Abortion providers,stigma and professional quality of life

Objectives

The Providers Share Workshop (PSW) provides abortion providers safe space to discuss their work experiences. Our objectives were to assess changes in abortion stigma over time and explore how stigma is related to aspects of professional quality of life, including compassion satisfaction, burnout and compassion fatigue for providers participating in the workshops.

Study Design

Seventy-nine providers were recruited to the PSW study. Surveys were completed prior to, immediately following and 1 year after the workshops. The outcome measures were the Abortion Provider Stigma Survey and the Professional Quality of Life (ProQOL) survey. Baseline ProQOL scores were compared to published averages using t tests. Changes in abortion stigma and aspects of professional quality of life were assessed by fitting a two-level random-effects model with repeated measures at level 1 (period-level) and static measures (e.g., demographic data) at level 2 (person-level). Potential covariates included age, parenting status, education, organizational tenure, job type and clinic type (stand-alone vs. hospital-based clinics).

Results

Compared to other healthcare workers, abortion providers reported higher compassion satisfaction (t= 2.65, p=.009) and lower burnout (t= 5.13, p<.0001). Repeated-measures analysis revealed statistically significant decreases in stigma over time. Regression analysis identified abortion stigma as a significant predictor of lower compassion satisfaction, higher burnout and higher compassion fatigue.

Conclusions

Participants in PSW reported a reduction in abortion stigma over time. Further, stigma is an important predictor of compassion satisfaction, burnout and compassion fatigue, suggesting that interventions aimed at supporting the abortion providing workforce should likely assess abortion stigma.

Implications

Stigma is an important predictor of compassion satisfaction, burnout and compassion fatigue among abortion care providers. Therefore, strengthening human resources for abortion care requires stigma reduction efforts. Participants in the PSWs show reductions in stigma over time.     

艾滋病病毒感染者生活质量与相关耻辱的关系

目的探讨艾滋病病毒感染者和病人的生活质量与耻辱的关系。方法对215名艾滋病病毒感染者和病人进行匿名问卷调查,采用WHO生活质量简表中文版和BergerHIV耻辱量表测定调查对象的生活质量和感受到的耻辱,对其生活质量和艾滋病相关耻辱感进行典则相关分析。结果艾滋病病毒感染者和病人生活质量各个维度的平均得分为50.74(生理领域)、46.01(心理领域)、53.78(社会关系领域)和43.94(环境领域);耻辱4个维度的得分为49.89(个人耻辱)、29.77(担心公开)、35.18(负面自我印象)和57.80(关注公众态度)。典则相关分析结果显示,自我负面印象和心理领域分别是耻辱和生活质量中起主要作用的因素,两者呈负相关,相关系数为0.4938(P<0.05)。结论艾滋病病毒感染者和病人的负面自我印象越小,生活质量心理方面越好。     

护理干预对糖尿病患者生存质量的影响

目的:探讨护理干预对糖尿病患者生存质量的影响。方法:选择在某医院接受治疗的62例2型糖尿病患者,随机分为实验组和对照组,实验组32人,对照组30人,对照组在住院期间给予常规宣教,实验组在此基础上进行有针对性的个体化宣教,并在患者出院后继续进行护理干预,6个月后采用糖尿病患者生存质量特异性量表对这62例糖尿病患者进行问卷调查。结果:实验组患者的生存质量明显提高,各项指标得到显著改善,对照组各指标无显著性变化。结论:对糖尿病患者采取必要的护理干预措施,能帮助糖尿病病人提高生存质量。     

The quality of life of patients with type 2 diabetes mellitus in general practice

Background: Improving patients' duration and quality of life (QoL) is the long-term goal in treatment of diabetes mellitus.

Aim: To estimate the QoL of patients with type 2 diabetes followed in primary care, using the newly developed and validated 'Well-being Enquiry for Diabetes' (WED) questionnaire. The questionnaire evaluates four subscales of QoL: diabetes-related somatic symptoms (Symptoms); diabetes-related worries (Discomfort); mental health (Serenity); familiar relationship and social network (Impact). Patients and methods: We randomly selected 100 patients with type 2 diabetes mellitus in our practice, of whom 98 completed the questionnaire (mean age ±SD: 64.6±9.5; 44 males, 54 females; duration of disease 8.3±6.0 years; 23.5% on diet only, 67.3% on oral hypoglycaemic agents, 5.1% on both oral hypoglycaemic agents and insulin, and 4.1% on insulin monothe-rapy). Micro- or macroangiopathy was present in 33 patients (33.7%, 15 males, 18 females). In each patient we considered the following variables: age, gender, duration of disease, type of treatment in use, presence of complications. Mann-Whitney test, Kruskal-Wallis test and multiple regression analysis were used for statistical analysis (p<0.05 as significant). Results: Females had lower total WED scores than males (p=0.0001) and lower scores in each of the four subscales. Patients with chronic complications had lower scores than patients without complications (p=0.19). Patients on insulin showed lower total WED scores than patients treated with oral hypoglycaemic agents or diet only. Multivariate analysis showed a correlation between WED scores and gender (p=0.0001) or complications (p=0.049), but not with duration of disease (p=0.28) or age (p=0.15). Conclusion: The WED questionnaire appears to be a simple, reliable measure of diabetes-related QoL in primary care. Females had significantly lower scores than males, with the greatest difference in the area of Serenity. This is in accordance with general data showing higher psychiatric morbidity (anxiety, depression, eating disorders) among females. The WED provides GPs with a tool for auditing care of patients with diabetes and to identify type 2 diabetes patients in whom interventions may be needed to improve their QoL. Eur J Gen Pract 2000;6:93–7.     

2型糖尿病患者生存质量影响因素分析

目的探讨2型糖尿病患者生存质量的影响因素,为改善2型糖尿病患者的生存质量,制定合理措施提供参考。方法采用糖尿病特异性生存质量量表（CN-ADDQoL）对697例2型糖尿病患者的生存质量进行测评,采用结构方程模型探讨其生存质量的影响因素。结果对模型进行拟合的结果显示,2型糖尿病患者的生存现状对其生存质量的影响差异有统计学意义（P〈0.05）,该因子所对应的年龄、职业、收入、病程、医疗费用、患病状态、并发症和生活事件等8个因素影响2型糖尿病患者的生存质量（P〈0.05）。年龄越大、脑力劳动和高紧张度工作岗位、收入较高、病程较长、医疗费用越高、合并并发症以及刺激性生活事件较多的患者,生存质量较差。结论2型糖尿病患者应该尽量避免高强度脑力劳动和紧张程度高的职业活动,积极进行有效地治疗,防止并发症的出现,保持积极乐观的心态。     

Dimensions of quality of life in people with non-insulin-dependent diabetes

The purpose of the study was to find out which of five Quality of life (QoL) questionnaires are reliable and valid for evaluating the QoL in German patients with type 2 diabetes: the Diabetes Treatment Satisfaction Questionnaire (DTSQ), the Well-Being Questionnaire (WBQ), the Short Form SF36 of the Medical Outcome Study (SF36), the Diabetes39 and the Quality of Life with Diabetes (LQD) questionnaire. A stratified sample of 144 patients who were attending one of nine special hospitals for people with diabetes at the time of the study were given the questionnaires twice. Most of the scales of the questionnaires had internal consistencies () of above 0.80 as recommended; the retest reliabilities were lower, especially for scales evaluating satisfaction with levels of blood sugar and treatment in general. A factor analysis of all scale scores yielded four factors: (1) physical aspects, (2) well-being and satisfaction, (3) diabetes-specific stress, and (4) treatment satisfaction. Construct validity showed frequency of hypoglycemias, neuropathies, treatment with insulin and number of late complications to have a negative impact on QoL scores. No single questionnaire covered all relevant aspects of the QoL of subjects with type 2 diabetes. Thus, quality of life in diabetic people should be evaluated with scales representing the cognitive dimensions found in this study so as not to miss significant aspects.     

学龄期1型糖尿病儿童生存质量差异的因素分析

目的 分析学龄期1型糖尿病(T1DM)儿童生存质量差异的因素,为制定改善TIDM患儿生存质量的治疗方案提供依据。方法 对2016年6月-2018年6月至西安市中心医院进行治疗的106例学龄期TIDM患儿进行问卷调查,问卷采用郑玲玲等编制的《重庆地区儿童青少年糖尿病患者生存质量调查量表》,观察调查问卷中患儿在影响领域、满意度领域得分,以及总体得分情况。观察不同的空腹血糖、糖化血红蛋白(HbA1c)等指标的患儿问卷得分差异,以及影响患儿生存质量的因素。结果 患儿生存质量量表分为影响领域和满意度领域两部分,106名学龄期T1DM患儿影响领域量表得分为(82.37±11.44)分,满意度领域(25.41±5.77)分,总体得分(110.54±18.89)分。空腹血糖≤6.1 mmol/L患儿的生存质量量表得分(105.16±14.88)明显低于空腹血糖>6.1 mmol/L的患儿(142.26±20.61)(t=10.064,P=0.001);HbA1c≤7.6%患儿的生存质量量表得分(103.67±19.26)明显低于HbA1c＞7.6%的患儿得分(144.58±22.27)(t=9.572,P<0.001)。不同性别、住址、家庭收入的患儿,其生存质量评分差异无统计学意义(P>0.05),但是糖尿病饮食遵守情况、胰岛素注射方式、注射次数、血糖监测次数以及病程会导致生存质量评分差异有统计学意义(P<0.001)。结论 1型糖尿病学龄期儿童的生存质量受多种因素影响,因此对此类儿童应制定严格的饮食方案,采用胰岛素泵进行注射,以维持患儿血糖和糖化血红蛋白在较长时间内的稳定。     

糖尿病患者生命质量量表研制及评价

目的对慢性病患者生命质量量表系列-糖尿病量表(QLICD-DM)测试版进行评价。方法收集2型糖尿病住院患者159例,采用自主研制的QLICD-DM测试版,于患者入院时、入院第2天和出院时进行量表测评,对量表的信度、效度、反应度进行评价。结果量表各维度的内部一致性α系数和分半系数均在0.7以上,重测信度相关系数均高于0.9;量表各条目与所属维度或维度的相关均大于该条目与其他维度或维度的相关;探索性因子分析结果显示,第1主成分主要涵盖心理状况各条目,方差贡献率达到33.919%;其次为第2主成分的糖尿病并发症条目,方差贡献率为12.006%;治疗前后患者的躯体功能、心理功能、社会功能、特异模块评分及量表总评分差异均有统计学意义(P<0.01),标准反应均数(SRM)分别为0.691、0.638、0.428、1.148、1.223。结论所研制的慢性病患者糖尿病生命质量量表具有较好信度、效度和反应度,可作为国内糖尿病患者生命质量测评工具。     

汉族与蒙古族人群2型糖尿病患者生活质量比较

目的 比较中国汉族人群和蒙古国蒙古族人群2型糖尿病患者的生活质量情况,并探讨影响2型糖尿病患者生活质量的可能因素。方法 采用36条目简明健康量表（SF-36）,在中国湖北省汉族人群和蒙古国乌兰巴托市蒙古族人群中选取922例2型糖尿病患者进行生活质量评价,比较两国患者生活质量各维度及与常模的差异,并采用单因素及多元逐步回归分析生活质量影响因素。结果 汉族2型糖尿病患者生活质量6个维度（PF、RP、GH、VT、RE、MH）得分均低于蒙古族患者（P<0.05）。汉族患者各个维度和蒙古族患者除MH外的7个维度得分均低于常模（P<0.05）。汉族和蒙古族2型糖尿病患者生活质量的可能影响因素不完全相同,年龄、就业状况、经济水平、腹型肥胖、并发症、空腹血糖对两国2型糖尿病患者生活质量的不同维度有影响。结论 中国汉族2型糖尿病患者生活质量低于蒙古国蒙古族患者,且两国患者的生活质量均低于健康人群。应重点关注高龄、失业、经济收入低的人群,控制血糖,预防并发症,提高患者的生活质量。     

Health‐related quality of life in children with myelomeningocele: a systematic review of the literature

Myelomeningocele (MMC) is the most complex congenital birth defect compatible with life. To provide the best health care for children with MMC, clinicians and researchers have to understand health and functional status of their patients as well as factors influencing their quality of life (QOL). The objective is to review studies that assess health‐related quality of life (HRQOL) and determinants of HRQOL in children with MMC. The data sources include MEDLINE, along with reference lists of relevant reviews and included articles. Study eligibility criteria are quantitative studies that assess HRQOL using validated HRQOL instrument. Participants include children aged 0–18 years with diagnosis of MMC or spina bifida. Risk of bias was assessed using the Hayden system for non‐randomized studies. Narrative synthesis and tables of results of HRQOL studies were conducted. Children with MMC have decreased HRQOL compared with normative population. Physical HRQOL is the most exposed aspect of QOL, while discrepancies in psychosocial domains vary by study. Many determinants of QOL have been found, and it is still not clear which determinant can be described as the strongest predictor. Psychosocial factors are the most consistent determinants of HRQOL.Heterogeneous study sample size, study designs, determinant and outcomes measures limited synthesis of findings. The HRQOL in children with MMC is complex and mediated by a number of associated medical problems, together with a variety of psychosocial and environmental factors. Future research is needed (a) on the relation between complex medical problems, functional independence, parent's and clinician's expectation and HRQOL in children and (b) to assess the differences in HRQOL by social environment and healthcare system.     

生存质量表评价2型糖尿病患者的信度、效度

目的探讨世界卫生组织生存质量测定量表简表(WHOQOL-BEFF)2型糖尿病患者生存质量评价中的信度与效度。方法采用WHOQOL—BEFF和糖尿病人生存质量特异性量表(DSQL)对210名2型糖尿病患者进行问卷调查。用SPSS软件进行信度、效度分析。结果WHOQOL—BEFF用于评价2型糖尿病患者生存质量的分半信度为0．843,效标效度为0．72,具有较好的信度与效度。且与糖尿病生存质量特异性量表(DSQL)相关程度较低。结论WHOQOL-BEFF与DSQL配合使用可兼顾普适性与特异性,综合评价患者生存质量。     

An audit of diabetes control, dietary management and quality of life in adults with type 1 diabetes mellitus, and a comparison with nondiabetic subjects

OBJECTIVES: The study's objective was to audit current diet and disease management in a community-based sample of people with type 1 diabetes. METHODS: The study involved adults with type 1 diabetes and control subjects. Reported amounts of dietary intake were collected. Indices of diabetes control were determined by standard methods. Quality of life of both groups was assessed with appropriate measures. Results were compared between two groups. RESULTS: Mean HbA(1c) concentration was 8.5% (SD 2.21%) for women with diabetes and 8.6% (SD 1.91%) for men. There was no significant difference between the diabetic and control subjects in self-reported energy intake and macronutrient intake, with the exception that the contribution of saturated fatty acid to energy intake was higher in male controls than in male diabetics. There was no association between dietary intakes and glycemic control in diabetic subjects. Anthropometric measurements, blood pressure and plasma lipids in patients were within normal range and not significantly different from the controls. Plasma fibrinogen concentration was higher in patients. Diabetic subjects did not have a diminished quality of life. CONCLUSIONS: Dietary management in these patients was generally focused on controlling carbohydrate intake. Most had suboptimal diabetes control.     

Health-related quality of life in relation to metabolic control and late complications in patients with insulin dependent diabetes mellitus

To investigate important factors with respect to health-related quality of life (HRQOL) in patients with longstanding insulin dependent diabetes mellitus, a patient cohort was followed prospectively for 10 years. The degree of metabolic control and the presence of late complications was assessed and HRQOL was measured with a 61-item questionnaire (SWEDQUAL) in which reference values have been obtained in a population sample. The results indicate that diabetic patients (n=108) experienced a quality of life as good as a general population. When patients were divided into four groups based on metabolic control, those with poor control (HbA1c9%) rated their physical and emotional functioning significantly lower than those with lower HbA1c values. Nearly 15% of the patients reported 1–5 hypoglycaemic episodes during the latest 6 months. Despite a lower HbA1c they rated their general health as being poorer than patients without severe hypoglycaemia. Of the 108 patients 39% appeared to be free from late complications of diabetes. These patients rated their general health as better than patients who already had developed late complications. We conclude that a satisfactory metabolic control with a minimum of hypoglycaemic episodes is desirable not only to prevent late complications but also because poor metabolic control seems to be one reason why diabetic patients experience a poorer quality of life.Funding has been obtained from Uppsala University.     

HIV感染者/AIDS患者生命质量调查及其影响因素分析

分析HIV感染者/AIDS患者的生命质量状况及其影响因素. 1.对象与方法:以2005年10月至2006年3月在湖北省艾滋病临床指导培训中心咨询就诊的HIV感染者/AIDS患者为调查对象.     

Conditions of experienced stigma in people living with HIV in Iran: a qualitative comparative analysis

Stigma against people living with HIV (PLWH) seriously affects their quality of life. Moreover it can lead them to hide their HIV status from others, which in turn endangers public health. Many studies dealing with HIV-related stigma focus on the consequences of this phenomenon and pay less attention to the social conditions which affect different types of HIV-related stigma (anticipated, internalized and enacted stigma [ES]). Therefore, in this study, we tried to achieve more understanding about effective causal conditions of various types of experienced stigma. First of all, data were collected from 19 PLWH, using semi-structured interviews from those who had visited the Counseling Center for Behavioral Diseases in Mashhad. Secondly, the data were analyzed by applying a mixture of two methods: thematic analysis and qualitative comparative analysis (Boolean Algebra). The analysis of the data reveals that a combination of informing family members about HIV status, lack of family support, and medical support lead to anticipated stigma; a combination of religious beliefs and poor self-esteem results in internalized stigma and a combination of lack of family support, mistreatment by community, poor self-esteem, poverty and no religious beliefs lead to ES.     

2型糖尿病患者生存质量相关因素的研究

目的探讨影响2型糖尿病患者生存质量的相关因素，为制定针对患者的干预措施提供依据。方法采用糖尿病人生存质量特异性量表(DSQL)及相关因素调查表对210名2型糖尿病患者进行问卷调查，并进行简相关和逐步回归分析。结果糖尿病生存质量与生理、心理、社会多种因素有关。逐步回归分析表明，应对倾向、学历、饮食控制、主观支持、病程、支持利用度被选入回归方程。结论应加强对2型糖尿病患者生存质量各种影响因素的干预，努力提高其生存质量。     

The effects of psychiatric disorders and symptoms on quality of life in patients with Type I and Type II diabetes mellitus

The purpose of this study was to evaluate the influence of psychiatric symptoms and illness status on the health-related quality of life (HRQOL) of outpatients with Type I and Type II diabetes mellitus. Using a two-stage design, all patients were assessed by two measures of quality of life (Diabetes Quality of Life Measure; Medical Outcome Study Health Survey) and a psychiatric symptoms checklist (SCL-90-R). Patients scoring 63 or greater on the global severity index of the SCL-90-R and 30% below this cutoff were then evaluated using the Structured Clinical Interview for the DSM-III-R (SCID). Quality of life in both Type I and Type II diabetes was influenced by the level of current psychiatric symptoms and presence of co-morbid psychiatric disorder, after controlling for number of diabetic complications (e.g. effect of lifetime psychiatric illness on diabetes-related HRQOL; F=46.8; df=3, 135; p < 0.005). These effects were found consistently across specific domains. Both recent and past psychiatric disorders influenced HRQOL. Separate analyses comparing patients with and without depression showed similar effects. No interaction effects between diabetes type, number of complications, and psychiatric status were found in analyses. Finally, increased severity of psychiatric symptoms was correlated with decreased HRQOL in patients without current, recent, or past psychiatric diagnosis. This study shows the consistent, independent contribution of psychiatric symptoms and illness to the HRQOL of patients with a co-existing medical illness. Thus, psychiatric interventions addressing common conditions, such as depression, could improve the HRQOL of patients without changing medical status.     

Unmet home healthcare needs and quality of life in cancer patients: a hospital‐based Turkish sample

Home healthcare services in Turkey are provided primarily to patients that are bedridden or seriously disabled. There are no such services integrated with hospital services that are specifically designed for cancer patients. The present study aimed to explore the home healthcare needs of cancer patients and their experiences related to unmet home healthcare needs. The study included 394 adult cancer patients who were followed up at the surgical oncology department of a university hospital. A 37‐item, study‐specific questionnaire and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire for cancer patients (EORTC‐QLQ‐C30) were administered, and patient clinical records were evaluated. Home healthcare was provided primarily by the patients' immediate family members; the professional home healthcare usage rate was only 2.8%. Patient quality of life (QoL) was negatively affected by cancer, especially those with stage three and four disease. The frequency of the need for home healthcare services due to disease‐related health problems during the 30 days prior to administration of the questionnaires was as follows: pain (62.9%), surgical wound care (44.9%), injection of therapeutics (52.3%), gastrointestinal complaints (51.8%), anxiety (87.1%), psychosocial assistance (77.2%) and information about cancer (94.4%). In the absence of home healthcare services, the patients primarily used institutional healthcare services to meet their needs; otherwise, their needs were not met. The physical and psychosocial problems that cancer patients experience could be solved in most cases by professional home healthcare services. Hospital‐integrated home healthcare services might not only improve cancer patient QoL but might also increase the effectiveness of hospital‐based healthcare services.     

The factors associated with care‐related quality of life of adults with intellectual disabilities in England: implications for policy and practice

Over the last three decades, quality of life (QoL) has been advocated as an indicator of social care outcomes for adults with intellectual disabilities. In England, the Adult Social Care Survey (ASCS) is conducted annually by local authorities to contribute to the evidence base of the care‐related QoL of people receiving publicly funded adult social care. This study explores relationships between QoL and non‐care‐related factors to identify relationships that could inform social care policy and practice. Cross‐sectional data collected from 13,642 adults who participated in the 2011 and 2012 ASCS were analysed using regression to explore the factors associated with QoL measured using the Adult Social Care Outcomes Toolkit (ASCOT). Self‐rated health, rating of the suitability of home design and anxiety/depression were all found to be significantly associated with ASCOT. Other individual and survey completion factors were also found to have weak significant relationships with ASCOT. The models also indicate that there was an increase in overall ASCOT‐QoL and in five of the eight ASCOT domains (Personal comfort and cleanliness, Safety, Social participation, Occupation and Dignity) between 2011 and 2012. These findings demonstrate the potential value of QoL data for informing policy for people with intellectual disabilities by identifying key factors associated with QoL, the characteristics of those at risk of lower QoL, and QoL domains that could be targeted for improvement over time. Future research should establish causal relationships and explore the risk adjustment of scores to account for variation outside of the control of social care support.