The impact of behavior on quality of life

The focus of my article centers on two main issues: why exercise is important and how to help people succeed in an exercise program that initially fails. In keeping with the theme of the conference, in the eye of the beholder, I thought that I might begin my talk with an orientation stemming from views by the late philosopher of science, Thomas Kuhn. Kuhn, who coined the phrase paradigm shift, referred, in his paper on the Essential Tension [The Third University of Utah Research Conference on the Identification of Scientific Talent, Salt Lake City: University of Utah Press, 1959], to the German term, einstellungen, as a way of seeing and interpreting objects in our world. Each person has a personal way of seeing based upon training, orientation, experiences, and daily problems. In my field, we have spent the last 20 years trying to reach a consensus about the benefits of physical activity. Yet, during that time we have known that only 10–25% of adults living in free market societies are active enough in their leisure time to reap those benefits. Hopefully, now we will follow Kuhn's advice and also consider the idea of pre-consensus, in which we diverge from existing policies to forge new policies designed to better deliver physical activity to the population to enhance the quality of life.     

Studies of the inner life: The impact of spirituality on quality of life

This article defines spirituality and relates the importance of spirituality to understanding quality of life. Spirituality is examined through organizational religious activities, non-organizational activities and/or as an expression of faith. Spirituality as a variable in the study of quality of life is not a new concept; however, it has returned to the scene during recent years, and has gone through an evolutionary process.     

The impact of severe preeclampsia on maternal quality of life

Purpose

Preeclampsia (PE) is a serious life event that can change women’s psychological profile. The aim of this study was to evaluate the physical and mental health-related quality of life (HR-QoL) in women after PE and the impact of contributing factors.

Methods

Ninety-five women who had suffered from PE answered the Short-Form-12 Health Survey on general state of health. Comparison was made with the reference values and among the study cohorts, namely mild (14.7 %), severe (74.7 %) and superimposed PE (10.5 %). Medical parameters were evaluated as additional factors, and age served as covariate.

Results

Quality of mental life was significantly worse in all patients (p < 0.01), especially in those after severe PE (p < 0.01) compared to the reference range. These women demonstrated significantly worse results than those affected by the mild form (p = 0.03). Women who had had superimposed PE were neither physically nor mentally impaired compared to the standard population values (p = 0.94 and p = 0.90, respectively). After controlling for medical parameters and age, differences remained statistically significant. Multiparous women scored significantly worse on the mental scale than primiparous (p = 0.02), and pregnant women scored significantly worse than non-pregnant women on the physical level (p = 0.04).

Conclusions

This study shows that women who have suffered from severe PE are substantially reduced in their mental quality of life. An extensive medical care including HR-QoL parameters might improve pregnancy outcome.     

Measuring quality of life in the frail elderly

This study was carried out to develop and test the Geriatric Quality of Life Questionnaire (GQLQ), a health-related qualify of life (HRQL) questionnaire designed for the frail elderly. One hundred patients were asked to identify areas of their daily lives affected by their health. The GQLQ, developed on the basis of the results, the Rand Physical and Emotional Function Questionnaires, and the Barthel Index, were administered serially to a group of 76 patients participating in a randomized trial of a Geriatric Day Hospital. Participants in all phases of the study were over 65 years of age, living in their own home but with sufficient functional status impairment to compromise their ability to live independently. The GQLQ includes 25 questions focusing on activities of daily living (ADL), symptoms, and emotional function. In the ADL and Symptom domains respondents define personal problem areas. The responsiveness coefficients of the GQLQ ADL and Symptom domains (0.26 and 0.30 respectively) were similar to those of the Rand Physical Function instrument and the Barthel Index (0.29 and 0.20). The responsiveness coefficient of the GQLQ Emotional Function domain (0.50) was similar to that of the Rand Emotional Function instrument (0.63). Correlations between the GQLQ ADL domain and the Barthel Index (0.41), and between GQLQ and the Rand Physical Function instrument (0.30), were similar to the correlation between the Barthel Index and Rand Physical Function (0.40). While the GQLQ captures important areas of health-related quality of life impairment for the frail elderly, we failed to show any advantages in either responsiveness or validity to existing, simpler measures. New, specific instruments should be tested in head-to-head comparisons with existing measures, particularly generic instruments, before dissemination.     

The impact of the Chi-Chi earthquake on quality of life among elderly survivors in Taiwan – A before and after study

This paper examines the impact of the Chi-Chi earthquake, which hit central Taiwan on September 21, 1999, on the quality of life among the elderly survivors. The 28-item Taiwanese-adapted brief version of the World Health Organization's quality of life questionnaire (WHOQOL-BREF) was used to measure quality of life in four domains: physical capacity, psychological well-being, social relationships, and environment. These measures were coincidently collected in a separate study from 368 subjects aged 65 and older in the affected area shortly before the earthquake. Of these subjects, 268 were interviewed in a follow-up assessment 12 months after the earthquake. Linear mixed models were applied to investigate how quality of life in each of the four domains changed from the pre-earthquake assessment to 12 months after the earthquake, and how these changes depended on the level of damage to residences. In conclusion, elderly survivors tended to report lower quality of life in physical capacity, psychological well-being, and environment 12 months after the earthquake than at the assessment prior to the earthquake, regardless of the level of damage to their residences during the earthquake. However, those whose residences completely collapsed during the earthquake reported a higher quality of life in social relationships while others reported the opposite.     

Individual quality of life in the healthy elderly

Quality of life research with the elderly has usually focused on the impact of decline in function, and used a pre-determined model of quality of life in old age. The Schedule for the Evaluation of Individual Quality of Life (SEIQoL) allows individuals to nominate, weigh and assess those domains of greatest relevance to their quality of life. The SEIQoL was administered to 56 healthy elderly community residents at baseline and 12 months later. Quality of life levels were significantly higher at baseline (t=–2.04; p=0.04) than that of a previously studied sample of healthy adults below 65 years of age, and did not change significantly over the study period. The domains nominated by both samples as relevant to their quality of life differed notably. Health status was not correlated with the perceived importance of health at baseline, and showed only a low correlation (r=0.27) at 12 months. The weight placed on health did not increase over the study period despite a significant decline in health status. The value of allowing the individual to define personal quality of life values in a research context is explored.Funding for this study was provided by Ciba Ltd, the Dhole Bursary of the British Geriatrics Society and by the Royal College of Surgeons in Ireland.     

The impact of skin disease on the quality of life of adolescents

Though relatively well-investigated in adults, the impact of skin disease on the health-related quality of life (HRQL) of adolescents has only recently begun to be systematically evaluated. The primary goal of this article is to critically review previous research that has examined the relationship between HRQL and three types of skin disease commonly experienced by adolescents, namely acne vulgaris, alopecia areata, and atopic dermatitis. A secondary goal is to provide strategies to adolescent medicine physicians that will enable them to more effectively manage the psychological components of their patients dermatological conditions.     

The impact of subject/respondent characteristics on a proxy-rated quality of life instrument for the Japanese elderly with dementia

The development of a quality of life (QL) instrument for evaluating quality of services requires extensive validation. This study examines the impact of subject/respondent characteristics on a newly developed quality of life instrument for the Japanese elderly with dementia (QLDJ) as a part of the validity examination. In the QLDJ, QL is defined as a three-dimensional construct: 'interacting with surroundings', expressing self', and 'experiencing minimum negative behaviors'. Thus the QLDJ is a multi-dimensional, 24-item instrument, and it is answered by a proxy, the formal caregiver (respondent) because the elderly with severe dementia cannot be directly interviewed. Altogether 623 elderly persons experiencing dementia from 37 institutions (e.g., nursing homes, day care centers) in Japan were assessed using the QLDJ by their formal caregivers. In addition to the levels of dementia and independence in activities of daily living, factors such as gender of the elderly person and respondent, elderly person's age, participation in recreational activities, qualification of the respondent were significantly associated with 'interacting with surroundings' and 'expressing self'. The levels of dementia and independence as well as qualification of the respondent were associated with 'experiencing minimum negative behaviors'. Possible reasons for these associations and how to deal with them are discussed. Careful control for those factors is needed when the QLDJ is used in future research.     

优质护理对老年高血压患者生活质量的影响

目的：探讨优质护理对老年高血压患者生活质量的影响。方法：选取88例老年高血压患者作为研究对象,将其随机分成对照组和护理干预组,每组44例,并对所有患者实施医疗护理,给予对照组按照常规方法进行治疗及护理,护理干预组则在常规护理的基础上实施优质护理干预;对两组患者的生活质量改善情况加以观察。结果：护理干预组的护理有效率为90.91%,对照组护理有效率为79.55%,两组数据差异有统计学意义（P〈0.05）;护理干预组患者的生活质量良好率为86.36%,对照组则为70.45%,差异有统计学意义（P〈0.05）。结论：对老年高血压患者实施优质护理,可有效的提高患者的治疗依从性,使临床症状得到改善,有力的促进了患者生活质量的提高。     

全国老年听力残疾人群现状调查研究

  目的  了解中国听力残疾老年人辅助器具使用现状及其影响因素,为中国听力残疾老年人的防治与康复提供参考依据。  方法  利用2006年第二次全国残疾人抽样调查数据中29 495名 ≥ 60岁单纯听力残疾老年人作为分析样本,通过描述性分析、多因素logistic回归等方法分析听力残疾老年人辅助器具使用现状及其影响因素。  结果  中国29 495名 ≥ 60岁单纯听力残疾老年人辅助器具的使用率为7.62 %,高龄、男性、居住在城镇、有配偶、受教育程度为初中及以上、家庭收入水平较高、有残疾人证、重度及以上听力障碍、有生活自理、与人相处功能障碍的听力残疾老年人辅助器具的使用率更高。多因素非条件logistic回归分析结果显示,人口学、社会经济、听力残疾程度及功能障碍因素与听力残疾老年人辅助器具服务利用相关。其中,中高龄、居住在城镇、有配偶、受教育程度为小学或初中及以上、家庭户人均收入 ≥ 1 500元、有残疾人证的听力残疾老年人使用辅助器具的可能性较高。在听力水平和活动与参与功能方面,听力障碍严重程度越高、存在生活自理、与人相处和社会参与功能障碍的听力残疾老年人,使用辅助器具的可能性更高。  结论  中国听力残疾老年人辅助器具服务的利用率较低,人口学、社会经济环境、听力及功能健康水平与听力残疾老年人辅助器具服务利用密切相关。     

The impact of urinary incontinence on self-efficacy and quality of life

Urinary incontinence impacts 15 to 35% of the adult ambulatory population. Men after the removal of the prostate for cancer can experience incontinence for several weeks to years after the surgery. Women experience incontinence related to many factors including childbirth, menopause and surgery. It is important that incontinence be treated since it impacts not only the physiological, but also the psychological realms of a person's life. Depression and decreed quality of life have been found to co-occur in the person struggling with incontinence.     

实施家属健康教育对老年抑郁症患者生活质量的影响

目的探讨同步实施家属健康教育对老年抑郁症患者生活质量的影响。方法选择56例老午抑郁症患者．分为对照组（28例）和观察组（28例）,两组患者在常规治疗的同时接受健康教育,观察组在此基础上同步实施家属健康教育。在患者入院时及入院后第8周,采用生活质量指数评定量表评价两组患者的生活质量。结果入院第8周时,观察组总体生活质量（6．21&#177;0．74）明显高于对照组（4．18&#177;1．49）且明显高于入院时（3．96&#177;1．07）,差异均有显著统计学意义（P〈0．01）。结论对老年抑郁症患者家属同步实施健康教育,可提高其家属对患者的照料水平及护理配合程度,提高老年抑郁症患者生活质量。     

Psychological acceptance and quality of life in the elderly

Many changes occur as people enter old age (e.g., declining productivity), and these changes may at times decrease quality of life. Do some people maintain high subjective quality of life despite these changes? This study investigated the influence of psychological acceptance (PA) on quality of life in a sample of 187 elderly from a home nursing service, a retirement village and various community groups. Average age was 78 years old with a range from 65 to 96. We administered a measure of psychological acceptance and The Comprehensive Quality of Life Scale (COMQol). As hypothesised, people higher in PA also had higher quality of life in the areas of health, safety, community participation and emotional well-being. In addition, individuals high in PA had less adverse psychological reactions to decreasing productivity. Interventions that increase PA may lead to improved quality of life and resilience amongst the elderly.     

The economic and quality of life impact of hypoglycemia

Hypoglycemia is an often underrecognized side effect of type 2 diabetes therapy. This study assessed the burden of hypoglycemia in this population in Sweden and included 309 patients aged 35 years or older and treated with insulin and/or oral antidiabetic agents. Data were gathered through patient questionnaires/interviews and chart reviews. The results showed that 115 patients (37%) reported symptoms of hypoglycemia during the preceding month. Patients with hypoglycemia were more affected by their diabetes, reported lower general health, and were more anxious about hypoglycemia than those without hypoglycemia. The direct and indirect costs of hypoglycemia per patient with hypoglycemic symptoms were estimated to be U.S. $12.9 and $14.1, respectively, for a 1-month period. The results indicate that hypoglycemia is common, and that a reduction in these symptoms, without reducing glycemic control, may improve patient well-being and possibly also reduce cost.     

Measuring the impact of onychomycosis on patient quality of life

According to survey research, onychomycosis, a fungal infection of the toenail or fingernail, affects quality of life including physical and social functioning and emotional health. We developed an onychomycosis disease-specific questionnaire (ODSQ) that sensitively assessed symptom distress, functional impact, and social stigma associated with the disease. Samples of patients enrolled in a randomized controlled clinical trial were used for the psychometric evaluations. The multi-item scales were internally consistent ( 0.80) and reproducible (ICC > 0.85). Interscale correlations between the ODSQ and generic scales were moderate and consistent with the hypothesized magnitude and directions. Construct validation, employing known groups analysis, supported the hypothesized impact of onychomycosis on three domains of quality of life: physical functioning, emotional health, and social functioning. Significant differences were found between clinically cured, improved, or failed patients, and between mycologically eradicated and persistent patients. The ODSQ was responsive to clinical change and more sensitive than derived Medical Outcomes Study Short Form-36 scales. The ODSQ provides reliable, validated and responsive information about the consequences of onychomycosis and its treatment.