Bakgrund: Tyreoideacancer drabbar cirka 400 personer årligen i Sverige varav kvinnor är överrepresenterade. Insjuknandet sker vanligen efter 50 års ålder men förekommer även i yngre åldrar. Syfte: Att få kunskap om omvårdnadsbehov och livskvalitet hos patienter med tyreoideacancer under och efter den medicinska behandlingen mot cancer. Metod: En litteraturstudie där 9 artiklar båda kvalitativa och kvantitativa artiklar har analyserats. Resultat: Resultatet pekar på att det finns omvårdnadsbehov under och efter avslutad cancerbehandling. Analysen visar att patienterna upplever en försämrad livskvalitet efter avslutad behandling och att detta påverkade patienternas förmåga att återgå till ett vanligt liv. Slutsats: Konsekvenserna av sjukdomen och behandling tyder på att patienterna bör erbjudas psykologiskt stöd, samtalsstöd i grupp och enskilt under en längre tid samt att en uppföljning behövs efter avslutad medicinsk behandling. Detta för att se hur patienten bibehåller sin livskvalitet och sin förmåga att klara av det vanliga livets krav och utmaningar. / Background: Thyroid cancer affects about 400 people annually in Sweden, of which women are overrepresented. The onset is usually after age 50 but also occurs in younger ages. Purpose: To ascertain the needs of care and quality of life in patients with thyroid cancer during and after medical treatment for cancer. Method: A literature review where 9 articles, both qualitative and quantitative articles were analyzed. Results: The results indicate that there is need for care during and after cancer treatment. The analysis show that patients experience a decreased quality of life after treatment and that this affected patients’ ability to return to a normal life. Conclusion: The consequences of the disease and treatment indicates that patients should be offered psychological support, counseling in groups and individually for a long time and that a follow-up is needed after medical treatment. This is to ensure that the patient maintain their quality of life and their ability to cope with the ordinary demands and challenges of life.

O auto-relato de qualidade de vida de pacientes com câncer de cabeça e pescoço é registrado por questionários que dimensionam impactos da doença e do tratamento sobre diferentes domínios de ordem fisiológica, psicológica e social. O presente estudo objetivou estimar valores de referência para os diferentes domínios de qualidade de vida incluídos no Questionário da Universidade de Washington sobre Qualidade de Vida (UW-QOL, 4ª edição) para pessoas sem câncer e comparar estes valores com aqueles obtidos para os pacientes com câncer de boca e orofaringe em estágio pré-cirúrgico. Para estimar os valores de referência foram entrevistados 141 pacientes atendidos nos ambulatórios do Hospital Heliópolis, pareados por sexo e idade com 47 pacientes com câncer de boca e orofaringe em estágio pré-cirúrgico, atendidos no mesmo hospital. A média global e os escores específicos dos domínios de qualidade de vida podem variar de 0 a 100, com valores mais elevados indicando melhor condição funcional. A pontuação média de QV para pacientes sem câncer foi 91,1. Essa medida foi significantemente (p<0,01) mais elevada que para os pacientes com câncer, cuja pontuação global foi 80,6. Para os pacientes sem câncer, os escores de ombros, recreação ansiedade e mastigação foram modificados por sexo, estado conjugal, renda, grau de instrução e presença de problemas na boca. A pequena redução dos valores de referência, em relação aos parâmetros máximos passíveis de aferição (100%) indica favoravelmente a especificidade do questionário. No entanto, nem toda redução de QV dos pacientes com câncer de boca e orofaringe pode ser atribuída à doença ou ao tratamento, pois uma redução do escore médio global de cerca de 9% pode ser decorrente de perdas naturais sofridas pelos indivíduos ao longo da vida. Os domínios dor, aparência, deglutição, fala, paladar e ansiedade apresentaram escores significantemente mais reduzidos nos pacientes com câncer de boca e orofaringe que nos pacientes não afetados pela doença. / The self report of quality of life, for patients with head and neck cancer is documented by questionnaires assessing the impact of the disease and its treatment on several physiological, psychological and social domains. This study aimed at assessing reference values for quality of life domains comprised by the University of Washington Quality of Life Questionnaire (UW-QOL, 4th edition) for persons without cancer, and comparing their answers with results obtained for patients with oral and oropharyngeal cancer previoulsly to the primary surgery of tumor resection. A total of 141 patients attended at outpatients units of the Heliópolis Hospital were interviewed to assess reference values for the UW-QOL questionnaire, paired by sex and age with 47 patients hospitalized for surgery of oral and oropharyngeal cancer in the same hospital. Overall and domain specific ratings for QOL can vary from 0 to 100, with higher figures for improved functional status. The overall rating of QOL for patients without cancer was 91.1. This rating was significantly (p<0.01) higher than the corresponding figure for patients affected by cancer, whose global score was 80.6. For patients without cancer, ratings for shoulders, recreation, anxiety and chewing were modified by sex, conjugal status, income, instruction and the self-report of problems in the mouth. The small reduction of reference values, in relation to the maximum parameters that may be assessed (100%) suggests that the questionnaire is specific for head and neck cancer. However, the reduction of QOL for patients with oral and oropharyngeal cancer should not be entirely attributed to the disease and its treatment, because nearly 9% of reduction in QOL ratings may be due to other causes associated with the aging process. Pain, appearance, swallowing, speech, taste and anxiety were the QOL domains with ratings significantly lower for patients with oral and oropharyngeal cancer, in the comparison with those not affected by the disease.

O presente estudo realizou teste de campo para uma versão em Português do questionário de qualidade de vida da Universidade de Washington (UW-QOL, quarta versão), com o intuito de avaliar a capacidade do questionário em descrever padrões diferenciais de qualidade de vida de pacientes com câncer de boca no contexto brasileiro, e incentivar avaliações dessa natureza em diferentes contextos culturais. Foram entrevistados 143 pacientes com carcinoma epidermóide de boca e orofaringe atendidos no Complexo Hospitalar Heliópolis, usando um questionário especificamente desenvolvido para esta finalidade. Dados colhidos do prontuário do paciente informaram características sócio-demográficas desses pacientes, sua condição clínica e os tratamentos efetuados. A auto-avaliação de qualidade de vida foi estratificada segundo categorias sócio-demográficas e clínicas, como estratégia para apreciar a capacidade do questionário em discriminar os domínios mais afetados em diferentes quadros de qualidade de vida. Os pacientes com tumores maiores, os que tinham tumores localizados na orofaringe ou na porção posterior da boca, os que apresentaram metástases regionais e os que foram submetidos a radioterapia apresentaram indicações significantemente menos elevadas (p < 0,05) de qualidade de vida. Mastigar, ansiedade, engolir e saliva foram os domínios de pior pontuação; dor, engolir, mastigar e saliva foram as queixas mais freqüentes na semana que antecedeu a entrevista. O questionário foi bem aceito e facilmente respondido pelos pacientes, permitindo a identificação de relevantes contrastes e similaridades entre os grupos de respondentes. Seu uso regular em ambiente hospitalar pode contribuir para antecipar intervenções voltadas à redução de impacto das aplicações terapêuticas e à gestão dos tratamentos. / This study performed a field trial of a Portuguese version of the University of Washington quality of life questionnaire (UW-QOL, fourth version), aiming at fostering these studies in cross-cultural contexts, and at appraising the questionnaire’s ability in identifying differential patterns of health-related quality of life of patients with cancer of mouth and oropharynx in the Brazilian context. We interviewed 143 patients undergoing treatment for oral squamous cell carcinoma at a large Brazilian hospital (Complexo Hospitalar Heliópolis), using a questionnaire specifically developed for this purpose. Hospital records informed socio-demographic characteristics of these patients, their clinical status, and treatments already performed. The self-report of quality of life was stratified by categories of socio-demographic and clinical characteristics of patients, as a strategy for assessing the ability of the questionnaire in discriminating the most affected domains for patients presenting different conditions. Patients presenting larger tumours, neoplasm in the oropharynx or in posterior parts of the mouth, those affected by regional metastasis and those already treated with radiotherapy presented significantly (p < 0.05) poorer scores of quality of life. Chewing, anxiety, swallowing and saliva were the poorest rated domain; pain, swallowing, chewing and saliva were the most frequent complaints during the week preceding the interview. The questionnaire was well accepted and easily answered by patients, and allowed the identification of relevant contrasts and similarities among subsets of respondents. Its regular use in hospital settings can contribute for anticipating interventions aimed at reducing the impact of therapeutic applications and at subsequent patient management.

O leiomioma uterino é o tumor ginecológico mais comum na mulher, causando principalmente sangramento uterino anormal e dor pélvica. Existe apenas um questionário que avalia a qualidade de vida de mulheres com esta doença, o Uterine Fibroid Symptom and Quality of Life (UFS-QOL), porém somente na língua inglesa. Dessa forma, objetivamos traduzir e validar culturalmente o questionário UFS-QOL para mulheres brasileiras. Realizamos um estudo transversal no Departamento de Ginecologia e Obstetrícia da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo. Cento e treze pacientes portadoras de leiomioma uterino (grupo caso) e 55 pacientes-controle foram entrevistadas com o questionário UFS-QOL, após tradução e adaptação cultural. O questionário Short Form-36 foi utilizado para controle. Variáveis demográficas e psicométricas dos questionários (consistência interna, validade de construto, teste-reteste e responsividade) foram analisadas. As mulheres com leiomioma uterino apresentaram maior média de idade, IMC, peso, paridade e comorbidades do que no grupo controle (p<0.05). O sangramento uterino anormal foi a queixa mais prevalente (93,8%), seguida de dor pélvica (36,3%) e compressão extrínseca (10,6%), sendo que tais queixas apresentaram adequada validade de construto com a severidade do UFS-QOL (p<0.05). O UFS-QOL apresentou adequada consistência interna com a severidade dos sintomas e com os domínios relacionados à qualidade de vida (ICC=0.82/0.88). A validade estrutural mostrou coeficientes de correlação variando de 0,59 até 0,91. O teste-reteste não diferiu entre as subescalas do UFS-QOL. O teste-reteste não diferiu entre as subescalas do UFS-QOL. Depois do tratamento, as mulheres com leiomioma apresentaram melhora em todas as subescalas do UFS-QOL. Portanto, o questionário UFS-QOL para a língua portuguesa apresentou adequada tradução, boa consistência interna, validade de constructo, discriminatória,estrutural e responsividade, assim como adequado teste-reteste / Uterine fibroids (UF) is the most prevalent gynecological tumor, and common symptoms are abnormal uterine bleeding and pelvic pain. The Uterine Fibroids Symptoms and Quality of Life (UFS-QOL) is the only specific questionnaire that assesses the intensity of symptoms and quality-of-life issues for women with symptomatic UF; however, we do not have its translation in another language than English. Thus, we aimed to translate and culturally validate the UFS-QOL questionnaire for Brazilian Portuguese language. We performed a transversal study at the Department of Gynecology and Obstetrics, Ribeirão Preto School of Medicine, University of São Paulo. One hundred and thirteen patients with UF and 55 patients without UF (control group) were interviewed with the UFS-QOL questionnaire after translation and cultural adaptation; the Short-Form 36 questionnaire (SF36) was used as a control questionnaire. Demographic and psychometric variables (internal consistency, construct validity, test-retest and responsiveness) were analyzed. Women with UF presented a higher mean of age, body mass index, weight, parity and comorbidities than the control group (p<0.05). The most prevalent symptoms were abnormal uterine bleeding (93.8%), pelvic pain (36.3%) and extrinsic compression (10.6%) and they presented adequate construct validity with the UFS-QOL severity index (p<0.05). The UFS-QOL presented good internal consistency in severity symptoms and HRQL scores (ICC=0.82/0.88). Test-retest did not differ among all domains of the UFS-QOL questionnaire (p>.05). After treatment, women with UF presented an improvement in all UFS-QOL domains. Therefore, the UFS-QOL presented an adequate translation and cultural validation to the Brazilian Portuguese language, with good internal consistency, discriminant validity, construct validity, structural validity, test-retest and responsiveness.

The aim of the study was to identify factors affecting quality of life in patients with schizophrenia. Method: Systematic literature review where scientific studies were searched in PubMed och Cinahl databases.   Result The analysis resulted in four categories: Life style related factors, Schizophrenia related factors, Sociodemographic factors and Mental illness. Current depressive symptoms and a high level of disease awareness affect QoL in patients with schizophrenia. The conclusion: Several factors affect quality of life in patients with schizophrenia. Some of the factors are preventable, so increased awareness regarding these factors can contribute to adequate nursing care to promote health for persons with schizophrenia.

Bakgrund   Höftfrakturer är ett globalt problem och mängden personer som drabbas har ökat sedan 90-talet och antalet drabbade kommer fortsätta öka med en ökande äldre population. Mellan 12–17 procent dör inom det första året efter en höftfraktur varav att alla lider av en högre risk att dö i förtid samt att mängden som återgår till samma funktionsförmåga sedan innan höftfrakturen är inte hög. Något som kan bedöma hur en person upplever sin hälsa är livskvalité. Författarna finner därför att det skulle vara intressant att belysa vad som händer med livskvalitén för den som drabbas av en höftfraktur.  Syfte Syftet med denna studie var att beskriva personers upplevda livskvalité vid höftfraktur. Metod En icke systematisk litteraturstudie har utförts på 17 artiklar, tre med kvalitativ design och 13 med kvantitativ design och en med mixed method. Artiklarna är inhämtade från CINAHL och Pubmed med hjälp av olika sökordskombinationer. Artiklarna kvalitetsgranskades utifrån Sophiahemmet högskolas bedömningsinstrument. En integrerad analys utfördes därefter och artiklarna delades in i tre steg för att identifiera huvudkategorier och underkategorier. Resultat Utifrån resultatartiklarna som bedömde livskvalité utifrån mätinstrument försämrades den upplevda livskvalitén som följd av höftfrakturen. Många upplevde en förbättring av livskvaliteten inom ett år men att den inte blev lika bra som före höftfrakturen. De kvalitativa artiklarna tar upp andra aspekter av att leva efter höftfraktur som “rädslor &amp; oro efter höftfraktur”, “Självständighet och ensamhet efter höftfraktur” och “Förväntningar efter höftfraktur”. Slutsats Majoriteten av de som drabbas av en höftfraktur upplever fortsatt försämrad livskvalité och hälsa en tid efter höftfrakturen inträffat. Det finns ett klart utvecklingsområde för att förbättra omvårdnaden vid en höftfraktur. Fortsatta studier inom ämnet livskvalité, hälsa och höftfraktur bör fokuseras på kvalitativa studier för att utveckla förståelsen för vad patienterna upplevelser och erfarenheter vid höftfraktur. / Background Hip fractures are a global problem and the amount of people suffering from this has increased since the 1990s and the number of people suffering from this condition will continue to increase with an increasing older population. Between 12-17 percent dies within the first year after hip fracture of which everyone affected has a higher risk for premature death. Something that assesses how a person experiences their health was quality of life. The authors of this study therefore find it interesting to see what happens with quality of life during and after hip fracture.  Aim The aim of this study was to describe patients' experienced quality of life during and after study.  Method A non-systematic literature study has been performed on 17 articles, three with a qualitative design, 13 with a quantitative design and one with mixed method. The articles have been obtained from CINAHL and Pubmed with the help of different keyword combinations. The articles have been quality reviewed with the Sophiahemmet högskolas assessment instrument. An integrated analysis has been done in three steps to identify main- and sub-themes.  Results From the result in the articles that assessed quality of life through assessment instruments the perceived quality of life deteriorated due to the hip fracture. Many of the patients perceived an improvement in quality of life within a year but that it did not turn out as well as before the hip fracture. The qualitative studies brought up other aspects of living with hip fracture such as “fears and worries after hip fracture”, “independence and loneliness after hip fracture” and “Expectations after hip fracture”. Conclusions The majority of those who suffer from a hip fracture experience a continued deterioration in quality of life and health some time after the hip fracture has occurred. There was a clear area for ​​development to improve nursing care for patients with a hip fracture. Continued studies in the subject of quality of life, health and hip fracture should focus on qualitative studies to develop an understanding of what patients experience with a hip fracture.

Background Parastomal hernia is a common stoma complication causing the patient considerable inconvenience. The patient becomes aware of a bulge around the stoma, but a bulge is not always a parastomal hernia and diagnostics must be performed to enable differential treatment. It is difficult to distinguish between a bulge and a hernia. Results based on clinical examination and computerised tomography (CT) in the supine position, have not been convincing. Three-dimensional intrastomal ultrasonography (3D US) is a novel technique shown to be promising in the assessment of stoma complaints. Two studies were performed to determine inter- and intra-observer reliability as well as the validity of 3D US as an alternative to CT when assessing stoma complaints. There are numerous options for the treatment of parastomal hernia, but none has been shown superior. In the recent decades the use of mesh in the repair of incisional and inguinal hernia has become routine. New materials must be evaluated as there are potential morbidity and even mortality risks with mesh repair. As recurrence of a parastomal hernia is an even greater challenge, the method of choice should have a low risk for recurrence. A prospective multicenter study was performed to evaluate safety and recurrence rate when using Parastomal Hernia Patch BARDTM (PHP), a mesh specially designed for parastomal hernia repair. A stoma has a profound impact on the patient´s daily life, both physical and psychological. A parastomal hernia with its associated risk for leakage and incarceration worsens the situation. Patient driven assessment of healthcare outcome is important if we are to improve medical care. A quality of life (QoL) survey was performed to assess the impact of parastomal bulging and hernia on the patient´s daily life. Methods Forty patients were investigated and the 3D US images were twice evaluated by two or three physicians to assess inter- and intra-observer reliability. Totally 20 patients with stoma complaints requiring surgery were examined with CT and 3D US prior to surgery. The findings were compared with the intraoperative findings – regarded as the true outcome. Fifty patients with parastomal hernia requiring surgery were enrolled from three hospitals. Patients were followed up one month and one year after repair using PHP. Patients still alive in 2008 who had been operated between1996 and 2004 for rectal cancer in Uppsala/Örebro-, Stockholm/Gotland-, and Northern Regions (986 patients) and registered in the Swedish Rectal Cancer Registry (SRCR) were invited to fill in four QoL questionnaires. Results Inter-observer agreement using 3D US reached 80% for the last 10 patients examined, with a kappa value of 0.70. Intra-observer agreement for two examiners was 80% and 95%. The learning curve levelled out at 30 patients. Both CT and 3D US showed high sensitivity and specificity when compared with intraoperative findings. After surgery for parastomal hernia with a PHP, the complication rate at one month was 30% and recurrence rate at one year was 22%. Twelve patients were reoperated within one year. In the QoL study, 31.5% of the patients with a stoma reported a bulging or a hernia. 11.7% had been operated for parastomal hernia. A hernia or a bulge gave rise to significantly more pain and impaired stoma function. Overall QoL was inferior in patients with a permanent stoma compared to a group without a stoma.

京都大学 / 0048 / 新制・課程博士 / 博士(社会健康医学) / 甲第19276号 / 社医博第67号 / 新制||社医||9(附属図書館) / 32278 / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 中山 健夫, 教授 川上 浩司, 教授 福原 俊一 / 学位規則第4条第1項該当 / Doctor of Public Health / Kyoto University / DFAM

Interpersonal Emotion Regulation (IER) in adulthood has been the area of attention in a growing number of studies over the last decade. Despite the normality of emotion regulation in social situations, focus has mainly been on pathology. Motivated by the lack of salutogenic perspectives, this cross-sectional study aims to shed light on associations between IER strategies and Quality of Life (QOL). Also, to explore age-related aspects, a developmental angle was taken. A non-clinical sample (N=73) residing in Sweden was recruited and responded to the self-assessments Interpersonal Emotion Regulation Questionnaire (IERQ) and WHOQOL-BREF. The respondents were divided into two age groups, younger (NY=35) and older (NO=38) adults. Furthermore, participants were divided into groups based on whether or not they were temporarily experiencing special circumstances affecting life quality. Multiple bivariate correlation analysis was performed on IER factors and QOL domains for the whole group and also for the two group conditions. All IER strategies represented in IERQ were positively associated with all domains of QOL in all conditions, although only some of them were significant correlations. The results indicated that Soothing and Social Modeling can be effective IER strategies in terms of psychological well-being. In the age condition, this was only valid for the younger adults. In addition, the findings supported Soothing as an effective strategy for those experiencing special circumstances. Hence, different correlational patterns emerged related to the specific conditions examined, giving support for context-dependency of Interpersonal Emotion Regulation.

No description available.