Diabetes mellitus patients' family caregivers' subjective quality of life

OBJECTIVES: To assess the subjective quality of life (QOL) of family caregivers of Sudanese type-1 and type-2 diabetic outpatients, using the WHO 26-item QOL instrument, compared with a general population sample; and to examine the factors associated with caregiver QOL. METHOD: Responses of caregivers of 105 outpatients with type-1 diabetes and 135 with type-2 diabetes were compared with 139 general population subjects. RESULTS: Caregivers were satisfied with the content of items related to general social supports. Type-1 caregivers had significantly lower QOL scores than type-2 caregivers and the general population. Parents and siblings had lowest scores compared with other family groups. Caregivers scored higher than patients. Patients' age and duration of illness, and caregivers' education, marital status and state of health were positively associated with caregiver QOL. Caregivers' QOL was predicted by their appraisal of patients' QOL. CONCLUSIONS: Caregivers who were sick, younger, single, less educated and caring for patients with more recent illness appeared relatively vulnerable. Clinicians should be interested in the dynamics of the family caregiving situation--as it impacts QOL--and in promoting caregiver awareness of diabetes in order to enhance the caregiving role, quality of care and QOL.     

Predicting cardiac patients' quality of life from the characteristics of their spouses

Recovery from surgery can be facilitated by personal and social resources such as perceived self-efficacy and social support. Moreover, the existence of a social network and the behavior of its members can also have a positive effect. Patients (N = 381; 302 men, 79 women) undergoing heart surgery were surveyed once before and twice after surgery. In addition, 114 social-network members (18 men, 96 women), most of them spouses, reported about their own perceived resources at Time 1. The patient-spouse dyad was chosen as the unit of analysis. It turned out that characteristics of spouses were related to those of patients. Recovery from surgery at Time 2 and readjustment to normal life after half a year (Time 3) could be partly predicted by spouses' perceived self-efficacy and social support as measured at Time 1.     

On subjective well-being and quality of life

We integrate the multi-disciplinary fields of quality of life (QoL) and well-being (WB) and appraise the impacts of health factors. Theoretical and methodological limitations are discussed and new conceptual and technical advances identified, These are informed by cross-cultural and community perspectives. Following a definitional review, social inequalities, and links with happiness are examined. Demographic, experiential and personal factors are outlined. Implications for poverty research are addressed. As the concept of SWB recently converged with the longstanding international QoL definition (WHOQOL Group, 1995), we discuss the separate need for SWB. Future collaborative conceptual and pragmatic research is recommended.     

Psychosocial counseling to improve quality of life in HIV infection

Psychosocial interventions such as cognitive behavioral stress management (CBSM), may enhance coping and social support which contribute to an improvement of quality of life factors such as emotional functioning, social functioning, and sense of well-being, for HIV-infected men during several phases of HIV spectrum disease. These phases include the acutely stressful period immediately following notification of HIV+ status, the adjustment period following this news, and the process of dealing with chronic symptomatic HIV infection. Normalization of some aspects of immunological status were found to accompany some of these psychosocial changes in the short-run. Longer-term follow-up indicated relationships between psychosocial factors and improved immunological status and physical functioning up to 2 years later. Factors such as an increased use of active coping strategies, including relaxation exercises, use of more functional appraisals and elicitation of social support, and decreased use of denial/avoidance coping strategies, may be key predictors of longer-term emotional well-being, social functioning, and physical functioning in HIV-infected populations. Special issues need to be addressed in emerging models of quality of life assessment in HIV populations. For example, the way resurgence of stigmatization and self-doubt affects sense of identity and well-being need to be addressed in quality of life research as well as in psychosocial interventions. Loss of employment and its financial and existential consequences are also factors which impact sense of self and well-being, and need to be addressed both in research as well as in interventions. The effect of repeated HIV-related bereavements upon an individual's social network and the emotional, social, and physical sequelae of bereavement have implications for HIV quality of life research as well. Quality of survival time has become a paramount issue in the context of HIV spectrum disease. Examining the relationships among coping strategies, social support, emotional well-being, realistic appraisals of one's functioning in comparison to their aspirations, and the influence of psychosocial functioning on disease course are central missions of our research program.     

Doctor-patient communication and cancer patients' quality of life and satisfaction

In this study, the relationship between (a) doctor's and patients' communication and (b) doctors' patient-centredness during the oncological consultation and patients' quality of life and satisfaction was examined. Consultations of 96 consecutive cancer patients were recorded and content analysed by means of the Roter Interaction Analysis System. Data collection (mailed questionnaires) took place after 1 week and after 3 months. Oncologists' behaviours were unrelated to patients' quality of life. Their socio-emotional behaviours related to both patients' visit-specific and global satisfaction. Patients' behaviour related to both patient outcomes although mostly to satisfaction. Multiple regression analyses showed that patients' quality of life and satisfaction were most clearly predicted by the affective quality of the consultation. Surprisingly, oncologists' patient-centredness was negatively related to patients' global satisfaction after 3 months. In summary, doctor-patient communication during the oncological consultation is related to patients' quality of life and satisfaction. The affective quality of the consultation seems to be the most important factor in determining these outcomes.     

A needs assessment of perceived life quality and life stressors among medical hospital employees

This study was designed to assist an employee-counseling program in a medical hospital by assessing the life quality and life stressors of its employees. 246 employees completed a written questionnaire which included a life events inventory and the Perceived Quality of Life (PQOL) Inventory (Andrews & Withey, 1976). Items on both inventories covered the areas of job, family/support, and financial affairs. Items measuring self-efficacy from the PQOL scale served as the criterion for potential counseling service utilization. Results indicated that family-support concerns were the most predictive of perceptions of self-efficacy. In addition, negatively perceived life changes were more powerful predictors of life quality than were life changes per se. Finally, employees who were identified as less satisfied in the various quality of life areas were separated from their spouses, over 55 years of age, and had lower education levels, large families, and low incomes.     

主诉失眠的门诊就诊者主客观评估的睡眠质量与生命质量

目的:失眠者的主观睡眠感与实际睡眠情况常有不一致的现象,本研究通过探讨以失眠为主诉的门诊就诊者睡眠质量的主观、客观评估指标与生命质量的相关性,为临床制定失眠的整体治疗方案提供参考依据。方法:连续收集64例以失眠为主诉的接受多导睡眠图(PSG)检查的门诊患者的资料,用匹兹堡睡眠质量指数(PSQI)评估主观睡眠质量,SF-36健康调查量表评估生命质量,用贝克抑郁问卷(BDI)、贝克焦虑问卷(BAI)评估情绪状态。以17例正常人的PSG数据作为客观睡眠质量的基础对照。结果:本组失眠就诊者90%主观评价睡眠质量差,其PSG指标中与正常对照相比睡眠潜伏期延长、清醒次数增加、睡眠效率降低、快动眼睡眠潜伏期延长(均P<0.05)。失眠就诊者PSQI总分与SF-36生理健康总分呈负相关(r=-0.25,P<0.05),但以BDI、BAI分作为控制变量进行偏相关分析显示,PSQI总分及各因子分与SF-36生理健康和心理健康总分相关性无统计学意义;PSG主要指标与SF-36生理健康和心理健康总分相关性无统计学意义。结论:本研究显示失眠者主观感受的睡眠质量更可能与生命质量相关,但与失眠相关的抑郁、焦虑情绪可能起到主要作用,这提示失眠治疗中应重视改善患者的主观睡眠质量,以及识别和处理情绪问题。     

The relationship of subjective sleep quality, pain, and quality of life in advanced cancer patients

STUDY OBJECTIVES: Cancer patients have been reported to complain about poor quality of sleep. This study evaluated the quality of sleep in this group, utilizing demographic data and clinical features of the cancers as assessment criteria. A secondary aim was to evaluate the correlation between the self-rated questionnaire for the quality of sleep with other instruments used in measuring pain and quality of life. DESIGN: A total of 102 patients with stage IV cancer completed the study and were subsequently followed for up to 10 months. Self-rated questionnaires were administered for the evaluation of quality of sleep (PSQI), quality of life Medical Outcomes Study 12-item short-form (SF-12) questionnaire, the Mental Component Summary (MSC) and the Physical Component Summary (PCS), and pain (VAS Pain). The mediation analysis model was also used to evaluate how quality of life can influence the quality of sleep through its relation to pain, the performance status of patients and analgesics (Opioids). PATIENTS: The mean age of the study participants was 62.8 (range: 26.0-87.0) years old. The majority (70.6%) of the patients presented with ECOG score between 2 and 3 and with metastasis (58.8%). RESULTS: Mean Global Sleep Quality score was 12.0+/-4.6. The use of the PSQI questionnaire in cancer patients demonstrated that these subjects were prone to sleep poor quality. However, the various demographic variables and clinical features of the cancers did not affect quality of sleep. Global Sleep Quality scores from the PSQI correlated with the scores obtained from the SF-12 questionnaire and with the VAS Pain results, indicating a relationship between quality of sleep, quality of life and pain. However, only the SF-12 questionnaire had predictive value on quality of sleep. Mediation analysis showed that quality of life influences quality of sleep both directly and indirectly by its effect on pain. In addition, some of the effect of quality of life on sleep quality was mediated by the use of opioids. CONCLUSIONS: Quality of sleep in patients suffering from stage IV cancer was significantly decreased. Demographic data and clinical variables of cancers did not affect the PSQI Global Sleep Quality score. The use of the mediation model also provides evidence that quality of sleep, quality of life, pain, and opioids are strictly correlated each other.     

Vulnerability to schizophrenia: relevance of patients' subjective experience for empirical and clinical work

Efforts are being made by clinicians and researchers to accurately delineate phenotypic traits of individuals at enhanced risk of schizophrenia. This issue is important for a better understanding of the etiopathogenic mechanisms of the disease and for the building up of programs of primary prevention. We suggest that disturbances of subjective experience, although difficult to operationalize, are an important-but until now neglected-core component of schizophrenia spectrum disorders. We advocate the development of valid and reliable instruments in order to allow the assessment of basic symptoms and disturbances of Self-experience. Delineation of vulnerability to schizophrenia cannot rely solely on neuropsychological and neurophysiological data, as prevention programs will be performed mainly by clinicians.     

Effects of the source of social comparison information on former cancer patients' quality of life

Objective. Life, following curative treatment, can be a struggle for former cancer patients. In this phase of their illness, social comparison information may help to improve a patient's quality of life (QOL). The objective of this study was to determine whether the effects of this information depend on the following two variables: (1) the individual's physical health and (2) the individual's sensitivity to social comparison. Design. In the current study, the effects on a patient's QOL were tested that occur when they are listening to a psychological oncological expert talking about cancer patients' experiences. Three different recorded interviews with experts were compared (on negative emotions, effective coping, or both), and individual differences were tested as moderators. In addition, the expert source conditions were compared with a condition in which the source was not an expert but a former patient. Methods. In a randomized field experiment, 154 Dutch former cancer patients (M(age) = 55 years; 68% women) were assigned to one of the four conditions (three expert source and one former patient source condition). QOL was assessed after 2 months. Results. The effects of the expert source conditions on QOL depended on the participants' physical health (good vs. poor) and on the participants' sensitivity to social comparison (whether the recipient reacts with contrast or identification), as indicated by significant three-way interactions (p < .001). Depending on these two variables, one of the three expert source conditions was at least as effective as the former patient source condition. Conclusions. The results show that desired and undesired effects are found when individual differences relevant to the processing of intervention information are examined. STATEMENT OF CONTRIBUTION: WHAT IS ALREADY KNOWN ON THIS SUBJECT??: It is known that social comparison processes are important determinants of emotions and QoL. In addition, research has shown that QoL in (former) cancer patients is lowered and interventions are needed. WHAT DOES THIS STUDY ADD??: This study showed that the application of social comparison as a method to increase QoL in cancer patients can be beneficial: It showed that applying the auditory channel, in which the expert source becomes more prominent, is effective. In addition, the study illustrates that psycho-social interventions can have side-effects; a phenomenon that has hardly been addressed in the literature and in practice.     

Changes of terminal cancer patients' health-related quality of life after high dose vitamin C administration

Over the years there has been a great deal of controversy on the effect of vitamin C on cancer. To investigate the effects of vitamin C on cancer patients' health-related quality of life, we prospectively studied 39 terminal cancer patients. All patients were given an intravenous administration of 10 g vitamin C twice with a 3-day interval and an oral intake of 4 g vitamin C daily for a week. And then we investigated demographic data and assessed changes in patients' quality of life after administration of vitamin C. Quality of life was assessed with EORTC QLQ-C30. In the global health/quality of life scale, health score improved from 36+/-18 to 55+/-16 after administration of vitamin C (p=0.001). In functional scale, the patients reported significantly higher scores for physical, role, emotional, and cognitive function after administration of vitamin C (p<0.05). In symptom scale, the patients reported significantly lower scores for fatigue, nausea/vomiting, pain, and appetite loss after administration of vitamin C (p<0.005). The other function and symptom scales were not significantly changed after administration of vitamin C. In terminal cancer patients, the quality of life is as important as cure. Although there is still controversy regarding anticancer effects of vitamin C, the use of vitamin C is considered a safe and effective therapy to improve the quality of life of terminal cancer patients.     

Structured data quality reports to improve EHR data quality

ObjectiveTo examine whether a structured data quality report (SDQR) and feedback sessions with practice principals and managers improve the quality of routinely collected data in EHRs.MethodsThe intervention was conducted in four general practices participating in the Fairfield neighborhood electronic Practice Based Research Network (ePBRN). Data were extracted from their clinical information systems and summarised as a SDQR to guide feedback to practice principals and managers at 0, 4, 8 and 12 months. Data quality (DQ) metrics included completeness, correctness, consistency and duplication of patient records. Information on data recording practices, data quality improvement, and utility of SDQRs was collected at the feedback sessions at the practices.The main outcome measure was change in the recording of clinical information and level of meeting Royal Australian College of General Practice (RACGP) targets.ResultsBirth date was 100% and gender 99% complete at baseline and maintained. DQ of all variables measured improved significantly (p < 0.01) over 12 months, but was not sufficient to comply with RACGP standards. Improvement was greatest with allergies. There was no significant change in duplicate records.ConclusionsSDQRs and feedback sessions support general practitioners and practice managers to focus on improving the recording of patient information. However, improved practice DQ, was not sufficient to meet RACGP targets. Randomised controlled studies are required to evaluate strategies to improve data quality and any associated improved safety and quality of care.     

Personal models of osteoarthritis and their relation to self-management activities and quality of life

We examined the personal models of osteoarthritis (OA) of 61 patients over 60 years of age. Models were elicited using a structured interview. Shared beliefs included perceiving OA as a serious, painful, chronic, and incurable condition that can be managed by recommended medical treatment. Considerable individual differences were found on six personal-model constructs: Symptoms, Seriousness, Cause, Control, Helpfulness of Treatment, and Negative Feelings about Treatment. The constructs of Symptoms and Seriousness were consistently related to a variety of important outcomes. For example, participants with higher scores on Symptoms and Seriousness reported higher levels of self-management (both concurrently and prospectively), reported more utilization of medical services, and experienced a poorer quality of life. The implications for the design of health-education materials and for patient-provider interactions are discussed.     

Health-related quality of life of women with disabilities in relation to their employment status

Aim

To compare the health-related quality of life of unemployed and employed women with disabilities and establish factors affecting their life satisfaction.

Methods

The study included 318 women with disabilities, 160 of whom were employed and 158 unemployed, paired according to age and region of residence. The health-related quality of life was assessed by The World Health Organization Quality of Life questionnaire, and social demographics and factors affecting life satisfaction were collected by a general questionnaire. The factors affecting life satisfaction were defined according to respondents’ statements.

Results

Unemployed women with disabilities had a lower mean score (±standard deviation) on all health-related QoL domains: psychological health (14.52 ± 2.80 vs 15.94 ± 2.55), social relationships (15.12 ± 3.08 vs 16.06 ± 2.69), environment (12.80 ± 2.78 vs 13.87 ± 2.49), as well as on a separate item of self-assessed health (3.33 ± 1.16 vs 3.56 ± 0.92) than their employed counterparts (P < 0.01). This disparity was not found only in the domain of physical health. The largest positive impact on life satisfaction in both groups was family.

Conclusion

As disabled women are a particularly vulnerable population group, stressing the importance of employment and family as factors affecting their quality of life may help equalizing opportunities and upgrading the quality of life of all – particularly unemployed women with disabilities.As estimated by the United Nations (UN), disabilities are far more widespread than believed: one in every 10 inhabitants of the world is to a certain point disabled, accounting for some 450 million persons worldwide (1). Croatia in 2009 registered 511 080 persons with disabilities, which amounts to 11.5% of the overall population, 205 662 (40.2%) of whom were women (2). UN Convention on the Rights of Persons with Disabilities, ratified by Croatia in 2007, defines disabilities as long-term physical, mental, intellectual, or sensory impairments that in interaction with various barriers may hinder persons’ full and effective participation in society on an equal basis with others (3). The right to work and employment is one of the fundamental human rights, which can help equalize opportunities for persons with disabilities and guarantee full and effective social integration (4). According to Croatian Employment Service, the employment rate for disabled persons echoes general hiring trends as the oscillations on the Croatian labor market reflect the global economic crisis.Recently, considerable research attention has been paid to the impact of employment on the quality of life of women with disabilities, with the term quality of life (QoL), in line with the world health organization’s (WHO) definition of health, referring to psychological, social, and physical well-being of a person and their ability to perform the usual daily activities (5). QoL implies satisfying one’s needs and interests, choice of values, and aspirations in different areas and in different stages of life. Prerequisites for this are full active participation in interaction and communication processes, as well as communication in one’s physical and social environment (3,6,7). Within the scope of the UN Development Program, a study on the quality of life and risk from social exclusion of disabled persons was carried out in Croatia. The principal objective of the Program is to support a balanced development and implementation of social inclusion strategies and policies focusing primarily on the vulnerable groups – first and foremost, persons with disabilities, most threatened by social exclusion and aggravated access to civil, political, and social rights.A significant connection was proven between the disabled person’s self-assessed position within the society and duration of their unemployment (8). To illustrate, persons who have been unemployed for a longer period believe that they are seen by the society as less valuable and that they feel socially excluded (8). Long-term unemployment is singled out as one of the causes of social exclusion, which is especially hard for women with disabilities (9). Regardless of the severity of their disability, disabled women tend to exhibit less self-confidence and a greater level of social exclusion. The ones who had received more support and love in their families show more self-esteem, which helps them find a job significantly sooner (10). Given that Croatia is one of the poorest countries of Europe, with an increasing unemployment rate (2), there is a great risk of unemployment and social exclusion among disabled women (11). This study is carried out as one of the preventing measures for discrimination of women with disabilities under the National Strategy for Equalization of Opportunities for Persons with Disabilities (4). The aim of this study is to compare the health-related quality of life of unemployed and employed women with disabilities, establish the factors affecting their personal life satisfaction, and give guidelines for advancing their quality of life.     

Group cognitive behavior therapy for bipolar disorder can improve the quality of life

Bipolar disorder (BD) can have an impact on psychosocial functioning and quality of life (QoL). Several studies have shown that structured psychotherapy in conjunction with pharmacotherapy may modify the course of some disorders; however, few studies have investigated the results of group cognitive behavior therapy (G-CBT) for BD. Our objective was to evaluate the effectiveness of 14 sessions of G-CBT for BD patients, comparing this intervention plus pharmacotherapy to treatment as usual (TAU; only pharmacotherapy). Forty-one patients with BD I and II participated in this study and were randomly allocated to each group (G-CBT: N = 27; TAU: N = 14). Thirty-seven participants completed the treatment (women: N = 66.67%; mean age = 41.5 years). QoL and mood symptoms were assessed in all participants. Scores changed significantly by the end of treatment in favor of the G-CBT group. The G-CBT group presented significantly better QoL in seven of the eight sub-items assessed with the Medical Outcomes Survey SF-36 scale. At the end of treatment, the G-CBT group exhibited lower scores for mania (not statistically significant) and depression (statistically significant) as well as a reduction in the frequency and duration of mood episodes (P < 0.01). The group variable was significant for the reduction of depression scores over time. This clinical change may explain the improvement in six of the eight subscales of QoL (P < 0.05). The G-CBT group showed better QoL in absolute values in all aspects and significant improvements in nearly all subscales. These results were not observed in the TAU control group.