Orientador: Renato Passini Junior / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-11-27T12:24:46Z (GMT). No. of bitstreams: 1 Couto_EvelynRegina_D.pdf: 4555639 bytes, checksum: 07486cfe591a36481600d34a037a01b8 (MD5) Previous issue date: 2006 / Doutorado / Ciencias Biomedicas / Doutor em Tocoginecologia

<p>”Bara du har hälsan är allting bra.” Stämmer detta? Hälsa har länge betraktats som avsaknad av ohälsa, men inkluderar i dag begreppet livskvalitet. Nöjdhet med livet består av många komponenter, tre som nämns ofta är ekonomi, sysselsättning och det sociala livet. Denna studie ämnar utröna hur sambanden ser ut mellan hälsa och nöjdhetsområdena ekonomi, sysselsättning samt det sociala livet. En enkätstudie utfördes på 98 studenter som skattade sin hälsa och nöjdhet. Studien fann låga samband förutom att hälsa korrelerade starkt med nöjdheten med det sociala livet. Studenter som har ett förhållande visade ett högre samband mellan hälsa och nöjdhet än singlar. Denna studie visade att hälsan är nödvändig men inte avgörande för studentens nöjdhet.</p>

<p>The overall aim was to study self-care, foot problems and self-perceived health in 150 consecutively invited Tanzanian diabetic patients and to compare them with gender- and age-matched Swedish diabetic patients (n=150) from a middle Sweden area. The main study was cross-sectional and took place at a diabetes clinic in Dar es Salaam. All patients answered questions about their self-care satisfaction, diabetes knowledge and skills, and educational needs. Foot examination also included questions about foot-care and perceived foot problems. The patients' health was assessed using the SF-36 general health questionnaire. The Swahili version of SF-36 was pre-tested in 518 Tanzanian diabetic patients showing an acceptable validity and reliability. Glycaemic control was measured by HbA1c. The results indicated that 45% of Tanzanians and 43% of the Swedes reported satisfaction with their self-care. The Tanzanian patients reported that following doctor's advice was the most important factor necessary for feeling well, whereas the Swedish patients emphasised diet and exercise. Lack of drugs and education were reasons of dissatisfaction in the Tanzanian group, whilst the Swedes were dissatisfied with their own behaviour. None of the Tanzanians monitored their blood glucose themselves, whilst 50% of the Swedes did it on a daily or weekly basis. Significantly more Swedes than Tanzanians knew the interaction between insulin, food and exercises, and how to manage hyperglycaemia and hypoglycemia. The Tanzanians wanted more education about diabetes, treatment and injection technique, whereas the Swedes wanted education about psychological aspects of diabetes, foot-care and oral anti-diabetic treatment. Foot problems reported in the Tanzanian group were pain, numbness and pricking sensations, whereas the Swedes reported ingrown toenails, pain and fissures. Seven Tanzanians and one Swede had foot ulcers. Twenty Tanzanians and 103 Swedes reported to inspect their own feet. The Tanzanians had significantly poorer self-perceived health and glycaemic control than the Swedish patients. A follow-up study was performed with the Tanzanian group of patients after two years. Many patients did not return for the second investigation and 70 patients were re-assessed. They showed an improved self-perceived health and a significant decrease in HbA1c-value. In conclusion the results indicated that Tanzanian patients needed better access to a continuous and regular supply of diabetes drugs. Furthermore the Tanzanians' burden of diabetes influenced their possibilities to work, whilst Swedish patients were hindered in social activities. In both countries the importance of regular foot inspections of the patients' feet should be emphasised. Glycaemic control and self-perceived health seemed to be poorly related and for that reason diabetes nurse specialists need to use both measures in order to guide the patients towards the goals experiencing a good health despite having diabetes.</p>

The overall aim of this thesis was to investigate psychosocial consequences of cancer during adolescence, using a longitudinal approach. An additional aim was to investigate if mode of administration has an influence on adolescents’ and young adults’ self-reported psychosocial function. In Study I participants, aged 13-23 years, were randomised according to two modes of administration, telephone interview and postal questionnaire, and asked to complete the Hospital Anxiety and Depression Scale (HADS) and Short Form 36 (SF-36). The telephone mode resulted in a higher response rate, better self-rated psychosocial function (except for the youngest age group), overall lower Cronbach’s alpha values, and a larger percentage of ceiling effects compared to the postal mode. A higher proportion of males than females chose not to participate in the postal mode. In Study II and III adolescents diagnosed with cancer completed the HADS and two sub-scales from the SF-36 (Mental Health and Vitality) 4-8 weeks, 6, 12, and 18 months after diagnosis. In Study II adolescents with cancer were compared to a reference group from the general population. Shortly after diagnosis the cancer group rated their psychosocial function as worse compared to the reference group. However, the differences gradually disappeared over time and were then reversed, resulting in the cancer group reporting better vitality and lower levels of anxiety and depression than the reference group eighteen months after diagnosis. In Study III five distinct psychosocial states were identified, characterised by: psychosocial dysfunction (state A), poor psychosocial function (state B), incomplete psychosocial function (state C), good psychosocial function (state D), and excellent psychosocial function (state E). Shortly after diagnosis more adolescents than expected by chance were found in states A and C and fewer were found in states D and E. Eighteen months after diagnosis a different pattern emerged, where more adolescents than expected were found in state E and fewer than expected in state C. In Study IV adolescents, two years after diagnosis, reported problems with physical impairment, intrusive thoughts, feelings of alienation, and problems catching up with school. However, a majority of the participants also reported positive consequences with regard to the cancer disease: a more positive view of life, good self-esteem, knowledge and experience with regard to disease and hospital care, good relations, broader perspectives, and material gains. Study V, a review of the literature, indicates that survivors of childhood/adolescent cancer do not differ from comparison groups with regard to relations to others and relation to self. However, some findings highlight that friendship and marital status are areas of concern, and parenthood and sexuality are areas of potential concern. In conclusion, mode of administration influences adolescents’ and young adults’ self-reported psychosocial function and is related to age. Psychosocial function increases with time from diagnosis for most adolescents diagnosed with cancer. However, some individuals remain in poor psychosocial states during the first eighteen months after diagnosis. Increased efforts should be taken to identify these individuals.

The overall aim was to study self-care, foot problems and self-perceived health in 150 consecutively invited Tanzanian diabetic patients and to compare them with gender- and age-matched Swedish diabetic patients (n=150) from a middle Sweden area. The main study was cross-sectional and took place at a diabetes clinic in Dar es Salaam. All patients answered questions about their self-care satisfaction, diabetes knowledge and skills, and educational needs. Foot examination also included questions about foot-care and perceived foot problems. The patients' health was assessed using the SF-36 general health questionnaire. The Swahili version of SF-36 was pre-tested in 518 Tanzanian diabetic patients showing an acceptable validity and reliability. Glycaemic control was measured by HbA1c. The results indicated that 45% of Tanzanians and 43% of the Swedes reported satisfaction with their self-care. The Tanzanian patients reported that following doctor's advice was the most important factor necessary for feeling well, whereas the Swedish patients emphasised diet and exercise. Lack of drugs and education were reasons of dissatisfaction in the Tanzanian group, whilst the Swedes were dissatisfied with their own behaviour. None of the Tanzanians monitored their blood glucose themselves, whilst 50% of the Swedes did it on a daily or weekly basis. Significantly more Swedes than Tanzanians knew the interaction between insulin, food and exercises, and how to manage hyperglycaemia and hypoglycemia. The Tanzanians wanted more education about diabetes, treatment and injection technique, whereas the Swedes wanted education about psychological aspects of diabetes, foot-care and oral anti-diabetic treatment. Foot problems reported in the Tanzanian group were pain, numbness and pricking sensations, whereas the Swedes reported ingrown toenails, pain and fissures. Seven Tanzanians and one Swede had foot ulcers. Twenty Tanzanians and 103 Swedes reported to inspect their own feet. The Tanzanians had significantly poorer self-perceived health and glycaemic control than the Swedish patients. A follow-up study was performed with the Tanzanian group of patients after two years. Many patients did not return for the second investigation and 70 patients were re-assessed. They showed an improved self-perceived health and a significant decrease in HbA1c-value. In conclusion the results indicated that Tanzanian patients needed better access to a continuous and regular supply of diabetes drugs. Furthermore the Tanzanians' burden of diabetes influenced their possibilities to work, whilst Swedish patients were hindered in social activities. In both countries the importance of regular foot inspections of the patients' feet should be emphasised. Glycaemic control and self-perceived health seemed to be poorly related and for that reason diabetes nurse specialists need to use both measures in order to guide the patients towards the goals experiencing a good health despite having diabetes.

”Bara du har hälsan är allting bra.” Stämmer detta? Hälsa har länge betraktats som avsaknad av ohälsa, men inkluderar i dag begreppet livskvalitet. Nöjdhet med livet består av många komponenter, tre som nämns ofta är ekonomi, sysselsättning och det sociala livet. Denna studie ämnar utröna hur sambanden ser ut mellan hälsa och nöjdhetsområdena ekonomi, sysselsättning samt det sociala livet. En enkätstudie utfördes på 98 studenter som skattade sin hälsa och nöjdhet. Studien fann låga samband förutom att hälsa korrelerade starkt med nöjdheten med det sociala livet. Studenter som har ett förhållande visade ett högre samband mellan hälsa och nöjdhet än singlar. Denna studie visade att hälsan är nödvändig men inte avgörande för studentens nöjdhet.

Till grund för denna uppsats ligger datamaterial från LSH-studien -Livsvillkor, Stress och Hälsa, som har genomförts av forskare vid Hälsouniversitetet vid Linköpings universitet. Med studien undersöker forskarna hur människors livsvillkor kan ge upphov till stress och hur stress i sin tur kan påverka hälsan. Datamaterialet är insamlat år 2003, det omfattar tio vårdcentraler runt om i Östergötland och består av drygt 1000 individer i åldern 45-69 år jämnt fördelade över ålder och kön mellan vårdcentralerna. Syftet med denna uppsats är att identifiera och försöka justera variationer i resultaten mellan de tio medverkande vårdcentralerna i LSH-studien. Den statistiska analysen är genomförd i tre steg. I steg ett har ett stort antal variabler valts ut från ursprungsmaterialet. Därefter har skillnader identifierats med Chi2-tester och variansanalys för några av variablerna rörande självskattad hälsa, stress, psykosociala faktorer samt traditionella riskfaktorer för hjärt- och kärlsjukdomar. I steg två har vi med bakgrundsfaktorer försökt justera dessa skillnader. Av de 19 variabler som har analyserats med linjär eller logistisk regression är det fem där bakgrundsfaktorerna förklarar skillnaderna mellan vårdcentralerna. Frapperande är att samtliga fem variabler har med den psykiska hälsan att göra, ingen av variablerna angående fysisk hälsa eller riskfaktorer har justerats. Efter justering för bakgrundsfaktorerna kvarstår skillnader för fyra variabler om psykisk hälsa, dessa är Tillit, Upplevelse av stress, Upplevelse av sömnkvalitet, Psykiskt välbefinnande. Även för samtliga tio riskfaktorer och mätvärden kvarstår skillnader, dessa är Puls, P-LDL-Kolesterol, Systoliskt blodtryck logaritmerad, Systoliskt blodtryck utan uteliggare, Diagnostiserad diabetes, Medicin för blodtryck de senaste två veckorna, Alkohol riskgrupper, Motion totalt, B-Hemoglobin, P-Glukos logaritmerad. Orsaker till dessa skillnader kan vi inte fastställa, men för mätdata kan mätfel vara en tänkbar anledning. I sista steget, steg tre, har vi tagit upp analysen ett plan till vårdcentralsnivå. Genom ekologisk korrelation har vi undersökt samband mellan inkomst och betaskattningar för vårdcentralerna när justeringar har gjorts för bakgrundsfaktorer. För variabeln Tillit har vi funnit ett positivt samband, där högre inkomst i ett område innebär generellt mer tillit. Dock avviker vårdcentralen i Ödeshög där man istället har en hög grad av tillit trots relativt låg inkomst.

The advance of technology brings the flourish and vigor in economy to global market. It also changes the way we do business. Every company is struggle to gain the competitive advantage. Peter Drucker (1999), a management master, points out that in the 21st century, the most valuable assets of an organization are knowledge workers and the productivity of knowledge workers. Last ten years, high-tech industries become the main force in Taiwan. However, there are some attributes under this industry that make employees hard to differentiate between work and life, for example, short period of product life cycle, nonstop product line and so on. The researches from Fassel(1990), Schaef & Fassel(1988) indicate that some companies are workaholics itself. Schneider(1987) thought that people will stay in a company suitable to himself/herself longer due to attraction-selection-attrition theory. Many researches pointed out that workaholics are more involved in work than other workers.(Fassel, 1990; Scott et al., 1997; Spence & Robbins, 1992). Therefore, maximizing the efforts from workaholics is an challenge. In this study, workaholism is defined as an independent variable. Other variables like health, work-family conflict and job performance are as independent variables. Besides, personal attributes and job characteristics are defined as antecedents. This study will take 136 engineers in high-tech industry to examine the effect of workaholism on other dependent variables, like health, work-family conflict and job performance. The findings in this study are as follows: 1. After using factor analysis to examine three dimensions of wokaholism from Spence & Robbins(1992), the result points out that job involvement is an unstable factor, but work enjoyment and driveness are applicable to this study. 2. The hypothesis that there is a significant effect of health on work enjoyment and driveness is partly supported. Driveness is a risk factor related to health because it has a negativ effect on general health, social function and mental health. Besides, work enjoyment has a positive effect to general health, vitality, social function and mental health. 3. The hypothesis that there is a significant effect of work-family conflict on work enjoyment and driveness is supported. Work enjoyment has a negative effect on work-family conflict. However, driveness has a positive effect on work-family conflict. 4. The hypothesis that there is a significant effect of job performance on work enjoyment and driveness is partly supported. Work enjoyment has a positive effect on task and contextual performance. However, driveness has a positive effect on contextual performance. 5. The hypothesis that there are significant differences in work enjoyment and driveness among personal attributes is partly supported. No significant difference was found in work enjoyment among personal attributes. In addition, there is a significant difference for marital status in driveness. The married workers experience a higher level of driveness than unmarried workers. 6. The hypothesis that there is a significant effect of job characteristics in work enjoyment and driveness is partly supported. The result indicates that time control is positively related to work enjoyment. Monitoring demand and product responsibility are positively related to driveness. Method control is negatively related to driveness. 7. After using cluster analysis, three types of workaholics are identified in this study. They are enthusiastic workers, disenchanted workers and relaxed workers.¡@Among three types of workaholics, enthusiastic workers have a better health condition, job performance and a lower level in work-family conflict than other two types of workaholics. Furthermore, enthusiastic workers have a higher level in time control and method control than disenchanted workers.

<p>Till grund för denna uppsats ligger datamaterial från LSH-studien -Livsvillkor, Stress och Hälsa, som har genomförts av forskare vid Hälsouniversitetet vid Linköpings universitet. Med studien undersöker forskarna hur människors livsvillkor kan ge upphov till stress och hur stress i sin tur kan påverka hälsan. Datamaterialet är insamlat år 2003, det omfattar tio vårdcentraler runt om i Östergötland och består av drygt 1000 individer i åldern 45-69 år jämnt fördelade över ålder och kön mellan vårdcentralerna.</p><p>Syftet med denna uppsats är att identifiera och försöka justera variationer i resultaten mellan de tio medverkande vårdcentralerna i LSH-studien. Den statistiska analysen är genomförd i tre steg. I steg ett har ett stort antal variabler valts ut från ursprungsmaterialet. Därefter har skillnader identifierats med Chi2-tester och variansanalys för några av variablerna rörande självskattad hälsa, stress, psykosociala faktorer samt traditionella riskfaktorer för hjärt- och kärlsjukdomar. I steg två har vi med bakgrundsfaktorer försökt justera dessa skillnader. Av de 19 variabler som har analyserats med linjär eller logistisk regression är det fem där bakgrundsfaktorerna förklarar skillnaderna mellan vårdcentralerna. Frapperande är att samtliga fem variabler har med den psykiska hälsan att göra, ingen av variablerna angående fysisk hälsa eller riskfaktorer har justerats.</p><p>Efter justering för bakgrundsfaktorerna kvarstår skillnader för fyra variabler om psykisk hälsa, dessa är Tillit, Upplevelse av stress, Upplevelse av sömnkvalitet, Psykiskt välbefinnande. Även för samtliga tio riskfaktorer och mätvärden kvarstår skillnader, dessa är Puls, P-LDL-Kolesterol, Systoliskt blodtryck logaritmerad, Systoliskt blodtryck utan uteliggare, Diagnostiserad diabetes, Medicin för blodtryck de senaste två veckorna, Alkohol riskgrupper, Motion totalt, B-Hemoglobin, P-Glukos logaritmerad. Orsaker till dessa skillnader kan vi inte fastställa, men för mätdata kan mätfel vara en tänkbar anledning.</p><p>I sista steget, steg tre, har vi tagit upp analysen ett plan till vårdcentralsnivå. Genom ekologisk korrelation har vi undersökt samband mellan inkomst och betaskattningar för vårdcentralerna när justeringar har gjorts för bakgrundsfaktorer. För variabeln Tillit har vi funnit ett positivt samband, där högre inkomst i ett område innebär generellt mer tillit. Dock avviker vårdcentralen i Ödeshög där man istället har en hög grad av tillit trots relativt låg inkomst.</p>

Measurement invariance (MI) is a prerequisite to conduct valid comparisons of Health-related quality of life (HRQOL) measures across distinct populations. This research investigated the performance of estimation methods for testing MI hypotheses in complex survey data using a simulation study, and demonstrates the application of these methods for a HRQOL measure. Four forms of MI were tested using confirmatory factory analysis. The simulation study showed that the maximum likelihood method for small sample size and low intraclass correlation (ICC) performed best, whereas the pseudomaximum likelihood with weights and clustering effects performed better for large sample sizes with high ICC to test configural invariance. Both methods performed similarly to test other forms of MI. In the numeric example, MI of one HRQOL measure in the Canadian Community Health Survey was investigated and established for Aboriginal and non-Aboriginal populations with chronic conditions, indicating that they had similar conceptualizations of quality of life.