Life Situation Survey Research Articles

Universal Screening for Social Needs in a Primary Care Clinic: A Quality Improvement Approach Using the Your Current Life Situation Survey.

Kaiser Permanente's Care Management Institute created a screening tool, Your Current Life Situation (YCLS), which primarily is used to identify social needs for populations at risk of high health care utilization. This frontline improvement project was designed to address key stakeholder concerns about implementing universal screening for social needs using the YCLS in a primary care clinic. I conducted a rapid stakeholder analysis through informal conversations to identify the most important concerns. Four Plan-Do-Study-Act cycles were conducted to answer stakeholder questions and address concerns. Stakeholders expressed concerns including YCLS length and low screening acceptability and the possibility that too few or too many patients may have social needs. Throughout the project's duration, 125 office visits occurred and 111 patients were screened. Among the patients for whom findings were positive, 27% requested help. Of the 14 patients who were not screened, only 1 patient opted out of screening. Practitioners and medical assistants stated that administration of the YCLS screening tool did not disrupt clinic workflow. By using a frontline improvement approach, these investigators could answer questions and address concerns most important to local operational stakeholders when implementing screening for social needs. When practitioners conduct universal social needs screening and more fully understand social needs prevalence in a primary care clinic, resources can be tailored more effectively to accommodate patient needs.

Randomized trial on the effectiveness of long- and short-term psychotherapy on psychosocial functioning and quality of life during a 5-year follow-up

Knowledge is incomplete on whether long-term psychotherapy is more effective than short-term therapy in treating mood and anxiety disorder, when measured by improvements in psychosocial functioning and life quality. In the Helsinki Psychotherapy Study, 326 outpatients with mood or anxiety disorder were randomized to solution-focused therapy (SFT), short-term psychodynamic psychotherapy (SPP), or long-term psychodynamic psychotherapy (LPP), and followed up for 5 years from the start of treatment. The outcome measures comprised 4 questionnaires on psychosocial functioning, assessing global social functioning (Social Adjustment Scale (SAS-SR), sense of coherence (Sense of Coherence Scale (SOC)), perceived competence (Self-Performance Survey), dispositional optimism (Life Orientation Test (LOT)), and 1 questionnaire assessing quality of life (Life Situation Survey (LSS)). Short-term therapies improved psychosocial functioning and quality of life more than LPP during the first year. The only exceptions were LOT and perceived competence, which did not differ between SPP and LPP. Later in the follow-up, SOC and perceived competence showed significantly more improvement in LPP than in the short-term therapy groups. No direct differences between SFT and SPP were noted. Short-term therapy has consistently more short-term effects on psychosocial functioning and quality of life than LPP, whereas LPP has some additional long-term benefits on psychosocial functioning.

Mental health and quality of life after feminizing genitoplasty

PurposeThe aim of the study was to evaluate mental health and quality of life (QoL) aspects in women operated on because of disorders of sexual differentiation (DSDs) in childhood. MethodsQuestionnaires were mailed to 45 women older than 15 years who had been operated on because of DSD, of which 24 patients (53%) responded. Of these, 16 had been prenatally exposed to androgens. Eight females had 46,XY karyotype. Mental health was measured with the 90-item Symptom Checklist, QoL with the 20-item Life Situation Survey questionnaire, and health-related QoL (HRQoL) with the 15D questionnaire. ResultsThe QoL and HRQoL scores appeared normal in most of the patients. Furthermore, mental health of the patients was similar or better compared with previously published scores of a Finnish community sample in all dimensions (somatization, obsessive compulsivity, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychoticism). However, 5 patients had poorer scores in some of the 3 questionnaires. These 5 had either distressful memories because of a too-late operation, the operative treatment itself, or current poor sexual function. ConclusionsThe QoL, HRQoL, and overall mental health of female patients with DSD are usually normal.

De voorspellers van werkwens en werkzoekgedrag

Predictors of employment aspiration and job search behaviour Predictors of employment aspiration and job search behaviour A study was designed to make a pair-wise comparison between people with a high employment aspiration and an active job search behaviour on the one hand and their counterparts not wanting and not searching for work on the other hand. This comparison was made for three non-working groups: non-employed without social benefits, registered unemployed, and people receiving disability benefits. Data originate from the 1997-1999 years of the Dutch life situation survey. In almost all groups, being a male, young, highly educated and being involved in part-time education was found to be a strong predictor for employment aspiration and job seek behaviour. Household situation, health and social isolation, and private and leisure activities predicted employment aspiration and job search behaviour weakly. Our conclusion is that government policy should first of all concentrate on motivating organisations to attract women, elderly, and low educated, for instance by means of making appointments with employers and by offering more opportunities for part-time education. Next concentration on the personal motivation of non-working people may stimulate them to find a job.

Androgen Replacement in Adolescents and Young Women with Hypopituitarism

The aim of this study was to test the hypothesis that young women with androgen deficiency due to hypopituitarism would benefit from androgen replacement in the form of dehydroepiandrosterone (DHEA). Five young women, age 15.2-23.1 years, with panhypopituitarism were studied in a 12-month double blind placebo-controlled crossover trial of DHEA replacement in a dose 50 mg/day (Belmar Pharmacy, Lakewood, CO). All had growth hormone (GH), thyroid stimulating hormone (TSH), adrenocorticotropic hormone (ACTH) and antidiuretic hormone deficiencies. Gonadotropin deficiency was complete in three and partial in two. The patients were evaluated at baseline, 6 months and 12 months. Serum hormone levels, body composition, lumbar bone mineral density (BMD), exercise capacity and tests of psychological function were performed. DHEA replacement restored serum DHEA levels to normal, 359.8+/-337 ng/dl (12.5+/-11.7 nmol/l). The Life Situation Survey showed significantly better life satisfaction on DHEA than placebo (110 vs 102, p = 0.05). Trends for improved maximal oxygen uptake (VO2), and decreased percent body fat did not reach statistical significance. In conclusion, androgen replacement with DHEA should be considered in young women with panhypopituitarism. Further studies over longer periods in larger groups of patients are necessary to better evaluate the effects of DHEA replacement on BMD, muscle strength and body composition.

Are families with adolescents and young adults with cerebral palsy the same as other families?

This study compared adolescents with cerebral palsy (CP) and their families to adolescents without physical disabilities and their families as the child enters and leaves adolescence (age ranges 13 to 15 years and 19 to 23 years). Families of 90 individuals with CP (42 females, 48 males) and 75 individuals without physical disabilities (34 females, 41 males) participated. They completed the Family Assessment Device, Life Situation Survey, Multidimensional Scale of Perceived Social Support, and Future Questionnaire. There were few differences in family functioning, life satisfaction, or perceived social support between the groups. Expectations of young adults with CP and parents of both adolescents and young adults regarding future independence and success were lower than the expectations of the control group. While the group results emphasize similarities between families during the two stages of adolescence, individual families and individual family members report specific challenges.

Application of a Quality of Life Measure, the Life Situation Survey (LSS), to Alcohol‐Dependent Subjects in Relapse and Remission

Recent studies have shown that quality of life (QOL) is improved significantly when subjects do not relapse to heavy drinking, and QOL deteriorates significantly on prolonged relapse. This article further investigates these relationships using a QOL index, the Life Situation Survey (LSS). Eighty-two DSM-IV alcohol-dependent subjects admitted for alcohol detoxification were studied at baseline and 12 week follow-up. Sociodemographic data were collected, and severity of alcohol dependence (SADQ) and General Health Questionnaire (GHQ-12) were baseline indices only. The main outcome measure, the LSS, was administered at both time points. Two subjects were lost to follow-up and one died during the study period. Thus, the relapse/ nonrelapse analysis related to 79 subjects. Fifty subjects (63%) had relapsed to heavy drinking at 3 months follow-up. There was a significant correlation between LSS and GHQ-12 scores. Significant changes occurred in total LSS scores as a result of relapse and nonrelapse. The improvement in LSS scores associated with nonrelapse was larger than the deterioration that accompanied relapse. In those subjects who did not relapse to heavy drinking, the mean follow-up score remained in the poor/borderline LSS range. Remission from heavy drinking was accompanied by significant improvements in appetite, sleep, and self-esteem. Relapse to heavy drinking coincided with a significant deterioration in mood/affect, public support, and work/life role scores. QOL as assessed by the LSS in recently detoxified alcoholics is impaired significantly. In the nonrelapse group, there was a significant improvement in LSS scores after 3 months. Relapse was accompanied by a smaller deterioration in LSS scores. The LSS can play an important role in monitoring the clinical care and progress of alcohol-dependent subjects.

Application of a Quality of Life Measure, the Life Situation Survey (LSS), to Alcohol-Dependent Subjects in Relapse and Remission

Background: Recent studies have shown that quality of life (QOL) is improved significantly when subjects do not relapse to heavy drinking, and QOL deteriorates significantly on prolonged relapse. This article further investigates these relationships using a QOL index, the Life Situation Survey (LSS). Methods: Eighty-two DSM-IV alcohol-dependent subjects admitted for alcohol detoxification were studied at baseline and 12 week follow-up. Sociodemographic data were collected, and severity of alcohol dependence (SADQ) and General Health Questionnaire (GHQ-12) were baseline indices only. The main outcome measure, the LSS, was administered at both time points. Results: Two subjects were lost to follow-up and one died during the study period. Thus, the relapse/nonrelapse analysis related to 79 subjects. Fifty subjects (63%) had relapsed to heavy drinking at 3 months follow-up. There was a significant correlation between LSS and GHQ-12 scores. Significant changes occurred in total LSS scores as a result of relapse and nonrelapse. The improvement in LSS scores associated with nonrelapse was larger than the deterioration that accompanied relapse. In those subjects who did not relapse to heavy drinking, the mean follow-up score remained in the poor/borderline LSS range. Remission from heavy drinking was accompanied by significant improvements in appetite, sleep, and self-esteem. Relapse to heavy drinking coincided with a significant deterioration in mood/affect, public support, and work/life role scores. Conclusion: QOL as assessed by the LSS in recently detoxified alcoholics is impaired significantly. In the nonrelapse group, there was a significant improvement in LSS scores after 3 months. Relapse was accompanied by a smaller deterioration in LSS scores. The LSS can play an important role in monitoring the clinical care and progress of alcohol-dependent subjects.

What Happens to Patients Who Teach?

Background: Over the last 35 years, the use of lay people as teaching patients has evolved from novel to routine. Purpose: Although many studies have examined the effectiveness, reliability, and validity of using trained patients to evaluate medical students and residents, little is known about the effect on patients of being teachers. This study addresses that question. Methods: Patients-in-training with actual musculoskeletal conditions completed 3 questionnaires: the SF-36 to evaluate perceived health status, the Chubon Life Situation Survey to examine perceived quality of life, and 3 visual analogue scales to assess the relationships with their personal physicians. One year later, the same questionnaires were readministered to patients who were actively teaching and those who had dropped out of training. Results: In comparison to those who dropped out of training, patients who were actively teaching demonstrated a trend toward lower health status but higher quality of life; they also reported more satisfying relationships with their personal physicians. Conclusions: This study provides evidence that patient-teachers appear to benefit from teaching despite lowered health status. Similar to other studies, instructors' personal relationships with their respective physicians were positively influenced.

Quality of life measures and outcome in alcohol-dependent men and women

A sample of 82 (41 men 41 women) DSM IV alcohol-dependent inpatients admitted for detoxification was studied at baseline and followed-up 12 weeks thereafter. The following questionnaires were administered 4–5 days after admission for detoxification: Socio-demographic information, Severity of Alcohol Dependence Questionnaire (SADQ), Alcohol Problems Questionnaire (APQ), Rotterdam Symptoms Checklist (RSCL), Life Situation Survey (LSS), Beck Depression Inventory (BDI), General Health Questionnaire (GHQ 12), and Nottingham Health Profile (NHP). All indices other than socio-demographic data, the SADQ, and APQ were administered at 12-week follow-up. After controlling for confounding factors at baseline, women were more likely to be in a higher social class, prescribed anti-depressants during the previous 12 months, drink fewer units of alcohol in a typical week, and have a higher level of psychiatric caseness scores (GHQ-12). A total of 80 subjects (97%) were successfully followed-up. Difference between gender did not significantly impact upon any of the 12-week outcome measures. There was no significant difference in the study relapse rates or time taken to relapse between men and women. The only significant total sample change was a reduction in the amount of alcohol consumed in a typical week. This was significantly related to changes in the following Quality of Life (QoL) measures, NHP emotional reaction sub-scores, LSS, and BDI scores.

Quality of life measures in alcohol dependent subjects and changes with abstinence and continued heavy drinking.

This study evaluates the quality of life status of 39 male and 21 female Caucasian subjects admitted to a voluntary sector community alcohol detoxification unit. Baseline data including socio-demographics, severity of alcohol dependence and alcohol problems were collected 4-5 days following admission. In addition, the following measures were obtained: Rotterdam Symptoms Checklist, the Beck Depression Inventory, the General Health Questionnaire 12, Chubon's Life Situation Survey and the Nottingham Health Profile. Subjects were followed up at 12 weeks, and subdivided into two groups: relapsers and non-relapsers. A relapse was defined as drinking 21 or more units per week for men and 14 units or more per week for women over 7 consecutive days (1 unit is the equivalent of 8-10 g of absolute ethanol). Fifty-eight (97%) subjects were successfully followed-up, with 36 (62%) of the group relapsing to heavy drinking within 12 weeks. The results show that alcohol dependence is associated with a poor quality of life. Subjects rated poorly on the standardized questionnaires compared with the normative values for their reference populations. Relapsers and non-relapsers differed significantly in their life situation, depression, physical and psychological symptom total scores and the Nottingham Health Profile sub-score energy at 12 weeks compared with baseline, and these changes were investigated for each group. Within the relapse group a linear regression showed no association between any of the quality of life measures and time to relapse. Individual sub-score analysis of the Nottingham Health Profile results point to the importance of sleep, social isolation, pain, physical mobility and anergia in alcohol dependency. There was little change as a result of either not remitting or returning to heavy drinking and overall these findings confirm that alcohol dependent subjects have a poor quality of life.

Factors associated with the quality of life of long-term spinal cord injured persons.

The purpose of this study was to identify issues associated with quality of life after spinal cord injury. The Life Situation Survey, a subjective indicator of life quality developed to address issues in chronic disability, served as the primary assessment tool. Data were collected during personal interviews of 100 persons with spinal cord injuries. Educational level, employment status, income, and a number of social activities were found to be associated with perceived life quality. Most notable was a finding that lower ratings of quality of life were associated with greater severity of disability, which was contrary to conclusions drawn from other studies. A plausible explanation for the inconsistency may lie in the different approaches and instruments used to measure quality of life.

Distinction by consumption in Czechoslovakia, Hungary, and the Netherlands

In this paper I investigate the impact of educational heterogamy on culture consumption and the impact of both educational heterogamy and status inconsistency on material consumption. Data from the 1986 TARKI Survey on Social Stratification in Hungary, the 1984 Social and Class Structure Survey of Czechoslovakia, and the Dutch 1977 Life Situation Survey are analyzed. Several hypotheses are tested employing diagonal reference models including covariates. The analysis of culture consumption shows that most variance is captured by a 'status maximization model' for Czechoslovakia and Hungary. This model assumes that the partner with the higher education has the strongest impact. The Dutch data show a pattern which contradicts such an effect, i.e. if the education of the respondent is at a lower level than that of the spouse, the former's education prevails. The analysis of material life-styles shows that for the Dutch data there is a male-dominance effect. There is no such effect in the two East European countries. Additionally, using a new design for detecting statusinconsistency effects, several such effects for the Netherlands and Hungary become apparent. For the Netherlands under-rewarded couples in general (those with low income and relatively high education) tend to have an extra low level of material consumption and over-rewarded couples (those with high income and relatively low education) tend to have an extra high level of material consumption. For Hungary this inconsistency effect becomes even stronger the more status-inconsistent couples are. For Czechoslovakia no inconsistency effect could be detected.

Quality of Life Measurement of Persons with Back Problems: Some Preliminary Findings

Persons with back problems comprise one of the largest disability populations. This disability is one of the most difficult and challenging with which rehabilitation counselors must deal. Significantgaps exist with regard to understanding the complexities of the problem, making treatment even more difficult. In part, these deficiencies can be attributed to the lack of a comprehensive measurement approach for use with the population. The Life Situation Survey was developed for such a purpose, and an initial application sheds light on the impact of back problems. Scores reflecting perceived satisfaction of life quality obtained from a group of persons with chronic back problems were significantly lower than those of graduate level college students and were similar to those of prison inmates.

Redundancy analysis for qualitative variables

Redundancy analysis (also called principal components analysis of instrumental variables) is a technique for two sets of variables, one set being dependent of the other. Its aim is maximization of the explained variance of the dependent variables by a linear combination of the explanatory variables. The technique is generalized to qualitative variables; it then gives implicitly a simultaneous ‘optimal’ scaling of the dependent, qualitative variables. Examples are taken from the Dutch Life Situation Survey 1977, using Satisfaction with Life and Happiness as dependent variables. The analysis leads to one well-being scale, defined by the explanatory variables Marital status, Schooling, Income and Activity.