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PubMed2005

Development and validation of a French obesity-specific quality of life questionnaire: Quality of Life, Obesity and Dietetics (QOLOD) rating scale.

OBJECTIVE: To develop and validate a new health related quality of life (HRQOL) questionnaire specific to obesity and its management. METHODS: This study was in two parts. The first (Study 1) consisted of the creation of a new tool derived from the American "Impact of Weight on Quality of Life Questionnaire" (IWQOL, 74 items) by adding to it a 17 items specific complementary module. This initial questionnaire (91 items) was reduced so as to obtain a questionnaire adapted to socio-cultural factors of obesity and dietary weight management in France. The objective of the second (Study 2) was to validate this final questionnaire by evaluating its psychometric properties: construction validity, internal reliability, concurrent validity in relation to a generic questionnaire, the SF-12, clinical validity by studying the effects of age, gender and body mass index (BMI), and reproducibility. RESULTS: The results of Study 1, obtained in 128 obese patients (mean age: 42.5 12.1, BMI: 34.5 2.8 kg/m2, women: 83.6%) enabled reduction of the 91 questionnaire items to 36, grouped into 5 dimensions: physical impact, psycho-social impact, sex life, comfort with food and diet experience. Two hundred and twelve patients (mean age: 43.3 12.2, BMI: 35.8 7.4 kg/m2, women: 77.7%) were included in Study 2, among whom 75 filled out the questionnaire twice at a one week interval. Analyses enabled verification of the construction validity and internal reliability (Cronbach alpha > 0.7) of the questionnaire as well as its concurrent validity in relation to summarized SF-12 scores and its clinical validity. The "physical impact" dimension was significantly influenced by BMI and age, the dimensions "sex life" and "diet experience" by the factors gender and BMI, while "psycho-social impact" was influenced by the 3 factors cited. Its reproducibility was also deemed satisfactory (intra-class correlation coefficient > 0.8). CONCLUSION: This new questionnaire, called the "Echelle Qualité de Vie, Obésité et Diététique (EQVOD)"/"Quality of Life, Obesity and Dietetics (QOLOD)" rating scale is sufficiently reliable and reproducible to be used in clinical practice. It is a simple tool adapted to socio-cultural factors of obesity in France, enabling taking into account of the effects of dietary management on the HRQOL of obese people.

Activities of Daily Living↗
PubMed2001

Life events, difficulties and onset of depressive episodes in later life.

BACKGROUND: The importance of stressful life events and long-term difficulties in the onset of episodes of unipolar depression is well established for young and middle-aged persons, but less so for older people. METHOD: A prospective case-control study was nested in a large community survey of older people. We recruited 83 onset cases during a 2-year period starting 2 1/2 years after the survey, via screening (N = 59) and GP monitoring (N = 24), and 83 controls, a random sample from the same survey population. We assessed depression with the PSE-10 and life stress exposure with the LEDS. RESULTS: Risk of onset was increased 22-fold by severe events and three-fold by ongoing difficulties of at least moderate severity. Severe events accounted for 21% of all episodes but ongoing difficulties for 45%. The association of onset with life stress, often health-related such as death, major disability and hospitalization of subject or someone close, was most pronounced in the cases identified by screening. While a clear risk threshold for events was found between threat 2 and 3 (on a scale of 1-4), the risk associated with difficulties increased more gradually with severity of difficulty. Compared with controls, severe events involved a larger risk for cases without a prior history of depression (OR = 39.48) than for cases with (OR = 8.86). The opposite was found for mild events (OR = 2.94 in recurrent episodes; OR = 1.09 in first episodes). The impact of ongoing difficulties was independent of severity of episode and history of depression. CONCLUSION: Although the nature of life stress in later life, in particular health-related disability and loss of (close) social contacts, is rather different from that in younger persons, it is a potent risk factor for onset of a depressive episode in old age. Severe events show the largest relative risk, but ongoing difficulties account for most episodes. The association of severe events with onset tends to be stronger in first than in recurrent episodes. Mild events can trigger a recurrent episode but not a first one.

Aged↗
PubMed2004

Half-life of leu-enkephalin in the serum of infants of the first year of life on different types of feeding: relationship with temperament.

The half-life of leu-enkephalin in the serum of infants aged under 1 year is significantly shorter than in adults. In girls leu-enkephalin half-life is significantly longer than in boys. The half-life of leu-enkephalin is different in infants on breast and formula feeding. Nine characteristics of temperament in infants of the first year of life were determined using EITQ and ITQ questionnaires. Serum leu-enkephalin half-life directly correlated with temperament characteristics (activity, perception, threshold), but not with the level psychomotor development.

Adult↗
PubMed2003

[Quality of life of children and adolescents with psychiatric disorders. Results of the 1st multicenter study with an inventory to assess the quality of life in children and adolescents].

OBJECTIVE: A newly developed, disorder-nonspecific instrument to measure the quality of life in children and adolescents (ILK, Mattejat et al., 1998) was tested with regard to its ability to differentiate between psychiatric in- and outpatient samples. METHODS: 626 children and adolescents from regionally different in- and outpatient clinics completed the ILK questionnaire. The data obtained were first described and then analyzed by means of logistic regression analysis. RESULTS: Whereas the descriptive analysis revealed that inpatients evaluated all areas of life more unfavorably than outpatients did, the logistic regression analysis modified these results. It became evident that some of the findings obtained were due to the effects of age and/or gender. However, given age and gender as covariates, there still remained some important life domains in which inpatients were more impaired than outpatients. CONCLUSIONS: The ILK turned out to be an efficient and economic instrument to measure the quality of life in children and adolescents depending on the severity of their disorder. Moreover, it is sensitive to effects of age and gender. As the ILK is able to reliably identify areas with a reduced quality of life, it offers valuable starting points for indications, therapy planning and initial therapeutic interventions.

Activities of Daily Living↗
PubMed1988

Major life events, hassles, and adaptation in adolescence: confounding in the conceptualization and measurement of life stress and adjustment revisited.

Prior work has suggested that methodological and conceptual confounding may play a role in the associations obtained between stressful life events, social resources, and adaptive outcome. Of particular concern in our work were (a) the source and method of assessment; (b) conceptual overlap between life stress and resource items and symptoms of disorder; and (c) induced response bias through the instructional sets of the stress measures. A second goal was to extend our understanding of the life stress-adjustment linkage in groups for whom little data of this type exist. By using multi-trait-multimethod procedures we found that both distal major life events and proximal daily stressors had important degrees of unique and shared variance with adaptive functioning, whereas the effects for social support were inconclusive. Further, the importance of considering possible sources of potential confounding in producing quite different levels of association between life stress and adaptation was underscored by the results.

Adaptation, Psychological↗
PubMed1990

Life stressors, social resources, and late-life problem drinking.

Life stressors and social resources among late-middle-aged problem and nonproblem drinkers were studied. Problem drinkers (n = 501) reported more negative life events, chronic stressors, and social resource deficits than did nonproblem drinkers (n = 609). In a comparison of problem drinkers, men reported more ongoing stressors involving finances and friends, and fewer resources from children, extended-family members, and friends than did women. Women who are problem drinkers reported more negative life events, more ongoing difficulties with spouses and extended-family members, and fewer resources from spouses. Among both the problem and nonproblem drinkers, more stressors were associated with fewer social resources, but only within certain life domains. Late-middle-aged adults' chronic stressors and social resources helped explain their drinking behavior, depression, and self-confidence even after sex, marital status, and negative life events were considered.

Age Factors↗
PubMed2002

Areas of concern, quality of life and life satisfaction in patients with peripheral vascular disease.

OBJECTIVES: to explore the ways in which peripheral vascular disease subjectively affect patients and to relate these findings to validated measurements of quality of life (QOL) and life satisfaction. DESIGN: a cross-sectional study. SUBJECTS: eighty patients, with carotid artery stenosis (CAS), abdominal aortic aneurysm (AAA), intermittent claudication (IC) or critical limb ischaemia (CLI). METHODS: semi-structured interviews were used to explore the effect of the disease on the patients life situation. QOL was assessed by SF-36 and life satisfaction by LiSat-11. RESULTS: the SF36, LiSat-11 and our interview revealed two principal patterns: one for patients with CAS and AAA, and one for patients with IC and CLI. The interview revealed important areas affecting the vascular patient. Some of these areas: higher intellectual function, concern, sexual function, family concern and factors related to the operated areas were not covered by either the SF36 or the LiSat-11. CONCLUSIONS: for a full understanding of how peripheral vascular disease affects the individual, disease specific questions need to be added to generic QOL instruments and measurements of life satisfaction.

Adult↗
PubMedDate not supplied

Achieving quality care at the end of life: a focus of the End-of-Life Nursing Education Consortium (ELNEC) curriculum.

This article introduces the didactic content and teaching strategies presented in the End of Life Nursing Education Consortium (ELNEC) curriculum on the topic of "Achieving Quality Care at the End of Life." The American Association of Colleges of Nursing joined forces with the City of Hope National Medical Center to begin a national education initiative, entitled the, "End of Life Nursing Education Consortium" (ELNEC) (available: http://www.aacn.nche.edu/elnec/). Funded for nearly $3 million from the Robert Wood Johnson Foundation, ELNEC was launched in February 2000 as a consortium of many organizations to ensure a collective professional approach to improve end-of-life care. The ELNEC curriculum is a train the trainers course with the expectation that those trained in the ELNEC curriculum will disseminate knowledge related to end-of-life care.

Curriculum↗
PubMed2005

[Forgoing life-sustaining measures in patients at the end of life in the German-speaking part of Switzerland: results of a death certificate study].

BACKGROUND AND OBJECTIVE: There have not been any comprehensive data from German-speaking countries on the medical practice of withholding or withdrawing treatment at the end of life. This study from the German-speaking part of Switzerland provides the first in-depth analysis in this field. This study is based on data from this region and is a contribution to a large empirical research project on medical end-of-life decisions in 6 European countries (EURELD). METHODS: Continuous random samples (n = 4991) were taken from all deaths in the German-speaking part of Switzerland that had been reported to the Swiss Federal Office of Statistics between June and October 2001. Doctors who had been attending the deceased person were asked to complete mailed questionnaires, their replies being kept strictly anonymous. RESULTS: The response rate was 67 %. Medications were withheld or withdrawn in 48 % of all treatments forgone: among these, antibiotics accounted for 17 %. Other potentially life-sustaining medical measures forgone included artificial hydration (12 %), surgery (7 %), artificial feeding (6 %), chemotherapy (6 %), diagnostic tests (4 %), hospital admissions (3 %), renal dialysis (2 %), blood product infusions (2 %), intubation (2 %), ventilation (2 %), resuscitation (2 %), and radiotherapy (1 %). 43 % of all treatments were forgone in patients who died in hospital, 42 % in nursing homes, and 15 % at home. In almost three-quarters (73 %) of the treatments forgone, a primary-care doctor had ordered the treatment to be withheld or withdrawn. On average, forgoing treatment led to a life-shortening effect of more than one month in 8 % of all cases. The proportion was higher for renal dialysis (25 %), blood products infusion (18 %), and diagnostic tests (16 %). CONCLUSIONS: Forgoing life-sustaining medical treatment comprises a wide range of decisions taken in many different clinical settings. In most cases the likely lifespan is only slightly shortened.

Adolescent↗
PubMed1986

The effect of recent life events stress, life assets, and temperament pattern on cardiovascular risk factors for Akron City police officers.

Police officers, as a group, experience many occupational demands with physiological and psychological effects that could be harmful to their health. A primary objective of this study was to analyze specific behavioral and physiological risk factors that could lead to hypertension and accelerated coronary artery disease. Three hundred thirty-one male Akron City police officers participated in the study. A group of volunteer males (n = 48) who worked in city clerical jobs were used as controls. Questionnaires were administered in order to measure such behavioral variables as recent life change, life assets, and temperament pattern. Blood chemistry and physiological variables were also measured. The police officers had higher diastolic blood pressure (DBP), norepinephrine (NE) levels, and recent life change unit (LCU) scores than the control group. Increased hostility and depression scores were associated with higher DBP and recent LCU scores and lower life asset unit (LAU) scores. Individuals with higher "dominant" scores and moderate to high recent LCU scores had higher cardiovascular risk factors than those with moderate to high recent LCU scores who were ranked as "subordinate." Rotating shift workers had abnormally elevated NE levels, which, if not controlled, may lead to higher cardiovascular risk. Behavioral intervention programs have been introduced with the goals of reducing stress, increasing life assets, and teaching relaxation techniques.

Adult↗
PubMed2003

Effects of life-event stress and hardiness on peripheral vision in a real-life stress situation.

Previous research has only examined perceptual deficits that are hypothesized in a model of stress and injury under laboratory-induced stress conditions. The generalizability of findings from such induced-stress conditions is limited beyond the laboratory. The current research examined the influence of life-event stress and hardiness on peripheral narrowing in a real-life stress situation. Athletes completed life-stress and hardiness questionnaires, along with measures of state anxiety and peripheral vision. The stress condition was obtained by assessing the athletes within 2 hours of a competition. The real-life stress condition had a larger effect on state anxiety and peripheral narrowing than the laboratory-induced situations used in previous research, with effect sizes twice and three times as large as those reported in the literature. All athletes experienced significant reductions in peripheral vision prior to competition, regardless of life-event stress or hardiness levels.

Adaptation, Psychological↗
PubMed2005

The AIDS epidemic in the city of Copenhagen, Denmark: potential years of life lost and impact on life expectancy.

AIMS: This study seeks to describe the impact of AIDS on the city of Copenhagen by estimating potential years of life lost (PYLL) before the age of 65 years and to estimate the impact of AIDS deaths on life expectancy for males and females. METHODS: All AIDS cases reported to the national AIDS surveillance register for residents in the city of Copenhagen in the period 1983-98 were included. For comparative purposes data were obtained on six other causes of death: accidents, suicide, lung cancer, ischaemic heart disease, testicular cancer, and breast cancer. RESULTS: Overall, deaths from AIDS accounted for 8% of all PYLL in men and showed an increasing tendency from 1983 to 1991, when it became the leading cause of PYLL. AIDS had most impact in men in the age group 25-44 years and accounted for 29% of all PYLL in this group at the peak in 1993, decreasing significantly after the introduction of anti-retroviral treatments to 5% of PYLL in 1998. Other leading causes of PYLL, accidents and suicide, also showed a decreasing tendency over the years, but of a much smaller magnitude than AIDS. The impact of AIDS in women was more modest. In the entire study period suicide, accidents, and breast cancer were the leading causes of PYLL in women. It was shown that AIDS deaths at the top of the epidemic in 1991-95 were responsible for a loss of 0.76 years in life expectancy for men and 0.08 years for women. CONCLUSIONS: AIDS has had a considerable impact on potential years of life lost. A significant decline in AIDS deaths has been seen since 1995 with an effect on life expectancy for men in the city of Copenhagen.

Acquired Immunodeficiency Syndrome↗
PubMed2002

Initial assessment of a new instrument to measure quality of life at the end of life.

PURPOSE: We conducted this study to pilot a new multidimensional instrument to assess the quality of life at the end of life. METHODS: Items were derived from focus groups and a national survey identifying attributes of the quality of dying. Fifty-four items measured on a five-point Likert scale covered six domains. We administered the instrument to equal numbers of Veteran's Administration (VA) and university medical center outpatients with advanced serious illness. We assessed psychometric properties using factor analysis. RESULTS: Two hundred patients completed the instrument (response rate, 85%). Diagnoses included cancer (64%), congenital heart failure (CHF) (19.5%), end-stage renal disease (ESRD) (10%) and chronic obstructive pulmonary disease (COPD) (6.5%). Seventy-four percent were male, 64% were caucasian, and 34% African American. Item reduction and factor analysis yielded a final instrument with 24 items in 5 distinct domains (overall Cronbach a = 0.83). The first factor (6 items; a = 0.84) measured a sense of completion, particularly through contributions to others. The second factor (7 items; alpha = 0.77) measured relations with the health care system. The third factor (6 items; alpha = 0.77) measured preparation. The fourth factor (4 items; alpha = 0.77) measured symptom severity, and the final factor (2 items; alpha = 0.60) measured affective social support. CONCLUSIONS: We have developed a new instrument to measure the quality of life at the end of life that assesses empirically derived domains that are of demonstrated importance to dying patients, is acceptable to a seriously ill population, and exhibits excellent psychometric properties. Some items related to completion and preparation represent particularly new contributions to quality-of-life measurement.

Aged↗
PubMed2001

Gender differences in the relationship between marital status transitions and life satisfaction in later life.

This study examined life satisfaction among individuals who had undergone a transition in marital status and those whose marital status remained stable over a 7-year period. In particular, using data from a large-scale, longitudinal study we assessed life satisfaction as measured in 1983 and 1990 among 2,180 men and women between the ages of 67 and 102. Groups of individuals were identified on the basis of whether a spouse was present or absent at the two measurement points. This allowed for a classification of groups who experienced stability or transitions in marital status. Among those individuals whose marital status remained stable over the 7 years, women's life satisfaction declined and men's remained constant. Among those who experienced a transition--in particular, the loss of a spouse--a decline in life satisfaction was found for both men and women, decline being more predominant for men. In addition, men's life satisfaction increased over the 7-year period if they gained a spouse, whereas the same was not true for women. Generally, these findings imply that the relationship between marital status transitions or stability differs for men and women.

Aged↗
PubMed2005

How a complex life cycle can improve a parasite's sex life.

How complex life cycles of parasites are maintained is still a fascinating and unresolved topic. Complex life cycles using three host species, free-living stages, asexual and sexual reproduction are widespread in parasitic helminths. For such life cycles, we propose here that maintaining a second intermediate host in the life cycle can be advantageous for the individual parasite to increase the intermixture of different clones and therefore decrease the risk of matings between genetically identical individuals in the definitive host. Using microsatellite markers, we show that clone mixing occurs from the first to the second intermediate host in natural populations of the eye-fluke Diplostomum pseudospathaceum. Most individuals released by the first intermediate host belonged to one clone. In contrast, the second intermediate host was infected with a diverse array of mostly unique parasite genotypes. The proposed advantage of increased parasite clone intermixture may be a novel selection pressure favouring the maintenance of complex life cycles.

Animals↗
PubMedDate not supplied

Development of a novel scale to assess life fulfillment as part of the further refinement of a quality-of-life model for epilepsy.

We have been involved in developing a health-related quality-of-life model for use as an outcome measure in epilepsy. As part of the further development of this model, we have developed a measure of life fulfillment. This scale is based on methods previously described by Krupinski in 1980. The value of Krupinski's approach is the opportunity for patients to weight the numerous aspects of their quality of life and assess the discrepancy between their actual and desired circumstances. The life fulfillment scale has been shown to be reliable (alpha = 0.7) and valid. The scale is currently being applied to several clinical studies in epilepsy. We believe that the scale provides a valuable contribution to our health-related quality-of-life model.

Adolescent↗
PubMed1996

Quality of life and life satisfaction in families after a child has undergone corpus callostomy.

Epilepsy is a chronic neurological condition which can have a detrimen tal effect on patients' quality of life (QOL). We evaluated the overall satisfaction with QOL and changes in QOL in 25 families with children who had undergone corpus callostomy for severe epilepsy. The mean age of seizure onset was 3.4 years, and the mean period from seizure onset to operation was 5.2 years. Mean follow-up was 19.3 months. Twenty of 22 patients had various degrees of mental retardation. Mean reduction in severity of seizure activity was 64%. Nineteen of 25 (76%) parents were satisfied with the surgical result. Eighteen of 25 parents (72%) described a good level of satisfaction with their families QOL after callostomy. Reduction in severity of seizure activity was significantly correlated with how successful families considered the surgery to be and how satisfied they were with their QOL (r = 0.72 and 0.77, respectively). Life domains showing one greatest improvement after callostomy included level of self-care, family life, and school performance. Improvements in level of self-care, family life, and school performance were associated with higher levels of life satisfaction (r = 0.69, 0.60, and 0.59, respectively). Hyperactivity, attention span, and social skills improved significantly in 11 patients after surgery. Callostomy did not improve mental performance. We conclude that improved seizure control after callostomy is also associated with improved QOL.

Achievement↗
PubMed2026

Effect of Narrative-Based Palliative Care on Psychological Stress, Quality of Life, and End-of-Life Acceptance in Elderly Terminal Cancer Patients and Their Families.

ObjectiveThis study aimed to preliminarily evaluate the impacts of narrative-based palliative care on psychological stress, end-of-life acceptance, and quality of life in elderly terminally ill cancer patients and their family caregivers.MethodsThis single-center, small-sample randomized controlled study enrolled 50 elderly terminal cancer patients. Patients were randomly assigned to either the observation group or the control group (n = 25 each). The observation group received narrative-based palliative care, while the control group received routine standard care. Family psychological stress was assessed using the Relative Stress Scale (RSS), and patients' perceived stress was evaluated with the Perceived Stress Scale-10 (PSS-10). Caregiver satisfaction was measured using a hospital-developed questionnaire. Patients' quality of life was evaluated using the SF-36, Chinese Version of the Death Attitude Profile (DAP-C), and Pittsburgh Sleep Quality Index (PSQI), respectively.ResultsBaseline characteristics did not differ significantly between the two groups (P > .05). Post-intervention, the observation group demonstrated significantly lower psychological stress among family members and higher caregiver satisfaction (P < .05). Patients in the observation group reported better quality of life, improved sleep, and greater acceptance of death than those in the control group (P < .05).ConclusionAs a small-sample, single-center study, these findings offer preliminary evidence that narrative-based palliative care may reduce psychological stress in elderly terminal cancer patients and caregivers while enhancing patients' quality of life, sleep quality, and acceptance of death. However, the limited sample size, single-site design, and narrow inclusion criteria restrict generalizability. Larger multicenter trials are needed to confirm these results.

Humans↗