Impact of bariatric surgery on depression and anxiety symptons, bulimic behaviors and quality of life

OBJECTIVE: To assess psychiatric symptoms, substance use, quality of life and eating behavior of patients undergoing bariatric surgery before and after the procedure.METHODS: We conducted a prospective longitudinal study of 32 women undergoing bariatric surgery. To obtain data, the patients answered specific, self-administered questionnaires.RESULTS: We observed a reduction in depressive and anxious symptoms and also in bulimic behavior, as well as an improved quality of life in the physical, psychological and environmental domains. There was also a decrease in use of antidepressants and appetite suppressants, but the surgery was not a cessation factor in smoking and / or alcoholism.CONCLUSION: a decrease in psychiatric symptoms was observed after bariatric surgery, as well as the reduction in the use of psychoactive substances. In addition, there was an improvement in quality of life after surgical treatment of obesity.

Evaluation of quality of life before and after videothoracoscopic simpathectomy for primary hyperhidrosis

Objective: To assess quality of life before and after thoracoscopic sympathectomy for treatment of primary hyperhidrosis.Methods: we conducted an observational, analytical, cross-sectional and quantitative study. We evaluated patients undergoing thoracoscopic sympathectomy for primary axillary hyperhidrosis, primary palmar hyperhidrosis, and axillary hyperhidrosis associated with palmar one. We applied a questionnaire on quality of life related to hyperhidrosis before and after the operation.Results: The questionnaire was administered to 51 patients with a mean age of 32.4 years, 45 women and six men. The average quality of life related to hyperhidrosis in a score of 0-100 before sympathectomy was 34.6 and after the operation it was 77.1. Compensatory hyperhidrosis occurred in 84.3% of patients.Conclusion: thoracoscopic sympathectomy improves the quality of life of patients with primary hyperhidrosis, with results supported over time. Compensatory hyperhidrosis occurred in most patients, but did not significantly influence the improved quality of life.

Understanding and improving quality of secondary school education : conceptions among teachers in Tanzania

Temat för studien handlar om gymnasielärares uppfattningar om kvalitet och om hur kvalitet kan utvecklas i gymnasieutbildningen in Tanzania. Studien är till sin karaktär kvalitativ och består av utprövade semistrukturerade intervjuer med sammanlagt trettio lärare som arbetar i fyra gymnasieskolor både i urbana och rurala miljöer. Lärarna har varierande arbetserfarenhet och undervisar i olika ämnen. Huvudfokus har gällt identifieringen av variationer i lärares uppfattningar om kvalitet. På basen av två forskningsfrågor avslöjar analysen uppfattningar av hur lärare förstår och önskar utveckla kvaliteten på gymnasieutbildningen. Resultaten visar att lärare förstår kvaliteten på utbildningen i sina skolor som försök att möta skolans och samhällets mål, som individuella prestationer och förmågor som att inneha kompetenser och som att möta utmaningar inom utbildning, Identifierade uppfattningar var baserade på lärarnas personliga kunskap, arbetsmiljön och varierande omständigheter som rådde i deras skolor. Uppfattningar om en förbättring av kvaliteten i gymnasieutbildningen innefattade utveckling av lärares motivation, skolmiljön, arbetet i klassrum, kvaliteten på lärares kunskaper och färdigheter och undervisningsmaterial. Ambitionen bakom studien ar att erbjuda en plattform för strategier för att förbättra kvaliteten på gymnasieutbildningen. Resultaten strävar till att ge en fördjupad insikt i uppfattningar hos en utvald grupp av lärare som arbetar under samma villkor inom gymnasieskolor I Tanzania. Av den här anledningen är den genererade kunskapen därför relevant för att belysa lärares uppfattningar även utanför den studerade gruppen av respondenter.

Quality of life and menopausal symptoms in women with liver transplants

PURPOSE: To assess quality of life and climacteric symptoms in women with and without liver transplants. METHODS: This was a cross-sectional study of 52 women undergoing follow-up at a university hospital in southeastern Brazil from February 4th, 2009 to January 5th, 2011. Twenty-four of these women were 35 years old or older and had undergone liver transplantation at least one year before study entry. The remaining 28 women had no liver disease and were matched by age and menstrual patterns to the patients with transplants. The abbreviated version of the World Health Organization (WHOQOL-BREF) questionnaire was used to assess quality of life. Menopausal symptoms were assessed using the Menopause Rating Scale (MRS). Statistical analysis was carried out by Student's t-test, Mann-Whitney test and analysis of variance. Correlations between MRS and the WHOQOL-BREF were established by correlation coefficients. RESULTS: The mean age of the women included in the study was 52.2 (±10.4) years and the mean time since transplantation was 6.1 (±3.3) years. Women with liver transplants had better quality of life scores in the environment domain (p=0.01). No difference was noted between the two groups in any domain of the MRS. For women in the comparison group, there was a strongly negative correlation between somatic symptoms in the MRS and the physical domain of the WHOQOL-BREF (p<0.01; r=-0.8). In contrast, there was only a moderate association for women with liver transplants (p<0.01; r=-0.5). CONCLUSIONS: Women with liver transplants had better quality of life scores in the domain related to environment and did not exhibit more intense climacteric symptoms than did those with no liver disease. Climacteric symptoms negatively influenced quality of life in liver transplant recipients, although less intensely than in women without a history of liver disease.

Fatigue and quality of life in breast cancer survivors: a comparative study

PURPOSE: To assess fatigue and quality of life in disease-free breast cancer survivors in relation to a sample of age-matched women with no cancer history and to explore the relationship between fatigue and quality of life.METHODS: A cross-sectional study was conducted in a sample of 202 consecutive disease-free Brazilian breast cancer survivors, all of whom had completed treatment, treated at 2 large hospitals. The patients were compared to age-matched women with no cancer history attending a primary health care center. The Piper Fatigue Scale-Revised and the World Health Organization Quality of Life Instrument (WHOQOL-BREF) were used to measure the fatigue and quality of life, respectively. Socio-demographic and clinical variables were also obtained. The χ2 test, generalized linear model, and Spearman correlation coefficient were used for statistical purposes. The adopted level of significance was 5%.RESULTS: Breast cancer survivors experienced significantly greater total and subscale fatigue scores than comparison group (all p-values<0.05). In addition, survivors reported a poorer quality of life in physical (p=0.002), psychological (p=0.03), and social relationships (p=0.03) domains than comparison group. No difference was found for the environmental domain (p=0.08) for both groups. For survivors of breast cancer and for comparison group, the total and subscale fatigue scores were related to lower quality of life (all p-values<0.01).CONCLUSION: The findings of this study highlight the importance of assessing fatigue and quality of life in breast cancer survivors.

Tradução, adaptação e validação da versão brasileira do questionário Utian Quality of Life para avaliação da qualidade de vida no climatério

OBJETIVOTraduzir, realizar a equivalência e validar o questionário Utian Quality of Life(UQOL) para a população brasileira.MÉTODOSParticiparam do estudo mulheres selecionadas aleatoriamente, na fase do climatério, residentes na cidade de Natal, Rio Grande do Norte, localizada na região do nordeste brasileiro. Foram utilizados os questionários UQOL e SF-36, sendo a fase da tradução realizada da língua inglesa para o português por três professores, enquanto que a fase de adaptação da versão traduzida foi feita através da aplicação do questionário a 35 mulheres, que poderiam marcar a opção de resposta "não compreendi a questão"; e para a validação foram usadas as medidas de reprodutibilidade (teste-reteste) e validade de construto, seguindo as normas metodológicas padronizadas internacionalmenteRESULTADOSA versão brasileira foi reconhecida plenamente pela população-alvo, que foi composta por 151 mulheres, devido a nenhuma questão apresentar percentual de "não compreensão" igual ou superior a 20%. Os resultados obtidos para a reprodutibilidade intra e interobservador demonstraram concordância significativa em todos os itens do questionário. Essa versão apresentou consistência acima do critério requerido (>70), demonstrando sua precisão, enquanto que a validade de construto foi obtida através de correlações estatisticamente significativas entre os domínios ocupação, saúde e emocional do UQOL com os domínios do SF-36. O coeficiente alfa de Cronbach para o instrumento como um todo foi de 0,82, representando boa precisão. Análise da correlação item-total demonstrou a homogeneidade da escala.CONCLUSÃOA partir das etapas realizadas, o questionário UQOL foi traduzido e adaptado para aplicação no Brasil, apresentando alta reprodutibilidade e validade. Dessa forma, pode ser incluído e utilizado em estudos brasileiros que visem avaliar a qualidade de vida durante a peri e pós-menopausa.

Association between Information and Communication Technology Usage and the Quality of Sleep among School-Aged Children during a School Week

ilm OKM 2013

Managing Customer Issues through a Support Channel Network

The importance of after-sales service or service in general can be seen and experienced by customers every day with industrial as well as other non-industrial services or products. This dissertation, drawing on theory and experience, focuses on practical engineering implications, specifically the management of customer issues in the after-sales phase in the mobile phone arena. The main objective of this doctoral dissertation is to investigate customer after-sales issue management, specifically regarding mobile phones. The case studies focus on issue resolution time and the issue of corrective actions. This dissertation consists of a main body and four peer-reviewed journal articles and one manuscript currently under review by a peer-reviewed journal. The main body of this dissertation examines the elements of customer satisfaction, loyalty, and retention with respect to corrective actions to address customer issues and issue resolution time through literature and empirical studies. The five independent works are case studies supporting the thesis research questions. This study examines four questions: 1) What are the factors affecting corrective actions for customers? 2) How can customer issue resolution time be controlled? 3) What are the factors affecting processes in the service chain? and 4) How can communication be measured in a service chain? In this work, both quantitative and qualitative analysis methods are used. The main body of the thesis reviews the literature regarding the elements that bridge the five case studies. The case studies of the articles and surveys lean more toward the methodology of critical positivism and then apply the interpretive approach in interpreting the results. The case study articles employ various statistical methods to analyze and to interpret the empirical and survey data. The statistical methods were used to create a model that is useful for significantly optimizing issue resolution time. Moreover, it was found that samples for verifying issues provided by the customer neither improve the perceived quality of corrective actions nor the perceived quality of issue resolution time. The term “service” in this work is limited to the technical services that are provided by product manufacturers and after-sales authorized service vendors. On the basis of this research work, it has been observed that corrective actions and issue resolution time are associated with customer satisfaction and hence, according to induction theory, to customer loyalty and retention. This thesis utilizes knowledge of marketing and customer relationships to contribute to the existing body of knowledge concerning information and communication technology for after-sales service recovery of mobile terminals. The established models in the thesis contribute to the existing knowledge of the after-sales process of dealing with customer issues in the field of mobile phones. The findings suggest that process managers could focus more on communication and training provided to the staff as new technology evolves rapidly. The study also suggest the managers formulate strategies for how customers can be kept informed on a regular basis of the status of issues that have been escalated for corrective action. The findings also lay the foundation for the comprehensive objective to control the entire product development process, starting with conceptualization. This implies that robust design should be applied to the new products so that problems affecting customer service quality are not repeated. The objective will be achieved when the entire service chain from product development to the final user can be modeled and this model can be used to support the organization at all levels.

PHYSIOLOGICAL QUALITY OF SOYBEAN SEEDS DEPENDING ON THE PREHARVEST DESICCATION

ABSTRACTDepending on the cultivar, the use of desiccants in the preharvest can favor maintenance of physiological quality. The objective of the study was to assess the physiological quality of soybean seeds as due to the use of apreharvest desiccant and desiccation time in two harvests (2011/12 and 2012/13). The treatments were five soybean cultivars, two growth stages of application, a control (without desiccant application), and three desiccants (glufosinate-ammonium, carfentrazone-ethyl and paraquat) (2011/12 harvest). In the 2012/13 harvest the carfentrazone-ethyl desiccant was replaced by diquat. The physiological quality of seeds was assessed by the percentage of viability and vigor (cold test, tetrazolium test and accelerated aging test). In 2011/12 harvest, there was an early harvest in six days with the use of glufosinate-ammonium and paraquat desiccants, when desiccation was done in stage R7.1, with maintenance of seed quality; however it was dependent on the cultivar. In the 2012/13 harvest there was no early harvesting due to the presence of rain in the preharvest and the use of desiccation did not affect the physiological quality of the seeds either. Cultivar NA5909 RG was more tolerant to remaining in the cultivation environment and maintained higher viability than 90% and greater vigor of 71% by the cold test compared to cultivar BMX Turbo (2011/12 harvest). It is concluded that desiccation can be a viable alternative to the soybean early harvesting, but it depends on the cultivar, the time of desiccation, the active principle of the desiccant and the absence of rain in preharvest.

QUALITY OF PROCESSING TOMATO FRUITS IN COMPETITION WITH Solanum americanum

ABSTRACT Five experiments were conducted to evaluate the hypothesis that Solanum americanum density and time of coexistence affect the quality of processing tomato fruit. The tomato crop was established using either the direct drilling or the transplanting technique. The factors evaluated consisted of weed density (from 0 up to 6 plants m-2) and time of weed interference (early bloom stage, full flowering stage, fruit filling, and harvest time). The effects of competition on tomato fruit quality were analysed using a multiple model. Tomato variables evaluated included industrial fruit types (which depended on ripeness and disease infection) and soluble solids level(obrix). Tomato fruit quality is dependent on the factors tested. Under low densities (< 6 plants m-2) of S. americanum there was a small impact on the quality of the tomato fruits. The percentage of grade A (mature fruit with red color and without pathogen infection) tomato fruits is the variable most affect by the independent variables. The impact of these independent variables on the percentage of grade C (green and/or with more than 15% disease infection) tomato yield was of smaller magnitude and in an inverse trend as the observed for grade A. The level of soluble solids was influenced by the weed interference on only two experiments, but the impact was of small magnitude. The impact of the results on current and future crop management practices is discussed.

Quality of radiotherapy care by development of e-feedback knowledge

The aim of this three phase study was to develop quality of radiotherapy care by the e-Feedback knowledge of radiotherapy -intervention (e-Re-Know). In Phase I, the purpose was to describe the quality of radiotherapy care and its deficits experienced by cancer patients. Based on the deficits in patient education in Phase II, the purpose was to describe cancer patients’ e-knowledge expectations in radiotherapy. In Phase III, the purpose was to develop and evaluate the outcomes of the e-Re-Know among breast cancer patients. The ultimate aim was to develop radiotherapy care to support patients’ empowerment with patient e-education. In Phase I (2004-2005), the descriptive design was used, and 134 radiotherapy patients evaluated their experiences by Good Nursing Care Scale for Patients (GNCS-P) in the middle of RT period. In Phase II (2006-2008), the descriptive longitudinal design was used and 100 radiotherapy patients’ e-knowledge expectations of RT were evaluated using open-ended questionnaire developed for this study before commencing first RT, in the middle of the treatment, and concluding RT period. In Phase III, firstly (2009-2010), the e-Re-Know intervention, i.e. knowledge test and feedback, was developed in terms of empowering knowledge and implemented with e-feedback approach based on literature and expert reviews. Secondly (2011-2014), the randomized controlled study was used to evaluate the e-Re-Know. Breast cancer patients randomized to either the intervention group (n=65) receiving the e-Re-Know by e-mail before commencing first RT and standard education or the control group (n=63) receiving standard education. The data were collected before commencing first RT, concluding last RT and 3 months after last RT using RT Knowledge Test, Spielberger’s State Trait Inventory (STAI) and Functional Assessment of Cancer Therapy - Breast (FACT-B) –instruments. Data were analyzed using statistical methods and content analysis. The study showed radiotherapy patients experienced quality of care high. However, there were deficits in patient education. Furthermore, radiotherapy patients’ multidimensional e-knowledge expectations through Internet covered mainly bio-physiological and functional knowledge. Thus, the e-Re-Know was developed and evaluated. The study showed when breast cancer patients’ carried out the e-Re-Know their knowledge of side effects self-care was significantly increased and quality of life (QOL) significantly improved in line with decrease in anxiety from time before radiotherapy period to three months after. In addition, the e-Re-Know has potential to have positive effects on anxiety and QOL, regardless of patient characteristics or knowledge level. The results support the theory of empowering patient education suggesting that empowerment can be supported by confirming patients’ understanding of own knowledge level. In summary, the e-Feedback knowledge of radiotherapy (e-Re-Know) intervention can be recommended in development of quality of radiotherapy care experienced by breast cancer patients. Further research is needed to assess and develop patient-centred quality of care by patient education among cancer patients.

Cultural adaptation and validation of the "Kidney Disease and Quality of Life - Short Form (KDQOL-SF™ 1.3)" in Brazil

The objective of the present study was to translate the Kidney Disease Quality of Life - Short Form (KDQOL-SF™1.3) questionnaire into Portuguese to adapt it culturally and validate it for the Brazilian population. The KDQOL-SF was translated into Portuguese and back-translated twice into English. Patient difficulties in understanding the questionnaire were evaluated by a panel of experts and solved. Measurement properties such as reliability and validity were determined by applying the questionnaire to 94 end-stage renal disease patients on chronic dialysis. The Nottingham Health Profile Questionnaire, the Karnofsky Performance Scale and the Kidney Disease Questionnaire were administered to test validity. Some activities included in the original instrument were considered to be incompatible with the activities usually performed by the Brazilian population and were replaced. The mean scores for the 19 components of the KDQOL-SF questionnaire in Portuguese ranged from 22 to 91. The components "Social support" and "Dialysis staff encouragement" had the highest scores (86.7 and 90.8, respectively). The test-retest reliability and the inter-observer reliability of the instrument were evaluated by the intraclass correlation coefficient. The coefficients for both reliability tests were statistically significant for all scales of the KDQOL-SF (P < 0.001), ranging from 0.492 to 0.936 for test-retest reliability and from 0.337 to 0.994 for inter-observer reliability. The Cronbach's alpha coefficient was higher than 0.80 for most of components. The Portuguese version of the KDQOL-SF questionnaire proved to be valid and reliable for the evaluation of quality of life of Brazilian patients with end-stage renal disease on chronic dialysis.

Study on Customer Perceived Value of Container Loading Equipment

The goal of the thesis was to gain understanding of organizational buying behavior and its effect from the selling perspective and to generate base for verifying customer value propositions for Actiw Oy. The first objective was to discover the current buying decision criteria of current customers to understand the buying motives which had led to the investment initially. Second objective was to understand how the buying decision criteria and customer experiences can be turned into customer value propositions. Research was done with 16 customer interviews, which were focused on obtaining the information on the buying center and the value of the solution. Thesis goes through the main theories of OBB and the theory behind customer value management. Based on customer interviews, the currently used customer value propositions were tested and categorized into points-of-parities and points-ofdifferences. The interviews confirmed customer behavior in new task and modified rebuy situations and also gave confirmation to the internally done customer value propositions. Main finding of the study was, that as the value propositions are possible to present more specifically to each new case instead of using all benefits at the same time.

Geochemistry and water quality of Lake Qarun, Egypt

Water geochemistry is a very important tool for studying the water quality in a given area. Geology and climate are the major natural factors controlling the chemistry of most natural waters. Anthropogenic impacts are the secondary sources of contamination in natural waters. This study presents the first integrative approach to the geochemistry and water quality of surface waters and Lake Qarun in the Fayoum catchment, Egypt. Moreover, geochemical modeling of Lake Qarun was firstly presented. The Nile River is the main source of water to the Fayoum watershed. To investigate the quality and geochemistry of this water, water samples from irrigation canals, drains and Lake Qarun were collected during the period 2010‒2013 from the whole Fayoum drainage basin to address the major processes and factors governing the evolution of water chemistry in the investigation area. About 34 physicochemical quality parameters, including major ions, oxygen isotopes, trace elements, nutrients and microbiological parameters were investigated in the water samples. Multivariable statistical analysis was used to interpret the interrelationship between the different studied parameters. Geochemical modeling of Lake Qarun was carried out using Hardie and Eugster’s evolutionary model and a model simulated by PHREEQC software. The crystallization sequence during evaporation of Lake Qarun brine was also studied using a Jänecke phase diagram involving the system Na‒K‒Mg‒ Cl‒SO4‒H2O. The results show that the chemistry of surface water in the Fayoum catchment evolves from Ca- Mg-HCO3 at the head waters to Ca‒Mg‒Cl‒SO4 and eventually to Na‒Cl downstream and at Lake Qarun. The main processes behind the high levels of Na, SO4 and Cl in downstream waters and in Lake Qarun are dissolution of evaporites from Fayoum soils followed by evapoconcentration. This was confirmed by binary plots between the different ions, Piper plot, Gibb’s plot and δ18O results. The modeled data proved that Lake Qarun brine evolves from drainage waters via an evaporation‒crystallization process. Through the precipitation of calcite and gypsum, the solution should reach the final composition "Na–Mg–SO4–Cl". As simulated by PHREEQC, further evaporation of lake brine can drive halite to precipitate in the final stages of evaporation. Significantly, the crystallization sequence during evaporation of the lake brine at the concentration ponds of the Egyptian Salts and Minerals Company (EMISAL) reflected the findings from both Hardie and Eugster’s evolutionary model and the PHREEQC simulated model. After crystallization of halite at the EMISAL ponds, the crystallization sequence during evaporation of the residual brine (bittern) was investigated using a Jänecke phase diagram at 35 °C. This diagram was more useful than PHREEQC for predicting the evaporation path especially in the case of this highly concentrated brine (bittern). The predicted crystallization path using a Jänecke phase diagram at 35 °C showed that halite, hexahydrite, kainite and kieserite should appear during bittern evaporation. Yet the actual crystallized mineral salts were only halite and hexahydrite. The absence of kainite was due to its metastability while the absence of kieserite was due to opposed relative humidity. The presence of a specific MgSO4.nH2O phase in ancient evaporite deposits can be used as a paleoclimatic indicator. Evaluation of surface water quality for agricultural purposes shows that some irrigation waters and all drainage waters have high salinities and therefore cannot be used for irrigation. Waters from irrigation canals used as a drinking water supply show higher concentrations of Al and suffer from high levels of total coliform (TC), fecal coliform (FC) and fecal streptococcus (FS). These waters cannot be used for drinking or agricultural purposes without treatment, because of their high health risk. Therefore it is crucial that environmental protection agencies and the media increase public awareness of this issue, especially in rural areas.

Relationship between disease severity and quality of life in patients with chronic obstructive pulmonary disease

Few studies have evaluated the relationship between Airways Questionnaire 20 (AQ20), a measure of the quality of life, scores and physiological outcomes or with systemic markers of disease in patients with chronic obstructive pulmonary disease (COPD). The aim of the present study was to investigate the relationship of forced expiratory volume in 1 s (FEV1), body mass index, fat-free mass index, 6-min walk test (6MWT) results, dyspnea sensation and peripheral oxygen saturation (SpO2) with the quality of life of COPD patients. Ninety-nine patients with COPD (mean age: 64.2 ± 9.2 years; mean FEV1: 60.4 ± 25.2% of predicted) were evaluated using spirometry, body composition measurement and the 6MWT. The baseline dyspnea index (BDI) and the Modified Medical Research Council (MMRC) scale were used to quantify dyspnea. Quality of life was assessed using the AQ20 and the St. George's Respiratory Questionnaire (SGRQ). The Charlson index was used to determine comorbidity. The body mass index/airflow obstruction/dyspnea/exercise capacity (BODE) index was also calculated. AQ20 and SGRQ scores correlated significantly with FEV1, SpO2, 6MWT, MMRC and BDI values as did with BODE index. In the multivariate analyses, MMRC or BDI were identified as predictors of AQ20 and SGRQ scores (P < 0.001 in all cases). Thus, the relationship between AQ20 and disease severity is similar to that described for SGRQ. Therefore, the AQ20, a simple and brief instrument, can be very useful to evaluate the general impact of disease when the time allotted for measurement of the quality of life is limited.