Positive functioning as an outcome in its own right.
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4201 to 4225 of 6,178Impact of functional results on quality of life after rectal cancer surgery.
Purpose: Quality of life is an important outcome measure that has to be considered when deciding treatment strategy for rectal cancer. The aim of this study was to find out the impact of surgery-related adverse effects on quality of life.
Methods: The RAND-36 questionnaire and questionnaires assessing urinary, sexual, and bowel dysfunction were administered to 94 patients with no sign of recurrence a minimum of one year after curative surgery. Results were compared with age-matched and gender-matched general population.
Results: Eighty-two (87 percent) patients answered the questionnaires. Major bowel dysfunction was as common after high anterior resection as after low anterior resection. Urinary complaints occurred as often after anterior resection as after abdominoperineal resection, but sexual dysfunction was more common after abdominoperineal resection. Overall, the patients reported…
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Jenkins V, Shilling V, Deutsch G, Bloomfield D, Morris R, Allan S, Bishop H, Hodson N, Mitra S, Sadler G, Shah E, Stein R, Whitehead S, Winstanley J (2006)MEDLINE-indexed journal, not yet read by usBritish journal of cancer275 citations A 3-year prospective study of the effects of adjuvant treatments on cognition in women with early stage breast cancer.
The neuropsychological performance of 85 women with early stage breast cancer scheduled for chemotherapy, 43 women scheduled for endocrine therapy and/or radiotherapy and 49 healthy control subjects was assessed at baseline (T1), postchemotherapy (or 6 months) (T2) and at 18 months (T3). Repeated measures analysis found no significant interactions or main effect of group after controlling for age and intelligence. Using a calculation to examine performance at an individual level, reliable decline on multiple tasks was seen in 20% of chemotherapy patients, 26% of nonchemotherapy patients and 18% of controls at T2 (18%, 14 and 11%, respectively, at T3). Patients who had experienced a treatment-induced menopause were more likely to show reliable decline on multiple measures at T2 (OR=2.6, 95% confidence interval (CI) 0.823-8.266 P=0.086). Psychological distress, quality of life measures and…
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Burden of care in families of patients with schizophrenia.
Background: Family caregivers of persons with schizophrenia and other disorders experience high levels of burden. Most studies of family burden in schizophrenia have taken place in developed countries. The current study examined family burden and its correlates in a medium income country in South America.
Method: Forty-one relatives of patients with schizophrenia who were attending a public mental health outpatient service in the province of Arica, Chile, were assessed on Spanish versions of the Zarit Caregiver Burden Scale.
Results: All caregivers show a very high degree of burden, especially mothers, older, with low educational level, without an employment and who are taking care of younger patients.
Conclusions: As developing country, Chile has a few national social welfare and community rehabilitation programs for relatives of psychiatric patients, especially in this part of the coun…
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Psychological adjustment of cancer caregivers with multiple roles.
Guided by the role strain and the role enhancement theories, this study examined the effect of caregivers' multiple roles, such as being employed and taking care of minors in their household, on their psychological adjustment. Of the caregivers who completed the American Cancer Society's Quality of Life Survey for Caregivers, 457 caregivers who were middle-aged (18-64) and provided complete data for the study variables were included in the analyses. The indicators of the outcome variables, namely, the levels of the caregivers' psychological adjustment, were cancer caregiving stress, management of meaning out of providing care, and negative and positive affect. Multivariate general linear modeling analyses revealed that employed caregivers who were also taking care of children reported higher levels of caregiving stress and negative affect. In contrast, employed caregivers who were not ta…
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Activity as a predictor of mental well-being among older adults.
This eight-year follow-up study examines the roles of physical and leisure activity as predictors of mental well-being among older adults born in 1904-1923. As part of the Evergreen project, 1224 (80%) persons aged 65-84 years were interviewed at baseline (1988), and 663 (90%) persons in the follow-up (1996). Mental well-being factors including depressive symptoms, anxiety, loneliness, self-rated mental vigour and meaning in life were constructed using factor analysis. The predictors of mental well-being included physical and leisure activity, mobility status and number of chronic illnesses. We used a path analysis model to examine the predictors of mental well-being. At baseline, low number of chronic illnesses, better mobility status and leisure activity were associated with mental well-being. Baseline mental well-being, better mobility status and younger age predicted mental well-bein…
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Religious coping is associated with the quality of life of patients with advanced cancer.
Background: For patients confronting a life-threatening illness such as advanced cancer, religious coping can be an important factor influencing their quality of life (QOL).
Objective: The study's main purpose was to examine the association between religious coping and QOL among 170 patients with advanced cancer. Both positive religious coping (e.g., benevolent religious appraisals) and negative religious coping (e.g., anger at God) and multiple dimensions of QOL (physical, physical symptom, psychological, existential, and support) were studied.
Design: Structured interviews were conducted with 170 patients recruited as part of an ongoing multi-institutional longitudinal evaluation of the prevalence of mental illness and patterns of mental health service utilization in advanced cancer patients and their primary informal caregivers.
Measurements: Patients completed measures of QOL (McGill…
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Breast cancer among Asian Americans: is acculturation related to health-related quality of life?
Purpose/objectives: To examine the association of acculturation with health-related quality of life (HRQOL) among Asian American breast cancer survivors.
Design: Cross-sectional.
Setting: Analysis of an Asian American subsample of breast cancer survivors from a larger multiethnic study.
Sample: 206 Asian Americans, including Chinese, Filipinos, Koreans, and Japanese. Most were diagnosed with early-stage breast cancer (stage 0-II) and were an average of 54 years old.
Methods: Participants completed a mailed questionnaire or answered a telephone survey in English, Mandarin, or Korean. HRQOL was measured using the Functional Assessment of Cancer Therapy Breast Version 4. Acculturation was measured using an eight-item scale adapted from Marin's Short Acculturation Scale.
Main research variables: HRQOL, acculturation, health insurance, life stress, and social support.
Findings: Acculturation …
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Living with chronic obstructive pulmonary disease: insiders' perspectives.
Aim: This paper reports a study of the experiences of older adults with severe chronic obstructive pulmonary disease, with the aim of gaining an understanding of how the disease had affected their lives.
Background: Chronic obstructive pulmonary disease is a major personal and public health burden and is the fifth cause of mortality worldwide. The brief encounters that healthcare professionals have with patients in hospitals, physicians' offices and other outpatient settings are insufficient to be able to truly understand the challenges that people face in the attempt to integrate a chronic illness into their lives. Previous qualitative studies on chronic obstructive pulmonary disease have tended to focus on specific problems associated with the disease, such as fatigue and social isolation.
Method: A hermeneutic phenomenological study was carried out with 10 older adults who participate…
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Long-term outcome after stroke: evaluating health-related quality of life using utility measurements.
Background and purpose: As stroke mortality rates decline, individuals are increasingly likely to live with their residual impairments and disabilities. Therefore, the quality of poststroke life is 1 of the pivotal topics that have to be considered beneath the functional outcome. However, data on health-related quality of life (HRQoL) have been infrequently used in stroke trials. The purpose of this study was to examine the long-term outcome (4 years after stroke) of HRQoL and to identify the determinants of HRQoL in stroke survivors.
Methods: Seventy-seven patients were included who were admitted to the Department of Neurology, Philipps-University Marburg, after experiencing an ischemic stroke, a transient ischemic attack, or a hemorrhagic stroke. All patients were examined by a physician, and assessment was performed using a standardized questionnaire. HRQoL was assessed using the Germ…
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Does who you marry matter for your health? Influence of patients' and spouses' personality on their partners' psychological well-being following coronary artery bypass surgery.
Research suggests that presurgical personality attributes influence postsurgical well-being in both patients and their spouses in the context of coronary artery bypass grafting (CABG) surgery. The authors hypothesized that a spouse's characteristics would influence a partner's psychological well-being, regardless of whether he or she was the patient or the caregiver. In this study, 111 male patients and their caregiver spouses completed measures of neuroticism, optimism, perceived marital satisfaction, and depression prior to elective CABG. Follow-up was conducted at 18 months. As expected, higher caregiver presurgical neuroticism predicted higher patient depressive symptoms at follow-up, with caregiver's concurrent 18-month affect controlled for. Likewise, higher patient presurgical neuroticism predicted higher caregiver depressive symptoms at follow-up. Additionally, higher patient pre…
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Predictors of health-related quality of life in obese youth.
Objective: Recent literature has documented the psychosocial consequences of pediatric obesity, including poor health-related quality of life (HRQOL). The present study examines HRQOL and its association with depressive symptoms and perceived social support in African-American and white youth pursuing weight management treatment.
Research methods and procedures: Study participants were 166 obese youth (mean = 12.7 years, 70% females, 57% African American, mean BMI = 37.0) referred to a pediatric weight management program. Parents of participants completed a demographics form and the parent-proxy Pediatric Quality of Life Inventory (PedsQL). Youth completed the Children's Depression Inventory, PedsQL, and Perceived Social Support Scale for Children.
Results: HRQOL scores were quite impaired relative to published norms on healthy youth (p < 0.001). Approximately 11% of the sample met crite…
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Understanding the determinants of health for people with type 2 diabetes.
Objective: We assessed which of a broad range of determinants of health are most strongly associated with health-related quality of life (HRQL) among people with type 2 diabetes.
Methods: Our analysis included respondents from the Canadian Community Health Survey Cycle 1.1 (2000-2001) who were aged 18 years and older and who were identified as having type 2 diabetes. We used regression analyses to assess the associations between the Health Utilities Index Mark 3 and determinants of health.
Results: Comorbidities had the largest impact on HRQL, with stroke (-0.11; 95% confidence interval [CI] = -0.17, -0.06) and depression (-0.11; 95% CI = -0.15, -0.06) being associated with the largest deficits. Large differences in HRQL were observed for 2 markers of socioeconomic status: social assistance (-0.07; 95% CI=-0.12, -0.03) and food insecurity (-0.07; 95% CI=-0.10, -0.04). Stress, physical ac…
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Stress and well-being among parents of children with rare diseases: a prospective intervention study.
Aim: This paper reports a study to assess stress, well-being and supportive resources experienced by mothers and fathers of children with rare disabilities, and how these variables were affected by an intensive family competence intervention.
Background: Despite diagnosis-specific studies, little overall knowledge exists about life-consequences for families of children with rare disorders.
Method: We used a prospective design with baseline data and two follow-ups (at 6 and 12 months) after an intervention. The intervention aimed at empowering parents in managing their child's disability. Parents from all parts of Sweden visiting a national centre for families of children with rare disabilities were consecutively selected (n = 136 mothers, 108 fathers). Instruments of parental stress, social support, self-rated health, optimism and life satisfaction and perceived physical or psychological…
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Assessing the impact of cancer: development of a new instrument for long-term survivors.
Objective: To develop and evaluate a new instrument that measures aspects of long-term survivorship not measured by existing tools.
Methods: In qualitative interviews, 47 long-term cancer survivors (LTS) detailed ways that cancer has impacted their lives. Content analysis resulted in the creation of 325 candidate items for inclusion in a new Impact of Cancer (IOC) instrument. Following expert review, item reduction and pilot testing, 81 items were administered with other established health status and quality of life (QOL) instruments to 193 LTS of breast, prostate, colorectal cancers and lymphoma. Internal consistency reliability and validity of newly-derived scales was assessed.
Results: Factor analysis of items using a priori QOL domains resulted in the derivation of ten new and specific subscales: Health Awareness, Body Changes, Health Worries, Positive and Negative Self-Evaluation, P…
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Cheung AM, Tansey CM, Tomlinson G, Diaz-Granados N, Matté A, Barr A, Mehta S, Mazer CD, Guest CB, Stewart TE, Al-Saidi F, Cooper AB, Cook D, Slutsky AS, Herridge MS (2006)MEDLINE-indexed journal, not yet read by usAmerican journal of respiratory and critical care medicine329 citations Two-year outcomes, health care use, and costs of survivors of acute respiratory distress syndrome.
Rationale: Little is known about the long-term outcomes and costs of survivors of acute respiratory distress syndrome (ARDS).
Objectives: To describe functional and quality of life outcomes, health care use, and costs of survivors of ARDS 2 yr after intensive care unit (ICU) discharge.
Methods: We recruited a cohort of ARDS survivors from four academic tertiary care ICUs in Toronto, Canada, and prospectively monitored them from ICU admission to 2 yr after ICU discharge.
Measurements: Clinical and functional outcomes, health care use, and direct medical costs.
Results: Eighty-five percent of patients with ARDS discharged from the ICU survived to 2 yr; overall 2-yr mortality was 49%. At 2 yr, survivors continued to have exercise limitation although 65% had returned to work. There was no statistically significant improvement in health-related quality of life as measured by Short-Form Genera…
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Low health-related quality of life among abused women.
In a cross-sectional study, we sent a self-administered questionnaire to all the women's shelters in Norway to describe health-related quality of life among women who had experienced violence from an intimate partner. Every woman who could understand Norwegian and was staying at a women's shelter in Norway for more than 1 week from October 2002 to May 2003 was asked to participate. We described violence by intimate partners by using the Severity of Violence against Women Scale and the Psychological Maltreatment of Women Index. We used the SF-36 Health Survey to measure health-related quality of life. These women experienced a multitude of threats and actual physical and psychological violence during their partnership. Their health-related quality of life was low and significantly (p<0.001) below the norm for the female population of Norway in all dimensions. The SF-36 mental health dimen…
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The contribution of marital quality to the well-being of parents of children with developmental disabilities.
Background: This study examines the contribution of the marital relationship to the well-being of both mothers and fathers of children with developmental disabilities. Parent well-being is conceptualized in terms of mental health, parenting stress and parenting efficacy.
Methods: These analyses are based on data from 67 families participating in the Early Intervention Collaborative Study, an ongoing longitudinal investigation of the development of children with disabilities and the adaptation of their families. Multidimensional assessment techniques were used to collect data from married mothers and fathers and their child with a disability. Mother and father data were analysed separately using parallel hierarchical regression models.
Results: For both mothers and fathers, greater marital quality predicted lower parenting stress and fewer depressive symptoms above and beyond socio-econom…
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Factors associated with caregiver reports of sleep disturbances in persons with dementia.
Objective: This investigation examined the relationship between caregivers' reports of sleep disturbances in persons with Alzheimer disease (AD) and actigraphic records of patients' sleep-wake activity, and explored the factors associated with discrepancies in this relationship.
Method: Forty-six patients with AD living with their caregivers participated. Before study entry, all caregivers reported poor patient sleep quality using the Neuropsychiatric Inventory (NPI) Nighttime Behavior Scale. Patient sleep-wake activity was recorded for one week using an Actillume wrist-movement recorder.
Results: Although all patients were reported by caregivers to have multiple sleep disturbances, 41% of patients had actigraphic sleep efficiencies in the normal range and 43% averaged eight or more hours of sleep nightly. In bivariate analyses, greater patient percent nighttime sleep (indicative of more…
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Arnow BA, Hunkeler EM, Blasey CM, Lee J, Constantino MJ, Fireman B, Kraemer HC, Dea R, Robinson R, Hayward C (2006)MEDLINE-indexed journal, not yet read by usPsychosomatic medicine346 citations Comorbid depression, chronic pain, and disability in primary care.
Objectives: The objectives of this study were to provide estimates of the prevalence and strength of association between major depression and chronic pain in a primary care population and to examine the clinical burden associated with the two conditions, singly and together.
Methods: A random sample of Kaiser Permanente patients who visited a primary care clinic was mailed a questionnaire assessing major depressive disorder (MDD), chronic pain, pain-related disability, somatic symptom severity, panic disorder, other anxiety, probable alcohol abuse, and health-related quality of life (HRQL). Instruments included the Patient Health Questionnaire, SF-8, and Graded Chronic Pain Questionnaire. A total of 5808 patients responded (54% of those eligible to participate).
Results: Among those with MDD, a significantly higher proportion reported chronic (i.e., nondisabling or disabling) pain than t…
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Quality of life among long-term survivors of breast cancer: Different types of antecedents predict different classes of outcomes.
Quality of life (QOL) has many aspects, both in the short-term and in the long-term. Different aspects of QOL may have different types of precursors: demographic, medical, and psychosocial. We examined this possibility in a group of long-term breast cancer survivors. Early-stage breast cancer patients (N = 163) who had provided information about medical, demographic, and psychosocial variables during the year after surgery completed a multidimensional measure of QOL 5-13 years later. Initial chemotherapy and higher stage predicted greater financial problems and greater worry about appearance at follow-up. Being partnered at diagnosis predicted many psychosocial benefits at follow-up. Hispanic women reported greater distress and social avoidance at follow-up. Initial trait optimism predicted diverse aspects of better psychosocial QOL at follow-up, but not other aspects of QOL. Thus, diffe…
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Insomnia comorbidity and impact and hypnotic use by age group in a national survey population aged 16 to 74 years.
Study objectives: To compare age-group differences in somatic/psychiatric comorbidity, impact, and pharmacotherapy associated with sleep disturbance across a broad adult age range.
Design: Cross-sectional national mental health survey.
Setting: Adults living in private households in England, Scotland, and Wales.
Participants: 8,580 people aged 16 to 74 years.
Measurements and results: Insomnia (4 symptom/syndrome definitions), depression, generalized anxiety disorder, and daytime fatigue were defined from the revised Clinical Interview Schedule. Any insomnia was reported by 37% of the sample, moderate insomnia by 12%, insomnia with fatigue by 13%, and symptoms fulfilling diagnostic criteria for primary/secondary insomnia by 5%. All categories of insomnia were associated with mental disorders, worse physical health, and fatigue to a similar degree in all decade age groups. The association…
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Brown SL (2006)MEDLINE-indexed journal, not yet read by usDemography70 citations Family structure transitions and adolescent well-being.
Using data from Waves 1 and 2 of the National Longitudinal Study of Adolescent Health, I extend prior research on family transitions and adolescent well-being by examining the influence of parental marital and cohabitation transitions on adolescent delinquency, depression, and school engagement. Adolescents who experienced a family transition reported decreased well-being, on average, relative to those in stable, two-biological-parent families. Specific comparisons of various types of family stability and change revealed that cohabitation is often associated with poorer outcomes. Moving out of a cohabiting stepfamily into a single-mother family was not harmful and was actually associated with improvements in school engagement. Moving into a cohabiting stepfamily from a single-mother family decreased adolescent well-being, and this impact was greater than that experienced by those who mov…
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Correlates of health-related quality of life in women with severe facial blemishes.
Background: Facial appearance plays a large role in self-perception and interaction with others. Visible facial skin lesions are a common condition. Purpose This study assessed factors associated with health-related quality of life (HRQOL) in women with visible facial skin lesions.
Methods: The study included 73 women with one or more of the following conditions: acne, dermatosis papulosis, hypopigmentation, lentigenes, melasma, rosacea, vascular proliferations and other facial scars. The Skindex-16 was used as a measure of HRQOL. Fear of negative evaluation (FNE) was assessed to determine whether self-perception characteristics relate to HRQOL.
Results: There were strong correlations in both bivariate and multivariate analyses among increased FNE, heightened perception of QOL without the facial condition and lower overall HRQOL (P< 0.05 and P< 0.01, respectively). There were no differen…
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Curvilinear associations between benefit finding and psychosocial adjustment to breast cancer.
Two previously studied cohorts of women with nonmetastatic breast cancer (Ns = 230 and 136) were reexamined. Participants were assessed during the year after surgery and 5-8 years later. Associations were examined between benefit finding (BF) and several indicators of psychosocial adjustment (e.g., perceived quality of life, positive affect, negative affect, social disruption, and intrusive thoughts). Significant curvilinear relations between BF and other outcomes were observed cross-sectionally during initial assessment and at long-term follow-up in both samples. Compared with the intermediate BF group, low and high BF groups had better psychosocial adjustment. Further analyses indicated that the high BF group reported higher optimism and more use of positive reframing and religious coping than the other BF groups. Discussion highlights the need to examine nonlinear as well as linear re…
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The importance of spirituality in the lives of domestic violence survivors.
Women with abusive partners utilize a variety of coping strategies to deal with and heal from the violence and sense of betrayal they have experienced. For many women, their trust in a higher power and the support they receive from their faith community is integral to their healing. Of 151 women interviewed for this study, the majority (97%) noted that spirituality or God was a source of strength or comfort for them. Extent of religious involvement predicted increased psychological well-being and decreased depression. For women of color, greater religious involvement was also related to increased social support. Implications for research and direct services are discussed.
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