Lives Deferred? Exploring Social Disconnection and Perceived Quality of Life Among Young Adults Residing in a Long-Term Care Facility

This qualitative study explores the perceptions of young adults concerning their experiences in a long-term care facility. Qualitative data were gathered via 15 intensive semistructured interviews with participants ages 18–45. Three dominant themes emerged: (a) social and family disengagement, (b) nonstimulating activities, (c) inadequate finances, and (d) the nature of resident/staff relations. Theoretical implications of empowerment theory, as well as implications for increasing social support and reducing barriers to service delivery for younger underserved residents, are discussed.     

Emerging Adults’ Discussion of Substance Use and Sexual Behavior with Providers

Emerging adulthood (ages 18–25) is a time of increased autonomy and associated with a high rate of risky substance use and sexual behavior. As emerging adults (EA) increasingly have more independence, they have the ability to make health decisions, including whether to see a provider (primary care (PCP) and/or gynecologist (GYN)) and whether to discuss substance use and sexual behavior. The current study aimed to determine: (1) factors associated with PCP and GYN health-care seeking by sexually active EA who use alcohol and/or marijuana; (2) gender differences in substance use and sexual risk topics initiated by providers; (3) whether PCPs compared to GYNs discuss different topics with women. Alcohol and/or marijuana-using, sexually active EA (n = 500) were recruited as part of a health behaviors study. Among participants, 39% did not see a PCP in the previous year. Women, White individuals, and EA with health insurance were most likely to attend a PCP appointment. Even among participants who saw a provider, many participants reported that providers did not initiate a discussion about substance use (approximately half discussed substance use) and sexual behavior (about half discussed STI history, two-thirds discussed condom use, and three-quarters discussed sexual partners). Among women with a PCP and GYN provider, discussions on substance use were more likely to be initiated by a PCP while sexual issues were more likely to be initiated by a GYN. Thus, even among sexually active, substance-using EA, central topics – specifically substance use and sexual behavior – are not routinely brought up by providers.     

How Do Older Portuguese and Mexican Adults Experience Their Sexual Well-Being? A Cross-Cultural Qualitative Study

Archives of Sexual Behavior - Sexual well-being (SWB) refers to the subjective emotional and cognitive evaluation of the quality of the individual's sexuality. SWB plays a relevant role in...     

Individual- and Family-Level Determinants of Risky Sexual Behavior Among Swedish- and Foreign-Born Young Adults 18–30 Years of Age,Residing in Skåne,Sweden

In Sweden, various public health interventions have been performed to reduce risky sexual behaviors among young people and promote safer and positive approaches to sexuality, while attempting to bridge the gap between the less privileged or more vulnerable young people and their more privileged peers. This study aimed to compare the individual- and familial-level determinants of risky sexual behavior among foreign-born and Swedish-born young adults 18–30 years of age residing in Skåne, the south of Sweden. This was a cross-sectional study that used a questionnaire to collect data from 2968 randomly selected respondents between 18 and 30 years between January and March 2013. The associations were analyzed using chi-square tests, and simple and multiple logistic regression analyses. Younger age, i.e., individual-level factor, and living with only one parent or another person while growing up, i.e., familial-level factor, increased the risk of engaging in sexual risk taking for both Swedish- and foreign-born youth. Male gender was related to a higher risk of engaging in sexual risk-taking behaviors among foreign-born youth but was not as important as influence on sexual risk taking among Swedish-born youth. Parental education level, on the other hand, was significantly associated with sexual intercourse on the “first night” and early sexual debut solely among Swedish-born youth. Condom use was not associated with any family-level factor among both Swedish-born and foreign-born youth. The design of sexual reproductive health and rights messages and interventions to target risky sexual behavior among Swedish youth should take into consideration immigration status (for example, being Swedish-born or foreign-born), individual- and family-level characteristics, as well as the type of behavioral change or outcome desired.     

Well-Being and Perceived Quality of Life in Elderly People Displaced After the Earthquake in L’Aquila,Italy

On 6 April 2009, the city of L’Aquila was hit by a violent earthquake that destroyed almost all of its medieval centre, and the surviving inhabitants were evacuated and relocated in temporary quarters or undamaged homes. The aim of this study was to investigate the perceived quality of life of the elderly population 3 years after the earthquake in relation to the social and logistic issues of new housing. The study was carried out between October 2011 and March 2012, and involved 571 subjects aged over 65 years living in the municipality of L’Aquila. The interviews took place in the surgeries of general practitioners and the city’s Department of Prevention and Vaccination in the anti-influenza immunisation period. The instrument used was a 36-item questionnaire with closed, multiple choice answers divided into the following sections: demographics, everyday activities, health and perceived health, and the quality of life in the city. The results show that, 3 years after the earthquake, the elderly population living in the new towns and temporary housing of L’Aquila have a worse perception of their quality of life than the others. They feel a certain social isolation and wish to live elsewhere. Governments faced with the problems arising from a natural calamity should take into account all of the elements making up a good quality of life and, before making choices whose impact cannot be changed, consider both their immediate and long-term social consequences.     

Effects of Gender and Psychosocial Factors on “Friends with Benefits” Relationships Among Young Adults

Hooking up or a sexual encounter ranging from kissing to intercourse that occurs on one occasion and where the partners do not necessarily expect future physical encounters or a committed relationship has become common place among college students. This study (N = 500) examined gender differences in emotional reactions after hooking up and explored the relationship between specific processes in the hooking up encounter and reactions to hooking up. Compared to women, men reported more positive and fewer negative emotional reactions; however, both men and women reported that the experience was largely more positive than negative. Coital hook ups were associated with fewer negative emotional responses for men as compared to women who engaged in coital and non-coital hook ups and to men who engaged in non-coital hook ups. For those who engaged in coital hook ups, women reported that condom use was associated with fewer positive and more negative emotional reactions whereas condom use was related to fewer negative emotion reactions for men. Negative emotional reactions were also related to reports of depressive symptoms and feelings of loneliness; however, feelings of loneliness were not related to negative emotional reactions after accounting for young adults’ positive emotional reactions. Positive emotional reactions were related to hope for and discussion of a committed relationship. Implications for relationship education and future research are outlined.     

Does Competitive Work Improve Quality of Life for Adults with Severe Mental Illness? Evidence from a Randomized Trial of Supported Employment

A randomized trial comparing a facility-based Clubhouse (N?=?83) to a mobile Program of Assertive Community Treatment (PACT; N?=?84) tested the widely held belief that competitive employment improves global quality of life for adults with severe mental illness. Random regression analyses showed that, over 24 months of study participation, competitively employed Clubhouse participants reported greater global quality of life improvement, particularly with the social and financial aspects of their lives, as well as greater self-esteem and service satisfaction, compared to competitively employed PACT participants. However, there was no overall association between global quality of life and competitive work, or work duration. Future research will determine whether these findings generalize to other certified Clubhouses or to other types of supported employment. Multi-site studies are needed to identify key mechanisms for quality of life improvement in certified Clubhouses, including the possibly essential role of Clubhouse employer consortiums for providing high-wage, socially integrated jobs.     

Examination of a Theoretical Model for Oral Health–Related Quality of Life Among Youths With Cleft

Objectives. We evaluated relationships among physical and psychological indicators and oral health–related quality of life (OHRQOL) in youths with cleft.Methods. We recruited youths aged 7 to 18 years with cleft palate (n = 282) or cleft lip and palate (n = 918) and their caregivers into a 5-year observational investigation at 6 US treatment centers from 2009 to 2011. At baseline, youths completed surveys to assess psychological status. After clinical evaluation, 433 youths received a recommendation for surgery. We developed structural models from the baseline data incorporating age, gender, race, and cleft diagnosis to examine direct relationships between depressive symptoms and, in separate models, self-concept and sense of mastery and OHRQOL. Subsequent models examined the possible mediating effect of surgical recommendation.Results. Depressive symptoms were negatively and self-concept and self-efficacy were positively associated with OHRQOL. Surgical recommendation appeared to mediate the effect of psychological well-being, but not depression, on OHRQOL, even after adjustment for cleft diagnosis. In some models, individual-level characteristics were significant.Conclusions. Path analyses support the theoretical model and underscore the importance of examining positive psychosocial characteristics such as resiliency and self-concept in this patient population.Clefting is the second most common birth defect in the United States.1 A cleft palate affects functional well-being through effects on speech, hearing, dental development, and eating; a cleft of the lip or primary palate also affects facial attractiveness. Such defects can influence youths'' sense of self and well-being. We examined well-being and factors theoretically associated with quality of life (QOL) in youths with cleft conditions.Typically, individuals with cleft experience evaluations and treatment that begin in infancy and often last into young adulthood. Cleft defects are therefore considered chronic conditions that can affect QOL.2,3 To date, numerous reports suggest that children with cleft have reduced self-concepts and are at risk for depression.4 Such reports, however, are cross sectional, have small samples, deal with different age groupings, and often lack a conceptual framework. These reports also have inconclusive findings regarding the relationship of oral health–related QOL (OHRQOL) to gender and overall well-being in youths with cleft.The theoretical perspective underpinning our study is consonant with the World Health Organization’s definition of health as more than the absence of disease5 and with its Quality of Life Group’s definition of QOL as an

individual’s perceptions of his/her position in life in the context of culture and value systems in which they live, and in relation to their goals, expectations, standards, and concerns.6^(pp1–2)

Because QOL is now recognized as an essential in patient assessment in nearly every area of physical and mental health care, including oral health,7 our goal was to adapt and evaluate a well-respected theoretical model by Wilson and Cleary8 to examine QOL among youths with cleft. According to the Wilson and Cleary model, the determinants of QOL include biological–physiological factors, symptom and functional status, and general health perceptions within the context of individual and environmental characteristics.Our adaptation expanded the model to include OHRQOL. Specifically, our model examined how individual characteristics (e.g., age, race, gender), biological function (e.g., type of defect), psychological characteristics, and surgical recommendation (which represents an indicator of current clinical status) were linked to OHRQOL. Further, environmental or contextual factors related to caregiver characteristics (e.g., sociocultural factors) and access to care may also be linked because they may influence children’s oral health perceptions and related QOL. Our adaptation of the model allowed us to elaborate on psychosocial factors that are relevant among youths with cleft, who are at risk for negative psychosocial sequelae as a result of their condition.4 Our model examined negative symptoms such as depression as well as positive psychological characteristics such as resiliency and self-concept, which have been shown to mediate the negative affect associated with a range of chronic conditions, including craniofacial conditions.9 In sum, we expanded on Wilson and Cleary’s model to create a more comprehensive understanding of these complex interrelationships potentially associated with OHRQOL among this population seeking care. Health service researchers are designing studies to provide empirical data to support the use of this model in health10–13 and oral health.14–16Over the past 2 decades, several OHRQOL tools have been developed for children and adults.17–20 These measures broadly conceptualize oral health as a construct that encompasses general well-being and the ability to eat, speak, and socialize with confidence. Traditionally, such QOL measures have focused on measuring the negative impact of chronic conditions or disease. Although many studies that include psychological variables have exclusively examined negative affect such as anxiety and depression, social scientists are increasingly exploring positive factors such as resilience and self-efficacy as well. In fact, health-related QOL experts now recognize that such positive attributes are essential in QOL assessment21–23 and warrant consideration during the development of models to examine health outcomes such as QOL.     

Health-related Quality of Life of Thai children with HIV infection: a comparison of the Thai Quality of Life in Children (ThQLC) with the Pediatric Quality of Life Inventory™ version 4.0 (PedsQL™ 4.0) Generic Core Scales

Purpose  

The purpose of this study was to evaluate the reliability and validity of the Thai Quality of Life in Children (ThQLC) and compare it with the Pediatric Quality of Life Inventory (PedsQL™ 4.0) in a sample of children receiving long-term HIV care in Thailand.     

Relationship between Diet Quality,Physical Activity and Health-Related Quality of Life in Older Adults: Findings from 2007–2014 National Health and Nutrition Examination Survey

Background

A growing body of research shows that diet quality and physical activity (PA) are associated with health-related quality of life (HRQOL). However, no study to date has assessed this association using the Healthy Eating Index-2015 as a measure of diet quality. Furthermore, few studies have examined the association between PA dose and HRQOL among a nationally representative sample of older adults. Objectives: To investigate the relationship between diet quality, physical activity, and HRQOL.

Objectives

To investigate the relationship between diet quality, physical activity, and HRQOL.

Design

A cross-sectional analysis was conducted using data obtained from 5,311 adults aged 60+ years who took part in the National Health and Nutrition Examination Survey between 2007 and 2014.

Measurements

HRQOL was assessed by general health status, and number of physically unhealthy days, mentally unhealthy days, and inactive days in past 30 days. Diet quality was assessed by the Healthy Eating Index-2015 using data generated by two 24-hour dietary recalls. PA was measured by the Global Physical Activity Questionnaire. Multivariate logistic/or linear regression models were used to examine the association between diet quality, PA and HRQOL controlling for confounders and accounting for complex sampling.

Results

Approximately half of the participants (55.2%) were women, 45.1% met current PA recommendations, 65% had less healthful diets according to the Healthy Eating Index-2015. Diet quality was associated with HROQL. For every 1-point diet quality score increase, the likelihood of respondents rating their general health as being excellent/good increased by 3% (OR=1.03, 95%CI: 1.02, 1.04), and number of inactive days (β =-0.03, 95%CI: -0.05, 0.00) and mental unhealthy days (β =-0.03, 95%CI: -0.05, -0.01) declined by 0.03 days. PA was associated with all HROQL measures and respondents with high PA levels reported better general health (OR=3.53, 95%CI: 2.69, 4.63), fewer inactive days (β =-1.53, 95%CI: -2.11, -0.95), fewer physical unhealthy days (β =-1.88, 95%CI: -2.74, -1.02) than individuals with low PA levels but not fewer mentally unhealthy days.

Conclusion

Among older adults in this study, eating a healthier diet and being physically active were associated with better general health and reporting fewer physical unhealthy days and inactive days. Study results provide valuable information that could inform policies, programs and interventions designed to improve HRQOL in older adults and reduce potentially preventable health disparities.

     

Effectiveness of a Sexual Education Program for Mothers of Young Adults with Intellectual Disabilities on Mothers’ Attitudes Toward Sexual Education and the Perception of Social Support

Healthy sexual development is possible only through effective sexual education, which could be provided by families. Lack of sexuality training could lead to inappropriate behavior in children and they could face problems such as exclusion from the society and sexual abuse. The purpose of the present study was to scrutinize the effect of a Sexuality Education Program for Mothers of Young Adults with Intellectual Disabilities (SEPID) on the attitudes of mothers toward the sexuality education of their children and their perceptions of social support. The present research employed an empirical pretest–posttest model with control group. Study participants included 44 mothers who were randomly assigned to experimental (n = 22) and control (n = 22) groups. The SEPID program was conducted at the seminar hall located in the second floor of a café where individuals with intellectual disabilities work and it was conducted in four 1-h sessions. Study data were tested with ANOVA and ANCOVA methods. Findings demonstrated that SEPID changed the attitudes of mothers toward the sexuality education of their children in a positive direction and improved their perceptions of social support. Social validity findings showed that the mothers were satisfied with the program.     

A Longitudinal Analysis of Rural and Urban Veterans’ Health-Related Quality of Life

Context: Cross-sectional studies have identified rural-urban disparities in veterans’ health-related quality-of-life (HRQOL) scores. Purpose: To determine whether longitudinal analyses confirmed that these disparities in veterans’ HRQOL scores persisted. Methods: We obtained data from the SF-12 portion of the veterans health administration's (VA's) Survey of Healthcare Experiences of Patients (SHEP) collected between 2002 and 2006. During that time, the SHEP was randomly administered to approximately 250,000 veterans annually who had used VA outpatient services. We evaluated 163,709 responses from veterans who had completed 2 or more surveys during the years studied. Respondents were classified into rural-urban groups using ZIP Code-based rural-urban commuting area designations. We estimated linear regression models using generalized estimating equations to determine whether rural and urban veterans’ HRQOL scores were changing at different rates over the time period examined. Findings: After adjustment for sociodemographic differences, we found that urban veterans had substantially better physical HRQOL scores than their rural counterparts and that these differences persisted over the study period. While urban veterans had worse mental HRQOL scores than rural veterans, those differences diminished over the time period studied. Conclusions: Rural-urban disparities in HRQOL scores persist when tracking veterans longitudinally. Reduced access among rural veterans to care may contribute to these disparities. Because rural soldiers are overrepresented in current conflicts, the VA should consider new models of care delivery to improve access to care for rural veterans.     

Parents’ Plans to Communicate About Sexuality and Child Sexual Abuse with Their Children with Autism Spectrum Disorder

Sexuality and Disability - The current study examined intended plans of parents of children (3–18 years) with autism spectrum disorder (ASD) to communicate with them about sexuality...     

Acceptability of Sexual Relationships Among People with Learning Disabilities: Family and Professional Caregivers’ Views in Mexico

The attitudes towards sexual relationships among persons with learning disabilities (PLD) of parents of children without disabilities were compared with the attitudes of family caregivers (parents of PLD) and with the attitude of professional caregivers. The importance of different situational factors that may alter acceptability judgments (i.e., gender, etiology of the disability, person’s present level of autonomy, use of contraceptive devices, and partner’s age and possible handicap) with regards to the sexuality of PLD was examined through the use of concrete cases. All the participants lived in Mexico. The only notable difference in attitude that was observed was between parents of PLD suffering from trisomia 21 and parents of PLD suffering from a neuromotor disorder. As a result, it may be erroneous to consider parents of PLD as a homogeneous group regarding attitudes to sexuality. Three different basic philosophies regarding the expression of sexuality among PLD were observed. They were called Mainly Unacceptable (37% of the sample), Mainly Acceptable (36%), and Depending on Circumstances (27%). In this later philosophy, contraception was by far the major determinant of acceptability.     

Women’s Quality of Life in the Premenopausal and Postmenopausal Periods

Purpose The purpose of this research was to determine the relationship between menopausal symptoms and quality of life in women in the pre and postmenopausal periods.Methods and instruments All 171 women in the climacteric period who registered at the Pamukkale University Education and Research Hospital Obstetrics and Gynecology Clinic between January and July 2001 were included in the study. A questionnaire asking for sociodemographic information, complaints related to the climacteric period, and HRT use, as well as the WHOQOL brief, were used in order to obtain data.Findings One hundred of the women who participated in the study were premenopausal and 71 were postmenopausal and the mean age was 47.39 (SD=6.65). No significant difference was found in pre and postmenopausal women in the comparison of their quality of physical life, psychological, social relationships and environment scores (p>0.05). The physical quality of life scores for those without vasomotor complaints in the pre and postmenopausal periods were significantly higher in those with a high educational level and women who had been menopausal between 1–5 years and more than 10 years (p<0.05). Age and HRT use in postmenopausal women were not found to affect quality of life scores (p>0.05).Result We did not find any significant difference in the quality of life of pre and postmenopausal women.     

A Qualitative Investigation of Older Adults’ Conceptualization of Quality of Life and a Think-Aloud Content Validation of the EQ-5D-5L,SF-12v2, Warwick Edinburgh Mental Well-Being Scale,and Office of National Statistics-4.

ObjectivesOld age is characterized by declining health, comorbidities, and increasing health and social care service use. Traditionally, patient-reported outcome measures (PROMs) including the EQ-5D-5L and SF-12v2 have focused on health. Nevertheless, aged care often aims to improve broader elements of quality of life (QoL), captured by well-being measures, such as the Warwick Edinburgh Mental Wellbeing Scale (WEMWBS) and Office of National Statistics-4 (ONS-4). This study investigates older adults’ conceptualization of QoL and the content validity of the EQ-5D-5L, SF-12v2, WEMWBS, and ONS-4 in measuring their QoL.MethodsQualitative cognitive think-aloud interviews were undertaken with older adults aged 75+, exploring their views on what was important to QoL and, for each measure, the relevance, acceptability, and interpretation of items; suitability of response options; and the comprehensiveness of the measure. Conceptualization of QoL was analyzed thematically and content validity using framework analysis.ResultsTwenty interviews were undertaken. Older adults’ conceptualization of QoL centered on health, ability to perform usual activities, social contact, and emotional functioning. Possible response shift was observed, as older adults assessed their health relative to lower health expectations at their age or to people in worse states. Participants questioned the relevance of negatively phrased mental items and often preferred the functioning-focused EQ-5D-5L to more subjective ONS-4 and WEMWBS items. Domains suggested to improve comprehensiveness included social contact, coping, security, dignity, and control.ConclusionsThese findings are useful to researchers developing new PROMs for older adults or for the developers of included PROMs considering permanently adapting or bolting-on domains to improve content validity in older adults.