<p>The goals of this thesis are to evaluate quality of life (QoL) in adult patients with growth hormone deficiency (GHD) in relation to population normative data, to construct a preference-weighted index (utility) from a disease-specific QoL measure and to assess it in a clinical context.</p><p>The study included samples from the general population and patients with GHD from four European populations: England & Wales, the Netherlands, Spain and Sweden. The country-specific patient cohorts were retrieved from KIMS (Pfizer International Metabolic Database). </p><p>A questionnaire was developed that contained items from existing QoL questionnaires including, among others, Quality of Life Assessment in Growth Hormone Deficiency in Adults (QoL-AGHDA) and the EQ-5D. The QoL-AGHDA is a disease-specific measure for use in adults with GHD. The EQ-5D is a generic instrument which describes health states for which country-specific preference-based weights are available. Thus, it was possible to generate preference-weighted indices (utilities) based on data generated by both instruments. </p><p>This thesis reports QoL-AGHDA normative values for the populations of England & Wales, the Netherlands, Spain and Sweden, and confirms the extent of QoL impairment in patients with GHD in comparison with the general population. Long-term GH replacement resulted in sustained improvements in overall QoL towards normative country-specific values, as well in most of the dimensions that were impaired before treatment. </p><p>For use in health economic evaluations, models for generating utilities (QoL-AGHDA_utility) from QoL-AGHDA were developed. It is believed that these models may facilitate medical decision making, given that they provide a tool for obtaining utilities in the absence of directly collected preference-weighted indices.</p><p>QoL-AGHDA_utility effectively monitored treatment effects in patients with GHD. Moreover, this study confirmed a QoL-AGHDA_utility deficit before treatment and a gain after starting GH replacement. </p><p>The novel aspect of the present approach was to apply preference-weighted indices derived from a disease-specific measure to assess QoL in the clinical context, together with patient demographic and clinical characteristics. The robustness of this analysis is reinforced by the fact that utilities in both general and patient populations were generated using the same methodology. </p>

The goals of this thesis are to evaluate quality of life (QoL) in adult patients with growth hormone deficiency (GHD) in relation to population normative data, to construct a preference-weighted index (utility) from a disease-specific QoL measure and to assess it in a clinical context. The study included samples from the general population and patients with GHD from four European populations: England &amp; Wales, the Netherlands, Spain and Sweden. The country-specific patient cohorts were retrieved from KIMS (Pfizer International Metabolic Database). A questionnaire was developed that contained items from existing QoL questionnaires including, among others, Quality of Life Assessment in Growth Hormone Deficiency in Adults (QoL-AGHDA) and the EQ-5D. The QoL-AGHDA is a disease-specific measure for use in adults with GHD. The EQ-5D is a generic instrument which describes health states for which country-specific preference-based weights are available. Thus, it was possible to generate preference-weighted indices (utilities) based on data generated by both instruments. This thesis reports QoL-AGHDA normative values for the populations of England &amp; Wales, the Netherlands, Spain and Sweden, and confirms the extent of QoL impairment in patients with GHD in comparison with the general population. Long-term GH replacement resulted in sustained improvements in overall QoL towards normative country-specific values, as well in most of the dimensions that were impaired before treatment. For use in health economic evaluations, models for generating utilities (QoL-AGHDAutility) from QoL-AGHDA were developed. It is believed that these models may facilitate medical decision making, given that they provide a tool for obtaining utilities in the absence of directly collected preference-weighted indices. QoL-AGHDAutility effectively monitored treatment effects in patients with GHD. Moreover, this study confirmed a QoL-AGHDAutility deficit before treatment and a gain after starting GH replacement. The novel aspect of the present approach was to apply preference-weighted indices derived from a disease-specific measure to assess QoL in the clinical context, together with patient demographic and clinical characteristics. The robustness of this analysis is reinforced by the fact that utilities in both general and patient populations were generated using the same methodology.

<p>HIV and AIDS are disease conditions that have led to high mortality rates in Southern Africa since the late 1970s. The socio-economic system has led to the unequal spread of resources&rsquo / and vulnerability and exposure to HIV is more prevalent in poorer communities. The added burden of life stresses cause for many to be isolated and stigmatised and are often not equipped with the necessary support and coping skills to deal with the magnitude of these circumstances. There is a high prevalence of mental disorders and especially depression amongst individuals infected with either HIV or AIDS. Research shows that stressful life events can impact HIV course progression and impacts the QoL of those infected with HIV or AIDS. Given the social and psychological context of HIV and AIDS, the aim of the study was to examine the relationship between depression and QoL in a sample of adults diagnosed with HIV or AIDS. This quantitative, cross-sectional study used the Becks Depression Inventory II (BDI II) and the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q), to measure the variables concerned. This battery of&nbsp / questionnaires was administered to a purposive sample of adult individuals diagnosed with HIV or AIDS residing in a previously disadvantaged area in the Cape Metropole region. Using SPSS,&nbsp / data was analysed and descriptive and inferential statistics were conducted. The study found that there were more women than men with HIV or AIDS that were found to be depressed (mild, moderate and severe depression). Furthermore, the depressive state increased when the progression of the disease increased. There were generally no significant differences in the QoL&nbsp / experienced within various areas of life and overall life satisfaction experienced. However, the QoL experienced in work was lower. There was a significant relationship between the depressed state and QoL and life satisfaction experienced in household duties and tasks. The contribution of this study includes informing the larger research project, with regards to future treatment&nbsp / regimes. It will update statistics on the prevalence of depression and QoL of adults diagnosed with HIV or AIDS in the area. This study is framed within a biopsychosocial model and is&nbsp / theoretically underpinned by Beck&rsquo / s theory of depression. Key words: HIV, AIDS, adults, depression, quality of life (QoL), Beck Depression Inventory II (BDI II), Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q), Antiretrovirals (ARV&rsquo / s), prevalence data, correlations.</p>

<p>HIV and AIDS are disease conditions that have led to high mortality rates in Southern Africa since the late 1970s. The socio-economic system has led to the unequal spread of resources&rsquo / and vulnerability and exposure to HIV is more prevalent in poorer communities. The added burden of life stresses cause for many to be isolated and stigmatised and are often not equipped with the necessary support and coping skills to deal with the magnitude of these circumstances. There is a high prevalence of mental disorders and especially depression amongst individuals infected with either HIV or AIDS. Research shows that stressful life events can impact HIV course progression and impacts the QoL of those infected with HIV or AIDS. Given the social and psychological context of HIV and AIDS, the aim of the study was to examine the relationship between depression and QoL in a sample of adults diagnosed with HIV or AIDS. This quantitative, cross-sectional study used the Becks Depression Inventory II (BDI II) and the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q), to measure the variables concerned. This battery of&nbsp / questionnaires was administered to a purposive sample of adult individuals diagnosed with HIV or AIDS residing in a previously disadvantaged area in the Cape Metropole region. Using SPSS,&nbsp / data was analysed and descriptive and inferential statistics were conducted. The study found that there were more women than men with HIV or AIDS that were found to be depressed (mild, moderate and severe depression). Furthermore, the depressive state increased when the progression of the disease increased. There were generally no significant differences in the QoL&nbsp / experienced within various areas of life and overall life satisfaction experienced. However, the QoL experienced in work was lower. There was a significant relationship between the depressed state and QoL and life satisfaction experienced in household duties and tasks. The contribution of this study includes informing the larger research project, with regards to future treatment&nbsp / regimes. It will update statistics on the prevalence of depression and QoL of adults diagnosed with HIV or AIDS in the area. This study is framed within a biopsychosocial model and is&nbsp / theoretically underpinned by Beck&rsquo / s theory of depression. Key words: HIV, AIDS, adults, depression, quality of life (QoL), Beck Depression Inventory II (BDI II), Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q), Antiretrovirals (ARV&rsquo / s), prevalence data, correlations.</p>

Non-Alcoholic Fatty Liver Disease (NAFLD) is characterized by accumulation of lipids in hepatocytes, which accounts for at least 5% of the weight of this tissue. It affects patients in different age groups; these tend to present hepatic alterations characterized not only by the accumulation of fat but, in some cases, also by the presence of inflammation and fibrosis, even evolving to cirrhosis. It is considered the hepatic component of Metabolic Syndrome (MS) and this, in turn, is also an inducer of NAFLD. The present study proposes to evaluate the degree of steatosis in patients with NAFLD and their relationship with cardiovascular risk, the prevalence of OSAS and quality of life. This is a cross-sectional study, where 173 patients were interviewed at the outpatient clinic. Hepatology, which is a reference service of the State, University Hospital of the Federal University of Sergipe. Socio-demographic data and anthropometric measurements, results of biochemical laboratory tests and image of medical records were collected, and these patients were submitted to quality of life (QOL) questionnaires (WHOQOL bref), CVD risk (Framinghan score), individual risk of OSAS (Berlin scale) and bioimpedance test. We obtained as results a prevalence in the low risk population to develop CVD (58.4%), a prevalence of the sample for high risk of OSAS (64%), the QV assessment showed better results in the psychological and social relations domains . We conclude that there is an association between the degree of NAFLD and the evolution of OSA in the patients studied. There was no association with the increase in the risk of CVD, and when we assessed the association with the QOL, there was no significant difference between the total score quality of life in patients with mild steatosis for individuals who presented them in marked form. Thus, we emphasize the importance of the global evaluation of these patients, from the beginning of the detection of NAFLD. / A Doença Hepática Gordurosa Não Alcoólica (DHGNA) é caracterizada por acúmulo de lipídios em hepatócitos, que representa, ao menos, 5% do peso deste tecido. Acomete pacientes em diferentes faixas etárias; estes tendem a apresentar alterações hepáticas caracterizadas não apenas pelo acúmulo de gordura, mas, em alguns casos, também pela presença de inflamação e fibrose, inclusive evoluindo para cirrose. É considerada o componente hepático da Síndrome Metabólica (SM) e esta, por sua vez, também um indutor da DHGNA. O presente estudo propõe avaliar o grau de esteatose em pacientes com DHGNA e a relação destes com o risco cardiovascular, a prevalência de SAOS e a qualidade de vida. Trata-se de um estudo transversal, onde foram entrevistados 173 pacientes atendidos no ambulatório de Hepatologia, um serviço de referência no Estado, do Hospital Universitário da Universidade Federal de Sergipe. Foram coletados dados sociodemográficos e medidas antropométricas, resultados de exames laboratoriais bioquímicos e de imagem dos prontuários, e estes pacientes foram submetidos a questionários de qualidade de vida (QV) (WHOQOL bref), risco de doenças cardiovasculares (DCV’s) (Escore de Framinghan), a avaliação do risco individual de Síndrome da Apneia Obstrutiva do Sono (SAOS) (Escala de Berlim) e ao teste de bioimpedância. Obtivemos como resultados uma prevalência na população estudada de baixo risco para desenvolver DCV’s (58,4%), houve uma prevalência da amostra para alto risco de SAOS (64%), a avaliação da QV demonstrou melhores resultados nos domínios psicológicos e das relações sociais. Concluímos que há uma associação do grau de DHGNA com a evolução do SAOS nos pacientes estudados, não havendo a mesma associação em relação ao aumento do risco de DCV’s e quando avaliamos a associação com a QV não observou-se diferença significativa entre o escore total de qualidade de vida em pacientes com esteatose leve para os indivíduos que as apresentavam na forma acentuada. Sendo assim, enfatizamos a importância da avaliação global desses pacientes, desde o início da detecção da DHGNA. / Aracaju

Magister Psychologiae - MPsych / HIV and AIDS are disease conditions that have led to high mortality rates in Southern Africa since the late 1970s. The socio-economic system has led to the unequal spread of resources’ and vulnerability and exposure to HIV is more prevalent in poorer communities. The added burden of life stresses cause for many to be isolated and stigmatised and are often not equipped with the necessary support and coping skills to deal with the magnitude of these circumstances. There is a high prevalence of mental disorders and especially depression amongst individuals infected with either HIV or AIDS. Research shows that stressful life events can impact HIV course progression and impacts the QoL of those infected with HIV or AIDS. Given the social and psychological context of HIV and AIDS, the aim of the study was to examine the relationship between depression and QoL in a sample of adults diagnosed with HIV or AIDS. This quantitative, cross-sectional study used the Becks Depression Inventory II (BDI II) and the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q), to measure the variables concerned. This battery of questionnaires was administered to a purposive sample of adult individuals diagnosed with HIV or AIDS residing in a previously disadvantaged area in the Cape Metropole region. Using SPSS, data was analysed and descriptive and inferential statistics were conducted. The study found that there were more women than men with HIV or AIDS that were found to be depressed (mild, moderate and severe depression). Furthermore, the depressive state increased when the progression of the disease increased. There were generally no significant differences in the QoL experienced within various areas of life and overall life satisfaction experienced. However, the QoL experienced in work was lower. There was a significant relationship between the depressed state and QoL and life satisfaction experienced in household duties and tasks. The contribution of this study includes informing the larger research project, with regards to future treatment regimes. It will update statistics on the prevalence of depression and QoL of adults diagnosed with HIV or AIDS in the area. This study is framed within a biopsychosocial model and is theoretically underpinned by Beck’s theory of depression. Key words: HIV, AIDS, adults, depression, quality of life (QoL), Beck Depression Inventory II (BDI II), Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q), Antiretrovirals (ARV’s), prevalence data, correlations. / South Africa

Magister Scientiae Dentium - MSc(Dent) / AIM:The aim of this study was to review the data available from the Department of Health(DOH), on pre-school paediatric patients treated under Dental General Anaesthesia(DGA), at public health facilities in the Western Cape (WC) in order to ascertain the type and nature of treatment provided.METHODOLOGY:This retrospective descriptive study reviewed the records on the Department of Health(DoH) Database of 16 732 pre-school patients treated under dental general anaesthesia in the period 1 January 2005 until 31 December 2007. A questionnaire was also completed telephonically with 22 dentists from the district dental health clinics.Summary descriptive statistics were calculated from data collected and comparisons were drawn between services available at the health districts and academic hospitals.RESULTS:Of the 58 255 procedures recorded for pre-school patients in the district health clinics in the Western Cape, 99.94% were for extractions provided and 0.5% for restorations.The average number of teeth extracted was 10.4 (SD ±3.9).The average rate of DGA per 1000 of the population was 1.06. Only 9% (2) of dentists at district clinics reported that pre-DGA prevention was provided and 5% (1) reported including post-DGA prevention. The Academic Hospital at Tygerberg Oral Health Centre was the only facility in the Western Cape that provided comprehensive dental treatment for pre-school patients which included restorations, extractions, pre and post DGA prevention. Red Cross Children’s Hospital provided treatment for pre-school patients under DGA that included extractions, pre- and post DGA, but no restorative treatment. CONCLUSION:The demand for DGA in pre-school patients in the WC was high. The lack of prevention associated with DGA in the public health service is the most likely reason the retreatment rate under DGA was reported by dentists as being 77%. There was an absence of protocol regarding DGA for pre-school patients in the public health service.RECOMMENDATIONS:Guidelines formulated were recommended for use in the public service for pre-school patients being treated under DGA and includes the provision of preventive interventions such as regular topical fluoride applications, oral hygiene instruction and dietary advice.

This mixed methods study examined the association between the frequency of five lifestyle-related complementary and alternative medicine (CAM) practices and perceived quality of life (QOL) and stress among patients in Japan diagnosed with chronic disease, and also examined why patients decided to receive Okada purifying therapy [(OPT) biofield therapy]. Data from 1,190 patients were analyzed using bivariate and multiple regression analysis, followed by analysis of one-on-one in-depth interviews conducted among 25 patients on reasons why patients decided to practice OPT. Grounded theory methodology was used to analyze transcribed interview data. Results of multiple regression analysis indicated that engaging in arts and cultural activities and exercise was associated with a decrease in perceived stress, while arts and cultural activities, exercise, consumption of organic (additive-free) food, and practice of OPT were associated with increased QOL. Gender weakly moderated the effects of arts and cultural activities on stress but not on QOL, and gender did not have any moderating effects on the association of OPT with either stress or QOL. One theme, five clusters, and 13 categories emerged from the qualitative analysis. Feelings of desperation due to unrelieved symptoms of disease seemed to be the principal reason for most patients’ practice of OPT. Other reasons were perception of the limits of conventional medicine in being able to treat patients’ disease, dissatisfaction with conventional medicine, positive relationship with staff and doctors of the integrative medicine clinic providing OPT, and benefits of OPT, among others. Although many patients expressed feeling doubts towards the practice of OPT at first, many seemed satisfied with the results of the practice, mainly because they were able to manage their symptoms and gain a sense of control. This may have led to an increase in QOL. The mixed methods design was able to inform the interpretation of the association of OPT with reported increase in QOL in the quantitative phase of the research.

多くの肥満者は，生活習慣のセルフマネジメントが困難であると指摘される。これに対し本稿は，肥満者の行動的QOLの低さ，すなわち行動レパートリーの不足に着目し，それを拡大する援助方略を行動変動性の観点から検討した。その結果，行動変動性が回避場面で減少することが示され，行動変動性に対する強化手続きや，その応用であるアクセプタンス＆コミットメント・セラピーが行動的QOLの拡大に有効であることが示された。 / It has been argued that many individuals with obesity have difficulty managing their lifestyle. This study focused on lack of behavioral repertory as a cause of the difficulty and attempted to expand behavioral repertory and behavioral quality of life (QOL) from the viewpoint of behavioral variability. The result showed that the decrease in behavioral variability was related to avoidant behavior. Furthermore, the result showed that reinforcement of behavioral variability and Acceptance and Commitment Therapy (ACT) promoted behavioral QOL expansion and lifestyle improvement. / 博士(心理学) / Doctor of Philosophy in Psychology / 同志社大学 / Doshisha University

No / PURPOSE. To evaluate whether the Amblyopia and Strabismus Questionnaire (A&SQ) is a suitable instrument for the assessment of vision-related quality-of life (VR-QoL) in individuals with strabismus and/or amblyopia. METHODS. The A&SQ was completed by 102 individuals, all of whom had amblyopia, strabismus, or both. Rasch analysis was used to evaluate the usefulness of individual questionnaire items (i.e., questions); the response-scale performance; how well the items targeted VR-QoL; whether individual items showed response bias, depending on factors such as whether strabismus was present; and dimensionality. RESULTS. Items relating to concerns about the appearance of the eyes were applicable only to those with strabismus, and many items showed large ceiling effects. The response scale showed disordered responses and underused response options, which improved after the number of response options was reduced from five to three. This change improved the discriminative ability of the questionnaire (person separation index increased from 1.98 to 2.11). Significant bias was found between strabismic and nonstrabismic respondents. Separate Rasch analyses conducted for subjects with and without strabismus indicated that all A&SQ items seemed appropriate for individuals with strabismus (Rasch infit values between 0.60 and 1.40), but several items fitted the model poorly in amblyopes without strabismus. The AS&Q was not found to be unidimensional. CONCLUSIONS. The findings highlight the limitations of the A&SQ instrument in the assessment of VR-QoL in subjects with strabismus and especially in those with amblyopia alone. The results suggest that separate instruments are needed to quantify VR-QoL in amblyopes with and without strabismus.