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Refugees who have fled from the ongoing civil war in Syria that arrived in Germany often develop post-traumatic stress symptoms (PTSS). The aim of this study was to determine health care services utilization (HCSU), health care costs and health-related quality of life (HrQoL) of Syrian refugees with mild to moderate PTSS without current treatment in Germany. The study was based on the baseline sample of a randomized controlled trial of a self-help app for Syrian refugees with PTSS (n = 133). HCSU and HrQoL based on the EQ-5D-5L and its visual analogue scale (EQ-VAS) were assessed with standardized interviews. Annual health care costs were calculated using extrapolated four-month HCSU and standardized unit costs. Associations between health care costs, HrQoL and PTSS severity were examined using generalized linear models. Overall, 85.0% of the sample utilized health care services within four months. The mean total annual health care costs were EUR 1920 per person. PTSS severity was not associated with health care costs. The EQ-5D-5L index score and the EQ-VAS score was 0.82 and 73.6, respectively. For Syrian refugees with higher PTSS severity, the EQ-5D-5L index score was lower (−0.17; p < 0.001). The HCSU and the resulting health care costs of Syrian refugees with mild to moderate PTSS without current treatment are low and those with a higher PTSS severity had a lower HrQoL.

Syfte: Syftet med studien är att undersöka sambandet mellan socioekonomiska faktorer, oral hälsa och oral hälsorelaterad livskvalitet. Material och metod: Det gjordes en systematisk litteratursökning som gav totalt 454 träffar varav 24 artiklar var relevanta. Artiklarna granskades efter relevans och kvalitet och inkluderades därefter i studien. Resultat: Socioekonomiska faktorerna inkomst, utbildning, yrke, social status, kön och etnicitet var associerade med oral hälsa, dock var inkomst och utbildning det som var mest korrelerat med oral hälsa. Sämre oral status kunde verifieras med klinisk undersökning som oftast undersökte antal tänder, karies och parodontit, vilket antogs kunna påverka oral hälsorelaterad livskvalitet. Detta tillsammans med patientens självskattade orala hälsa formar patientens egentliga orala hälsa ur ett biomedicinskt och biopsykosocialt perspektiv. Slutsats: Denna studie har beskrivit sambanden mellan oral hälsorelaterad livskvalitet, socioekonomiska faktorer och oralt hälsostatus. De socioekonomiska faktorer som har mest påverkan på oral hälsa är inkomst och utbildning för alla ålderskategorier. / Purpose: The purpose of this study is to examine the relationship between socio-economic factors, oral health and oral health-related quality of life. Material and methods: A systematic literature search yielded a total of 454 hits of which 24 articles were relevant. The articles were reviewed for relevance and quality before inclusion in the study. Results: Socio-economic factors such as income, education, occupation, social status, gender and ethnicity were associated with oral health status. However, income and education were strongly correlated with oral health status. Poorer oral health status such as fewer number of teeth, dental caries and periodontal disease could affect the oral health-related quality of life. This, together with the patient's self-rated oral health mold the patient's actual oral health from both a biomedical and biopsychosocial perspective. Conclusions: This study described links between oral health-related quality of life, socioeconomic factors and oral health status. The socio-economic factors that have the most impact on oral health in all age categories are income and education.

<p>Background: Health status and quality of life (QOL) instruments developed for children were created with many different conceptual perspectives. These perspectives were based on contextual understandings of the terms health and QOL at different points in time. As a result, there is a wide variety in the perspectives, health and life domains that are measured with these instruments.</p> <p>Purpose: This thesis is dedicated to resolving conceptual inconsistencies that arise from various instruments using content analysis techniques.</p> <p>Method: A method for analyzing the content of self-report instruments has been created and validated for adult measures. This method uses the International Classification of Functioning, Disability and Health (ICF) as the conceptual framework and the standard terminology to code each item from each instrument. Content analysis using this method will be reviewed, revised and validated for child health status and QOL instruments.</p> <p>Results: The content analysis method was revised to resolve issues regarding the perspective of instruments (e.g. health status versus QOL). Once applied to child self-report instruments, many inconsistencies between measures and their application were discovered.</p> <p>Discussion: The field of child health and QOL measurement applies and interprets the use of health status and QOL instruments inconsistently and this impacts upon content validity. Additionally, the repercussions of conceptual inconsistencies have an important effect on consequential validity in child health.</p> / Doctor of Philosophy (PhD)

Purpose: Working from lifespan development theory and the theory of Selective Optimization with Compensation (SOC), I provide theoretical analyses to inform and direct research on Taijiquan where research questions involve issues of adaptive development (optimization of gains, maintenance of function, and prevention of lost resources). I also used these frameworks to construct a biopsychosocial mind-body practices model that seeks to explain and predict the role of key aspects (curriculum, practice, context) in Taiji-related development. The above frameworks are further substantiated through a comparative analysis of health status between Taijiquan practitioners (N =120; age range = 24-83, M = 54.77) and a nationally representative sample (N = 414,629; age range = 18-99, M = 54.86) collected by the Centers for Disease Control and Prevention (CDC). The model's predictive potential is explored through an analysis of health status within a subset of experienced Taiji practitioners (N = 94; age range = 24-83, M = 55.82). Design: Theoretical and cross-sectional; between- and within-group comparisons. Methods: Responses from a convenience sample of Taiji practitioners were collected using an online survey. The instrument was designed to collect data on health-related quality of life (HRQoL), lifestyle variables, and Taiji practice regimens. Data from Taiji practitioners were merged with the CDC's 2008 Behavioral Risk Factor Surveillance System (BRFSS) dataset, forming three groups: no exercise, some exercise, and Taiji exercise. Health status was regressed on exercise group while controlling for age, income, and education, as well as the interaction between age and exercise group. Further analyses were also conducted on a subset of the Taiji data (N=94). These analyses examined the relationships among self-reported health, practice regimens, and diet while controlling for age and experience. Results: In the first set of analyses (see paper one), I controlled for the effects of age, income, education, and the differential effects of age on exercise group, while determining associations between health and group membership. A significant interaction effect (p < 0.001) occurred between age and exercise group membership. This interaction showed little difference between exercise groups in the young adult age range, but among older adults, Taijiquan practitioners displayed the best HRQoL. In the second set of analyses (see paper 2), I found significant interaction effects between (a) curricular complexity and out-of-class practice (p < 0.05) and (b) curricular complexity and diet (p < 0.05). Conclusions: The extraordinary health status trajectory among Taiji practitioners may be attributable to several conditions including: (a) the implied presence of SOC-related strategies, (b) the general benefits of psychophysical expertise, and (c) concomitant structure between Taiji-related goals and health behaviors that contributes to optimal aging. Specifically, intervention designers, Taiji teachers, and practitioners should consider the potential benefits of well rounded Taiji curricula, regular out-of-class practice, and healthy diet for optimizing health-related gains and minimizing losses typically associated with aging. / Ph. D.

Yes / Objectives. Coeliac disease (CD) is an autoimmune condition managed by a lifelong therapeutic gluten-free diet. Previous research suggests that the chronicity of CD, the limitations imposed by the gluten-free diet, and the risk of other associated diseases can have a negative impact on health-related quality of life (HRQoL) and psychological well-being. The aim of this study was to explore the illness perceptions and self-efficacy beliefs of adults with CD in the United Kingdom and to report their subjective levels of HRQoL and psychological well-being. Design. The study employed a cross-sectional postal questionnaire design. Method. Participants (n= 288) were adults with CD recruited via Coeliac UK. Measures of well-being, HRQoL, self-efficacy, illness perceptions, and dietary self-management were analysed. Preliminary descriptive and univariate procedures were employed before bivariate tests of association or difference were carried out. Backward stepwise multiple regression analysis was used to investigate the predictive strength of variables on well-being, quality of life, and self-efficacy. Logistic regression was used to look at the influence of variables on adherence. Results. Results indicate that HRQoL and psychological well-being were comparable to those found in previous related studies. Participants with weak beliefs in the serious consequences of CD and poorer emotional reactions to the condition had a greater likelihood of having enhanced HRQoL, improved psychological well-being, and higher self-efficacy. Strong beliefs in personal control and a greater perceived understanding of CD were associated with greater self-efficacy. Conclusions. Perceived self-efficacy and illness perceptions could play a role in informing psychological interventions for individuals with CD.

No / Objective To compare the incidence of treatment-related complications, including lymphoedema, after two programmes of shoulder mobilisation in women with invasive breast cancer when surgical treatment included axillary lymph node dissection. Design Randomised controlled trial. Setting Two secondary care National Health Service trusts. Participants One hundred and sixteen women (mean age 57 years, standard deviation 13.1 years) recruited from November 2003 to March 2006 (58 intervention group, 58 control group). Seven patients (6%) did not complete the study. Intervention Arm exercises and shoulder movement restricted to below shoulder level for the first 7 days after surgery. Controls commenced an exercise programme that incorporated exercises above shoulder level within 48 hours. Outcome measures All outcomes were recorded at baseline (pre-operatively) and at 1 year. The primary outcome was incidence of lymphoedema, defined by a limb volume difference of 200 ml or more compared with the contralateral arm. This outcome was measured using volume displacement. Secondary outcome measures included volume differences between the two limbs measured by actual volume displacement difference, wound drainage volumes, range of shoulder movement (manual goniometer), grip strength (hand-held dynamometer) and health-related quality of life (Shoulder Disability Questionnaire, Functional Assessment of Cancer Therapy – Breast). Results All statistical tests were two-sided. Data were analysed using intention-to-treat principles. The incidence of lymphoedema (200 ml or more) increased significantly in women who had undertaken a programme of early full shoulder mobilisation. Twenty-two women (19%) developed lymphoedema (200 ml or more) in their first postoperative year. There were significantly more women with lymphoedema in the early full shoulder mobilisation group (n = 16) compared with the delayed full shoulder mobilisation group (n = 6). The relative risk of developing lymphoedema after early mobilisation was 2.7 (95% confidence interval 1.1 to 6.3; P = 0.031). Limb volume differences were significantly higher in the early mobilisation group. This was apparent in differences in limb volume displacement (P = 0.004) and percentage difference between the two limbs (P = 0.007). There were no statistically significant differences in shoulder movement, grip strength or self-evaluated outcomes between the two groups at 1 year. Conclusion A programme of exercise that delays full shoulder mobilisation for 1 week is recommended after axillary node dissection for invasive breast cancer.

Contemporary conceptual models of health emphasize the importance of patient-based outcomes and recognize the complexity involved in their assessment. Various health conditions, personal, social, and environmental factors, are all thought to contribute to individual’s quality of life. However, the impact of orthodontic treatment on Oral Health-related Quality of Life (OH-QOL) outcomes in children has not yet been systematically studied. Hence, this research was planned to assess the effect orthodontic treatment has on pediatric OH-QOL outcomes. Further, the important moderational role of children’s psychological assets on OH-QOL reports is explored. Following completion of a preliminary study to confirm the psychometric properties of the Child Perception Questionnaire (CPQl1-14), the current two-phase study was undertaken. This consisted of a cross-sectional study examining the relationship among Self-Esteem (SE), malocclusion, and OH-QOL, and a longitudinal study examining the influence of orthodontics and children’s Psychological Wellbeing (PWB) on OH-QOL reports. This PhD dissertation is presented in the “Publishable Style”. The journals which hold the copyrights for the papers published from this thesis have given permission for the reproduction of the text and figures for this dissertation. The preliminary data confirmed that the CPQ11-14 is sensitive to change when used with children receiving orthodontic treatment. Our cross-sectional findings indicated that the impact of malocclusion on OH-QOL is substantial in children with low SE and identified SE as a salient determinant of OH-QOL in children seeking orthodontic treatment. Longitudinal data, on the other hand, detected significant improvement of OH-QOL outcomes after orthodontic treatment. As postulated, these improvements were most evident for the social and emotional domains of OH-QOL. However, covariate analysis emphasized the important role psychological factors play in moderating OH-QOL reports, as children with better PWB were more likely to report better OH-QOL regardless of their orthodontic treatment status. These results substantiate the validity of contemporary models of patient-based outcomes linking biological, personal, social, and environmental factors. Researchers and clinicians are encouraged to adopt this forward thinking approach when dealing with children with oro-facial conditions. Further studies with larger samples and longer follow-ups would be of value to expand on these findings.

Contemporary conceptual models of health emphasize the importance of patient-based outcomes and recognize the complexity involved in their assessment. Various health conditions, personal, social, and environmental factors, are all thought to contribute to individual’s quality of life. However, the impact of orthodontic treatment on Oral Health-related Quality of Life (OH-QOL) outcomes in children has not yet been systematically studied. Hence, this research was planned to assess the effect orthodontic treatment has on pediatric OH-QOL outcomes. Further, the important moderational role of children’s psychological assets on OH-QOL reports is explored. Following completion of a preliminary study to confirm the psychometric properties of the Child Perception Questionnaire (CPQl1-14), the current two-phase study was undertaken. This consisted of a cross-sectional study examining the relationship among Self-Esteem (SE), malocclusion, and OH-QOL, and a longitudinal study examining the influence of orthodontics and children’s Psychological Wellbeing (PWB) on OH-QOL reports. This PhD dissertation is presented in the “Publishable Style”. The journals which hold the copyrights for the papers published from this thesis have given permission for the reproduction of the text and figures for this dissertation. The preliminary data confirmed that the CPQ11-14 is sensitive to change when used with children receiving orthodontic treatment. Our cross-sectional findings indicated that the impact of malocclusion on OH-QOL is substantial in children with low SE and identified SE as a salient determinant of OH-QOL in children seeking orthodontic treatment. Longitudinal data, on the other hand, detected significant improvement of OH-QOL outcomes after orthodontic treatment. As postulated, these improvements were most evident for the social and emotional domains of OH-QOL. However, covariate analysis emphasized the important role psychological factors play in moderating OH-QOL reports, as children with better PWB were more likely to report better OH-QOL regardless of their orthodontic treatment status. These results substantiate the validity of contemporary models of patient-based outcomes linking biological, personal, social, and environmental factors. Researchers and clinicians are encouraged to adopt this forward thinking approach when dealing with children with oro-facial conditions. Further studies with larger samples and longer follow-ups would be of value to expand on these findings.

Background: Cheap and effective tools for measuring patients’ physical activity (PA) level are needed. The first aim in this thesis was therefore to assess the validity of two PA -questions, and their three associated answer modes, that are used within the Swedish health care system. Sitting, light intensity PA (LIPA), and moderate and vigorous intensity PA (MVPA), are associated with health and longevity, but detailed population data assessed with objective methods is needed. The second aim was thus to assess the above with motion sensor technology, in a middle-aged Swedish sample. Low self-perceived health is a strong predictor of morbidity and mortality, but this association may vary over time with changes in the society and our lifestyle. The third aim was to assess secular trends in the interrelations between self-perceived health, physical fitness, and selected covariates. The effects of PA on prescription (PAP) on health-related quality of life (HRQoL) in overweight adults are unclear, thus the fourth aim was to explore this. Methods: All data was collected in the Swedish population. Data from the PA -questions and accelerometers, aerobic fitness, counter movement jump, and balance tests, blood samples, and self-rated general health were collected in 365 participants, 21–66 yrs. The PA pattern was assessed in 948 individuals, 50‒64 yrs, from the SCAPIS pilot study. Self-perceived physical health, and measured aerobic fitness, counter movement jump height, and balance, and demographic and lifestyle data, was assessed in three independent samples from 1990, 2000 and 2013, including 3564 adults, 20‒65 yrs. The effects of Swedish PAP on HRQoL was assessed in a randomized controlled trial including 101 men and women, 67‒68 yrs, that were inactive, overweight (BMI&gt;25 kg/m2), and had a waist circumference ≥102 cm (men) or ≥88 cm (women), who were randomized to an intervention group or a control group. The 36-item Short Form Health Survey (SF-36) was used to assess HRQoL. Results: The multiple choice answer mode of the two PA -questions was found to have the strongest validity, compared with the two other (an open mode, and one where PA minutes is specified per weekday). The validity is in line with many other established PA-questionnaires, but the open mode has limitations. The assessment of PA pattern showed that 61% of motion sensor wear time represented sitting, 35% LIPA, and 4% MVPA. Only 7% of the sample met the PA recommendations. The odds for describing perceived health as good was found to increase by 5% per each increment of 1 ml/kg/min in VO2max. This was stable across genders and all three LIV-samples (i.e. over time). Waist circumference, chronic disease, sleep problems, and level of satisfaction with one’s life, were also important correlates. The Swedish PAP group improved significantly more, and more participants displayed clinically relevant improvements (OR 2.43), in mental aspects of HRQoL, compared to the controls. Physical aspects of HRQoL improved in the PAP group, but not in the control group. Conclusions: The multiple choice answer mode has the strongest validity and Open mode the weakest. The PA -questions may be used in populations, or in individuals to determine appropriateness for treatment. The questions’ advantages and limitations must be considered and further reliability and validity studies are needed. The results regarding sitting, LIPA, MVPA and fulfillment of PA recommendations, are of high clinical relevance. A great challenge remains to further implement methods to increase the level of PA in the Swedish population. Physical fitness is related to self-perceived health independently of changes in society and lifestyle over time, and simple questions may be useful for the clinical assessment of physical fitness. Swedish PAP has a positive effect on mental aspects of HRQoL, measured by the SF-36. This finding supports the clinical use of the Swedish PAP model. / LIV 2013