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PubMed2006

Elderly veterans' beliefs concerning life-sustaining treatment and the control of their end-of-life health and health care.

OBJECTIVE: This study used qualitative methods to explore patients' beliefs about control of their end-of-life health and health care. METHOD: The authors recruited 30 elderly patients from a large, urban Veterans Administration medical center in the United States and engaged them in semistructured interviews about end-of-life care concepts. Using grounded theory methods, they coded, categorized, and compared responses. RESULTS: The authors discovered that patients' decisions about using life sustaining treatment were interconnected with their beliefs about their degree of control over circumstances and the role of external factors, including a higher power; institutions and individuals; medical interventions; medical conditions; and luck, chance, or fate. DISCUSSION: The results shed light on why patients do or do not take active roles in advance decisions concerning the use of life-sustaining treatment.

Aged↗
PubMed1996

Stress in the life course: a life history approach.

This article examines the relationship between stress and distress in the life course, emphasizing the time elapsed between the event and measurement of psychological distress. Stressors are conceptualized as either distal or proximal based on how recently they occurred. Distal stressors are further classified as status changes or undesirable life changes. Using a life history calendar approach, we examine stressors occurring over a 15-year-period. We explore whether distal stressors affect current depressive symptomatology above and beyond the effect of more recent stressors and how these stressors vary in frequency and affect over 3 empirically defined age groups. While some events decrease in frequency over age, others occur consistently across age groups. Most important, distal stressors significantly impact current depressive symptomatology, independent of proximal stressors. Types of distal stressors affecting depression vary over age, indicating that the stage of life at which a stressor occurs is a significant determinant of the stressor's effect on depression.

Adult↗
PubMed2006

Measuring health-related quality of life in young adolescents: reliability and validity in the Norwegian version of the Pediatric Quality of Life Inventory 4.0 (PedsQL) generic core scales.

BACKGROUND: Health-Related Quality of Life (HRQOL) studies concerning children and adolescents are a growing field of research. The Pediatric Quality of Life Inventory (PedsQL) is considered as a promising HRQOL instrument with the availability of age appropriate versions and parallel forms for both child and parents. The purpose of the current study was to evaluate the psychometric properties of the Norwegian translation of the Pediatric Quality of Life Inventory (PedsQL) 4.0 generic core scale in a sample of healthy young adolescents. METHODS: A cross-sectional study of 425 healthy young adolescents and 237 of their caregivers participating as a proxy. Reliability was assessed by Cronbach's alpha. Construct validity was assessed using exploratory factor analysis and by exploring the intercorrelations between and among the four PedsQL subscales for adolescents and their parents. RESULTS: All the self-report scales and proxy-report scales showed satisfactory reliability with Cronbach's alpha varying between 0.77 and 0.88. Factor analysis showed results comparable with the original version, except for the Physical Health scale. On average, monotrait-multimethod correlations were higher than multitrait-multimethod correlations. Sex differences were noted on the emotional functioning subscale, girls reported lower HRQOL than boys. CONCLUSION: The Norwegian PedsQL is a valid and reliable generic pediatric health-related Quality of Life measurement that can be recommended for self-reports and proxy-reports for children in the age groups ranging from 13-15 years.

Adolescent↗
PubMed1999

The applicability of quality-of-life assessment in palliative care: comparing two quality-of-life measures.

Two self-administered quality-of-life measures, the McGill Quality of Life Questionnaire (MQOL) and the Patient Evaluated Problem Scores (PEPS) were compared in patients receiving palliative care. The MQOL is a multidimensional questionnaire consisting of 16 items in five quality-of-life (QOL) domains: physical symptoms, physical well-being, psychological, existential and support domains. The PEPS is an individualized questionnaire asking patients to identify and rate major problems affecting their QOL. Both questionnaires were completed by 36 patients during outpatient clinic visits in three palliative care settings in Wales. Of those patients who stated their questionnaire preference 60% favoured MQOL due to its comprehensiveness, while others (28%) preferred PEPS due to its simplicity. The MQOL showed excellent internal consistency (alpha = 0.90). The intrapatient analysis of answers from both questionnaires showed that MQOL was better than PEPS in reporting physical symptoms and support domain, while PEPS detected more psychosocial issues. The MQOL overall QOL score correlated highly with its existential domain (rs = 0.57, P < 0.0005) and the PEPS overall quality of life (rs = 0.77, P < 0.0005). Similarly, the PEPS overall QOL correlated well with MQOL total score (rs = 0.76, P < 0.0005) and existential domain of the MQOL (rs = 0.63, P < 0.0005). The findings support the importance of an existential domain in assessing the QOL of this population. Both MQOL and PEPS were found to be relevant and acceptable in advanced cancer patients receiving palliative care. However, with its favourable psychometric properties MQOL may be more suitable for QOL assessment in this population.

Adolescent↗
PubMed1998

[Effect of mobile phone on life-saving and life-sustaining systems].

Since the beginning of the nineties there have been warnings not to use mobile phones in the vicinity of medical devices. Functional failures of dialysis machines, respirators and defibrillators prompted the banning of their use in many hospitals in Scandinavia, and then in other countries. Since we believe that a general ban in hospitals is problematic, we decided to investigate the influence of mobile telephone on life-saving and/or life-support systems, with the aim of establishing rules for its use in hospitals. We investigated available phones of varying power of the C-, D- and E-net, as also of a cordless phone meeting the DECT standard. The aim was to identify the devices susceptible to interference and determine the minimum distances at which interference occurred. A total of 224 devices classified into 23 types of devices were examined. Nine different sets of transmission conditions were applied, giving a total of 2016 tests. Our results permit the conclusion that the ban on mobile phones in hospitals is based not on actual events, but on theoretical considerations in the absence of any practical information on the actual susceptibility of devices and their reaction to the electromagnetic fields involved. The fact that hazardous situations are very rare is due firstly to the need for the simultaneous occurrence of four coincidences, and the fail-save feature of medical devices. We would therefore recommend that all life-saving and life-support systems that can also be used outside the hospital should be made mobile phone-proof. When apnoea monitors and respirators are protected from such interference, hazardous situations could be avoided by establishing the rule: "No portables, and mobile phones only at a distance of at least 1 metre from medical devices". With regard to emergency telephones, the minimum distance to medical devices should be at least 1.5 metres.

Electromagnetic Fields↗
PubMed2002

The effects of constant and alternating temperatures on the reproductive potential, life span, and life expectancy of Anastrepha fraterculus (Wiedemann) (Diptera: Tephritidae).

Ovarian development, oviposition, larval eclosion, ornithine decarboxylase (ODC) activity, ovarian, testis and ejaculatory apodeme measurements (length, width, and area), and the number of spermatozoa of Anastrepha fraterculus (Wiedemann) were analyzed at alternating (20 degrees/6 degrees C and 20 degrees/13 degrees C) and constant (6 degrees C; 25 degrees C) temperatures. Life span and life expectancy were also analyzed for both genders. All the results suggest that temperature, especially alternating temperatures, increase not only male and female reproductive potential but also their life span and life expectancy. These changes can be a powerful strategy triggered by A. fraterculus as a means to survive the stressful temperature conditions found in winter in the apple production region in Brazil, enabling this species to increase its population density and cause apple damage when spring begins.

Animals↗
PubMed2001

Factor analytic properties of the Quality of Life Profile: examination of the nine subdomain Quality of Life Model.

The Quality of Life Profile is a 54-item multidimensional measure of quality of life. The measure is based upon a theoretical approach that considers quality of life to include satisfaction with nine subdomains of functioning. To date, the factor structure of this 54-item collection has not been examined. To do so, an examination was made of the factor structure that emerged from an administration to 219 gay men, half of whom were HIV+. Analysis indicated that seven subdomains were clearly represented in seven of the 11 factors that emerged. One subdomain was fractured into two factors and one subdomain did not appear in the factor structure. Two minor factors appeared to represent issues that may be especially important to gay men living in the HIV era. The study provides insights into the structure of quality of life among gay men living in Ontario.

Adult↗
PubMed1992

Quality of life during chemotherapy for small cell lung cancer. II. A longitudinal study of the EORTC Core Quality of Life Questionnaire and comparison with the Sickness Impact Profile.

Sixty-two patients with small cell lung cancer, 36-80 years of age, who were receiving chemotherapy during a maximum of one year, were consecutively included in a study of quality of life during treatment. An interim version (C-36) of the EORTC Core Quality of Life Questionnaire (QLQ) was applied for quality of life assessment prior to treatment and every third month during the treatment period. The assessments were related to clinical variables (performance status and tumour response), and compared with results from assessment with the Sickness Impact Profile (SIP). The QLQ was sensitive to differences in clinical status and responded to clinical change over time. In general, the pattern of correlations with SIP lends support to the construct validity of the QLQ. However, some questions arose from the comparison with SIP: QLQ emotional functioning did not change in concordance with SIP, and assessment of social functioning was not optimal prior to treatment. The questionnaire was well accepted by the patients. The EORTC QLQ C-36 constitutes a promising step in the development of a feasible standard instrument for quality of life assessment in cancer clinical trials.

Aged↗
PubMed1994

Detoxification from methadone maintenance treatment in Sweden: long-term outcome and effects on quality of life and life situation.

Of 59 subjects who have undergone voluntary and serious attempts to terminate methadone maintenance treatment (MMT) within the framework of the Swedish methadone program, 50 could be reached for an interview. Of these, 25 were classified--with some reservations--as successful (Group 1), i.e., they lived opiate-free and to all appearances well-ordered lives. The other 25 had failed in their attempts (Group 2) and were all in methadone treatment, most functioning well. A comparison was made between the two groups with regard to change in perceived quality of life and actual life situation from the time before the detoxification attempts were begun (Period 1) until the time preceding the interview (Period 2). The results indicate that Group 1 has achieved a higher quality of life and a more stable actual life situation compared with Group 2.

Adaptation, Psychological↗
PubMed2002

Catapulting through life stages. When younger adults are diagnosed with life-threatening illnesses.

Knowledge of developmental stages through the life cycle has always been a hallmark of quality nursing care. The knowledge base gleaned from the older adult literature, such as Schachter-Shalomi and Miller's construct of sage-ing (1995), can help nurses understand that many of the completion tasks usually associated with aging suddenly are thrust to the forefront for younger adult patients diagnosed with a life-threatening illness. Using this knowledge base, nurses can facilitate developmental stage work facing younger adult patients whose illness catapults them into more mature stages for which they may have been unprepared. When younger adult patients are so diagnosed, nurses need to recognize the signs of catapulting life stage work and support it. It is no small task to complete the gestalt of one's life tapestry, but it is especially difficult when one is young.

Adult↗
PubMedDate not supplied

[The impact of vertebral fractures on quality of life in postmenopausal women with osteoporosis. Validity of the Italian version of mini-Osteoporosis Quality of Life Questionnaire.].

BACKGROUND: Vertebral fracture is one of the most commonly occurring osteoporotic fractures. Vertebral fractures associated with osteoporosis are a major cause of pain in elderly people and may hardly affect patient's health-related quality of life (HRQOL), making this an important parameter for assessment in these patients. Studies comparing the performance of HRQOL instruments in osteoporosis are lacking. OBJECTIVES: The purposes of this study were to assess the effect of vertebral fractures on health HRQOL in post-menopausal women with osteoporosis and to investigate the validity of the Italian version of the mini-Osteoporosis Quality of Life Questionnaire (mini-OQOL) in a clinical setting. METHODS: Patients were divided into two study groups, according to fracture status: vertebral fractures (41 patients) and no vertebral fractures (27 patients). Baseline assessments of anthropometric data, medical history, and prevalent fracture status were obtained from all participants. All of the participants were evaluated using both disease-targeted mini-OQOL and QUALEFFO, generic instrument (EUROQoL), disability scale (Roland Morris Disability questionnaire- RMDQ) and chronic pain grade questionnaire. RESULTS: Vertebral fractures due to osteoporosis significantly decreases scores on physical function, socio-emotional status, clinical symptoms, and overall HRQOL. Both disease-targeted questionnaires showing an association between the number of prevalent vertebral fractures and decreased HRQOL. Significant correlations existed between scores of similar domains of mini-OQOL and the QUALEFFO, especially for symptoms, physical function, activities of daily living and social function. The receiver operating characteristic (ROC) curve analysis of mini-OQOL and the QUALEFFO indicated that both questionnaires were significantly predictive of vertebral fractures. Number of concomitant diseases presented a weak significant correlation with EUROQoL (p=0.041). CONCLUSIONS: Our study suggests that the patients with vertebral fractures due to osteoporosis have a relevant impairment in quality of life. Both disease-targeted questionnaires discriminated between patients with and without vertebral fractures though the mini-OQOL, originally developed to measure the effect of vertebral fractures on quality of life, showed slightly better discriminant power. The benefit of the mini-OQOL is that it is efficient, self administered, and requires 3-4 minutes to complete.

Absorptiometry, Photon↗
PubMed1999

The Wisconsin Quality of Life Index: a multidimensional model for measuring quality of life.

The Wisconsin Quality of Life Index (W-QLI) is a multidimensional model for measuring quality of life. This model assumes that quality of life is comprised of 9 dimensions: life satisfaction, occupational activities, psychological well-being, physical health, social relations, economics, activities of daily living, symptoms, and the patient's own goals. The W-QLI takes into account the different perspectives of the patient, the patient's family, and the clinician, both currently and over time. An accompanying taxonomy and patient outcome report can be used in clinical practice to group the patient's goals and to track the attainment of the goals over time, as well as to show the agreements and disagreements between the patient and clinician in terms of how satisfied each is with the patient's progress. The W-QLI, taxonomy, and outcome report can also incorporate the service provider's goals and can be used to examine program results.

Activities of Daily Living↗
PubMedDate not supplied

Issues at the end of life. The revised Ethical and Religious Directives discuss suicide, euthanasia, and end-of-life procedures.

Part 5 of the Ethical and Religious Directives for Catholic Health Care Services reminds us that death is necessary for the transition to eternal life. Thus, although Christians have a duty to preserve worldly life, a gift from God, that duty is not absolute. Suicide and euthanasia are never morally acceptable. On the other hand, life-prolonging therapy need not be used if it provides insufficient benefit or imposes an excessive burden. Directive 55 describes the comfort and care that should be given to dying patients. Directives 56 through 59 discuss the ethical norms for either using or forgoing procedures designed to prolong life. Directive 60 repeats the Church's teaching in regard to euthanasia and physician-assisted suicide (PAS)--that is, whatever the intentions of those who employ them, euthanasia and PAS remain forms of murder. Directive 62 considers the methods used to determine that death has occurred. Directive 66 encourages patients to donate their organs and bodily tissue after death. However, the directive says, Catholic healthcare facilities should not make use of tissue obtained by direct abortions.

Catholicism↗
PubMedDate not supplied

[Quality of life and mortality of patients in intensive care. Indices of quality of life].

INTRODUCTION: At present there is no single practical standardized scale for measuring quality of life (QL). Any proposal should include the patient's physical impairment, level of independence, and subjective perception of happiness. We combined three previously published scales to define a quality of life index (QLI) that we propose as a standard quantitative instrument. The applicability and usefulness of QLI for the measurement of the level of deterioration of patients after admission to an intensive care unit (ICU) was examined. We prospectively evaluated QL before patient admission to determine if it influences mortality, as well as long-term changes in the QL and the factors conditioning te deterioration of patients released from the UCI as evaluated by QL indicators. MATERIAL AND METHODS: To calculate QLI, we combined the Karnofsky scale, daily life activities index, and the perception of quality of life scale. The resulting percentage (QLI) was used to evaluate 536 patients after admission to the ICU and 6 and 12 months after release. QLI was compared with the severity of disease (Apache II), probability of death (MPM), diagnostic group, and socioeconomic variables. RESULTS: Using multivariate methods, four significant variables related with mortality were identified: Apache II--MPM, duration of the stay in the unit, age, and QLI. Our analysis of long-term deterioration showed that advanced age, high QLI before admission, and the patient's diagnostic group explained the degree of deterioration. DISCUSSION: QLI was a useful instrument for obtaining a quantitative estimate of the QL of critically ill patients.

APACHE↗
PubMed2000

Distinction of quality of life, health related quality of life, and health status in children referred for rheumatologic care.

OBJECTIVE: Current health status measures [sometimes called quality of life (QOL) measures] are based on the values of their designers. QOL, though, reflects the idiosyncratic values of each individual. We investigated whether children referred for rheumatologic care differentiate between the concepts of health related quality of life (HRQOL), overall QOL, and health status. METHODS: One hundred twenty-two consecutive children seen at a pediatric rheumatology referral clinic completed a new global self-report quality of life scale (Quality of My Life), a functional impairment scale (Childhood Health Assessment Questionnaire), and a disease severity visual analog scale. Sixty children were seen for a followup assessment. RESULTS: HRQOL was somewhat lower than overall QOL (median 6.6 vs 8.6 out of 10; respectively) in this sample of patients. Our subjects did differentiate between overall QOL and HRQOL and health status. Health status, as measured by disease severity, accounted for only a moderate amount of variability in HRQOL (R2 = 0.25, p< or =0.0001). Health status measured by functional disability accounted for even less of the variability in HRQOL (R2 = 0.047, p = 0.013). Similarly, HRQOL accounted for only a moderate amount of the variability seen in overall QOL (R2 = 0.31, p< or =0.0001). CONCLUSION: The goal of most health professionals is to improve their patients' overall QOL. QOL, though, appears to be a broad and idiosyncratic construct affected only moderately by health. Health status, global HRQOL, and overall QOL all provide independent information. All 3 measures should be considered for use in research studies. HRQOL and overall QOL reflect patients' own values, and therefore may offer important information for clinicians in addition to health status.

Adolescent↗
PubMedDate not supplied

[Evaluation of the quality of life of schizophrenic patients: validation of the brief version of the Quality of Life Interview].

UNLABELLED: The main objective of the study was to determine the psychometric properties (mainly, validity and reliability) of the French language version of the brief Quality of Life Interview (QoLI). That instrument evaluates both the subjective and objective aspects of quality of life. METHODS: 128 patients fulfilling the DSM IV criteria for schizophrenia were included. Quality of life was evaluated using the brief QoLI. Schizophrenic symptoms were evaluated using the Positive and Negative Syndrome Scale (PANSS). The validity of the internal structure of the QoLI was investigated by means of item analysis, study of the correlations between the items and between the item-dimensions and principal component analysis addressing the subjective fields. The validity of the external structure was mainly investigated through the nomological validity study. The reliability of the scale was evaluated by studying the internal consistency. In addition, the acceptability of the scale was documented. RESULTS: The results of the study of the validity of the internal structure confirmed the pertinence of the pre-defined fields, particularly the subjective fields. Only some of the subjective fields of the QoLI showed significant correlations with the PANSS sub-scales. The acceptability of the scale was satisfactory. CONCLUSIONS: The psychometric properties of the French language version of the brief QoLI appeared satisfactory. The brief QoLi was shown to be an easily used instrument for assessment of the various objective and subjective aspects of the quality of life of schizophrenic patients.

Adult↗
PubMedDate not supplied

Policies designed to enhance the quality of life of children with cancer at the end-of-life.

This study evaluated preventive intervention designed to enhance the quality of life of children with cancer at the end-of-life, based on a theoretical model of crises denoted as the Perceived Personal Control Crisis Model. Preventive intervention on the Social Action level consists of introducing policies and services in the pediatric hemato-oncology department designed to enhance the quality of life of children with cancer at the end-of-life.

Attitude to Death↗
PubMed2003

Psychological aspects in orthognathic surgery. Body image and quality of life in postsurgical assessment. Body image and quality of life in postsurgical assessment.

AIM: The aim of this study is to evaluate the psychological assessment of 20 patients after orthognathic surgery. Body image, anxiety levels, depression, somatic symptoms, aggressiveness and quality of life have been evaluated using 3 different questionnaires (BDDE, SQ, Q-LES-Q) during the postsurgical period. Analysis of the questionnaire has shown that the patients undergo orthognathic surgery mainly for esthetical reasons and, even if they could be considered normal, psychological evaluation followed by a proper support is a must. The present study has mainly developed and outlined this aspect. METHODS: BDDE has been utilised to evaluate body image, self-estimation and social relationship. It was evident that the psychological impact after surgery represents a "revolution" for the patient. The "new face" may generate psychological problems for the patients. The SQ test has been used to evaluate the emotional profile. We also considered it essential for our study to evaluate several aspects of the quality of life of our sample group. The body image, particularly when others find it pleasing or displeasing may affect everyday life behaviour. RESULTS: The study reports positive results in the psycho-emotional profiles and in several aspects of the quality of life, while the results of the self-perception of the body image could be considered average. CONCLUSION: Reported data show that the corrections following orthognathic surgery have a positive impact on the assessment of the patients and on the personal and social attitude and behaviour, however suggesting, a long term psychological support to assure a satisfactory postoperative recovery.

Adult↗