Browsing by Subject "quality of life"
Now showing items 1-13 of 13
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Associations of early life stress, late adulthood quality of life and depression on DNAm age in men (2016)Goals As the proportion of the elderly population increases, studying biomarkers of cellular aging have become an important focus of research. However, these risk factors of age-related diseases have been difficult to identify. Recently an estimator of cellular aging, based on DNA methylation levels, the DNAm age, has been developed, and it has been linked to risk for both greater mortality and physical and mental health diseases. Effects of early life stress and later health on DNAm age have not yet been studied together. We set out to study, if early life stress and later quality of life and depression each separately or in combination associate with DNAm age. Methods The participants comprised Finnish males, of which 83 were separated from their families during the World War 2, and 83 non-separated controls belonging to the Helsinki Birth Cohort Study. Genome-wide methylation profiles, Rand-36 quality of life and BDI-1 depression inventory were assessed during years 2001-2004. DNAm age was estimated using the Horvath procedure. Associations of separation status, Rand-36 scores and BDI scores on DNAm age were studied with linear regression after adjusting for chronological age, cell type counts, tobacco smoking and frequency of alcohol consumption. Results and conclusions The separation status did not associate with the DNAm age. The Rand-36 Bodily Pain –scale associated differently with DNAm age in the separated group compared to the non-separated group. In analyses stratified for separation status, mild-severe depressive symptoms associated with lower DNAm age in the separated group. Similarly, lower quality of life on Rand-36 Role Functioning-scale and Emotional and Role Functioning Physical -scale associated with lower DNAm age in the separated group. Results are in line with previous studies, which have shown that early life stress doesn't associate with the DNAm age, but the cumulative total life stress and later adulthood diseases do associate with the DNAm age. This study brings novel information of the associations of early life stress and later depression symptomatology and psychosocial quality of life on the DNAm age, and suggests the early life stress and later depression and poorer psychosocial quality of life to have a cumulative effect on the DNAm age. More studies and longitudinal follow-up is needed to clarify the role of DNAm age as a biomarker of cellular aging, especially when examining the effects of early life stress exposure and later health together.
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(2021)Purpose: To assess the long-term outcome of breast reconstructions with special focus on chronic postsurgical pain (CPSP) in a larger cohort of breast cancer survivors. Materials and methods: A cross-sectional study on 121 women with mastectomy and breast reconstruction after mean 2 years 4 months follow up. The mean time from breast reconstruction to the follow-up visit was 4 years 2 months. We studied surveys on pain (Brief Pain Inventory, BPI and Douleur Neuropathique 4, DN4), quality of life (RAND-36), sleep (insomnia severity questionnaire, ISI), mood (Beck’s Depression Index, BDI; Hospital Anxiety and Depression Scale, HADS), and a detailed clinical sensory status. Patients were divided into three groups: abdominal flap (DIEP, fTRAM, and pTRAM), dorsal flap (LD and TDAP), and other (TMG, implant). Clinically meaningful pain was defined ≥ 4/10 on a numeric rating scale (NRS). We used patients’ pain drawings to localize the pain. We assessed preoperative pain NRS from previous data. Results: 106 (87.6%) of the patients did not have clinically meaningful persistent pain. We found no statistically significant difference between different reconstruction types with regards to persistent pain (p = 0.40), mood (BDI-II, p = 0.41 and HADS A, p = 0.54) or sleep (p = 0.14), respectively. Preoperative pain prior to breast reconstruction surgery correlated strongly with moderate or severe CPSP. Conclusion: Moderate to severe CPSP intensity was present in 14% of patients. We found no significant difference in the prevalence of pain across different reconstruction types. Preoperative pain associated significantly with postoperative persistent pain.
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(2020)Helsinki Chronic Pain Index (HCPI) is a validated clinical metrology instrument used to measure canine chronic pain. In pain assessment, it is recommended to use validated instruments, and behavioural changes provide the best basis for pain measurement. A measuring instrument is valid when it does what it is intended to do. Validation can be done using many different methods. The aim of this study was to investigate which items of the HCPI are still useful and psychometrically test a new structure of the HCPI (HCPI-E3) after four new questions had been added to the test. The data consisted of 1140 internet-based questionnaire responses from dog owners. The study dogs were divided into different groups based on their reported amount of pain symptoms, pain medications, and other treatments to relieve pain. Based on the comparison of different items, five possible structures of the new HCPI were developed and tested with different statistical methods. Based on the initial item comparison, the “vocalization” item was deleted from the HCPI. Overall, the “ease in” locomotion items showed better criterion validity than the “willingness to” items. Both of the “jumping” items performed excellent compared to the other locomotion item pairs, as well as the new structure containing both “jumping” items and only the “ease in” items from the other locomotion items. Thus, this structure was chosen to be the best candidate for the new structure of the HCPI. Jumping is an easily assessed activity, which does not occur too frequently, possibly making it easier to measure the dog’s willingness to do it compared to gait changes (walking, trotting, and galloping). The HCPI-E3 is a reliable tool for canine chronic pain measurement; however, future validation in the form of repeatability and reliability are still needed.
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(2016)Music interventions carried out by caregivers of persons with dementia (PWDs) have lately become the focus of music rehabilitation in dementia research. Dementia can be burdening for caregivers and it may disrupt the relationship between PWDs and caregivers. The aim of this thesis was to determine whether 1) awareness deficits frequently observed in PWDs manifest in rating discrepancies between PWDs and their caregivers when rating mood and quality of life of PWDs or if these differences are primarily explained by caregiver burden and 2) a caregiver-based music intervention can attenuate the rating discrepancies. In the current study, 89 PWD-caregiver dyads were randomly allocated in three groups: singing group, music listening group, and control group. Cognition, mood, and quality of life of the PWDs were assessed at baseline, immediately after the intervention, and 6 months after intervention. Discrepancy scores were calculated between the PWDs' and caregivers' ratings in Cornell-Brown Scale for Quality of Life in Dementia (CBS) and Quality of Life in Alzheimer's Disease (QOL-AD). Correlations of the discrepancy scores to intervention outcomes and baseline PWD and caregiver characteristics were examined. Differences between intervention groups in CBS and QOL-AD discrepancies were analyzed with ANOVA. QOL-AD discrepancy was associated with dementia severity at baseline. CBS discrepancies were consistently associated with caregiver burden, higher discrepancies corresponding to higher burden. The intervention groups did not show any differences in change in the discrepancy scores in mixed-model ANOVAs. Further research with more focused measures is needed to determine whether music interventions can alleviate awareness deficits and/or PWD-caregiver discrepancies and, regarding the latter, to reveal the exact route of the effect.
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(2022)Objectives. The world population aged over 60 years is estimated to increase to 1.4 billion by 2030. This increasing trend evidences the current need for promoting healthy ways of living and aging. Previous research has studied music as a protective factor for several aspects in aging-associated neurological illnesses. This thesis aims at researching if healthy amateur choir singers and controls across age in adulthood differ in self-reported cognitive functions, social support and quality of life. It is hypothesized that amateur choir singers will report higher values of the three aspects mentioned above. Methods. Participants (N=93) were recruited from two general population groups, amateur choir singers (N = 54) and controls (N = 46), from 3 age groups split as follows: young adults: 20–39 years (N=34, mean = 29.79, SD = 5.65); middle-aged adults: 40–59 years (N=32, mean = 50.31, SD = 6.47); and older adults: 60–90 years (N=27, mean = 69.37, SD = 7.62). Outcome measures were questionnaires on quality of life (WHO-QOL-BREF), social support (Social Provisions Scale, SPS), cognitive functioning (Cognitive Failures Questionnaire, CFQ; Prospective and Retrospective Memory Questionnaire, PRMQ). Statistical analyses were performed with SPSS. Results and conclusions. The variable “total years of education” was included as a covariate when comparing the age groups, due to significant difference in the demographic pre-analysis. When studying the effects of amateur choir singing (choir vs controls), none of the results were significant. In comparing the three age groups (young, middle-aged, old), significant group differences were found in all the domains of theCFQ (cognitive failures) questionnaire except for Names, with young adults scoring higher (indicating more cognitive failures) than the middle-aged and older adults. A significant singing x age interaction was observed in all CFQ domains (except Names) as well as in the Reliable alliance subdomain of the SPS, with choir singers showing a more positive trend (less cognitive failures, more social support) across the age groups compared to the control group. These findings suggest a possible protective effect of amateur choir singing on subjective cognitive and social functioning in aging, which should be further studied.
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(2013)Prostate cancer is the most common cancer among men in Finland. Today, new prostate cancers are diagnosed in an early phase of the disease when the cancer is still local and effectiveness of the treatments good. There are many effective treatment options for localised prostate cancer but all of them cause multiple side effects. No comprehensive information about prostate cancer patients' experiences, treatment consequences and outcomes has been available. National Institute for Health and Welfare (THL) carried out a nationwide survey to prostate cancer patients diagnosed in 2004. The questionnaire was sent by mail in 2009. Patients were asked to report their experiences during the diagnosis and treatment selection (prostatectomy, hormone therapy, external beam radiation, brachytherapy, surveillance). They were asked about amount and harmfulness of side effects and satisfaction with outcome of the treatment. An association between the side effects and satisfaction with the treatment outcome was also studied. A total of 1239 responses were accepted for the study (response rate 73%). All treatments caused several side effects, and up to half of the patients had some adverse effect still present at the time of the survey. Most of the side effects concerned urinary or sexual dysfunction, in external beam radiation also bowel dysfunction. All treatments caused sexual dysfunction, but radiation therapy less than the other treatments. Side effects caused by hormone therapy were specific for this treatment, like hot flashes and mood disturbances. Patients treated with prostatectomy were least satisfied with the outcome of the treatment and dissatisfaction was mostly associated with sexual and urinary dysfunction. Patients treated with radiation therapy were most satisfied with the outcome. Urinary and bowel dysfunction impaired the satisfaction in patients treated with external beam radiation. All prostate cancer treatments cause plenty of potentially harmful side effects that may be challenging for psychological and psychosocial well-being of the patients. Thus, both treatment modalities and means to support well-being of the patients should be developed further. Actions that enhance well-being and prevent and relieve side effects should be an essential part of standard clinical procedures for every prostate cancer patient.
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(2023)Abstract Objective: Cleft lip and/or palate (CL/P) can have long-lasting effects on the appearance, function, and psychosocial wellbeing of patients. The CLEFT-Q questionnaire is a patient-reported outcomes instrument specifically designed to assess the health-related quality of life of patients with CL/P. The aim of this study was to produce and linguistically validate a Finnish version of the CLEFTQ questionnaire. Design: The CLEFT-Q questionnaire was translated into Finnish following guidelines of the International Society for Pharmacoeconomics and Outcomes Research. Pilot testing with cognitive debriefing interviews was conducted on patients of the target age range of the questionnaire, 8–29, and with various cleft types. Results: The CLEFT-Q questionnaire translated readily into Finnish. A review of the backward translation led to two words being changed. Thirteen patients – ten females and three males – with a median age of 14 years, participated in the cognitive debriefing interviews. The interviews led to further nine word changes. The pilot study data suggested that the performance of the Finnish version of the instrument is in line with the original CLEFT-Q questionnaire. Conclusions: The Finnish version of CLEFT-Q produced here is linguistically valid and ready for use in the evaluation of the healthrelated quality of life of patients with CL/P. However, future work is needed to further assess the validity and the reliability of the CLEFT-Q in the Finnish patient population.
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(2019)Objective: Traumatic brain injury (TBI) is a major public health issue leading to long-term cognitive, emotional, and physical impairments. New, effective, multimodal and multidisciplinary rehabilitation practices are needed. Dance is a multimodal activity that engages several brain regions simultaneously and, therefore, might be ideal for enhancing complex functions. Dance also combines physical exercise and the use of music, both of which positively affect healthy and neuropathological populations. The aim of the research project was to develop a multidisciplinary dance rehabilitation method and to evaluate its feasibility and effectiveness in chronic severe TBI. The current study investigates the intervention’s effects on cognition, depressive mood, and health-related quality of life. The feasibility of the intervention is also discussed. Methods: The current study had 11 participants with severe TBI; four women and seven men, 19 – 45 years old, with an average time of 7.6 years from the acquisition of the injury. A two-group crossover design with random allocation was used. The intervention (three months, two weekly sessions) was carried out together by a dance instructor and a physiotherapist. Neuropsychological assessments were conducted at the beginning of the study (t0), and twice after that every three months (t3 and t6). Performance before and after the intervention in general cognition, frontal lobe functions, abstract reasoning, visuo-spatial reasoning, working memory, mood, health-related quality of life, and executive functions were compared with paired sample t-tests. Time and group interactions were studied by repeated measures analyses of variance. Results: Abstract reasoning, health-related quality of life, and most saliently, mood improved significantly during the intervention. Qualitative findings also indicated enhanced mood. One of the participants described being reconnected to emotions for the first time a after the acquisition of the TBI and several other participants expressed positive feelings and experiences during the intervention. Conclusions: The current study suggests that dance rehabilitation may improve mood, abstract reasoning, and quality of life in the chronic state of severe TBI. These results are tentative and more research with larger samples is needed to verify the findings.
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(2012)Prostate cancer is the most common cancer in men in Finland. Health care costs increase annually and cost of cancer is significant to the society. Because resources are scarce more information is needed about the costs of diseases as well as treatment effectiveness. In addition to clinical effectiveness it is important to assess the value of healthcare technologies from the patient's point of view by measuring the treatment's effect on patients' quality of life. In this thesis a literature review was made on the following topics: cost of treating prostate cancer, prostate cancer patients' quality of life and cost-effectiveness of prostate cancer. The aim of the research was to determine what the drug costs are in relation to the total cost of treatment for prostate cancer in different stages of the disease and assess how the quality of life changes during the first year of treatment depending on the form of treatment. Drug costs were calculated from the health care payer's perspective in a six month cross-sectional study. The study population included a total of 629 prostate cancer patients treated in the Helsinki and Uudenmaa hospital district (HUS). The quality of life study population (N=367) was different of that used to calculate drug costs. The quality of life was measured according to an ongoing cost-effectiveness research at HUS. It was measured with 15D-instrument before receiving cancer treatment and three, six and twelve months after the beginning of treatment. Drug costs in relation to the total cost of prostate cancer treatment were significant. In patients with meta-static cancer drugs were 53 % of the total cost of cancer treatment. In remission patients the total costs of cancer treatment were the lowest compared to other diseases stages, but drug costs were still 30 % of the total costs. For patients receiving palliative treatment, local or relapse cancer patients, and patients whose cancer was just diagnosed, the total drug costs were 19%, 13% and 0%, respectively. Policlinic visits and policlinic procedures were also a significant cause of the total costs. Quality of life of prostate cancer patients is incredibly good compared to age-standardized population. However the patients' quality of life decreases statistically and clinically significantly during the first year of treatment. Before treatment 15D score was 0,91 and after 12 months it was 0,88. When assessed in different treatment groups the quality of life decreased the least in patients treated with waiting. The largest statistically significant change occurred in patients treated with radiation. The strength of the study is that the costs were calculated per patient according to real resource use. The study also had limitations. The costs of primary care were not included in the calculations. Also cancer related pain medication, depression and erectile dysfunction drugs should be included in the drug costs. The follow-up time of measuring quality of life was too short. In the future it would be important to study the cost-effectiveness of medication as well as the cost-effectiveness of the different forms of treatment in prostate cancer.
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(2019)Breast cancer is the most common cancer among women world wide and it´s incidence is constantly growing. The prognosis of local breast cancer is good and patients with metastatic breast cancer are living longer with their disease. The growing survivorship and population of chronically ill breast cancer patients has made quality of life one of the most important aspects in the treatment of breast cancer. Cytotoxic chemotherapy is a widely used treatment for breast cancer. Chemotherapy can cause difficult adverse events, which can affect the patients’ quality of life. Chemotherapy can also relieve the symptoms caused by cancer when used to treat metastatic breast cancer. The aim of this systematic review was to collect the currently available literature about breast cancer patients´ health related quality of life as comprehensively as possible, review the quality of the literature and the effects of chemotherapy on breast cancer patients ‘quality of life. The literature search produced 1666 references. According to the inclusion and exclusion criteria, 107 full text articles were accepted to the final systematic review, 53 of which reported the health related quality of life during adjuvant treatment of breast cancer, and 51 of which reported it during the treatment of advanced or metastatic breast cancer. In addition 3 previous systematic reviews were found. The basic information about the articles was extracted into a table. Articles were heterogeneous regarding their study settings, used quality of life instruments and reporting. Most studies used a disease specific quality of life instrument. The collected literature gave a strong indication of quality of life worsening during adjuvant chemotherapy of breast cancer. This observation was further supported by the previous systematic reviews. Most of the studies reporting the quality of life during chemotherapy for metastatic breast cancer, reported less than clinically important changes during the treatment. A few studies reported clinically important worsening or improvement in quality of life. 11 studies, which were made during or after 21: st century, which reported numerical data from quality of life, which reported predominantly quality of life and which had sample size of at least 100 patients in baseline, were accepted to further assessment of quality of the studies and closer observation. The quality of the studies was assessed with STROBE and CONSORT checklists. The quality of studies was heterogeneous as the studies fulfilled 44.8 % to 86.1 % of the scoring items. Only one randomized controlled trial reported quality of life as their primary end point. The data from these studies supported the previous observation of quality of life worsening during adjuvant chemotherapy of breast cancer. The effect of chemotherapy during metastatic breast cancer on quality of life was not unambiguous. Both clinically meaningful worsening and improvement of quality of life was reported. Breast cancer patients´ health related quality of life has been assessed in multiple publications, but the existing literature is heterogeneous and it´s use in decision making and economic evaluation is not easily feasible. Breast cancer patients´ health related quality of life worsened during adjuvant chemotherapy. Significant improvement in breast cancer patients´ health related quality of life was not observed during chemotherapy for metastatic breast cancer.
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(2016)Tutkielman tavoitteena oli kartoittaa 85 vuotta täyttäneiden helsinkiläisten suunterveyspalvelujen käyttöä vuosina 2007-2012, sillä väestön ikärakenteen muutos aiheuttaa kasvavan määrän yhä vanhempia hoidettavia terveyskeskuspotilaita. Rajallisten suun terveydenhuollon resurssien kohdentamiseksi ja palvelujen suunnittelemiseksi on tärkeää kerätä tietoa palvelujen käytön nykytilanteesta. Erityishuomiota haluttiin kiinnittää ikäihmisten proteettisiin käynteihin ja näiden jakautumiseen sekä parodontologisiin käynteihin, sillä nämä muodostavat tärkeän osa-alueen vanhusten hammashoidosta. Hypoteesinä esitettiin proteettisten korjaustoimenpiteiden muodostavan suurimman osan kaikista proteettisista toimenpiteistä. Lisäksi parodontologisen hoidon osalta hypoteesinä oli hoidon jakautuminen tasaisesti suuhygienistin ja hammaslääkärin kesken. Tutkielman aineisto kerättiin Effica-potilastietojärjestelmästä ja saatiin käyttöön Helsingin kaupungilta. Tuloksia analysoitiin Excelin tilastointimenetelmillä, ja vertailuun käytettiin eurooppalaisia tutkimuksia aihepiiristä. Tutkielmassa havaittiin tarve kehittää informointia säännöllisten hammaslääkärikäyntien tärkeydestä, sillä käyntimäärä ei kasvanut, vaikka potilasmäärä lisääntyi. Vuonna 2012 hammaslääkärissä/suuhygienistillä käyneiden määrä jäi alle viidennekseen, mikä on huomattavasti vähemmän kuin aiemmissa julkisen sektorin vanhusväestöä analysoineissa tutkimuksissa. Lisäksi todettiin proteesin korjauksien muodostavan suurimman osan proteettisista käynneistä, ja kiinteän protetiikan olevan selkeä minoriteetti.
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(2016)Previous studies have examined quality of life among people with traumatic brain injury (TBI) using quantitative measures and/or structured questionnaires. Recently some studies have focused on the patient's own perception of TBI and used the International Classification of Functioning, Disabilities and Health (ICF) framework to examine quality of life from a wider perspective of functioning. The aim of this study was to examine: What kind of occasions do the participants report as the happiest or unhappiest after TBI, and how are these related to the life areas within the ICF framework. An additional aim was to examine how are these life areas, as well as demographics variables, injury severity, and emotional state associated with the individuals' quality of life. A total of 233 Finnish persons with TBI participated in the Wave 1 of the international QOLIBRI (Quality of Life after Brain Injury) validation study in 2004—2006. The individuals' own descriptions about the happiest/unhappiest occasions were linked to the most precise ICF categories. Correlation and regression analysis were used to examine the association with demographic variables, injury related variable, emotional state, most frequently reported life areas and perceived quality of life. The most frequently reported life areas for both happy and unhappy occasions were Interpersonal interactions and relationships, followed by Community, social and civic life in happy occasions, and Mental functions and Services, systems and policies in both happy and unhappy occasions. Regression analysis showed that younger age, longer post-traumatic amnesia, fewer symptoms of anxiety and depression, happy occasion related Mental functions and Community, civic and social life, and not reporting an unhappy occasion related to Mental functions, yet reporting unhappy occasions related to Interpersonal interactions and relationships, were associated with higher perceived quality of life. The results of this study are in line with previous studies that have shown emotional state, age, and injury severity as factors relevant to quality of life after TBI. Additionally, this study informs clinicians about the life areas that individuals with TBI themselves experience as most relevant to their quality of life. From the individuals' perspective, rehabilitation should focus on supporting social relationships, participation in community activities, using services and helping the persons to cope with the demands of the environment. Furthermore, individuals need emotional support to adapt to their new life situation.
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(2022)The past decades have seen the emergence of the shrinkage phenomenon throughout cities leaving urban planners, communities and their administrations perplexed as to what to do next. The phenomenon encompasses complex, interconnected processes which are embedded in economic, demographic and structural changes. However, it is the population decline aspect that is often one of the telltale signs synonymous with shrinkage. Whilst shrinking cities are not something new, it has been gaining widespread attention as it becomes more prominent in urban areas and is no longer just an issue associated with rural areas. With Finland’s population forecast expected to decline in the coming decades, the relevance of the phenomenon and its urban planning implications will only become more prominent. Historically and still widely today, a city’s success has been connected to its ability to grow, resulting in the ideal that only growing cities are deemed to be successful. Urban planning transpired from the need to spatially manage growth and therefore, has its origins in facilitating for growth. Given the negative implications associated with the phenomenon and its impact on demographics, economy and the built environment of cities, it is often stigmatised and portrayed in a negative light. This research contributes to the knowledge on the shrinkage phenomenon in the context of Finnish urban planning. The study aims to explore the negative portrayal of the phenomenon through understanding the social and structural implications for cities and examining the implications this has on the actions that are being taken by cities to adapt to shrinkage. Specifically, the study involved interviews with urban planners, researchers and other relevant experts across Finland with knowledge on the shrinkage phenomenon and/or urban planning. The results of the study demonstrated that the negative connotation has led to many cities unwilling to openly accept the phenomenon. In turn, this has resulted in denial and the constant desire to strive for growth which has compromised the opportunities available to appropriately plan for the future. The influence of the political realm has shown to be a contributing factor to the stigma surrounding the phenomenon and further reinforced growth aspirations that are not reasonable for many shrinking cities. The prominence of the phenomenon has further fuelled the debate of whether old and current urban planning practices supporting and emphasising growth is the way forward and if existing planning systems are able to (un)plan for shrinkage. Ensuring the importance of quality of life indicators for residents within shrinking cities and the obligation for urban planners to accept shrinkage and plan the future of cities accordingly are key takeaways from the research.
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