| 1. |
- Loizou, Christos, 1980-
(author)
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Human papillomavirus in recurrent respiratory papillomatosis, tonsillar and mobile tongue cancer
- 2016
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Doctoral thesis (other academic/artistic)abstract
- This thesis focuses on the effects of the human papillomavirus (HPV) in tonsillar cancer, mobile tongue cancer, and recurrent respiratory papillomatosis (RRP). The purpose was to characterize patients with RRP in northern Sweden in order to identify more care-intensive RRP patients and to describe the voice and quality of life aspects that follow RRP. Further aims were to confirm the expected increase of HPV-positive tonsillar cancer cases in northern Sweden, and to study the correlation between HPV, its surrogate marker p16 and HPV receptor syndecan-1 in both tonsillar cancer and mobile tongue cancer.A total of 27 consecutive patients with RRP were evaluated at 3 months postoperatively using the voice handicap index (VHI) and SF-36 questionnaires to assess the impact on life and voice in a RRP population. The values were compared to normative data. This report was further extended by examining consecutive data from 21 new patients in order to characterize RRP patients in northern Sweden. In order to study HPV DNA in tonsillar (n= 65) and mobile tongue cancer (n=109), HPV DNA was extracted from paraffin-embedded biopsies and detected by polymerase chain reaction using general primers Gp5+/6+ and CpI/IIG. Expression of HPV surrogate marker p16 and the HPV receptor syndecan-1 was analysed by immunohistochemistry.Patients that underwent more than one RRP surgery per year were younger than those treated less frequently and they had significantly impaired voice quality as compared to normal subjects. Females, patients with frequent surgical treatment sessions, and patients with the high-risk HPV subtypes scored significantly lower in several domains of the quality of life assessment as compared with normal subjects. Forty-eight RRP patients had a median age of 44.5 years; 71% were men and 29% females, preferentially infected with HPV6. Patients with high surgical treatment frequency/year showed more widespread RRP in the larynx compared to the patients treated less frequently.A total of 214 tonsillar cancer cases were identified. The vast majority were men. They had a median age of 58 years at diagnosis and expressed HPV as well as p16. The incidence of tonsillar cancer revealed a 2,7-fold increase in men between the years 1990 and 2013. The study demonstrates a strong association between p16 and HPV infection in tonsillar malignancies. These findings are in contrast to the mobile tongue cancer cases, where no evidence of HPV DNA could be detected although one-third showed p16 staining. This demonstrated a poor correlation between HPV and p16 in mobile tongue cancer. There was no difference in the expression of the primary HPV receptor, syndecan-1, between tonsillar and mobile tongue cancer.In conclusion, the frequency of RRP operations, age at onset, gender and subtype of the HPV may be used as factors to predict voice disability. RRP patients with high surgical treatment frequency were significantly younger and had a more widespread laryngeal disease compared to the low-frequency treated group. This study confirms the existence of a clinical RRP group, not primarily related to HPV subtype, but to a more care-intensive RRP population. Our findings identify a 2,7-fold increase in the incidence of tonsillar cancer, HPV and p16 in men between 1990-2013. We can use p16 to detect HPV in tonsillar cancer but not in tongue cancer.The introduction of vaccination against HPV may have a role in the prevention of specific HPV-subtype positive head and neck malignancies and recurrent respiratory papillomatosis since the current vaccine protects against HPV6, 11, 16, 18, 31, 33, 45, 52 and 58. Males will definitely benefit indirectly from vaccination of females, though males will still remain at risk of cancers associated with HPV. This highlights the need for sex-neutral vaccination strategy. Our intention is that this thesis will provide scientific data to support a gender-neutral vaccination and to develop simple tools to detect HPV in tonsillar cancer.
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| 2. |
- Holm, Anna M., 1989-
(author)
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Human papillomavirus in sinonasal inverted papilloma, recurrent respiratory papilloma and non-malignant tonsils
- 2019
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Doctoral thesis (other academic/artistic)abstract
- Background: Human papillomavirus (HPV) is known to cause recurrent respiratory papilloma (RRP) and certain types of oropharyngeal cancer. HPV has also been associated with sinonasal inverted papilloma (SIP). HPV transmission routes are under investigation and the conviction is that the infection occurs sexually at an adult stage, however, vertical transmission at birth with a dormant viral condition until disease eruption/co-activation has been stated as a possibility.Purpose: The purpose of this work was to contribute to the understanding of HPV related chronic diseases in the airway. Specific aims were: 1. To increase understanding regarding changes in the immune system as well as of the glycosaminoglycan hyaluronan in patients with RRP. 2. To evaluate prevalence of HPV and its surrogate marker p16 in SIP as well as HPV, p16 and Epstein-Barr virus (EBV) in benign tonsillar disease. HPV and EBV in non-malignant tonsillar disease were studied due to the fact that incidence of HPV positive tonsillar cancer is increasing and the time of viral infection is unknown.Methods: A phenotypic characterization of peripheral blood from 16 RRP patients and 12 age-matched controls, using immunoflow cytometry, and monoclonal antibodies against differentiation and activation markers, was performed. The cytokine mRNA profile of monocytes, T helper-, T cytotoxic-, and NK cells was assessed using RT-qPCR. 54 SIP samples were studied of which 53 were available for analyzation with PCR. Genotype screening for 18 high risk and six low risk HPV types was performed using the PapilloCheck® HPV-screening test (a PCR method). 54 samples were immunohistochemically (IHC) stained for p16. Biopsies from vocal folds (VFs) and false vocal folds (FVFs) were collected from 24 patients with RRP, 12 were randomly selected to histochemistry for Hyaluronan (HA) and IHC staining for CD44 in the epithelium, stroma and RRP lesions. The remaining 12 patients were analyzed for HA molecular mass distribution with a gas-phase electrophoretic molecular mobility analyzer (GEMMA). Eight VF samples and four FVF samples were successfully analyzed. Biopsies from 40 non-malignant tonsils were analyzed using Papillocheck® for HPV, IHC for p16 and EBER analysis for EBV.Results: We found a dominance of cytotoxic T cells, activated NK cells, and high numbers of stressed MIC A/B (MHC class I chain-related molecule A/B) expressing lymphocytes. The HPV analysis was successful for 38 SIP samples and two (5%) were positive for HPV 11. Notably, p16 was present in the epithelia of all samples and in the papilloma portions in 37 of 38 samples. We found extensive HA staining in the stroma of both VFs and FVFs. CD44 was expressed throughout the epithelium, stroma, and RRP lesions in both FVFs and VFs, it did however, not concur with the expression of HA. Very high mass HA was found in both VFs and FVFs, though more variation regarding amounts of HA was seen in the VFs compared to FVFs. No HPV was found in non-malignant tonsils, the p16 levels were low and the counted EBER positive cells showed great variation in numbers.Conclusions: Our findings demonstrate an immune dysregulation with inverted CD4+/CD8+ ratio and aberrant cytokine mRNA production in RRP patients, compared to healthy controls. We concluded that p16 cannot be used as a surrogate marker for high-risk HPV-infection in SIP and that HPV incidence was low (5%). CD44 does not seem to bind to HA, which might explain the noninflammatory response previously described in RRP. Very high mass HA possibly crosslinked was seen in both VFs and FVFs. A possibility to counteract inflammatory crosslinking of HA may be found for medical treatment options in RRP.
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| 3. |
- Montelius, Elin, 1983-
(author)
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Att göra det materiella virtuellt : Subjektifiering, moral och motstånd i konstruktionen av den riskfyllda mathållningen
- 2020
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Doctoral thesis (other academic/artistic)abstract
- Den här avhandlingen syftar till att bidra till förståelsen av hur risk konstrueras och förändras i diskussioner om mathållning på nätforum och vilka subjektspositioner som görs möjliga då risk uttrycks i relation till klass och kön. Mat har kommit att få stor uppmärksamhet i samhällsdiskussionen, men i det moderna samhället är det inte bristen på mat som står i fokus, utan snarare de val människor måste göra relaterade till mat. Vad vi äter har kommit att bli en signal om vem vi är och vem vi vill vara, men diskussioner kring mat handlar också om vad som betraktas som riskfyllt eller inte. Därtill har mat länge använts för att göra distinktioner mellan människor baserat på maktstrukturer som klass och kön. Avhandlingen är inspirerad av en feministisk poststrukturalistisk ansats vilken används för att undersöka hur maktrelationer och subjektifieringsprocesser uttrycks i konversationer på nätbaserade diskussionsforum.Genom att ta avstamp i den kritiska riskforskningen samt i genusvetenskaplig forskning visar avhandlingen hur risk konstrueras genom riskperformativ. Riskperformativ, uttryckta i det virtuella rummet, medför att olika ”sanningar” konstrueras runt mathållningar vilket får konsekvenser får vilka subjektspositioner som möjliggörs. Genom riskperformativen konstruerats olika förväntningar om vad som kan och bör sägas för att konstituera sig som ett ansvarsfullt och moraliskt subjekt. Därigenom görs olika riskpositioner, det vill säga klass- och könskodade subjektspositioner som konstitueras i relation till riskkonstruktioner, tillgängliga. Analysen visar också hur utrymme för betydelseförskjutningar och motstånd mot riskkonstruktioner skapas i diskussionerna, vilket sker genom dels bekännelsen som teknik och dels genom en teknik som här kallas en responsibiliserad paternalism varigenom det individualiserade ansvaret för upprätthållandet av självreglering inför risk uttrycks i samverkan med kollektivt upprätthållna klass- och könsnormer. I avhandlingen analyseras därigenom hur kön och klass görs i samverkan med riskkonstruktioner på sätt där dessa förstärker varandra.
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| 4. |
- Schindele, Alexandra, 1967-
(author)
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Mapping viruses in non-malignant tonsils, nasal polyps, sinonasal inverted papilloma and laryngeal cancer
- 2022
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Doctoral thesis (other academic/artistic)abstract
- Background: The upper respiratory tract is exposed to viruses, which can lead to infection and cancer development. We chose to study common and/or chronic diseases along with common and cancer related viruses in the upper airway. High-risk human papillomavirus (HPV) causes cancer in tonsils and base of tongue, and Epstein-Barr virus (EBV) in the nasopharynx. p16 is used as a site-specific tumor marker for HPV. Human cytomegalovirus (HCMV) and human adenovirus (HAdV) are proposed to be oncomodulatory. It is unclear what significance these viruses have in benign tonsillar disease, chronic rhinosinusitis with nasal polyps (CRSwNP), sinonasal inverted papillomas (SIP) and laryngeal squamous cell carcinoma (LSCC). If virus is identified, it could make possible the use of current vaccines in prevention and treatment, as well as protection of healthcare providers.Material and Methods: We analyzed 40 benign tonsils, 45 paired nasal polyp and healthy nasal mucosa samples, 53 SIP and 78 LSCC samples. We used PCR/microarrays (PapilloCheck®) for HPV detection and genotyping, immunohistochemistry (IHC) for p16 expression and real-time PCR for EBV, HCMV and HAdV detection. Additionally, Epstein-Barr encoding region (EBER) in situ hybridization (ISH) was used for EBV localization and count.Results: HPV and p16 were not co-expressed, and p16 levels were low in benign tonsils, nasal polyps, and paired controls. Also, 9% of LSCC samples were high-risk HPV 16 positive and over-expressed p16.EBV-positive cells were detected in 65% of the tonsils, nasal polyps (36%) versus controls (12%), 30% of SIP cases and 33% of LSCC samples.Conclusions: EBV is commonly identified in benign tonsils, nasal polyps, SIP and LSCC, when using sensitive and robust detection methods. At the same time, viral infection with HPV, HCMV or HAdV appears to be uncommon in these conditions. p16 does not emerge as a reliable marker for HPV infection in LSCC.
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| 5. |
- Larsson, Emelie
(author)
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Risky distances : Peripheralisation and normalisation in the case of a maternity ward closure in Sweden
- 2021
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Doctoral thesis (other academic/artistic)abstract
- This thesis explores risk, peripheralisation and normalisation in the case of the maternity ward closure at Sollefteå Hospital, located inland in the Swedish region of Västernorrland. When the ward closed in 2017, it drew significant media attention and political discussions on the continuous cuts to Swedish maternity care and the growing economic gap between urban and rural areas – discussions that actualised questions of power and risk. This thesis, building on newspaper articles and interviews with expectant parents and midwives in Sollefteå, uses feminist risk theory to 1) investigate the experiences of those directly affected by the closure, i.e. expectant parents and midwives at the ward and 2) explore how the theoretical approach of ‘doing risk’ can be used to deepen our understanding of the processes of peripheralisation and normalisation. The two aims are addressed in four empirical studies and in the Discussion and Concluding remarks. I conclude that three peripheralisation processes were at work in the closure of BB Sollefteå: peripheralisation of women’s risks, periheralisation of people in rural municipalities from the welfare state and peripheralisation of small-ward work practices in the healthcare discourse. I also found that the closure made Swedish norms on childbirth and discourses on family visible, predominantly manifested through the ‘gender-equal nuclear family’ norm, which repeated in the material. Further, addressing the thesis’ second aim, I conclude that normalisation and peripheralisation can be seen as regulatory practices, which in different ways are structured around risk and power. In this context, ‘doing risk’ helps to theorize how these concepts intersect, and relate to ideology, and thus contributes to a better understanding of ideological processes in contemporary societies.
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| 6. |
- Ntouniadakis, Eleftherios, 1983-
(author)
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Subglottic stenosis : Diagnostics, endoscopic treatment and follow-up
- 2023
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Doctoral thesis (other academic/artistic)abstract
- Subglottic stenosis (SGS) is a rare condition of upper airway obstruction transforming tracheal mucosa below the vocal folds into scar tissue. It is primarily caused by laryngotracheal trauma and infrequent autoimmune conditions ofsystemic inflammation. Cases without an evident cause despite a comprehensive investigation are classified as idiopathic. SGS’s unspecific clinical presentation and the underrated findings from conventional spirometry, conceal the diagnosis. Hence, the role of spirometry in the preoperative evaluation and the postoperative monitoring of patients with SGS is unclear. The goal of treatment is to maintain a patent airway while recurrence is part of the natural course of the condition.This thesis focuses on the diagnosis, preoperative functional and self-reported assessment, choice of endoscopic treatment and the postoperative follow-up of patients with SGS.Dyspnea Index (DI), a 10-item, 5-point Likert questionnaire with scores ranging from 0 to 40, specifically developed for patients with upper airway obstruction, is now translated and validated in Swedish. The expiratory disproportion index (EDI), which is the ratio of forced expiratory volume in 1 second divided by the peak expiratory flow (PEF), is the spirometry measurement of choice to diagnose patients with SGS from those with obstructive lung disease, when found above 0.39. The percent deterioration of the EDI or PEF ( ) from each patient’s best achieved values correlates with a percent deterioration of the DI and thus, it could be used to monitor treatment effects indicating a disease recurrence. Furthermore, a DI score over 14 refines the diagnostic value of crude spirometry measurements and could be helpful to detect recurrence in patients treated for SGS. Finally, balloon dilatation was found more favorable regarding short-term disease recurrence compared to CO2 laser treatment and patients with a younger age of SGS onset, overweight or obesity showed an increased risk for restenosis
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| 7. |
- Olofsson Hallén, Katarina, et al.
(author)
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Interactions between Human, Technology and Organization in Building Information Modelling (BIM) - A scoping review of critical factors for the individual user
- 2023
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In: International Journal of Industrial Ergonomics. - : Elsevier BV. - 0169-8141 .- 1872-8219. ; 97
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Research review (peer-reviewed)abstract
- Building Information Modelling (BIM) is a process, often mentioned as an enabler of various benefits within Architecture – Engineering – Construction (AEC), of creating and managing information for a built asset. Despite the potential benefits associated with BIM, the use seems to have been relatively inefficient. One explanation may be the lack of system perspective in the implementation and use of BIM. The aim of this study was to map critical factors influencing the use of BIM based on existing research, including interactions among the three subsystems human, technology and organization. A scoping review was performed analyzing 46 included articles. The results showed that BIM is a holistic and social system, that the technology itself is insufficient, and that the acceptance of BIM is a significant critical factor for its efficient implementation and use. The research on how humans interact with the technology of BIM, and how the organization can facilitate those interactions, is however limited. Relevance to industry: Learnings from this study include that the AEC industry, by approaching BIM as a holistic and social system and recognizing the role of the individual user, can add another piece of the puzzle to achieving the effective use of BIM.
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| 8. |
- Olofsson, Katarina
(author)
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Immune cells in human pharyngeal and palatine tonsils and in the uvula : tissue distribution, cellular composition and functional properties
- 1999
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Doctoral thesis (other academic/artistic)abstract
- The adenoid (pharyngeal tonsil), the palatine tonsils and the uvula are strategically located at the entrance of the upper airodigestive tract. By virtue of their location they are incessantly exposed to inhaled and ingested antigens. Severe nasal obstruction, otitis media with effusion, recurrent tinsillitis and obstructive airways during sleep are conditions often due to diseases in these organs.To advance our knowledge about the etiology and pathogenesis of these diseases, we have compared immune cell composition, cytokine expression and microbial colonisation in adenoids from children with hypertrophic obstructive adenoid (HOA) and chronically infected adenoid (CIA). Similarly, we compared immune cell composition in palatine tonsils from children with idiopathic tonsillar hypertrophy and recurrent tonsillitis. Finally, we wanted to characterise the human uvula from an immunological point of view, which had previously not been done. Its composition and distribution of immune cells, its cytokine profile, connective tissue elements and ultrastructure was studied.When comparing adenoids from children with HOA and CIA, the most striking finding was their similarity. A cytokine profile that was independent of diagnosis but seemed characteristic for the adenoid emerged. T cell expression of IL-5 and TGF-β1 but not IL-4 suggested an ongoing humoral response driven by a "mucosal TH2" cell. αβ T cells also expressed TNF-α, IFN-γ and IL-2, indicating a concomitant cell mediated response. Cell mediated immune responses often reflect viral infection. In line with this, adenovirus DNA was found in 80% of the adenoid samples. Furthermore, IL-6, IL-8 and TNF-α expressed in the non-T cell fraction suggested that the tissue macrophages were activated. TNF-α, IFN-γ and TGF-β1 were expressed by γδ T cells. The following differences between HOA and CIA were however, noted: i) most intraepithelial lymphocytes were CD8+ γδ T cells in HOA, while CD8+ αβ T cells dominated intraepithelially in CIA; ii) the number of follicles was twice as high in CIA as in HOA; iii) there were signifacantly more granulocytes in the interfollicular area in CIA than in HOA; iv)IL-6 mRNA expressing γδ T cells were only found in HOA and v) there was a tendency of higher TNF-α mRNA levels in non-T cells of CIA compared to HOA. The following scenarios emerge: in CIA there appears to be an inadequate first line of defence, with a low frequency of intraepithelial γδ T cells and a high frequency of cytotoxic CD8+ αβ T cells eliminating infected epithelial cells. Togehter, these two conditions cause a "leaky" epithelium, allowing infiltration of microbes into the underlying tissue and subsequent recruitment of granulocytes and follicle formation initiated by activated macrophages. In HOA, activated intraepithelial γδ T cells appear to be involved in antimicrobial defence reactions and surveillance of the epithelium.The difference in leukocyte profiles between tonsils from patients subjected to surgery due to idiopathic tonsillar hypertrophy or recurrent tonsillitis was limited to the surface epithelium. CD8+ γδ T cells utilising the unusual combination Vδ1/Vγ9 in their T cell receptor constituted the majority of intraepithelial lymphocytes in both groups. However, the frequency of these cells was significantly higher in recurrent tonsillitis. These results suggest that CD8+ Vδ1/Vγ9+ γδ T cells are characteristic of palatine tonsils and selectively expanded in recurrent tonsillitis. These γδ T cells may be involved in clearing infectious bacteria at the surface of the tonsil.Tissue macrophages, αβ T cells, γδ T cells, mast cells and B cells constituted, in declining order, the immune cell populations in the uvula. No fillicle-like structures were present. Most T cells had a CD8+ CD28-TCR-αβ+ phenotype, suggesting a down-regulatory function. Production of the down-regulatory cytokine TGF-β was also noted. This is consistent with the hypothesis that the uvula contributes to the development of mucosal tolerance. Furthermore, the uvula seems to be protected from pathogens penetrating the internal milieu by a subepithelial barrier of γδ T cells and macrophages. TNF-α secreting immune cells were found at this location. TNF-α and TGF-β may cause tissue fibrosis, TNF-α indirectly by stimulating mast cells to release histamine. Tissue fibrosis in conjunction with water binding to hyaluronan present in the connective tissue is the most likely explanation for the observed enlargement of the uvula in patients with sleeping disorders.
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| 9. |
- Sundstedt, Stina, 1988-
(author)
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Swallowing function in patients with Parkinson’s disease and Deep Brain Stimulation
- 2017
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Doctoral thesis (other academic/artistic)abstract
- BackgroundParkinson’s disease (PD) is one of the most common neurodegenerative diseases in Europe. Besides motor dysfunction, PD is characterized by several non-motor and secondary motor features, such as weight change, sialorrhea, constipation and swallowing problems. Of these, swallowing is one of the most critical, as it is associated with aspiration pneumonia and consequently is the comorbidity with the highest mortality rate. Swallowing problems affect four of every five patients with PD, and even mild swallowing problems have notable psychosocial effects for patients and their caregivers. Consequently, it is essential to find treatment strategies for PD that may alleviate symptoms for patients with swallowing problems and their potential consequences.Deep Brain Stimulation (DBS) is a surgical treatment option for PD, which improves overall motor function and quality of life, but its effect on swallowing function is not clear.The purpose of this thesis was to contribute to the understanding of the effect of deep brain stimulation in the subthalamic nucleus (STN DBS) and the caudal zona incerta (cZI DBS) on pharyngeal swallowing function and on swallow-specific quality of life in patients with PD.The specific aims were to assess longitudinally the effect of STN DBS and cZI DBS on swallowing at 6 and 12 months postoperatively, in order to identify possible effects of the DBS on swallowing function. In addition, the effects of cZI DBS on ratings of swallowing-related non-motor and secondary motor features such as body weight changes, sialorrhea and speech problems were to be assessed.Methods Eleven PD patients with STN DBS (Paper I) and seventeen patients with cZI DBS (Paper II-IV) were included in this thesis. All patients were evaluated preoperatively and 6 and 12 months postoperatively. The effect of STN DBS and cZI DBS on swallowing was assessed with Fibreoptic-Endoscopic Evaluation of Swallowing (FEES) according to a predefined protocol including Penetration-Aspiration scale, Secretion Severity scale, preswallow spillage, pharyngeal residue, and pharyngeal clearance. Self-assessments were addressed using a visual analogue scale. The cZI DBS patients also completed the Swallowing Quality of Life (SWAL-QOL) questionnaire. Weight changes measured by Body Mass Index, and specific items from the Unified Parkinson’s Disease Rating Scale were also examined. Nine controls without PD were included in Paper IV, by answering the SWAL-QOL questionnaire.Results No clear effect of DBS on swallowing function or swallow-specific quality of life could be observed. There was no effect of DBS on the occurrence of aspiration, secretion, pharyngeal residue or clearance in the study groups with STN DBS or cZI DBS. Patients with STN DBS reported a subjective improvement in swallowing function with DBS stimulation turned on at 6 and 12 months after surgery.In patients with cZI DBS, the median body mass index was postoperatively increased with 1.1kg/m2 and the median increase in weight were +3.0 kg after 12 months with cZI DBS.The scores from the SWAL-QOL questionnaire were high overall in the group with cZI DBS, and the scores were unaffected by the cZI DBS surgery and stimulation. The SWAL-QOL total score was not significantly different between the PD patients and the controls, but the scores from the ‘burden’ and the ‘symptom’ subscales were worse in PD patients.ConclusionsSTN DBS or cZI DBS did not have a negative effect on swallowing function or ratings of swallow-specific ‘quality of life’ aspects in this cohort. Patients with STN DBS reported a self-perceived improvement in swallowing function when DBS was turned on. With regard to swallowing, patients with cZI DBS had an overall good quality of life throughout the conduct of the study and their swallow-specific quality of life was not negatively affected by cZI DBS. There seems to be no increased risk for aspiration or penetration due to surgery or stimulation for either the STN DBS or the cZI DBS groups. cZI DBS caused weight gain postoperatively. Since the sample sizes in these cohorts are small, the findings need to be confirmed in larger studies.
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| 10. |
- Svedbo Engström, Maria, 1968-
(author)
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Patient Perspectives brought to the Fore for Diabetes Care : Descriptions as well as Development and Testing of the Diabetes Questionnaire
- 2019
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Doctoral thesis (other academic/artistic)abstract
- Aim: The overall aims were to describe perspectives of living with diabetes, to develop a patient-reported outcome and experience measure for the Swedish National Diabetes Register, and to initiate the evaluation of evidence of measurement quality for that measure. A further aim was to describe health-related quality of life and to assess its associations with glycaemic control.Methods and results: In study I, aspects important to adults with diabetes embracing experiences of daily life and support from diabetes care were identified through 29 semi-structured qualitative interviews. In study II, those aspects were used to develop the Diabetes Questionnaire. Expert reviews, six cognitive interviews, and a regional survey of 1,599 adults with diabetes yielded supporting evidence for content and face validity, test-retest reliability, and answerability. For studies III-IV, the Diabetes Questionnaire and the SF-36v2 were presented to 4,976 adults with diabetes in a nationwide cross-sectional survey. In study III, adjusted regression analyses showed that adults with high-risk glycaemic control have lower health-related quality of life than those with well-controlled glycaemic control. In study IV, correlation, machine learning and adjusted regression analyses demonstrated support for construct validity. The Diabetes Questionnaire captures some SF-36v2 dimensions while adding information not targeted by clinical variables or the SF 36v2 and it is sensitive to differences between groups of glycaemic control.Conclusion: The Diabetes Questionnaire has the potential to support clinical meetings and assessments and hence help to bring patients’ perspectives to the fore for diabetes care.
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