Several Domains Of Life Research Articles

Pain intensity is associated with self-reported disability for several domains of life in a sample of patients with musculoskeletal pain aged 50 or more

BackgroundMost studies that investigate the impact of pain on function have focused on a particular pain site and use unidimensional measures of disability, making it difficult to know how pain impacts on different areas of functioning and whether different pain characteristics impact differently on function. AimTo investigate the relationship between pain characteristics and self-reported disability in patients with musculoskeletal pain aged ≥50 years. MethodsTwo hundred and four consecutive patients with musculoskeletal pain aged ≥50 years had their pain assessed (frequency, global pain intensity, pain intensity for the most painful site, location and number of pain sites) and were asked to fill in the World Health Organization Disability Assessment Schedule (WHODAS 2.0) that assesses disability in 6 domains of daily life. ResultsMost patients reported chronic (77.5%), multisite or widespread (55.4%) pain that was always present (90.2%) and of moderate to severe intensity (mean score for global pain intensity = 5.91; SD = 2.02). Mean WHODAS 2.0 total score was 28.06 and SD was 19.86, corresponding to moderate disability. When entering age, sex, level of education, depression, number of comorbid chronic conditions and pain characteristics in a stepwise regression analysis, global pain intensity was the most important predictor for the domains of getting around (adjusted R2 = 0.21, p < 0.001), self-care (adjusted R2 = 0.14, p < 0.001), household activities (adjusted R2 = 0.20, p < 0.001) and work (adjusted R2 = 0.34, p < 0.001) and total score (adjusted R2 = 0.19, p < 0.001). ConclusionsPain intensity seems to be an important predictor of disability for several domains of life, suggesting that pain-related disability should be assessed for these domains.

Correlation between sleep parameters, physical activity and quality of life in somnolent moderate to severe obstructive sleep apnea adult patients

Several symptoms are described in obstructive sleep apnea (OSA), including excessive daytime sleepiness, depressive mood and neurocognitive dysfunction. However, few studies examined the relationship between objective physical activity, quality of life and sleep parameters. The purpose of this study was to determine sleep parameters (evaluated by actigraphy and polysomnography) implied in the occurrence of impaired physical activity and reduced quality of life in somnolent moderate to severe OSA patients. We reviewed retrospectively data of 75 somnolent moderate to severe (Apnea-Hypopnea Index > 20) OSA patients. Data of 5-days actigraphy and polysomnography were analysed. They all completed the Nottingham Health Profile questionnaire (NHP). Sleep parameters associated with physical activity and quality of life were assessed. Patients were mainly obese (mean BMI 36) and males (53 %). Controlling for age and BMI, physical activity, expressed as number of steps walked/day, is associated with OSA severity in REM sleep (p = 0.05). Subjective somnolence was not associated with reduced physical activity. Regarding quality of life, "sleep", "energy" and "emotional reactions" scored highest; and patients evaluated correctly their activity impairment through the "mobility" item of NHP questionnaire. Low level of physical activity is associated with increasing OSA severity in somnolent moderate to severe OSA patients but is not linked to subjective somnolence. These patients describe concomitantly a severely impaired quality of life in several domains, and the negative perception in the "mobility" domain is effectively related to an objective low level of physical activity.

Quality of life in patients with dysphagia after radiation and chemotherapy treatment for head and neck tumors

Objective: The aim of this study is to analyze subjectively, using the SWAL-QOL questionnaire, swallowing dysfunction and associated factors after treatment with radiotherapy and chemotherapy in patients treated for head and neck cancer. Material and Methods: This is a cross-sectional study, based on the selection of patients with tumors of the head and neck area, treated with radiotherapy with or without chemotherapy during the years 2000 to 2006 at the Oncology Institute of Juiz de Fora. The data were analyzed using SPSS 15.0 software, and were evaluated using the chi-square test to compare differences in proportions between groups. The statistical significance level was set at 5%. Results: It was observed that with respect to foods of solid consistency, there was a statistically significant difference for mouth tumors (p<0.01), with a tendency in this group to use softer foods, easier to chew (stews, boiled vegetables, creamy soups, canned fruit). With reference to the domains of the SWAL-QOL, the location of the tumor in the mouth was statistically associated with the lowest quality of life in the symptoms domain (p<0.05). The female gender variable was associated with the lowest perceived quality of life in several domains, namely swallowing (p=0.02); fatigue (p=0.008); symptoms (p=0.009). Age (split below and above 60 years) was not associated with differences in perceived quality of life in any domain. Conclusion: Tumor in the mouth and the total dose of radiation in the superior fossa were associated with the lowest quality of life in the symptoms domain. The female gender variable was associated with the lowest perceived quality of life in several domains This study shows that speech therapy should maintain a presence in the teams, to then guide the rehabilitation of organic dysphonia and mechanical dysphagia possibly afflicting patients after cancer treatment with radiation therapy and chemotherapy. Key words:Quality of life, dysphagia, head and neck neoplasms, rehabilitation.

A Longitudinal Cohort Study on Quality of Life in Stroke Patients and Their Partners: Restore4Stroke Cohort

Stroke is a major cause of disability in the Western world. Its long-term consequences have a negative impact on the quality of life of both the patients and their partners. The aim of the Restore4Stroke Cohort study is to investigate the changes in quality of life of stroke patients and their partners over time, and to determine factors predicting quality of life in several domains, especially personal and environmental factors. Multicentre prospective longitudinal cohort study. Inclusion and the first assessment take place during hospital stay in the first week post-stroke. Follow-up assessments take place at two months, six months, one year, and two years post-stroke. Recruitment of 500 patients from stroke units in six participation hospitals is foreseen. If the patient has a partner, he or she is also asked to participate in the study. The main outcome is quality of life, considered from a health-related quality of life and domain-specific quality of life perspective. Factors predicting long-term quality of life will be determined by taking into account the health condition (pre-stroke health condition and stroke-related health condition), personal factors (e.g. coping and illness cognitions), and environmental factors (e.g. caregiver burden and social support). This study is expected to provide information about the changes in quality of life of stroke patients and their partners over time. Furthermore, the identification of factors predicting quality of life can be used to improve rehabilitation care and develop new interventions for stroke patients and their partners.

Does higher income equal higher levels of happiness in every society? The case of the Mayan people

Guardiola J, González‐Gómez F, García‐Rubio MA, Lendechy‐Grajales Á. Does higher income equal higher levels of happiness in every society? The case of the Mayan peopleThis study analysed happiness and several domains of life of Mayan people in the poor rural areas of Yucatan, Mexico. Using a sample of 373 households, we examined the influence of income on happiness and its domains, obtaining results that lend support to the ‘paradox of happy peasants and miserable millionaires’. According to the results, income influences happiness among the Mayan people, as do material domains and health, but income does not influence the domains related to intangible feelings and public goods. A number of reasons, such as a lack of a means for comparison, close contact with nature, adaptation to deprivation, general material improvements compared with the past, low aspirations and a Mayan culture that is devoted to solidarity and enjoyment of social relationships, could explain why the sample population reported high levels of happiness. Although the Mayans' level of happiness is high, their situation nevertheless requires political attention.

Evaluating contemporary social exclusion in Europe: a hierarchical latent class approach

In recent years, the concept of social exclusion has received a renewed attention in scientific research, as well as in politics. In this contribution we propose a hierarchical Latent Class (LC) model for the analysis of differences and similarities about experiences and perceptions of social exclusion among European regions. Social exclusion is a situation that affects individuals, and derives from a multidimensional deprivation in several domains of life. In particular, we identify and define an economic, a social and an institutional dimension. The LCs, which structure the individuals with respect to a set of observed indicators, represent different typologies of social exclusion at individual level according to the three identified dimensions. The regional differences in the latent variable distribution are modeled following a nonparametric approach for the random effects. This multilevel extension leads to the identification of a typology of regions, allowing different social exclusion structures to stand out for different European areas. The hierarchical latent class approach proves to be profitable in investigating the relevance of different risk factors of social exclusion and their relationships, and in verifying whether, and to what extent, the same risks and disadvantages determine the same perception of marginalization and exclusion in different political, economic, social and cultural contexts. The analysis is carried out using the 56.1-2001 Eurobarometer Survey, which focused on poverty and social exclusion situations, from both a subjective and an objective point of view.

Health-Related Quality of Life of Patients Recieving Hemodialysis and Peritoneal Dialysis in São Paulo, Brazil: A Longitudinal Study

ObjectivesThe aim of this study was to evaluate quality of life in patients undergoing hemodialysis (HD) or peritoneal dialysis (PD) in São Paulo, Brazil. MethodsInclusion criteria for this is a 1-year prospective study included being 18 years of age or older and clinically stable receiving chronic dialysis. Quality of life was measured using the SF-12 and the Kidney Disease Quality of Life questionnaires at baseline, 6 months, and 12 months. Patients who completed the surveys for all three periods were evaluated. Differences in quality of life scores were measured using univariate and multivariate regression analyses. ResultsOne hundred eighty-nine of 249 (76%) HD patients and 161 of 228 (71%) PD patients completed all three surveys. The PD group was older and a larger number had diabetes. PD patients consistently had higher scores than HD patients at all three measurement periods for patient satisfaction (P = 0.002, P = 0.005, and P = 0.005, respectively), encouragement/support from staff (P = 0.003, P = 0.017, and P = 0.029, respectively), and burden of kidney disease (P = 0.003, P = 0.017, and P = 0.057, respectively). The HD group had a greater percent of patients who clinically improved from baseline to 12 months compared to PD patients for sleep quality, social support, encouragement/support from staff, and overall health. Scores for other dimensions of the Kidney Disease Quality of Life and SF-12 questionnaires were not significantly different between the PD and HD groups. ConclusionsThe results provide evidence that PD and HD patients have equivalent health-related quality of life in several domains, although the former performed better in some quality of life domains despite being older and having more comorbidities.

Impacto do cancro do osso e tecidos moles no ajustamento emocional e qualidade de vida

Introduction The aim of the present study was the comparison of emotional adjustment and quality of life (QoL) of bone and soft tissue cancer patients that were in different phases of the disease trajectory. Material and methods Fifty five patients between diagnosis and treatment initiation, 55 under treatment and 74 in follow-up consultations were assessed using self-report questionnaires. Seventy persons from the general population were used as control group. In the different phases of the disease the majority of patients revealed normal or mild levels of anxiety and depression but, an important minority showed moderate to severe levels. Results In general, the emotional distress of patients in each phase of the disease was not clinically relevant and was comparable to that of healthy individuals. Only patients under treatment exhibited significant higher levels of depression compared to survivors in the follow-up phase. In diagnostic and treatment phase patients reported a poorer perception of overall and physical QoL compared to survivors and healthy controls. The impact on QoL, in general, seems more marked in the treatment phase given the worse levels of functioning in several domains of life, and the higher experience of physical symptoms, mainly compared with the follow-up phase. Free-disease survivors showed a QoL comparable to that of healthy individuals, in its different dimensions. Conclusions The number of patients with significant levels of emotional distress (between 25% and 29.6% for anxiety, and 8.3% and 23.6% for depression), and the impact of bone and soft tissue cancer on QoL, mainly in diagnostic phase and during treatments, call to the need of implementing multidisciplinary interventions in patients with this specific cancer diagnose. These interventions should include a psychosocial component and be adapted to each phase of the disease trajectory.

P03-178 - Participation restrictions at work and at home in primary care patients

BackgroundHealth problems are often associated with activity limitations and participation restrictions (ICF, WHO, 2001). An example are problems at work or sick leave. The research question has been whether in these cases activity limitations and participation restrictions refer only to the workplace, or whether and to which degree other areas of life are similarly affected.MethodType and degree of participation restrictions in different domains of life were assessed in 382 primary health care patients (aged 18-65) with the IMET, a questionnaire which measures participation restrictions across several domains of life. Additionally, the patients were interviewed about health-related problems at work. IMET scores were compared between patients with and without health related problems at work.Results27% of 299 presently employed patients were suffering from workplace problems. These patients had significantly longer durations of sick leave than patients without problems at work and also reported significantly more problems in functioning in general daily activities.ConclusionWorkplace problems are a frequent topic in primary health care and related to sick leave. Health related problems at work are indicative for problems in functioning in other areas of life as well. Participation restrictions in non-work areas can be early indicators for participation problems at work.

Adding Consumer-Providers to Intensive Case Management: Does It Improve Outcome?

Adding Consumer-Providers to Intensive Case Management: Does It Improve Outcome?

Happiness in shrinking cities in Germany

After decades of urban growth, modern societies now face an increasing number of shrinking cities. What is the impact on the inhabitants of shrinkage of their city? Negative effects dominate in the public discourse, but does growth or shrinkage really matter for the livability in urban environment? In this paper, I take stock of the effect on subjective well-being in present day Germany. Overall satisfaction with life appears not to be lower in shrinking cities and satisfaction with several domains of life even higher. This is not because inhabitants are unaware of the situation of their city, since they appear to be more concerned about job-chances and crime.

Exploring health-related experiences of children and young people with congenital heart disease.

To determine the health-related experiences of children with congenital heart disease. Qualitative, semi-structured interviews. A purposive sample (N = 35) of children and young people, aged between 8 and 19 years, with a variety of congenital heart conditions recruited from one treatment care centre in the north of England. The main themes identified included: physical limitations of their condition; restrictions; attitudes of others; choices about information; coping with life and privacy. This study suggests that while many of this sample of children said that they coped well with their condition some children did experience significant impact on their quality of life in several domains. Children and young people identified a need for improved strategies to help them communicate about their condition with peers, schoolteachers and health-care professionals to allow a better understanding of what they are able to achieve.

Prevalence of Violence against Women: Distress, Coping and Psychological Well-Being. Surviving the Fire?

The aims of this study were to establish the prevalence of violence in a sample of women in the North West Province of South Africa, and to determine whether a higher frequency of experiences of violence are associated with more distress and differences in coping strategies and levels of psychological well-being. A stratified, random population-based sample of 387 participants completed several questionnaires in a cross-sectional survey design with the aid of trained fieldworkers who conducted the survey in the mother tongue of the participants. Questionnaires measured the frequency and kinds of violence experienced, distress symptoms, coping strategies, psychological well-being and quality of life experienced. Data on the relevant variables were also gathered in four in-depth individual interviews and a focus group discussion. The results indicated that 62% of women in the sample had experienced some form of violence in relationships and 42% experienced violence on a regular basis. This study adds data on the epidemiology of various types of violence against women in South Africa. Women who had experienced violence, and more so, women who had experienced a higher frequency of violence, showed more distress symptoms, lower levels of psychological well-being and a lower quality of life in several domains of life, than women who had no or less experience of violence. However, even those women who experienced high levels of violence managed to maintain some strengths and constructive coping strategies that might have helped them to survive. It is indicated that identifying and building psychological strengths in women from a positive psychology perspective may add value to current interventions and preventative efforts.

The Influence of Conflict Context Characteristics on Conflict Regulation Preferences of Immigrants

Conflict regulation preferences of male immigrant Turks living in Germany were analyzed. The nature of social relationship between opponents (German or Turk as opponent) and conflict property (tangible vs. intangible) were systematically varied. Furthermore, acculturation preferences were measured both globally and across several domains of life. Results showed that immigrants’ conflict handling preferences varied along social relationship with opponent and along conflict property. Contrary to the assumptions underlying an acculturation perspective, there were no systematic relationships between conflict handling preferences and global or domain-specific acculturation preferences. However, irrespective of their heritage, a majority of the immigrants were familiar with the conflict regulation styles of their host society. This result suggests that behavioral acculturation often results in the acquisition of bicultural competence.

Differential Effects of Oral Estrogen Versus Oral Estrogen-Androgen Replacement Therapy on Body Composition in Postmenopausal Women

A decrease in lean body mass and increased fat characterize menopause, related to both aging and likely decreased hormone secretion. Estrogen/androgen (E/A) treatment not only relieves vasomotor symptoms in menopausal women but demonstrably reduces fat mass while increasing lean body mass. This 16-week, double-blind trial randomly assigned 40 postmenopausal women (mean age 57 years) to receive either esterified estrogen alone (Estratab) in a dose of 1.25 mg daily (E group) or E/A therapy in the form of esterified estrogen plus 2.5 mg daily of methyltestosterone. The 37 women completing the study all had received estrogen for 3 months or longer. A double-dummy design was used to blind the study medication. In addition to anthropometric measurements, bone density was measured by dual-energy x-ray densitometry at the spine, hip, and forearm. The same technique provided estimates of fat mass, percentage of fat tissue, and lean body mass of the trunk and extremities. Muscle strength was estimated by weight lifting. The two treatment groups were demographically comparable. E/A treatment increased lean body mass in the trunk and extremities significantly more than estrogen alone. Body fat percentage declined significantly in the E/A group only. The difference between groups was significant for lean body mass and percentage of fat tissue when analyzing changes in the arms, legs, and trunk simultaneously. Body weight increased with E/A treatment by 2.7 pounds on average, and skin-fold thickness decreased. Upper- and lower-body strength increased with E/A treatment. Lower-body strength did not increase significantly with estrogen alone. Serum estradiol levels increased similarly in the two groups after 16 weeks. Percentage of free testosterone increased more in the E/A group, and luteinizing hormone and sex hormone-binding globulin values decreased significantly more in this group than in women given estrogen alone. Women given E/A therapy had significant reductions in total and high-density lipoprotein cholesterol and triglycerides, with no substantial change in low-density lipoprotein cholesterol. Low-density lipoprotein cholesterol fell significantly in the estrogen-only group. Several measures of sexual function demonstrated increases in frequency of sex, pleasure, and orgasms in women given E/A treatment. Changes were significantly more marked than in the estrogen group. Women in both groups exhibited an improved quality of life in several domains, including cognition, anxiety, depression, and vasomotor/sleep problems. Three women withdrew because of side effects, but no clinically significant liver dysfunction was observed. Postmenopausal women in good general health gained an improved body composition in this trial after 4 months of estrogen/androgen therapy. Muscle strength also improved, and these women seemed to have an improved quality of life and better sexual function compared with those given estrogen alone.

Quality of life and its measurement in children

The concept and definition of quality of life have not been co-ordinated yet, so measurement indicators have not been. The concept of quality of life is mostly understood as a multidimenstional construct reflecting several domains of life. Quality of life in general includes all factors influencing person's life (economic, political, religious), while health related quality of life includes only factors which influence health. Each domain is measured separately by most authors, which is followed by transformation of every domain into a quantitative value. Quality of life measurement in children population is associated with numerous difficulties. As for adults, measuring quality of life in children must include measuring health status, so a comprehensive generic instrument must include full spectrum of health status. Beside that, these instruments must be applicable study for children of different gender, age and culture. Those who design a must consider who is the most appropriate respondent (child or parent), what is the optimal mode of administration, whether respondent will understand questions and whether questionnaire length is appropriate. Quality of life is getting a more and more important place in medical investigations. Quality of life measurement in children population is still insufficiently explored and associated with numerous methodological problems. The existing instruments for quality of life measurement in children significantly differ, and their selection must depend on their psychometric characteristics.

Why do patients with rheumatoid arthritis use alternative treatments?

The aim of this study was to analyse the characteristics of patients with rheumatoid arthritis (RA) who make use of alternative or complementary medicine (CM). Two hundred and sixty-two randomly chosen patients with RA filled out self-assessment health status and pain questionnaires. Differences between the group of patients making use of both CM and conventional treatment (n = 52) and the group of patients who relied only on conventional treatment prescribed by their rheumatologists (n = 210) were explored with respect to demographic characteristics, duration of RA, levels of physical, psychological and social functioning, and pain-coping behaviour. We found that female patients used CM more often than did male patients, and those who used CM were younger than those who did not. There were no differences with respect to duration of RA, physical, psychological or social functioning or pain coping; however, the perceived impact of RA on several domains of life was higher in patients who used CM than in those who did not. Nevertheless, the patient groups did not differ in terms of medical consumption, except that those who used CM visited medical specialists for RA-related complaints less than those who relied only on conventional treatments. We concluded that the higher impact of RA, in the absence of worse disease, perceived by users of CM in several domains of life, especially psychosocial functioning, could be the reason they use CM. This suggests that CM cannot be substituted by additional conventional treatment prescribed by the rheumatologist, but rather by psychosocial intervention.

Involvement in decision-making and breast cancer survivor quality of life

Advances in treatment for breast cancer have improved women's chances of surviving this disease, while giving patients more treatment options than in the past. This study examined the influence of patient involvement in decision-making on survivor quality of life. A prevalence sample of breast cancer survivors were interviewed about their involvement in decision-making about their cancer treatment and follow-up care. A series of multivariate regression analyses were then conducted to examine how involvement in decision-making about cancer treatment and follow-up care contributed to survivor quality of life. Analyses revealed involvement in decision-making about the use of testing for recurrent disease (TFR) as part of follow-up care is associated with improved quality of life in several domains (p < 0.05). This association of improved quality of life with involvement in decision-making about follow-up TFR was independent of associations of quality of life with surgical treatment received, involvement in decision-making about surgical treatment, frequency of TFR, use of mammography, age, income, education, and years since diagnosis. This suggests that efforts to increase patient involvement in decision-making about follow-up care may improve quality of life for breast cancer survivors.

Psychosocial adjustment in patients after a first acute myocardial infarction: The contribution of salutogenic and pathogenic variables

Objective: To ascertain the differential and independent impact of sociodemographic, medical, and psychologic variables assessed at patients' hospital discharge on these patients' psychosocial adjustment in several domains of life 3 to 6 months later. Design: Two-hundred ninety Israeli male patients, aged 30 to 65 years, with a documented first acute myocardial infarction (AMI) were interviewed once before discharge and again 3 to 6 months postinfarct. Sociodemographic, medical, and psychologic data were elicited at the first interview and completed from medical information in the hospital files. Psychosocial adjustment in seven significant life domains was evaluated by the Psychosocial Adjustment to Illness Scale-Self-Report Version (PAIS-SR) at the second interview. Hierarchical regression analysis was used to examine the relation between the sociodemographic, medical, and psychologic variables at discharge to psychosocial adjustment in the different life domains 3 to 6 months later. Results: Psychologic variables, such as depression, sense of coherence, and social support, and the sociodemographic variable of educational level at discharge predicted a relatively substantial amount of variance in psychosocial adjustment in most PAIS-SR-measured life domains. Low to moderate relations were found between such medical variables as Killip class, heart disease before AMI, other medical conditions, and perceived health before first AMI and psychosocial adjustment in specific life domains. The results also raised the possibility that part of the impact of the medical variables at discharge on psychosocial adjustment 3 to 6 months later may have been mediated by the psychologic variables. The centrality of the psychologic and domestic life domains to psychosocial adjustment in post-AMI patients was also suggested by the results. Conclusions: Both external and internal pathogenic (depression) and health proneness variables (sense of coherence and social support) at discharge predict psychosocial adjustment in most life domains 3 to 6 months after AMI.

Quality of life 4 years after stroke.

The quality of life for 46 stroke survivors under the age of 65 years in a stroke register was studied 4 years after their first stroke. A questionnaire covering four domains of life (working conditions, activities at home, family relationships, and leisure time activities) was used for investigation of the quality of life. The results showed that in spite of a good recovery in terms of discharge from the hospital, activities of daily living, and return to work, the quality of life of most patients (83%) had not been restored to the prestroke level. Deterioration among the several domains of life ranged from 39% to 80%, the lowest being in the domain of activities at home and the highest in the domain of leisure time activities. Hemispheral localization of the lesion, paresis, coordination disturbances, and especially subjective tendency to depression were highly correlated with a deterioration in the quality of life. Dependence in activities of daily living and an inability to return to work were also associated with the lack of restoration. Our results suggest that much more attention should be paid to the quality of life of stroke patients.