Making the links between community structure and individual well-being: community quality of life in Riverdale, Toronto, Canada.

An inquiry into community quality of life was carried out within a framework that recognizes the complex relationship between community structures and individual well-being. Through use of focus groups and key informant interviews, community members, service providers, and elected representatives in a Toronto community considered aspects of their community that affected quality of life. Community members identified strengths of access to amenities, caring and concerned people, community agencies, low-cost housing, and public transportation. Service providers and elected representatives recognized diversity, community agencies and resources, and presence of culturally relevant food stores and services as strengths. At one level, findings were consistent with emerging concepts of social capital. At another level, threats to the community were considered in relation to the hypothesized role neo-liberalism plays in weakening the welfare state.     

Hunting for health,well-being,and quality of life

Health, well-being, quality of life, and lifestyle are central concepts within health science, although generally accepted definitions are still lacking. Lifestyle can either be seen as an independent variable and the cause of unhealthy behaviour or as a dependent variable, which is affected by conditions in the society. In the first case, the attention is directed on each individual case: maintaining or improving health requires changes in lifestyle and living habits. In this perspective, diet and physical activity are important features for health promotion. In the second case the attention is rather directed on structural conditions in society, for example the food industry, the lunches for children at school, and the “fast food” industry should be influenced to protect human health. The structural perspective has, so far, received restricted impact when it concerns prevention and promotion of health. Processes of individualisation in the society have to an increasing extent viewed health as an affair for the individual. The benefits of physical activity, healthy food and beverage, social support, and joy are documented scientifically. In general, the trend towards increasing responsibility for one''s lifestyle and health is positive, but might reinforce the inequality in health. With an even harder climate in society there might be a risk that individual health projects undermine the solidarity and the will to accept costs for medical treatment and care for people who risk their health through an unhealthy and risk-taking lifestyle. However, we argue that peoples’ well-being and quality of life presupposes a society that stands up for all people.     

洪灾溃垸区居民生活质量研究

目的 探讨溃垸型洪灾对于居民生活质量的影响。方法 在民主垸溃垸后3个月，随机抽取灾区494人，以另一非受灾区为对照，随机抽取471人，采用李凌江GQOL－76等工具进行生活质量及相关因素调查。结果 洪灾后群体生活质量下降，在心理、躯体、社会功能维度与对照差异有显性，受损最严重的为社会、心理功能维度。结论 生活质量的影响因素很多，是否患有慢性疾病以及受灾经历、社会支持、个性特性等均对生活满意度有显影响。     

Race,menopause, health-related quality of life,and psychological well-being in obese women

OBJECTIVE: To investigate the health-related quality of life (HR-QOL) in African-American (AA) and white (W) obese women. RESEARCH METHODS AND PROCEDURES: Participants were 145 obese women (80 AA and 65 W; 87 premenopausal and 58 postmenopausal) who completed the Medical Outcomes Study short form, the Brief Symptom Inventory, the Life Distress Inventory, the Satisfaction With Life Scale, and the Rosenberg Self-Esteem Scale before entering a weight-loss study. The mean age of the subjects was 46.3 +/- 11.1 years and the mean body mass index was 35.2 +/- 4.2 kg/m(2). RESULTS: Although AA women were slightly heavier (95.3 +/- 10.3 kg vs. 91.5 +/- 11.6 kg, p < 0.05) and less educated (14.2 +/- 3.7 years vs. 15.7 +/- 3.7 years, p < 0.05) than the W women in the sample, there was no difference between the two ethnic groups in any of the reported HR-QOL variables. Menopausal status had a significant effect on HR-QOL, with premenopausal women being more distressed (p = 0.002), having more limitations in social activity (p = 0.007), and having less vitality (p < 0.001) than the postmenopausal women. This was especially true in the AA women. DISCUSSION: These data show no difference in HR-QOL between AA and W obese women and suggest that menopausal status may have an impact on HR-QOL, especially in AA women.     

Familial hypercholesterolaemia and quality of life in family members

BACKGROUND: Awareness of genetic disease in the family may influence quality of life. The purpose of this study was to describe quality of life among nonaffected members of families with familial hypercholesterolaemia. All were aware of the risk for coronary heart disease. Their quality of life was compared with a reference group and with the patients with familial hypercholesterolaemia themselves. METHODS: Names of family members (n = 129) were given by the patients with familial hypercholesterolaemia. A randomly selected reference group (n = 1485) and patients with familial hypercholesterolaemia (n = 185) were included for comparison. They all completed the questionnaire Quality of Life Index, the Hospital Anxiety and Depression Scale, and the Mastery Scale measuring coping. Family members and patients with familial hypercholesterolaemia also completed a questionnaire on health and lipids. RESULTS: Family members were more satisfied with family life, mean 22.1 +/- 3.5 (SD), and psychological/spiritual life, 22.9 +/- 4.0, than the reference group, 21.4 +/- 4.3 and 21.1 +/- 4.8, respectively; this was particularly expressed among partners, P < 0.05. Of family members, 91% were anxious about the patient with familial hypercholesterolaemia developing coronary heart disease. CONCLUSIONS: Family members have as good a quality of life as members of the reference group, but they were anxious about the patient with familial hypercholesterolaemia developing coronary heart disease.     

World assumptions, posttraumatic stress and quality of life after a natural disaster: A longitudinal study

ABSTRACT: BACKGROUND: Changes in world assumptions are a fundamental concept within theories that explain posttraumatic stress disorder. The objective of the present study was to gain a greater understanding of how changes in world assumptions are related to quality of life and posttraumatic stress symptoms after a natural disaster. METHODS: A longitudinal study of 574 Norwegian adults who survived the Southeast Asian tsunami in 2004 was undertaken. Multilevel analyses were used to identify which factors at six months post-tsunami predicted quality of life and posttraumatic stress symptoms two years posttsunami. RESULTS: Good quality of life and posttraumatic stress symptoms were negatively related. However, major differences in the predictors of these outcomes were found. Females reported significantly higher quality of life and more posttraumatic stress than men. The association between level of exposure to the tsunami and quality of life seemed to be mediated by posttraumatic stress. Negative perceived changes in the assumption "the world is just" were related to adverse outcome in both quality of life and posttraumatic stress. Positive perceived changes in the assumptions "life is meaningful" and "feeling that I am a valuable human" were associated with higher levels of quality of life but not with posttraumatic stress. CONCLUSIONS: Quality of life and posttraumatic stress symptoms demonstrate differences in their etiology. World assumptions may be less specifically related to posttraumatic stress than has been postulated in some cognitive theories.     

Quality of life after stroke: well-being, life satisfaction, and subjective aspects of work

Stroke incidence in those of working age has been reported to be increasing significantly, implying strong incentives for research concerning working ability after stroke. This study focused on differences in subjective aspects of work and dimensions of quality of life after having experienced stroke. Sixty-five persons answered a postal questionnaire. The median age at the time of the stroke was 54 years, (Q3 -Q1 = 8 years). "Financial aspects" and "intrinsic aspects" of work were rated as the most important by 37% and 36% of the respondents, respectively. Fewer respondents ranked "social aspects" as most important. In total, 23 persons had returned to work, but no difference in the ratings of the most important aspects of work between those who had returned to work and those who had not was found. Persons who rated "intrinsic aspects" of work as the most important were more satisfied with the subjective dimensions of quality of life "vocational situation" (p = 0.020) and "work" (p = 0.015) than the others. In conclusion, subjective aspects of work need to be explored and discussed thoroughly in rehabilitation of younger stroke patients.     

Health related quality of life after mitral valve repairs and replacements

Background: The decision to replace or repair mitral valves is often a difficult decision, and outcomes from the patients’ perspective should guide decision-making. We investigated whether the change in health related quality of life (HRQOL) after mitral valve surgery is different after valve repairs compared with replacements.Methods: We prospectively studied 25 patients with mitral valve replacement and 45 patients with valve repairs performed in 1998–99. We measured HRQOL at baseline and at 18 months using the Medical Outcomes Trust Short Form 36-item Health Survey (SF-36) questionnaire. We compared mean HRQOL scores of the groups with age-adjusted U.S. population scores. We used analysis of covariance to determine a change in HRQOL within groups (repair or replacement) and if the change in HRQOL was different between the groups.Results: We found few differences between the groups, with more men and simultaneous coronary artery bypass graft surgery in the valve repair group and more prior operation in the valve replacement group. HRQOL improved after surgery in most domains, and was comparable to age-adjusted U.S. norms in the valve repair group. In the multivariable analysis, mitral valve repair recipients reported higher social functioning compared with patients who received valve replacement (p = 0.04). We did not find other statistically significant differences. However, the adjusted improvements in the component scales of physical functioning (PCS) and mental functioning (MCS) were substantial in the valve repair group (mean changes: PCS = 6.8, p = 0.003; MCS = 8.1, p = 0.014) and less pronounced in the replacement group (mean changes: PCS = 3.6, p = 0.09; MCS = 4.3, fsp = 0.16).Conclusions: While many considerations influence the decision to repair or replace mitral valves, these findings suggest that repair may be better from the health status perspective. Further studies are necessary to validate this finding.     

Impacts of an environmental disaster on psychosocial health and well-being in Karakalpakstan

The people of Karakalpakstan, along with those of the entire Aral Sea region, are facing a multitude of health problems corresponding to the drying of the Aral Sea and accompanying ecological consequences. In case studies of other environmental disasters, research has shown that environmental exposures may impact not only the physiological but also the psychosocial health of individuals. This research aims to determine the contribution of the environmental disaster to the psychosocial health of people living in Karakalpakstan, a semi-autonomous Republic in Uzbekistan. An interview survey was carried out by Médecins Sans Frontières, with the assistance of the McMaster Institute of Environment and Health, local Universities and local health care workers, on a random sample of 1118 individuals aged 18 years and older in three communities in Karakalpakstan in May/June 1999. The communities were chosen according to distance from the former seashore, urban/rural characteristics and ethnic composition. The survey included questions about perceived general health, the General Health Questionnaire, the somatic symptom checklist of the Symptom Check List-90, questions about perceptions of the environmental disaster, social support as well as socio-demographic and socio-economic characteristics. Findings show that 41% of all respondents reported environmental concern while 48% reported levels of somatic symptoms (SCL-90) associated with emotional distress, above the normalized cut-point. Significant differences in levels of emotional distress were reported between men and women as well as between ethnic groups. Environmental problems are commonly perceived to be the cause of somatic symptoms and are significantly related to self-rated health status.     

A matter of life and death: Health care change in an Andean community

Saraguro Indians in Ecuador employ optimizing techniques to select from several available health care resources. Ideational needs, rather than physical access, appear to impose the greatest influence on therapeutic choice. The influence of felt needs on health care is particularly apparent at birth and death. The community's new hospital provided free health care, but doctors failed to consider indigenous attitudes toward birth and death. The ideational cost of hospital care has made it an unacceptable alternative for residents.     

Body mass index and quality of well-being in a community of older adults

BACKGROUND: The impact of obesity and associated conditions on health has not been assessed in older adults using a generic, utility-based measure of health-related quality of life (HRQOL). This study evaluates the relationship between body mass index (BMI) and HRQOL scores and gives estimates of quality-adjusted life years (QALYs) lost to overweight, obesity, and associated conditions. METHODS: A total of 1326 adults from the Rancho Bernardo longitudinal cohort study, with a mean age of 72 years, completed the Quality of Well-Being Scale (QWB), a generic health-related quality of life measure. Height, weight, exercise, and smoking status were also assessed. Differences in QWB scores between obese adults and those with a normal BMI were used to estimate the QALYs lost due to obesity and associated conditions. RESULTS: Participants were divided into four groups based on BMI: <20 (underweight); 20 to 24.9 (normal); 25 to 29.9 (overweight); >30 kg/m(2) (obese). Analysis of covariance controlling for age, gender, smoking history, and exercise showed a significant difference between group means (F(7,1310)=30.79; p <0.001). The normal BMI group had the highest QWB score (0.709), followed by the underweight (0.698), overweight (0.695), and obese (0.663) groups. The QWB score for the obese group was significantly lower than that for the normal and overweight groups. An estimated 2.93 million QALYs are lost in this country each year from obesity and associated conditions. CONCLUSIONS: Obese older adults tend to have lower HRQOL than those who are overweight or of normal BMI. The lower QWB scores associated with obesity translate into millions of QALYs lost each year. Being overweight but not obese did not have a significant impact on HRQOL in this population.     

医护人员工作压力与生活质量和幸福感的相关分析

目的了解医院医护人员工作压力、生活质量及主观幸福感情况,探讨工作压力对医护人员生活质量和幸福感的影响及其影响过程中的关键因素。方法采用医护人员工作压力问卷、生活质量综合评定问卷-74(GQOLI-74)、总体幸福感量表(GWB)对381名医院医护人员进行测评。结果 (1)医疗事故压力、工作负荷压力是医护人员主要压力源,医生在医疗事故压力(P﹤0.05)、职称晋升及聘任压力高于护士(P﹤0.01)。(2)医生在躯体功能和心理功能纬度得分高于护士(P﹤0.01)。(3)全部压力源均与心理功能和总体幸福感呈负相关(P﹤0.01)。结论工作压力是影响医护人员生活质量与总体幸福感的重要因素。     

医院社区协同健康管理对老年冠状动脉介入治疗后生活质量的影响

目的探讨医院、社区协同健康管理对老年冠心病患者经皮冠状动脉介入治疗（PCI）术后生活质量的影响。方法PCI术后老年冠心病（CAD）患者147例,按照所在社区分为对照组（75例）和观察组（72例）。对照组出院后转社区医疗组织管理,医院不再提供后续健康干预治疗;观察组出院后医院协同社区共同健康管理1年,比较两组患者在发生心脏事件方面的差异,并在统一指导语的前提下进行生活质量综合评定问卷（GQOLI-74）、焦虑自评量表（SAS）、抑郁自评量表（SDS）评分。结果与对照组比较,观察组患者焦虑（34±6VS41±7,t=2．714,P〈0．01）、抑郁心理评估分数（35±7VS41±8,t=2．572,P〈0．05）明显降低,躯体健康度（63±12VS59±11,t=5．935,P〈0．01）、心理健康度（64±14VS58±13,t=6．116,P〈0．01）、社会功能维系度（64±11VS58±10,t=6．157,P〈0．01）均好于对照组,但心脏事件发生率及物质生活维系度两组差异无统计学意义（P〉0．05）。结论医院、社区协同健康管理是老年PCI术后患者降低焦虑、抑郁状态,提高生活质量切实有效的方式。     

Work ability and quality of life of brazilian industrial workers

The scope of this study was to evaluate the quality of life and work ability of industrial workers by means of self-perception questionnaires. 100 industrial production line workers on the night shift participated in this study. Authorized Brazilian translations of the Work Ability Index (WAI) and the Abbreviated World Health Organization Quality of Life (WHOQOL-Bref) Assessment Instrument were applied. The results show an association between work ability and the whole set of domains of quality of life, presenting a closer association with the physical domain (r =0.61). Furthermore, young men obtained higher ability to work results, while women aged between 30 and 39 had the lowest quality of life indices (p =0.027), especially in the Social Relationships and Environment domains. This shows that preventive guidelines for the improvement of aspects linked to the Physical domain are necessary both in the workplace and outside the workplace, since this interaction exacerbates the effects on the physical aspect in both spheres.     

Health aspects in adults over 80 with independent community life: an Australian perspective

This qualitative study describes the factors that influence the health care practices of 14 elderly persons living independently in Perth, Western Australia. Through in-depth interviews with the participants, the health care practices people were explored. Five distinct themes emerged from the data. These themes were the past time, an active life, nutrition, getting old, economical security and personal satisfaction. This study provides an insight into the life of older adults and the problems associated with ageing.     

Testosterone for male contraception during one year: attitudes, well-being and quality of sex life

Men's attitudes, well-being, and sex life were studied during 1 year's use of testosterone contraception. A consecutive series of 25 men were followed by structured interviews at baseline, during the efficacy phase of oligo-azoospermia and after recovery. Open questions gave qualitative aspects on male contraception. Themes obtained were expectations about freedom and control over their reproduction (16/25) and an enhanced sex life (17/25). The method was rated to be as expected or better by the great majority. Health and most aspects of the men's sex life did not change, but the frequency of intercourse and the quality of sex life in general were higher (p = 0.001 and p = 0.006, respectively) during the efficacy phase compared to the recovery phase. The decrease during recovery phase may be explained by a pharmacological down-regulation of the androgen receptors. Eight of 22 men admitted slightly aggressive feelings during treatment. Five of 11 women reported the men as more self-assertive during the efficacy phase.