Introduction : De nos jours, les femmes atteintes de cancer du sein peuvent espérer une survie prolongée et un grand nombre d’entre elles peuvent même entrevoir la guérison. Alors que le dépistage précoce et les traitements rigoureux donnent espoir à de plus en plus de femmes, les chercheurs et les cliniciens doivent maintenant se pencher sur la qualité de vie de ces femmes à chaque phase clinique de la trajectoire de soins. Les difficultés physiques, fonctionnelles, psychologiques et sociales avec lesquelles les femmes vivent peuvent compromettre leur qualité de vie, d’où l’intérêt d’évaluer celle-ci. Peu de chercheurs se sont intéressés au changement longitudinal de la qualité de vie de ces femmes aux différents moments de la trajectoire de soins en oncologie : diagnostic, traitement et suivi. De plus, peu se sont demandés si la perception que les femmes ont de leur communication avec les professionnels de la santé influence leur qualité de vie le long de la trajectoire de soins. Objectifs principaux : 1) Décrire l’évolution de la qualité de vie liée à la santé des femmes atteintes de cancer du sein pendant le diagnostic, les traitements de radiothérapie et le suivi; 2) Décrire l’évolution de la perception que les femmes ont de leur communication avec les médecins, les infirmières et les technologues en radio-oncologie au cours des mêmes phases cliniques; 3) Examiner l’évolution de la relation entre la perception que les femmes ont de leur communication avec les professionnels de la santé et leur qualité de vie liée à la santé durant les phases citées précédemment. Méthodes : L’échantillon se composait de 120 femmes atteintes d’un cancer du sein précoce (stades I et II) qui parlaient le français, âgées de plus de 18 ans (55 ans ± 9,5) qui ont eu une chirurgie conservatrice. Les femmes ont complété des questionnaires à la période entourant le diagnostic (en moyenne six semaines après le diagnostic), à mi-chemin de la radiothérapie (en moyenne 27 semaines après le diagnostic) et de trois à quatre mois après la fin de la radiothérapie (en moyenne 48 semaines après le diagnostic). À chaque temps de mesure, elles ont complété six questionnaires d’une durée totale de 60 minutes au centre hospitalier ou à domicile : un sur les données sociodémographiques, un sur les renseignements médicaux, le MOS SSS, le EORTC QLQ-C30/BR23 et le MCCS. Résultats : Les analyses GEE montrent que la qualité de vie liée à la santé des femmes atteintes de cancer du sein change dans le temps. Elle diminue pendant la radiothérapie, sauf pour le fonctionnement émotionnel et cognitif. Les analyses démontrent aussi que certains facteurs cliniques, intrapersonnels et interpersonnels influencent leur qualité de vie. Précisément, plus les femmes avancent en âge et plus elles perçoivent qu’elles ont eu du soutien social le long de la trajectoire de soins, plus leur qualité de vie est meilleure pour les dimensions génériques et spécifiques du fonctionnement. De plus, celles qui présentent une tumeur de stade II et celles qui ont eu de la radiothérapie et l’hormonothérapie ont des scores plus élevés pour certaines dimensions de qualité de vie comparativement à celles dont le cancer se situe au stade I et à celles qui ont eu la chimiothérapie, la radiothérapie et l’hormonothérapie. Les résultats font état également d’une interaction entre le facteur « temps » et un facteur intrapersonnel pour le fonctionnement « rôle » et le fonctionnement sexuel des femmes. La perception que les femmes ont de leur communication avec les médecins et les autres professionnels de la santé change très peu avec le temps. Ainsi, les femmes se perçoivent plus compétentes dans la recherche d’information avec les radio-oncologues pendant la radiothérapie qu’avec les chirurgiens-oncologues au moment du diagnostic. Elles perçoivent aussi la vérification et la recherche d’information par les radio-oncologues pendant la radiothérapie plus satisfaisante que celle des chirurgiens-oncologues lors de l’annonce du diagnostic. Globalement, les femmes perçoivent leur communication avec les radio-oncologues et les chirurgiens-oncologues comme étant meilleure pendant la radiothérapie et au suivi qu’au moment du diagnostic avec les chirurgiens-oncologues. Les analyses GEE montrent aussi que certains facteurs cliniques (nature des traitements), intrapersonnels et interpersonnels (âge, niveau de scolarité et soutien social perçu) sont des facteurs susceptibles d’influencer la façon dont elles perçoivent leur communication avec les professionnels de la santé. Enfin, la perception des femmes quant à leurs compétences de communication à l’égard des médecins et des autres professionnels de la santé explique davantage leur qualité de vie liée à la santé que celle des compétences des professionnels de la santé. Donc, les femmes ont un meilleur score pour le fonctionnement « rôle », émotionnel et elles ont moins d’effets secondaires et de symptômes pendant la radiothérapie et au suivi lorsqu’elles se perçoivent compétentes envers les médecins (chirurgiens-oncologues et radio-oncologues) pour la recherche d’information et l’aspect socio-affectif d’un entretien aux temps précédents. De plus, l’âge des femmes, le soutien social perçu, le stade de la maladie et la nature des traitements ont une influence sur le lien entre leur qualité de vie et leur communication avec les professionnels de la santé. Enfin, une interaction est présente entre le facteur « temps » et un facteur clinique ou intrapersonnel pour les dimensions de qualité de vie suivantes : rôle, émotionnel et fonctionnement sexuel. Conclusion et retombées : Les résultats de la présente thèse soulignent l’importance d’évaluer de façon longitudinale la qualité de vie liée à la santé des femmes atteintes de cancer du sein à différents moments de la trajectoire de soins, particulièrement pendant la radiothérapie, et, pour les intervenants psychosociaux, de s’occuper des jeunes femmes diagnostiquées et de celles qui ne perçoivent pas recevoir un soutien social. Ainsi, de meilleures ressources psychosociales pourront être mises sur pied pour aider ces groupes de femmes. Les résultats montrent également qu’il est essentiel d’informer les chirurgiens-oncologues de l’importance d’établir une communication satisfaisante avec les femmes atteintes de cancer du sein lors de l’annonce du diagnostic afin de favoriser une perception positive par les femmes de leur communication avec les chirurgiens-oncologues. Enfin, les résultats obtenus soulignent les avantages pour les femmes atteintes de cancer du sein d’être proactives et de se sentir compétentes pour la recherche d’information et l’aspect socio-affectif d’une relation avec les chirurgiens-oncologues et les radio-oncologues dans le maintien d’une bonne qualité de vie liée à la santé. / Introduction: Nowadays, women with breast cancer can have a longer survival and many of these women can even foresee a cure. While early screening and aggressive medical treatment offer hope to more women, researchers and clinicians must now look into the quality of life of these women at each clinical phase of the disease’s trajectory. The physical, functional, psychological and social difficulties that women treated for cancer experience can compromise their quality of life, hence the importance to evaluate it. Few researchers were interested in examining the longitudinal change of the quality of life of these women at the various phases of the disease’s trajectory in oncology: diagnosis, treatment and follow-up. Also, few researchers wondered if the perception women have of their communication with healthcare providers influence their quality of life throughout the trajectory of the disease. Main objectives: 1) Describe the evolution of the health-related quality of life of women suffering from breast cancer during diagnosis, radiation therapy and follow-up; 2) Describe the evolution of the women’s perception of their communication with the doctors, nurses and the technicians in radio-oncology during the same clinical phases; 3) Examine the evolution of the association between the perceived communication the women have with healthcare providers and their health-related quality of life during the three phases described above. Methods: The sample consisted of 120 French-speaking women with early breast cancer (stage I or II), aged 18 years and over (55 years ± 9,5) who underwent a lumpectomy. The women have filled out questionnaires around the diagnosis period ( on average six weeks from diagnostic), during half-way of radiation therapy (on average 27 weeks from diagnostic), and between three and four months after the end of radiation therapy (on average 48 weeks after diagnostic). At each measurement time, they completed five questionnaires of 60 minutes of total length at the hospital or at home : One pertaining to demographic data, one on medical data, the MOS SSS, the EORTC QLQ-C30/BR23 and the MCCS. Results: The GEE analyses indicate that the health-related quality of life of breast cancer women changes with time. It diminishes during radiotherapy, except for the emotional and the cognitive functioning. The analyses also show that certain clinical, intrapersonal and interpersonal factors influence their quality of life. Precisely, with age and with a better perceived social support along the disease’s trajectory, better is the women’s quality of life for the generic and specific dimensions of functioning. Moreover, those with stage II cancer and those who received radiotherapy and hormonotherapy have better scores for some quality of life dimensions compared to those who had a stage I cancer and those who were treated with chimiotherapy, radiotherapy and hormonotherapy. The results also revealed an interaction between the factor “time” and one interpersonal factor for the role functioning and the sexual functioning of these women. The perception the women have of their communication with doctors and other healthcare providers changed a little with time. Hence, the women perceived themselves more competent regarding the seeking of information with radio-oncologists during radiotherapy than with surgeons at diagnosis. They also perceived the verification and the seeking of information provided by the radio-oncologists during radiotherapy more satisfying compared to those of surgeons during diagnosis. The women perceived better their overall communication with the radio-oncologists and the surgeons during radiotherapy and at follow-up than during diagnosis with the surgeons. The GEE analyses indicate as well that some clinical (type of treatment), intrapersonal and interpersonal factors (age, education, and perceived social support) are factors that seems to influence the way they perceive their communication with healthcare providers. Finally, women’s perceptions of their competence with regards to their communication skills towards doctors and other healthcare providers explain more their health-related quality of life than their perception of the competence of healthcare providers. Therefore, women have better role and emotional functioning as well as fewer side effects and symptoms during radiotherapy and at follow-up when they perceive themselves as competent communicators for the seeking of information and the socio-emotional aspect of a relation at preceding phases towards doctors (surgeons and radio-oncologists). Moreover, women’s age, their perceived social support, the stage of their cancer and the type of treatments received influence the association between their quality of life and their communication with healthcare providers. Finally, an interaction exists between the factor “time” and one interpersonal or intrapersonal factor for the following quality of life dimensions : role, emotional, and sexual functioning. Conclusion and repercussions: The results of the present thesis underscore the importance to assess longitudinally the health-related quality of life of women with breast cancer at various times along the disease’s trajectory, especially during radiotherapy and for psychosocial specialists to take care of younger women diagnosed with breast cancer and those who do not perceive receiving social support. Thus, better psychosocial ressources can be developed to help those groups of women. The results illustrate as well that it is important to inform surgeons the importance of establishing a satisfactory communication with breast cancer women during diagnosis in order for them to have a positive perception of their communication with surgeons. Finally, the results obtained underscore the benefits for breast cancer women to be proactive and feel competent with regards to seeking information and the socio-emotional aspect of the relation between them and the surgeons and radio-oncologists in order to maintain a good health-related quality of life.

Problématique : La satisfaction des patients et la qualité de vie reliée à la santé bucco-dentaire (OHRQoL) sont deux mesures de résultats fréquemment utilisées durant les études cliniques. Néanmoins, chez les patients totalement édentés, les évidences scientifiques relatives au niveau de relation entre ces deux mesures sont faibles. De plus, on ignore toujours quels éléments de la satisfaction des patients relativement à leurs prothèses partagent la meilleure relation avec la OHRQoL. Objectifs : Déterminer, chez les patients totalement édentés, s’il existe un lien entre leur satisfaction de leurs prothèses et leur OHRQoL et identifier les déterminants de satisfaction qui démontrent le meilleur niveau de relation avec la OHRQoL. Méthodologie : Les données provenant de 255 patients totalement édentés qui ont participé à une étude randomisée et contrôlée ont été utilisées. La OHRQoL a été évaluée à l’aide du questionnaire Oral Health Impact Profile (OHIP-20). Le McGill Denture Satisfaction Instrument a été utilisé pour estimer la satisfaction des patients. Ces mesures ont été prises au temps initial, à 6 mois et à 12 mois suivants la mise en bouche des prothèses. Des analyses statistiques de régression linéaire simples et multiples ont été utilisées afin d’évaluer la relation entre les deux mesures. Résultats : Une relation positive et considérable existe entre la satisfaction des patients totalement édentés et leur OHRQoL. La difficulté masticatoire (P = .005) et la condition buccale (P = .002) sont les éléments de la satisfaction qui possèdent le meilleur lien avec la OHRQoL. Ces deux facteurs expliquent 46.4% (P = .0001) de la variance dans l’amélioration d’OHIP suivant un traitement prosthodontique. La relation décrite est dépendante du temps, mais pas du type de traitement ni des variables sociodémographiques. Conclusions : Dans les limites de l’étude, il est conclu qu’une relation positive existe entre la satisfaction des patients et leur OHRQoL. La difficulté masticatoire et la condition buccale sont les deux éléments de la satisfaction les plus importants. / Statement of problem: Patients’ satisfaction and oral health-related quality of life (OHRQoL) are two commonly used patient-reported outcomes. Convincing evidence is lacking to demonstrate the relation between these two outcomes in completely edentate patients who receive prosthodontic treatments. In addition, it is still unclear which elements of denture satisfaction share the best association with OHRQoL. Objectives: To evaluate the level of association between patients’ denture satisfaction and OHRQoL in edentulous patients, and to identify the determinants of satisfaction that best predict OHRQoL. Methods: Data from 255 edentulous elders who participated in a randomized clinical trial were used to analyze the relationship between OHRQoL and denture satisfaction. OHRQoL was evaluated with the Oral Health Impact Profile (OHIP-20) questionnaire. The McGill Denture Satisfaction Instrument was used to assess patients’ satisfaction with treatment. Outcomes were measured prior to treatment and 6 and 12 months after delivery of new dentures. Simple and multiple linear regressions analyses were performed to statistically assess the relationship between the variables. Results: A highly positive association exists between oral health-related quality of life and denture satisfaction ratings. Chewing ability (P = .005) and oral condition (P = .002) are the aspects of satisfaction presenting the best association with OHRQoL. These two variables explained 46.4% (P = .0001) of the variance in OHIP’s change score following treatment. This association varied with time, but not with type of treatment or socio-demographic variables. Conclusions: Within the limitations of this study, a highly positive association exists between OHRQoL and denture satisfaction. Chewing ability and oral condition are the determinant of denture satisfaction best associated with OHRQoL, predicting 46.4% of its improvement following a treatment.

AIM: To evaluate the prevalence of orthodontic problems and quality of life in relation to orthodontic problems among adolescent children in the city of Chennai, India. OBJECTIVES: To analyze the differences in the need for orthodontic treatment among children in the public and private schools; to analyze the need for orthodontic treatment among the various socioeconomic groups; to evaluate the Quality of Life (QoL) among the children; to analyze the relationship between Quality of Life (QoL) and the need for orthodontic treatment. METHODS: 200 children participated in the study, out of which 100 were from the private school and 100 from the public school from the city of Chennai, India. Two sets of questionnaires were used for the study, one was filled by the children and the other was filled by the researchers and trained dental assistants after doing a thorough dental examination and asking questions from the participants. This was carried out according to the recommendations of WHO oral health assessment. Statistical data was collected, recorded and analyzed using the software SPSS 17.0 for Windows. RESULTS: The private school children had more orthodontic problems than the public school children (49% and 44% respectively). The need for Orthodontic Treatment was the highest in children under the rich category (56.4%), followed by the children under the poor category (45.3%) and is least among the children under the average category (44.4%). The Quality of Life was... [to full text] / TIKSLAS: Įvertinti ortodontinio problemas ir perspektyvas atsižvelgiant į ortodontinio problemas tarp paauglių vaikų mieste Chennai, Indija. TIKSLAI: Analizuoti skirtumus reikalingas Ortodontinis gydymas tarp vaikų, viešąsias ir privačias mokyklas; analizuoti kad ortodontinio gydymo tarp įvairių socialinių ir ekonominių grupių; vertinti gyvenimo kokybę (QoL) tarp vaikų; išanalizuoti ryšį tarp gyvenimo kokybę (QoL) ir ortodontinio gydymo poreikį. METODAI: 200 vaikai dalyvavo tyrime, iš kurių 100 buvo privati mokykla ir 100 iš viešųjų mokyklų iš miesto Chennai, Indija. Vienų, ir klausimynų buvo naudojami tyrimo, vienas buvo užpildyti vaikų ir kitų buvo užpildyti mokslininkų ir apmokyti dantų padėjėjai po daro dantų nuodugniai ir užduoti klausimus iš dalyvių. Tai buvo daroma pagal PSO burnos sveikatos vertinimo rekomendacijas. Statistiniai duomenys buvo renkami, įrašytos ir analizuoti naudojant SPSS 17,0 programinė įranga Windows. REZULTATAI: Privačios mokyklos vaikai turėjo daugiau ortodontinio problemų nei valstybinių mokyklų vaikai (atitinkamai 49 % ir 44 %). Ortodontinio gydymo poreikis buvo didžiausias vaikams pagal turtingas kategorija (56.4 %), po to vaikai iki prastos kategorija (45.3 %) ir kas tarp vaikų iki vidutinės kategorijos (44.4 %). Gyvenimo kokybė buvo nustatyta, kad geriau tarp vaikų, privačios mokyklos nei valstybinėse mokyklose (90,6 % ir 89.0 % atitinkamai). Vaikams, kurie neturėjo nei gera gyvenimo kokybė turėjo mažai arba visai nėra ortodontinio kai... [toliau žr. visą tekstą]

Coronary heart disease (CHD) is a leading cause of morbidity and mortality in the industrialised world, and places a heavy burden on society in terms of personal disability and health care costs. The first signs of CHD often present acutely as a myocardial infarction (AMI), commonly known as a heart attack. Survivors of a heart attack remain vulnerable to poor health-related quality of life (HRQOL), further cardiac events, and increased morbidity due to a progression of CHD. Thus, the implementation of interventions to reduce these risks is an important public health strategy. To date, secondary prevention and rehabilitation efforts post-AMI focus primarily on the patient. However, it is argued that recovery from AMI occurs within a social context, and that risk reduction strategies are likely to be enhanced if interventions take into account the impact of the event on the quality of life of patients and their partners. Evidence from a review of couple relationship literature indicates that a significant proportion of couples experiences poor HRQOL (i.e., physical and emotional wellbeing) when coping with stressful life events, and that interactive aspects of a couple relationship (i.e., dyadic functioning and behaviour) are associated with individual well-being at such a time. Information from studies of couples dealing with recovery from heart attack is sparse, but tends to reflect the findings from the broader literature. Further research is required with post-AMI couples, though, as there are a number of shortcomings associated with the existing evidence. For instance, it is derived from studies conducted with, mostly small, samples of convenience; many different instruments are used to collect the data; and no studies specifically measure HRQOL. Analytically, most evidence is obtained with univariate and bivariate statistics, and data are analysed as groups of patients or partners, as opposed to dyads. Where multivariable analyses are undertaken a number of bivariate relationships are no longer significant after accounting for covariates such as age and gender; and few researchers investigate predictive associations between dyadic functioning/behaviour and HRQOL outcomes. Finally, there is a paucity of information from comparative analyses. Thus, it is not known whether the well-being of post-AMI couples over time is better than, similar to, or worse than, for example, that in the general population. The research program underpinning this thesis, the QUT-AMI Project, comprised two studies designed to address these methodological issues. The first was an observational, cross-sectional, pilot study conducted in 1998 with 26 post-AMI couples. The main investigation was a prospective cohort study of 93 post-AMI couples undertaken in 1999-2000. In both studies the samples comprised a consecutive series of adult males younger than 75 years who had experienced a first AMI, and their female partners. The average couple in both studies was middle-aged, had been married for many years, and both members of the dyad were working at the time of the heart attack. Prospective participants were identified in major clinical centres that admit cardiac patients, and couples were recruited to the project soon after the patient's heart attack. Clinical data were collected in hospital. Further data were collected with self-administered questionnaires during a home visit at 1 month (pilot and main study), and by mailed questionnaire or during a home visit at 6 months(main study) after the heart attack. The pilot study was undertaken to test recruitment and data collection procedures in preparation for the second (main) study, measure couples' HRQOL at 1 month after the event using the SF-36, and qualitatively investigate life issues for couples coping with recovery from AMI. In the main study couples' HRQOL outcomes were measured at 1 and 6 months post-AMI using the SF-36, and examined for changes over that time. The outcomes were also compared with those from matched population norms to estimate the impact of a heart attack on couples' HRQOL during the early and later recovery period. Additionally, the following relationships were investigated to determine the extent to which:* patients' dyadic functioning (e.g. happiness/satisfaction with relationship, measured with the Marital Adjustment Scale) and use of dyadic behaviour (e.g., hiding concerns and negative feelings from the other member of the dyad, measured with the Protective Buffering Scale) at 1 month predicted patients' emotional well-being at 6 months post-AMI;* partners' dyadic functioning and behaviour at 1 month predicted partners' emotional well-being at 6 months post-AMI;* patients' and partners' dyadic functioning at 1 month predicted patients' or partners' emotional well-being at 6 months post-AMI; and* patients' and partners' dyadic behaviour at 1 month predicted patients' or partners' emotional well-being at 6 months post-AMI. Exploratory analyses were also undertaken to determine the effect of dyadic discrepancies in functioning and behaviour, at 1 month after the heart attack, on patients' and partners' emotional well-being at 6 months after the event. Important findings were as follows:* At 1 month after an AMI the HRQOL of couples is impaired. The major impact is on physical well-being for patients, and emotional well-being for their partners.* In general, couples' HRQOL improves between 1 and 6 months after an AMI.* At 6 months after an AMI, the HRQOL of average couples is similar to that of their peers in the normal population.* There are subgroup variations in the quality of life of post-AMI couples, and these are associated with age, clinically poor physical health, and depression.* The combination of patients' and partners' use of dyadic behaviour at 1 month after an AMI explains 7% of the variation in patients' emotional well-being at 6months after the event, after adjustment for patients' concurrent physical wellbeing and prior levels of emotional well-being, as well as duration of couple relationships.* The combination of partners' perceptions of dyadic functioning and use of dyadic behaviour at 1 month after an AMI explains 5% of the variation in partners' emotional well-being at 6 months after the event, after adjustment for partners' concurrent physical well-being and prior levels of emotional well-being, as well as duration of couples' relationships.* Patients have poorer emotional well-being at 6 months after an AMI if partners use dyadic behaviour infrequently at 1 month after the event.* Partners have poorer emotional well-being at 6 months after an AMI if they are not satisfied/unhappy with the functioning of their relationships at 1 month after the event. Adjusted exploratory analyses, undertaken to determine the extent to which dyadic discrepancies in perceptions of functioning or use of protective buffering behaviour, predict emotional well-being, show that patients who are less satisfied/unhappier with functioning than their partners at 1 month after an AMI have poor emotional wellbeing at 6 months after the event; patients who use the behaviour more frequently than their partners at 1 month after an AMI have poor emotional well-being at 6months after the event; and partners who are less satisfied/unhappier with functioning than their patients at 1 month after an AMI have poor emotional well-being at 6months after the event. The evidence from the QUT-AMI Project supports the proposition that the interaction that occurs within a couple relationship, combined with individual characteristics of members of a dyad, influences the extent to which a heart attack impacts on couples' HRQOL. It is argued that it is not enough to merely focus on implementing secondary prevention strategies with post-AMI patients. Given that poor emotional well-being is known to predict adverse cardiac events, and premature mortality due to cardiac disease, it is recommended that a couple-focused intervention designed to meet specific needs should be implemented with at-risk couples as a public health strategy to improve not only the patients' quality of life but also that of his partner. Further research is recommended to determine the extent to which such an intervention improves post-AMI couples' quality of life.

Objective The aim of this study firstly, was to translate and test the validity and reliability of two diabetes-specific self-efficacy instruments (the Diabetes Management Self-Efficacy Scale; DMSES and the Perceived Therapeutic Efficacy Scale; PTES) in a Taiwanese population. The main aim of this study was then to develop an intervention based on self-efficacy theory that was appropriate for the Taiwanese population and to examine the effects of a self-efficacy enhancing intervention program (SEEIP). Background In Taiwan, the prevalence, mortality rate and healthcare cost of diabetes has dramatically increased. People with diabetes have low participation rates in performing self-care activities, with some two-thirds of diabetic patients not controlling their disease appropriately. Moreover, few studies in Taiwan have conducted randomised controlled trials or had improvement in patient self-care or self-management as their primary goal and no instruments that measure self-efficacy related to the management of diabetes (especially for outcome expectations) have yet been found and appropriately used to measure the effectiveness of self-management. Therefore, there is a particular need for research on self-efficacy enhancing intervention programs for people with type 2 diabetes. Design A convenience sample survey (n=230) was used in order to test the validity and reliability of C-DMSES and C-PTES in a Taiwanese population. Moreover, a randomised controlled trial (RCT) (n=145; the intervention group (72); the control group (73)) design was conducted in the main study with pre (baseline) and post-testing (undertaken at 3 months and 6 months following baseline collection). Intervention Both the control group and intervention group received the standard diabetic educational program in the outpatient clinic. The intervention group participants received the standard diabetic educational program and the following additional interventions: (1) viewed a 10-minute DVD (2) received a &quotDiabetes Self-Care" booklet (3) participated in four efficacy- enhancing counselling intervention sessions, and (4) participated in telephone follow-up. The self-efficacy model was adapted from Shortridge-Baggett & van der Bijl (1996). Diabetes self-management principles were used in program development and evaluation. Main outcome measures Instruments used in data collection included 1) Self-efficacy towards management of type 2 diabetes (as measured by the Chinese version of the Diabetes Management Self-Efficacy Scale; C-DMSES and the Chinese version of the Perceived Therapeutic Efficacy Scale; C-PTES); 2) self management behavior (as measured by the Summary of Diabetes Self-Care Activities; SDSCA); 3) health-related quality of life for diabetes (as measured by the Short Form-12; SF-12); 4) psychosocial well-being (as measured by the Medical Outcomes Study (MOS), Social Support Survey (SSS) tool and the Center for Epidemiology Studies Short Depression Scale; CES-D) and 5) health care utilisation (as measured by health care utilisation self report instrument). Data analysis Data were double-entered for verification using SPSS® statistical software. Study I: Descriptive statistics, regression analysis, Pearson's correlation, Cronbach's alpha-coefficients, factor analysis and Bland-Altman plots with 95% limits of agreement (LOA) were performed to evaluate validity and reliability of C-DMSES and C-PTES. Study II: Descriptive analysis was used to examine demographic variables and outcome variables. T-tests were used to analyse differences on continuous data between mean scores for the intervention and control groups. Categorical data were analysed using Chi-square statistics to test the significance of different proportions. To assess the group differences of dependent variable changes, repeated measures ANOVA/ ANCOVA were used. Results Study I: Convergent validity showed that C-DMSES correlated well with the validated measure of the General Self-Efficacy Scale (GSE) in measuring self-efficacy. Criterion-related validity showed that the C-DMSES was a significant predictor of the Summary of Diabetes Self-Care Activities (SDSCA) scores. Factor analysis supported the C-DMSES being composed of four subscales with good internal consistency (Cronbach's alpha=.77 to .93) and stability (ICC=.82). Similarly, significant criterion-related validity was demonstrated between the C-PTES and SDSCA scores. Convergent validity was confirmed as the C-PTES converged well with the GSE Scale in measuring self-efficacy. Construct validity of the C-PTES was confirmed through factor analysis and a single subscale formed. Internal consistency with a Cronbach's alpha was .95 and the test-retest reliability (ICC) was .77 and a Bland-Altman plot showed 97% of the subjects were within 2 standard deviations of the mean. Study II: The 3- and 6-month benefits of the intervention over usual care were increases in self-efficacy, outcome expectation, self-care activities, and social support. However, the results of the health-related quality of life and depression scores indicated that the change over time was not different in the two groups. A smaller proportion of the participants significantly in the intervention group, had been hospitalised and visited the emergency room than participants who were in the control group at the 6-month period. However, health-related quality of life and depression were not significantly increased in the intervention group at the 3- and 6-month compared to the control group. Conclusion Results of Study I support the psychometric properties of C-DMSES and C-PTES in providing a measure for self-efficacy specific to persons with type 2 diabetes in Taiwan. The main study revealed that the SEEIP for type 2 diabetes based on self-efficacy theory was culturally acceptable to Taiwanese people with diabetes and that the SEEIP was effective in the self-management of people with type 2 diabetes.

Background Recently, Taiwan has been faced with the migration of numbers of women from Southeast Asian (SEA) countries. It was estimated that the aggregate number of SEA wives in Taiwan was more than 131,000 in 2007 (Ministry of Foreign Affairs, 2006).These women are often colloquially called, “foreign brides” or “alien brides”; most of them are seen as commodities of the marriage trade, whose marriages are arranged by marriage brokers. Some women can be regarded as being sold for profit by their families. These young Vietnamese immigrant women come to Taiwan alone, often with a single suitcase, and are culturally and geographically distinct from Taiwanese peoples; the changes in culture, interpersonal relationships, personal roles, language, value systems and attitudes exert many negative impacts on their health, so greater levels of acculturation stress can be expected. This particular group of immigrant women are highly susceptible and vulnerable to health problems, due to language barriers, cultural conflicts, social and interpersonal isolation, and lack of support systems. The aims of this study were to examine the relationships between acculturation and immigrantspecific distress and health outcomes among Vietnamese transnational married women in Taiwan. This study focuses on Vietnamese intermarriage immigrants, the largest immigrant group in the period from1994 through to 2007. Methodology The quantitative study was divided into two phases: the first was a pilot study and the second the main study. This study was conducted in a communitybased health centre in the south of Taiwan, targeting Taiwanese households with Vietnamese wives, including the Tanam, Kaohsiung, and Pentong areas. This involved convenience sampling with participants drawn from registration records at the Public Health Centre of Kaohsiung and used the snowball technique to recruit 213 participants. The instruments included the following measures: (1) Socio-demographic information (2) Acculturation Scale (3) Acculturative Distress Scale, and (4) HRQOL. Questions related to immigrant women’s acculturation level and health status were modified. Quantitative data was coded and entered into the SPSS and SAS program for statistical analysis. The data analysis process involved descriptive, bivariate, multivariate multiple regression, and classification and regression trees (CART). Results Six hypotheses of this study were validated. Demographic data was presented and it revealed that there are statically significant differences between levels of acculturation and years of residency in Taiwan, number of children, marital status, education, religion of spouse, employment status of spouse and Chinese ethnic background by Pearson correlation and Kendall’s Tau-b or Spearman test. The correlations of daily activity, language usage, social interaction, ethnic identity, and total of acculturation score with DI tend to be negatively significant. In addition, the result of the one-way ANOVA supported the hypothesis that the different types of acculturation had a differential effect on immigrant distress. The marginalized group showed a greater immigrant distresses in comparison with the integrated group. Furthermore, the comparison t-test revealed that the Vietnamese immigrant women showed a lower score than Taiwanese women in HRQOL. The result showed higher acculturative stress associated with lower score of HRQOL on bodily pain, vitality, social functioning, mental health, and mental component summary. The CART procedure to the conclusion that the predictive variables for the physical component of the SF-36 (PCS) were: alienation, occupation, loss, language, and discrimination (predicted 28.8% of the total variance explained). The predictive variables for the mental component of the SF-36 (MCS) were: alienation, occupation, loss, language, and novelty (predicted 28.4% of the total variance explained). Conclusion As these Vietnamese immigrant women become part of Taiwanese communities and society, the need becomes apparent to understand how they acculturate to Taiwan and to the health status they acquire. The findings have implications for nursing practice, research, and will assist the Taiwanese government to formulate appropriate immigrant health policies for these SEA immigrant women. Finally, the application of this research will positively contribute to the health and well being of thousands of immigrant women and their families.

Bakgrund: Befolkningens hälsoutveckling följs ofta genom enkätundersökningar. Dessa har ofta med en generell fråga om självskattad hälsa, vilket har visat sig ha samband med såväl fysiska som psykiska faktorer. För enkätundersökningar riktade till ungdomar används ofta en fråga om självskattat mående. Det är dock inte empiriskt klarlagt vad självskattat mående hos ungdomar egentligen mäter. Syfte: Studien syftar till att undersöka i vilken utsträckning självskattat mående hos ungdomar mäter hälsorelaterad livskvalitet, där både positiva och negativa aspekter av hälsa ingår, positiv hälsa i form av positiv psykisk hälsa, psykisk ohälsa i form av symptom på depression/ångest, fysisk ohälsa gällande symptom på smärta/värk samt medicinska tillstånd i form av astma, födoämnesallergi, allergi, migrän och öronsus/tinnitus. Metod: En kvantitativ metod med tvärsnittsdesign användes med data från enkätundersökningen Liv och Hälsa Ung 2014, där 4047 elever från årskurs nio på högstadiet och årskurs två på gymnasiet i Västmanland inkluderades. Korrelationsanalyser genomfördes. Resultat: Självskattat mående mäter hälsorelaterad livskvalitet, positiv psykisk hälsa och psykisk ohälsa i måttlig utsträckning, smärta/värk i liten utsträckning och medicinska tillstånd i mycket liten utsträckning.  Slutsats: Självskattat mående mäter psykiska faktorer mer än fysiska faktorer. Självskattat mående mäter även hälsorelaterad livskvalitet i måttlig utsträckning, vilket motsvarar ett helhetsperspektiv på hälsa. Självskattat mående bland ungdomar är inte en adekvat indikator för fysisk ohälsa vilket bör tas i beaktande när denna fråga tolkas i befolkningsundersökningar. / Background: The health development of the population is often followed by questionnaires. These often include a general question of self rated health, which has been shown to be associated with both physical and mental factors. For questionnaires aimed at adolescents, a genereal question of self rated well-being is often used. However, it is not empirically clear what that question really measure. Aim: This study aims at investigating to which extent self rated well-being among adolescents measures health related quality of life, including both positive and negative aspects of health, positive health in terms of positive mental health, mental health in terms of symptoms of depression/anxiety, physical health complaints and medical conditions. Method: A quantitative method with a cross-sectional design was used with data from ”Survey of Adolescent Life in Vestmanland” (SALVe), 2014, which included 4047 students in grade 9 in elementary school and grade 2 in high school in Västmanland. Correlation analysis were used. Results: Self rated well-being is measuring health related quality of life, positive mental health and mental health to a moderate extent, physical complaints to a small extent and medical conditions to a very small extent. Conclusion: Self rated well-being measures mental factors more than physical factors. Self rated well-being also measures health-related quality of life to a moderate extent, which corresponds with a holistic perspective of health. Self rated well-being among adolescents is not an adequate indicator of physical complaints and medical conditions, which should be taken into consideration when the result of the question is interpreted in population surveys.

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The dissertation {\clq}qHealth Related Quality of Life (HRQoL) in Eating Disorders`` is divided into theoretical and practical part. In the theoretical part is analyzes the problems with eating disorders. It is especially focused on its two basics forms, anorexia nervosa and bulimia which are illnesses occasioned by hypothrepsia. The next part drala with history, symptoms, cause, medication, process, prognosis and complications resulting from these disorders, including the main diagnostic criteria and prevalence data. Women are affected by both diseases more frequently than man. Mental anorexia occurs mostly between the 14th and 15th year of the life, mental bulimia at the age of 13 to 20 years. The second part is practicaly aimed at evaluation of SF-36 forms, where I verify hypotheses how eating disorders influence quality of life of theirs carriers and how the changes in quality of life are dependant on the grade of education. The analysed results indicate the difference between the sick and the healthy individuals and also the fact the level of education is important too.

UNIVERZITA KARLOVA V PRAZE FAKULTA TĚLESNÉ VÝCHOVY A SPORTU The effect of physical activity and nutrition interventions on physical fitness and quality of life during the first year after kidney transplantation Abstract of disertation Zpracovala: Mgr. Klára Švagrová Školitel: Prof. Ing. Václav Bunc, CSc. Školící pracoviště: Laboratoř sportovní motoriky Praha, 2012 ABSTRACT Kidney transplantation is the best known treatment of chronic kidney failure. However, it is often accompanied by a number of health complications. The transplantation itself positively affects both physical fitness and quality of life during the first year after the transplant surgery which are seriously diminished when compared to the healthy population. This improvement can be even enhanced by appropriate physical activity and nutrition interventions otherwise both the physical fitness and quality of life would start declining after the first post-transplant year again. The aim of this study was to confirm a positive effect of a long-term physical activity and nutrition interventions on health-related physical fitness and health-related quality of life in a representative sample of individuals in the first year after the kidney transplantation. At the same time it was fundamental to verify that the experimental trial can be...