratamento multimodal, foram avaliados em um centro terciário de saúde, entre maio de 2013 e abril de 2014. Foram avaliados o performance status (PS), espirometria, pressões respiratórias máximas, capacidade de exercício pelo teste de caminhada de seis minutos (TC6m) e um questionário de QVRS (QQVRS) específico para portadores de câncer. Os valores médios da avaliação de força muscular respiratória e da espirometria estavam dentro dos limites de normalidade. Todavia, foram encontrados valores reduzidos na pressão inspiratória máxima (PImax), na pressão expiratória máxima (PEmax) e na distância percorrida no TC6m em 6/25 (24%), 4/25 (16%), e 9/20 (45%), respectivamente. A PImax se associou com o PS, enquanto que a PEmax se associou com a capacidade de exercício, escala funcional do QQVRS e PS. Em conclusão, uma significativa proporção de pacientes apresentava fraqueza muscular respiratória e redução da capacidade de exercício. A força muscular respiratória mostrou associação significativa com PS, enquanto que a PEmax se relacionou com a capacidade de exercício e escala funcional do questionário de QVRS. / Peritoneal carcinomatosis (PC), secondary to advanced abdominal malignancies, causes great morbidity and is currently treated using multimodal approaches combining aggressive cytoreductive surgery (CRS) and intraperitoneal hyperthermic chemotherapy (HIPEC). The aim of the present study is to characterize the respiratory functional status of patients with PC potentially candidates to multimodal treatment approaches and the relationship of respiratory function with exercise capacity and health related quality of life (HRQL). In a cross-sectional study, 25 patients with PC referred for CRS plus HIPEC treatment approach at a tertiary care center between May 2013 and April 2014 were evaluated. Performance status, spirometry, maximal respiratory pressure measures,6-minute walk test (6MWT) and cancer specific HRQL questionnaire were assessed. Mean values of spirometry and respiratory muscle strength were above normal limits. However, reduced maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP) and 6MWT distance was found in 6/25 (24%), 4/25 (16%), and 9/20 (45%), respectively. MIP was associated with performance status while MEP was associated with exercise capacity, functional scale of HRQL questionnaire and performance status. A significant proportion of patients presented respiratory muscle weakness and impaired exercise capacity. MEP and MIP were related with performance status while MEP was additionally associated with exercise capacity and functional scale of HRQL.