Podcasts about body functions

Send us a Text Message.How much do you really know about the calories you consume every day? Discover the truth about how these little units of energy power your body and why understanding them is crucial. In this episode, we demystify calories, breaking down how carbohydrates, proteins, and fats transform into the energy that keeps your organs functioning and your body moving. We'll explore the critical role your liver and brain play in this energy expenditure, consuming a significant portion of your basal metabolic rate (BMR).Ever wondered why you can't seem to shake off those extra pounds, despite all your efforts? Learn how calculating your BMR can be a game-changer for your health journey. We'll uncover how factors like age, gender, and activity level influence your BMR, and why lean body mass is key. We'll also highlight the risks of restrictive diets and the importance of accurate BMR measurement methods, from equations to body composition scans like DEXA. Regular scans can be especially beneficial for those dedicated to strength training, as they reveal true progress beyond what the scale shows.Imagine the dangers of severely cutting calories and over-exercising, leading to muscle loss and severe health issues. Through a compelling case study, we'll highlight the potential consequences and stress the importance of balanced nutrition and realistic goal-setting. Our goal is to shift the conversation from mere weight loss to overall health and well-being. By understanding how balanced meals and listening to your body contribute to a healthier, happier life, we'll provide you with the tools to make informed decisions about your nutrition and fitness. Join us as we prioritize health, longevity, and a positive relationship with food in your wellness journey.BMRThe Energetic Functions of the BodyThyroid Function and Metabolism  Thank you for listening. Please subscribe to this podcast and share with a friend. If you would like to know more about my services, please message at fueledbyleo@gmail.comMy YouTube Channel https://www.youtube.com/channel/UC0SqBP44jMNYSzlcJjOKJdg

https://lovewithsex.me/?p=22602 Magnesium: The Nutritional Revolution You've Been Waiting For! In this podcast, we explore the incredible benefits of magnesium and why it's the key to a nutritional revolution that can transform your health. Discover how magnesium plays a crucial role in over 300 biochemical reactions in your body, influencing everything from muscle and nerve function to blood glucose control and protein synthesis. We'll break down the best sources of magnesium, how to incorporate them into your diet, and the amazing health benefits you can expect. Whether you're looking to boost your energy levels, improve your sleep, or enhance your overall well-being, this podcast is your ultimate guide to the power of magnesium. Don't miss out on this essential health information! magnesium the nutritional revolution, health benefits of magnesium, magnesium supplements, Magnesium, Nutritional Revolution, Magnesium Sources, Essential Nutrients, Magnesium for Better Health, Magnesium and Wellness, Magnesium Explained, Magnesium Guide, Boost Your Health with Magnesium, Magnesium and Energy, Magnesium and Sleep, Healthy Living with Magnesium, Magnesium and Body Functions, Magnesium Importance, Magnesium for Optimal Health, Nutrition Tips, Magnesium in Diet, Magnesium Benefits Explained, Best Magnesium Sources, Magnesium and Fitness, Magnesium and Blood Sugar, Magnesium for Nerve Function, Magnesium and Muscle Health, Daily Magnesium Intake, Natural Sources of Magnesium, Magnesium and Protein Synthesis, Improve Health with Magnesium, Magnesium Health Guide, Magnesium Wellness Tips, Magnesium for Health Improvement, Magnesium Impact on Health, Magnesium Information, Magnesium Health Revolution, --- Send in a voice message: https://podcasters.spotify.com/pod/show/antiaging-beauty-health/message

Join us now as we welcome our esteemed guest, Dr. Bijoy, a board-certified physician and renowned sleep specialist with over 25 years of expertise in Pulmonary/Critical Care and Sleep Medicine. Operating from Nashville, TN, Dr. Bijoy extends his care to both children and adults grappling with diverse sleep disorders. As the founder and medical director of Sleep Wellness Clinics of America, he offers a comprehensive range of services including in-person and online consultations, educational resources, modern diagnostic tools, home testing, and tailored treatments to address the entire spectrum of sleep-related issues.Explore the wealth of resources available on Dr. Bijoy's website, [Sleep Fix Academy](https://sleepfixacademy.com/), featuring podcasts, sleep assessments, journals, the "SLEEP NOW" course, and the opportunity to acquire his book, "Nobody's Sleeping." Hosted on Acast. See acast.com/privacy for more information.

learn words and phrases about body functions

Estrogen is the main driving hormone in your body that affects just about everything - so let's talk about it! Estrogen is so important for your overall health, not just your reproductive health, because you have estrogen receptors all over your body. We need to stop demonizing estrogen and start talking about all the great things estrogen does for you and your body!You will hear:Systems in your body affected by estrogenThe functions of estrogen and progesterone and keeping them in checkHow conventional medicine is failing womenThe trouble with synthetic hormones after menopauseAnd so much more!Struggling with balancing your hormones? Grab your copy of the The Gutsy Gynecologist's Guide to Balancing your Hormones: https://drtabatha.com/free-guide/Support your hormone balance- EnergyLift! Connect with Dr. Tabatha:Work with us: Schedule a callDr. Tabatha's Facebook: https://www.facebook.com/DrTabathaDr. Tabatha's IG: https://www.instagram.com/thegutsygynecologist/Dr. Tabatha's YouTube: https://www.youtube.com/channel/UCWea1x1abLERehb5yn_nfow

In this episode of The Habit Coach Podcast, Ashdin engages in a discussion with Neha Ranglani, an Integrative Health Coach. They explore topics such as gut health, the fascinating daily functions of our body, significance of self-care and relaxation, among other subjects. Additionally, Neha introduces a novel technique called the "Ultradian Rhythm break" to boost our energy levels and productivity during work hours.You can connect with Neha Ranglani-YouTube: https://www.youtube.com/c/NeharanglaniInstagram: https://www.instagram.com/neharanglani_/?hl=enLinkedIn: https://www.linkedin.com/in/neharanglani/?originalSubdomain=inWebsite: https://neharanglani.com/Going ahead we will meet you thrice a week- Monday, Wednesday & Friday on YouTube as well as on all audio streaming platforms. You can watch the full video episodes of The Habit Coach-Awesome 180 on the YouTube channel.You can also check out Ashdin's Linktree Page here: (https://linktr.ee/awesome180) You can follow Ashdin Doctor on Twitter | Linkedin | Instagram | FacebookCheck out the Awesome180 website: (http://awesome180.com/) Find the show across audio streaming apps:Spotify | Apple Podcasts | Google Podcasts | JioSaavn |  Amazon Music Do follow IVM Podcasts on social media.We are @ivmpodcasts on Facebook, Twitter, & Instagram.See omnystudio.com/listener for privacy information.

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learn words and phrases about body functions

Listen to Dr. Tom Roselle, DC discuss the brain and how the brain is the master director of all body functions such as breathing air, digesting food, circulating blood, moving your body, and much more. Also, in this episode, Dr. Roselle discusses brain encephalitis, myocarditis, neurotransmitters, and the neurobiology of brain disorders.

We open up with some birthday updates, then turned quickly to our random topic. Things seem to be shaping up for a short episode today, or does it? Terry answers…

Listener Kandi wrote into the Naked Scientists to explain the science behind this major medication method. "I have Hyponatremia as a result of a medication. How does a drug stop your body from using/absorbing the salt you consume?" Otis Kingsman spoke to Gerogetown University's professor of medicine, Joseph G Verbalis to find the answer... Like this podcast? Please help us by supporting the Naked Scientists

learn words and phrases about body functions

How writing takes up mental bandwidth, because we're creating the story even when we're not actually writing, trying to compartmentalize, the trick to delegating, and thoughts on writing in the body vs the head.Upcoming panel: The Cross-Genre Author Experience! and you can get your free tickets here (https://www.eventbrite.com/e/highgarden-entertainment-presents-a-farofeb-author-panel-tickets-258695183257).The audiobook of DARK WIZARD is here (https://www.audible.com/pd/Dark-Wizard-Audiobook/B09QQRHTYZ?source_code=AUDFPWS0223189MWT-BK-ACX0-294201&ref=acx_bty_BK_ACX0_294201_rh_us) and you can check out FaRoFeb here (https://farofeb.com/farofeb-2022/).You can order FIRE OF THE FROST here (https://jeffekennedy.com/fire-of-the-frost) and DARK WIZARD here (https://jeffekennedy.com/dark-wizard). You can preorder GREY MAGIC here (https://jeffekennedy.com/grey-magic) and THE STORM PRINCESS AND THE RAVEN KING here (https://jeffekennedy.com/the-storm-princess-and-the-raven-king).If you want to support me and the podcast, click on the little heart or follow this link (https://www.paypal.com/paypalme/jeffekennedy).You can watch this podcast on YouTube here (https://youtu.be/BRUZGfN6bvQ). Sign up for my newsletter here! (https://landing.mailerlite.com/webforms/landing/r2y4b9)Support the show (http://paypal.me/jeffekennedy)

This man's condition can't even be described cleanly in words. You just have to listen for yourself.

Dr. Bexxx joins Chet, Diane, and Wells as they discuss men having multiple orgasms and Wells dealing with his fear of cunnilingus. A women asks advice on how to queef less during sex and a pubic groomer seeks new inspirations for hair designs.

Lauren Schwabish is a speech pathologist and she sees every day people that have lost some of their basic body functions and she's helping them regain them by using rehabilitation and gratitude principles.Keeping a daily digital gratitude journal for the past 5 years has greatly benefitted her mental health. As a speech pathologist working with people with neurological injuries, she frequently recommends such a journal as part of their recovery. As a mother and wife, she frequently reflects on past entries.Resources:Thank you to BetterHelp for sponsoring this episode: Get 10% off on BetterHelp: https://betterhelp.com/georgianIntro by Cristina Muresan-Toth: https://www.instagram.com/p/CLHlus5Jwj3/

This episode is also available as a blog post: https://francherbalandmakeover.wordpress.com/2021/07/17/how-the-human-body-functions/ --- Send in a voice message: https://anchor.fm/franc-herbal/message

The Law Offices of Quibble, Squabble & Bicker venture into sketchy territory when addressing their newest client, Body Functions and Body Dysfunctions. You should be warned this client exposes VERY GROSS CONTENT as the Law Offices morph into the Medical Offices of Quibble, Squabble and Bicker while discussing money circulation, an inflamed wheezer, exocrine glands, sweat grows, weevils, miniature bounty hunters, Elon Musk the Bond villain, Gates and Epstein, sex with toilets, binary pooping, footprints in a bathtub, gleek-offs, the Scarface Challenge, fashion jabs, floppy no longer, Poople, Sly and The Family Stone, Dr. Oz the Poop Guy, the Anti-Corn Network, teratoma has a bigger penis, homunculus, weirdly googly, green massive schlong, the Sewer Walkers Of Chicago, a TFT and stay golden, gator boy. For other episodes, go to www.qsblaw.org. They are also internettable on: Instagram - @lawofficesofquibble; Twitter - @qsblaw; TikTok - @qsblaw; Uhive - www.uhive.com/z/QTTCLFU; Facebook: https://www.facebook.com/quiblle.bicker.3; Tumblr - quibblesquabblebicker; Reddit - https://www.reddit.com/user/QuibbleSquabble or watch them on YouTube - https://www.youtube.com/c/LawOfficesofQuibbleSquabbleBicker --- Send in a voice message: https://anchor.fm/qsb/message Support this podcast: https://anchor.fm/qsb/support

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Welcome! Speaker: Billy Ferris To give, text "give" to 914-371-2978. Venmo @WokeRemnant.com Merch: https://righteous-rags-2.creator-spring.com/ Prayer Requests: Info@wokeremnant.com Deliverance Inquiries: Deliverance@wokeremnant.com Social Media: https://www.tiktok.com/@jitneycan www.facebook.com/awakeningremnant www.instagram.com/woke.remnant www.twitter.com/wokeremnant

נדה - This is the law for him who has a discharge and for him who has an emission of semen, becoming unclean thereby; also for her who is unwell with her menstrual impurity, that is, for anyone, male or female, who has a discharge, and for the man who lies with a woman who is unclean. LEVITICUS 15:32–33 — LINKS Purchase "Unveiling Mercy" and learn more... 1517 Podcast Network Support the work of 1517 CONTACT and FOLLOW chad@1517.org Facebook Twitter SUBSCRIBE Apple Podcasts Spotify Overcast RSS Google Podcasts Stitcher TuneIn Radio iHeartRadio Audio production by Christopher Gillespie (gillespie.media).

Get YOUR copy of the Rock Bottom Thyroid Treatment: https://www.rockbottomwellness.com/book Get your free 7 Day Eating plan here: https://www.rockbottomwellness.com/7-day-eating-plan Schedule your FREE Thyroid Breakthrough Session today by clicking here:  https://p.bttr.to/3jtRIgI Sarah shares her personal story and journey of how her breast implants negatively affected her body. She was doing all the right things (eating healthy, exercising, taking supplements to address what I thought were root causes) but couldn't get well. We discuss How breast implants affect the body’s functions including gut health, hormones, brain chemicals and how it can affect autoimmunity.  That’s just the first step. After explant surgery, restoring balance and function can be tricky and a healing environment needs to be a first important step in your healing journey.  Sarah has a passion for restoring health that has taken her along a path from RN, to becoming a certified Functional Diagnostic Nutrition® Practitioner, True Cellular Detox™ Practitioner, and Breast Implant Illness Expert. She believes the solution to Reversing Breast Implant illness is about more than just the explant and that we all need to take personal responsibility for restoring our health by addressing all of the root causes that contribute to chronic illness. It is Sarah’s believe that the body has an innate desire to heal if given what it needs and she focuses on teaching women how to unlock that innate intelligence and heal themselves. CONTACT SARAH PHILLIPE HERE: https://reversingbreastimplantillness.com/ https://www.facebook.com/groups/reversingbreastimplantillness/ https://www.instagram.com/reversingbreastimplantillness/ https://www.youtube.com/channel/UCGwG5O_n4i1_FHe6ZOzfrJg/ Freebie: Neurotoxic Questionnaire: https://gallery.mailchimp.com/12f621ad8f9cf55e68e68b2ef/files/c69933be-454a-4999-8193-a102e756befe/Neurotoxic_Questionnaire.pdf  

Logan and Robertson talk a variety of topics while trying to figure out what is wrong with their bodies. Sneezes galore in this episode of Quick! Call an Adult!

This time out your hosts are talking about the 24 movies (+ TV shows) that crossed their path since our last episode and it's a mixed bag of cinema - and too much talk of bodily fluids!We get the triumphant return of Robert Logan to the show, a duo of truly oddball films starring musicians (one of which doesn't even sing!), a love letter makes its rounds as it only could in an 80's teen comedy, Charles Bronson invades both coasts (and is bad-ass doing so), Chris watches a film he thinks truly defines the term "cult movie", we gush over a recent Vinegar Syndrome blu-ray release, Josh revisits 1976's THE OMEN and so much more!NOTE: There are some some sound glitches and background noise this episode. We did our best to make them less noticeable.Thanks for listening! Be sure to subscribe, rate and review the show wherever you listen to podcasts; join in the discussion on our Facebook group, and if you like what you hear - tell a friend and spread the word - every little bit helps!Links to all our web stuff at www.gbwpodcast.com

Today, Julianne dives into a conversation about emotions, energies, and how body functions help us understand how to be in the world.   Julianne had been in the health and fitness space for a long time and had developed her own method that she used when coaching clients that intertwines emotions and the body. And one thing she's found in each and every one of her clients is that it's never about the food. For nearly every client she's had, as well as herself, the thing that really moved the needle in their growth is the emotional piece.   We have so many different levels to who we are - spiritual, sexual, social, emotional, mental, physical - and Julianne goes through why it's so important to recognize and honor each of these.   Quotes:   “All of these things that you're calling in and creating for yourself in your life often causes a lot of contraction in our bodies because it's an edge, it's out of our comfort zone. But just like when you'd be in labor if you've ever had a baby or you plan to be a mother, you push in the contraction. So when we're having these really big ideas, we need to push.”   -----------------------------------------   You can join Awaken Your Divine Feminine ANYTIME! Get ready to reclaim your erotic Goddess, come home to your body's wisdom, and soften into your power. Feel called to join? CLICK HERE!   FREEBIES: Knowing where to start can be overwhelming. Here you'll find a FREE GUIDE to support yourself in every area of Julianne's founded Goddess Approach™ Methodology… » Pump Up The Pleasure (How To Get Started Feeling Confident x Sexy With Self Pleasure) » Gut Guide (3 holistic gut healing hacks for amazing digestion, clear skin, & a happy mind) » Seed Cycling 101 (The top holistic strategy for regulating your cycle & kicking PMS symptoms) » Sweet x Salty Chocolate Coconut Cups (A healthy & super easy recipe to satisfy that sweet tooth) Click here to grab them all!     To learn more about Julianne's proven 5 Phase Methodology, the Goddess Approach™ -- CLICK HERE! There's more than one way to start your reclamation process

Welcome to Create Your Holistic Lifestyle, a show dedicated to sourcing and providing you with the best information out there regarding holistic services, practitioners and education in order give you the results you desire most: A healthy life! This week, Join founder Johnathan Colbert, Dr. Brookh Lyons, Dr. Nathan F Rabb Jr, and Jennifer "Detox Chef" Houst as they give a personalized overview of what the body is, and how to treat it right! From food and fresh air to sleep and sex, this episode covers a lot of the things we question most! Put in your earbuds and brace yourself for a big dose of helpful information, and a gentle push to start doing the right things for yourself. It's time to start Creating Your Holistic Lifestyle.   In This Episode Infections within the body, and how they prevent us from healing properly. What is the body? Load sharing and how it works within the body. When do we start putting strain on our bodies? Where do you start getting in touch with your body and treating it right? Putting the right things into the body to get the best result from it. Where does rest and relaxation fit into the equation? Fresh air is crucial to your body’s regenerative efforts! Foraging for health.  Quotes “It’s this vessel that we inhabit for this journey on the planet” “I wanna do some things that I haven’t already done” “One of the prime things we need is a sense of safety” “The body, what is it and how do I get it to survive in the right environment? What do I give it?” “Someone reaches out to you, you reach back” “Stop eating dead food” “It’s more important to be fed than full” “Get your body moving. You gotta sweat” “So many people forget to breathe” “The more you get educated the better choices you can make about what to put in your body”   Check Out Our Website! www.createyourholisticlifestyle.com   Like Us On Facebook! https://www.facebook.com/holisticlifestyleshow/

Did you know that every believer has an office in the Body of Christ? So, maybe you’re not called to the fivefold, but you still have a function! Watch this video as Torema uncovers what your office might be. --------------------------------------------------------------- **NOTE** The Lord has given more teaching clarity and so we no longer use the terms "heavenly kingship" and "heavenly priesthood" but the principles remain the same. Please visit our website for more understanding regarding, kingship, priesthood office, sonship and priesthood calling. --------------------------------------------------------------- For more free resources visit our website: www.pura-t-international.org.uk You can also connect with us via social media: https://www.facebook.com/PuraTInternational https://twitter.com/puraTIntl https://www.instagram.com/puratinternational/

In this episode, we jump in to a conversation with musician, yoga instructor and craft beer salesperson Jamie Colpoys and the conversations is…lively. Plus more Halloween commercials, Happy Hour presented by Maine Spirits and the Bull Moose Minute, and recently unearthed track by AS FAST AS.

Hey ADDers!  So glad you could join me for today’s podcast episode.  I shared in the last episode that I was late on the release of episode 46 because of some health challenges last week, and said that I was going to talk about it today.  So, today’s episode is a little different format, however, I trust you will find benefit in the content. The information I need to share today is relevant whether you have ADHD, executive function deficits, depression, anxiety or physical health challenges.  Why is it important for me to share this?  Because if you aren’t aware of the far-reaching effects of mold (which I wasn’t) and where it can hide and what it can do to your brain and body, you need this information.  And I’m only scratching the surface here. And it isn’t just water leaks creating mold you need to be thinking of.  Many of the adults I work with have stacks and stacks of papers lying all around because that’s their organizational system.  Dust on papers can contain mold spores; the same with the dust on your walls if you haven’t dusted them recently or ever.  I looked at my walls in that room and then all my rooms and dusted all the walls with something that attracted the dust so it wouldn’t just go flying into the air and make things worse.  And then there are the carpets, rugs, curtains, drapes and any of your fabric furniture, such as a sofa, loveseat, or chair.  I’m lucky there because I only have wood and tile flooring, except for the one or two throw rugs.  And I have very few window coverings because I like the natural light to come in.  I don’t need many window coverings for privacy where I live.  So I didn’t have to get all of those things taken down and cleaned.  Many of the symptoms of mold exposure can be misdiagnosed as other health conditions and it’s important to know what to look for because it could be a missing piece to your better health and functioning, especially if you experience a foggy brain. It wouldn’t be a complete episode if I didn’t ask you about your WINS and encourage you to acknowledge them and celebrate them, so that’s what we’ll do now. I generally ask you about just one thing that’s gone right or is right with you, and I’d like to encourage you to look at more than just one WIN right now. The more I pay attention to the concept of WINS, the more WINS of my own I become aware of. I also experience a lot of gratitude when I celebrate my WINS. Do you? Unless this is your first time listening to my show, you’ve heard lots of examples of what I consider WINS, and I’d like you to take a moment and think about ALL the things that have gone right for you or with you today. If you woke up today, that’s a WIN. If you’re breathing on your own, that’s a WIN. If you have food to eat and you’re able to eat, that’s a WIN. If you have a bed of your own to sleep in, that’s a WIN. If you’re a kind person, that’s a WIN. If you’re able to think about your life with some clarity, that’s a WIN. If you are a compassionate person, that’s a WIN. Perhaps you reach other to others to help them, that’s another WIN. You get the picture; there’s a lot to be grateful for every day and to me these are WINS as well. So whatever you choose to reflect on right now is up to you; and I’d love it if you’d take a moment right now and think about some of the things that you’re grateful for that are WINS for you. That’s right. I know it doesn’t take away all the challenges you also have in your life right now; I get that. However, with a shift in your focus and attitude so many more good things can happen. Whatever really challenging circumstances exist in your life right now doesn’t take away from the fact that you have things to be grateful for and celebrate as WINS. You are a precious child of the universe; and are called a “human being” not a “human doing” for good reason. You don’t have to earn your value; you were born with it. You’re value comes from “who” you are; not what you do. Got it? I hope so because it can make a world of difference. In this episode, I’m going to be talking about mold exposure and it's impact on your mind and body, as well as your canine and feline companions and what you can start to do about it so you can live a healthier, happier and more productive life. To help out the show: Leave an honest review on iTunes.  Your ratings and reviews really help and I read each one. Subscribe on iTunes. Share on social media, and with your family and friends. Thanks for listening!  Until the next time! Download the Transcript and read through the whole episode, from start to finish. Download the MP3 Audio File and listen to the episode however you like with the audio file. You'll learn about: The importance of really looking for, acknowledging and celebrating your WINS! Having gratitude Impact of mold on your mind and body Impact of mold on your canine and feline companions What you can do to start taking care of this problem I've created many different resources for you.  Here's what's available currently: This podcast, with Show Notes (transcript) for each episode The Harness Your ADHD Power Community on Facebook where I'm actively involved with the community members Live videos on my Facebook page, ADDventures in Achievement Ask Dr B your questions for an episode Reach out to me with your thoughts or feedback or needs A free video and e-book about getting your ADHD needs met A free tips e-book on decision-making My innovative online coaching and educational program, ADDventures in Achievement; get on Waitlist to receive information about big addition to the program A Favorite Quote: Zig Ziglar said, “Gratitude is the healthiest of all human emotions. The more you express gratitude for what you have, the more likely you will have even more to express gratitude for.” The question I have for you at this point of our journey together is, “Will you take the time today to look at all your WINS and things that you could be grateful for about your circumstances and yourself and celebrate them?” I hope so. It’s totally worth it!!

We basically go into teenage boy mode to talk about weird body functions, people get called OUT, the movie you need to go see + when adults act like kids (let's just say someone sleeps with a light on...)

To deal with pain in the body we first must understand some basic functions of the body. How is moves, reacts and why when are knee hurts it might be caused by my hip.  We need to remember the body needs to move there is no such thing as muscle memory only movement memory.  

Background: In line with patient-centered health care, it is necessary to understand patients’ perceptions of health. How stroke survivors perceive their health at different time points after stroke and which factors are associated with these feelings provide important information about relevant rehabilitation targets. Objective. This study aimed to identify the independent factors of health-related quality of life (HRQoL) from a biopsychosocial perspective using the methods of multivariate regression at 3 different time points poststroke. Methods. Included in the study were 99 patients from stroke units with diagnosed first-ever stroke. At admission and at 6 weeks, 3 months, and 1 year poststroke, HRQoL was assessed using the EuroQoL-5D Visual Analogue Scale (EQ-5D VAS). Consequences in Body Functions and Activities and Participation, and Environmental Factors were documented using 155 categories of the International Classification of Functioning, Disability and Health (ICF) Core Set for Stroke. Results. For a period of 1 year, problems with recreation and leisure, personality functions, energy and drive functions, and gait pattern functions were repeatedly associated with worse HRQoL. Whereas Body Functions and Activities and Participation explained more than three-fourths of the variances of HRQoL at 6 weeks and 3 months (R2 = 0.80-0.93), the variation at 1 year was best explained by either Body Functions or Environmental Factors (R2 = 0.51). Conclusions. The results indicate the importance of Body Functions and Activities and Participation (mainly personality functions and recreation and leisure) on HRQoL within 3 months poststroke, but increased impact of Environmental Factors on HRQoL at 1 year.

Multiple sclerosis (MS) has a great impact on functioning and disability. The perspective of those who experience the health problem has to be taken into account to obtain an in-depth understanding of functioning and disability. The objective was to describe the areas of functioning and disability and relevant contextual factors in MS from the patient perspective. A qualitative study using focus group methodology was performed. The sample size was determined by saturation. The focus groups were digitally recorded and transcribed verbatim. The meaning condensation procedure was used for data analysis. Identified concepts were linked to International Classification of Functioning, Disability and Health (ICF) categories according to established linking rules. Six focus groups with a total of 27 participants were performed. In total, 1327 concepts were identified and linked to 106 ICF categories of the ICF components Body Functions, Activities and Participation and Environmental Factors. This qualitative study reports on the impact of MS on functioning and disability from the patient perspective. The participants in this study provided information about all physical aspects and areas of daily life affected by the disease, as well as the environmental factors influencing their lives.

Objective: The “Comprehensive ICF Core Set for Rheumatoid Arthritis (RA)” is an application of the International Classification of Functioning, Disability and Health (ICF) and represents the typical spectrum of problems in functioning of patients with RA. The objective of this study was to validate this ICF Core Set from the perspective of physicians. Methods: Physicians experienced in RA treatment were asked about the patients’ problems, patients’ resources and aspects of environment from their scope of practice. This survey was conducted via e-mail in three rounds using the Delphi technique. The responses were linked to the ICF by two trained individuals according to empirically tested linking rules. Consensus of the results was calculated statistically by the statistical Kappa coefficient. Results: 79 physicians in 41 countries named 512 patients’ problems spanning all ICF components. 227 ICF categories were linked to the physicians’ responses. 16 ICF categories were not represented in the Comprehensive ICF Core Set for RA although at least 75% of the participants have rated them as important. 19 issues were not covered by the ICF classification and 26 answers were linked to the not yet developed ICF component Personal factors. Conclusion: The validity of the ICF components Body Structures, Activities and Participation and Environmental Factors was well supported by the physicians whereas there was less support for the validity of the component Body Functions. Several issues arose that are not covered and need to be investigated further.

1. Background Stroke is a frequently occurring condition and a common cause of death and disability. Many stroke survivors are facing long-term disability. The consequences of stroke on patients’ functioning are usually complex and heterogeneous. Precise knowledge of patients’ stroke related disability is necessary in health services provision and research. Clinical stroke management, but also epidemiological and clinical research, depend on the careful detection of functioning problems, as well as resources, in patients with stroke. Two conceptual approaches to describe patients’ disability can be distinguished: the health status measurement and the classification approach. Health status measures, like standardized performance tests, rating scales, and questionnaires are used to operationalize and to assess patients’ burden of disease, functioning and health. The classification approach towards the description of patients’ health state is represented by the World Health Organization’s International Classification of Functioning, Disability and Health (ICF). The ICF provides a comprehensive conceptual framework and a unified standardized language to describe health and health related states, both at the individual, as well as at population levels. To enhance the applicability of the classification, ICF Core Sets for specific health conditions have been developed in an evidence based and consensus based process. The ICF Core Sets for Stroke are selections of salient ICF categories out of the whole classification, which describe the spectrum of problems in stroke patients’ functioning based on the universal language of the ICF. The ICF Core Sets for Stroke represent the practical implementation of the classification approach in clinical practice and research. The two approaches to represent stroke related disability, the health status measurement and the classification approach, can be regarded as complementary principles. From the classification perspective, the ICF and the ICF Core Sets can serve as standards to define what to measure. From the perspective of health status measurement the question how to measure can be answered. An explicit connection between the two approaches can be established by the so-called linking method. Thereby, using the ICF’s category system the contents of measures can be mapped, explored and compared in a standardized, transparent and straightforward way. The linking method can be useful for various purposes. The application of the linking method along with the ICF Core Sets constitutes a new approach for examining health status measures’ content validity. However, beyond content validity, meaningful measurement essentially depends on the psychometric quality of the applied instruments. Techniques based on modern test theory, especially Rasch analysis, are increasingly adopted to ensure instruments’ psychometric properties. 2. Objectives In the following, the doctoral thesis is subdivided into four parts. The first three parts present different studies performed to pursue the objectives named below. Each of the three studies contains a respective discussion section referring to the results of the study. The fourth part of the doctoral thesis refers to aim four, namely the discussion of the relationship between the methods presented in the previous three parts. The current doctoral thesis aims (1) to illustrate, how the connection between the health status measurement approach and the classification approach can be established by the application of the linking method, (2) to demonstrate, how this approach can be used to select health status measures based on their content validity, (3) to show, how the psychometric features of health status measures can be examined based on Rasch analyses, and (4) to discuss the relationship between the demonstrated methods in the context of the connection of the health status measurement and the classification approach. 3. Applying the linking method: Content comparison of patient-centered health status measures used in stroke based on the International Classification of Functioning, Disability and Health (ICF) The first study, “Content comparison of patient-centered health status measures used in stroke based on the International Classification of Functioning, Disability and Health (ICF)” illustrates the application of the linking method in stroke measurement. The objective of this study was to examine and to compare the contents of patient-centred health status measures used in stroke. The specific aims of the study included the identification of generic and condition-specific patient-centred health status measures applied in stroke patients, the examination of the contents of the single measures based on their linking to the ICF, and the comparison of the contents of generic and stroke-specific measures. A systematic literature review was conducted to identify current generic and condition-specific patient-centred health status measures applied in stroke. The most frequently used instruments were selected. The contents of the selected measures were examined by linking the concepts within the instruments’ items to the ICF. Six generic and seven stroke-specific health status measures were selected. Within the selected instruments 979 concepts were identified. 200 different ICF categories were used to map these concepts. No single ICF category is contained in all instruments. Out of the total 200 different ICF categories used, 77 (40%) applied to only one of the 13 selected measures. Overall, the most frequently used category is b152 emotional functions’ contained in 53 items from 10 instruments. Stroke-specific measures more often address mental functions, while the selected generic instruments more often include Environmental Factors. The study provides an overview on current patient-centered health status measures in stroke and their covered contents. The results of the content comparison provide valuable information to facilitate and to account for the selection of appropriate instruments for specific purposes in clinical as well as research settings. 4. Selecting health status measures based on content validity: Comparison of stroke-specific health status measures with the Comprehensive ICF Core Set for Stroke The aim of the second study is to demonstrate how the ICF as a fundamental reference can be used to select health status measures according to their content validity. The specific aims are (1) to examine the content validity of the selected stroke-specific health status measures by comparing them with the Comprehensive ICF Core Set for Stroke, and (2) to discuss the selection of measures based on their coverage of the ICF Core Set. Taking the results from the previous study, the seven stroke-specific patient-centered health status measures are involved in the current analyses and compared to the Comprehensive ICF Core Set for Stroke. Descriptive frequency analyses are conducted to indicate the instruments’ bandwidth and specificity of content coverage regarding the ICF Core Set. 67 (52%) out of the 130 categories of the ICF Core Set are covered by at least one of the examined instruments. The single measures cover in total between 29% and 14% of the Comprehensive ICF Core Set for Stroke. Overall, 31 categories of the ICF Core Set are measured at the more specific 3rd and 4th levels by at least one of the seven instruments. All instruments cover Activity and Participation and Body Functions, but only two instruments address Environmental Factors. No categories of the ICF component Body Structures are contained in the examined instruments. In contrast the Comprehensive ICF Core Set for Stroke contains categories from all ICF components. The Quality of Life Instrument for Young Haemorrhagic Stroke Patients (HSQuale), the Stroke-specific Quality of Life Scale (SSQoL), and the Stroke Impact Scale(SIS) represent the top three instruments according to bandwidth as well as specificity of content coverage. The comparison of instruments against the Comprehensive ICF Core Set for Stroke can be used to characterize and compare measures’ content validity. The examination and comparison of patient-centered health status measures’ content validity accounting for the bandwidth and the specificity of content coverage can serve as a first step of selecting a measure. However, further features of the measures have to be considered. Especially, their psychometric properties have to be carefully examined to accomplish the well-founded choice of appropriate measures to assess stroke related health status. 5. Applying the Rasch method: Evaluation of the Stroke Impact Scale using Rasch Analyses The third study, the “Evaluation of the Stroke Impact Scale using Rasch Analyses” undertakes the psychometric evaluation of the Stroke Impact Scale 2.0 (SIS), in a German sample adopting Rasch based techniques. The specific aims of the study were to examine (1) the unidimensionality of the SIS domains and item fit, (2) the structure of the response scales, (3) the targeting of the domains, (4) reliability, (5) differential item functioning (DIF) or item bias for relevant patient groups, and (6) to compare the fit results of this study with the Rasch analysis results of the SIS 2.0 in a North American sample which led to the creation of the most current version of the SIS, the SIS 3.0. The Rasch analyses based on Master’s Partial Credit model has been carried out using data collected from stroke patients in Germany within an ongoing multicentric international study. 196 stroke patients from 16 study centers participated in the study and completed the Stroke Impact Scale. Unidimensionality of the eight SIS domains was confirmed according to the mean infit statistics (.97 to 1.02). 7 items displayed model misfit. Response categories of 25 items showed threshold disordering. For the domains Communication and Memory/Thinking ceiling effects (>3 logits) became apparent. Reliability values lay above .80 in six domains. No DIF was found as to age, gender, disability severity, and rehabilitation setting. Item fit results in the current study differed from those in the reference study of the SIS 2.0 in a North American sample. The SIS is according to its psychometric qualities a sufficiently robust, valid and reliable measure of stroke-specific quality of life. It seems suitable to capture consequences of stroke in patients’ with different levels of disability severity, within an inpatient as well as an outpatient setting, across age groups and genders. However, the response categories currently used with the SIS should be object to further study and revision. The fit results of the reference study of the SIS 2.0 could not be replicated and therefore, an item reduced version of the German SIS equivalent to the most current SIS 3.0 can not be created. Thus, the SIS needs to prove its cross-cultural validity in future. 6. Discussion: Towards a unified measurement approach in stroke Two complementary principles towards the description of disability have been introduced: the health status measurement and the classification approach. Connected to these conceptual approaches two methodological procedures have been regarded: the linking method and the Rasch method. The application of both methods has been illustrated. The connection of the classification approach with the health status measurement approach entails advantages reaching beyond the applications presented here. Rasch analysis and the linking method, representing qualitative and quantitative methods, may shed light on different facets of stroke measurement, which combined increase information value and lead to a complete picture of functioning and health. Advances of the classification approach, like the development of the ICF Core Sets for Stroke, and advances in health status measurement, like the application of Rasch analyses can be concatenated by the linking method. From this concatenation of different conceptual and methodological approaches, unified and comparable, conceptually sound, high quality measurement of functioning can emerge. The integration of a common reference framework with the merits of objective measurement within the proceedings of item banking and adaptive testing can contribute to compass a common standard and agreement on what and how to measure. A unified measurement approach could thereby be achieved in stroke. Advanced measurement can serve to promote precise, comprehensive, and efficient knowledge of stroke disability at the individual and at population levels, to enable better decisions for treatment and action, in the long run improving stroke care and relieving the burden to the patients.

Validation of the ICF Comprehensive Set for Patients with Low Back Pain: Background: The International Classification of Functioning, Disability and Health (ICF) is a multipurpose classification to describe functional states associated with health conditions. To ensure practicability the ICF Checklist was developed, a short form of the ICF which only contains the most important categories irrespective of the present diagnoses. Furthermore ICF Comprehensive Sets were developed which contain the most important categories concerning a specific disease. Objectives: The general objective is to examine the explanatory power of the ICF Checklist in order to explain the PHI-score and the MHI-score of the SF-36. The specific aims are 1) to explore the percentage of variance of the SF-36 parameters accounted for by the ICF categories, 2) to identify the ICF categories which explain most of the variance of the two SF-36 parameters, 3) to assess the importance of the four components of the ICF Checklist for the SF-36 parameters. Methods: Cross sectional analysis of n=200 inpatients of rehabilitation centres suffering from low back pain. The International Classification of Functioning, Disability and Health (ICF) belongs to the WHO family of international classifications. At present in the ICF the following components are included: 1) Body Functions 2) Body Structures 3) Activities and Participations 4) Environmental Factors. Patients’ health status was assessed by the SF-36 Health Survey, a generic instrument to measure health status. Analyses were focused on the two summary measures Physical Health Index Score (PHI-score) and Mental Health Index Score (MHI-score). Statistical Analysis was conducted in four steps: In step 1 a first selection of potential predictor variables of health status was performed by the use of descriptive statistics. Analysis of regression in step 2 was conducted for each component of the ICF. In step 3 the variables selected in the four analyses of regression in step 2 were integrated into one multiple linear regression model. In the fourth step the model constructed in step 3 was verified and optimized. Finally three control variables were included into the model (gender, age and number of concomitant diseases). Results: The first model accounts for 44.6% of the variance of the PHI-score with F= 16.36 (p