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PubMed2006

The impact of meaning in life and life goals on adherence to a tuberculosis medication regimen in South Africa.

SETTING: Out-patient tuberculosis (TB) clinics in Durban, South Africa. OBJECTIVE: Health care provider concerns about persons with active TB defaulting on medications led to a study of adherence among persons receiving anti-tuberculosis therapy and, specifically, the relationships between meaning in life, life goals, sense of coherence, social support, symptom presence and intensity, and adherence in individuals diagnosed with TB. DESIGN: A cross-sectional, descriptive design was used to gather self-reported data from TB-infected individuals who were enrolled in out-patient clinics. Data were collected from 159 Zulu and/or English-speaking persons who agreed to participate in the study. RESULTS: A significant relationship was found between higher life goals and adherence to TB treatment (P = 0.027). Analysis of variance revealed that higher meaning in life ratings were significantly associated with older age (P = 0.007). Having children and children living in the same household were significantly associated with low meaning in life ratings (P = 0.006 and P < or = 0.001, respectively), indicating that these individuals were more concerned about basic matters of home and sustenance. CONCLUSIONS: The results of this study indicate that meaning in life and life goals may be useful for identifying individuals who will require additional support in adhering to anti-tuberculosis treatment.

Adolescent↗
PubMed1991

A general theory of life table construction and a precise abridged life table method.

"In this paper we lay the foundation of life table construction by unifying the existing life table methods. We also present a new method of constructing current (period) abridged life tables.... The development includes (1) a careful formulation and computation of age-specific death rates, (2) derivation of a new set of formulas for computing the survivorship function from the observed age-specific death rates and populations, (3) estimation of the main life table functions by spline interpolation, integration and differentiation, and (4) use of a quadratic and a Gompertz function to close the life table.... The method is illustrated with construction of abridged life tables using Canadian data."

Americas↗
PubMed1996

Existential well-being is an important determinant of quality of life. Evidence from the McGill Quality of Life Questionnaire.

BACKGROUND: The McGill Quality of Life Questionnaire (MQOL) is being developed to correct what we perceive to be a flaw in existing quality of life instruments: neglect of the existential domain. METHODS: This study reports the first use of MQOL for people with cancer at all phases of the disease, including those with no evidence of disease after therapy. RESULTS: The data suggest that MQOL is comprised of an item measuring physical well-being and four subscales: physical symptoms, psychological symptoms, existential well-being, and support. MQOL is acceptable to oncology outpatients. Correlation of the MQOL total and subscale scores with a single item scale measuring overall quality of life and with the Spitzer Quality of Life Index suggests that MQOL has construct and concurrent validity. CONCLUSIONS: The hypothesis that the existential domain is important, especially to those patients with a life-threatening illness, is supported because multiple regression showed that the existential subscale is at least as important as any other subscale in predicting a single item scale measuring the overall quality of life and plays a greater role in determining the quality of life of patients with local or metastatic disease than in patients with no evidence of disease.

Adult↗
PubMedDate not supplied

Life purpose: effect on functional decline and quality of life in polio survivors.

This article explores the protective effects that finding a purpose in life has on the level of physical and mental impairment and overall quality of life. Results were gathered from a national sample of 2,153 polio survivors. Although the combined social and physical experience of living with the disabling effects of polio has been associated with accelerated aging due to an increased allostatic load, finding a purpose in life may diminish these effects. The findings of this study indicate that purpose in life is associated with less perceived decline in health. Moreover, purpose in life is predictive of better quality of life despite levels of physical and mental impairment. Rehabilitation nurses should consider ways to help persons with polio maintain activities and interests that promote their sense of purpose in life.

Activities of Daily Living↗
PubMed1984

The load of genetic and partially genetic disorders in man. I. Congenital anomalies: estimates of detriment in terms of years of life lost and years of impaired life.

This paper represents an attempt to estimate quantitatively, the detriment associated with spontaneously arising congenital anomalies in man. The system used in the International Classification of Diseases (Chapter XIV, entries 740-759) has been followed to classify the congenital anomalies. Detriment was assessed using estimates of the years of life lost, years of life potentially impaired and years of life actually impaired, as indicators. The data on birth prevalences for the various conditions were derived from several epidemiological surveys carried out in Hungary and from the Hungarian Congenital Malformation Registry. Most of the information on mortality profiles was obtained from the records of the Hungarian Central Statistical Office, Budapest. An overall comparison of the prevalence figures in Hungary with those for the U.S. (this study aimed at complete ascertainment) and for the Canadian province of British Columbia (in this study, ascertainment is believed to be incomplete) showed that, in Hungary, at least certain classes of congenital anomalies, particularly some of the less severe ones, have been under-ascertained. Since detriment estimates are heavily dependent on accurate estimates of birth prevalences, we believe that the estimates of detriment arrived at using the Hungarian data may also be underestimates. In Hungary, the total birth prevalence of all isolated major congenital anomalies is of the order of about 600/10(4). Our calculations show that these congenital anomalies may cause, per 10(4) livebirths, about 4800 years of life loss, about 37000 years of potentially impaired life and about 4500 years of actually impaired life. In these calculations, it has been assumed that the average life-expectancy at live birth for the general population is 70 years. These estimates are considerably higher than those made by Carter for detriment associated with spontaneously arising monogenic disorders.

British Columbia↗
PubMed1996

Measuring the meaning of life for patients with incurable cancer: the life evaluation questionnaire (LEQ).

Clinical observation, systematic research and popular anecdote indicate that, when confronted by death, people change the criteria by which they evaluate their lives. Questionnaires used routinely to assess quality of life in people with poor-prognosis cancer tend to be symptom-based and do not assess factors which become important when confronted by fatal illness, such as the meaning of life and the degree to which life has been enriched by the illness. To develop a questionnaire which would be sensitive to these areas, patients with incurable cancer and carers of such patients were interviewed in depth. Responses were reviewed by a panel of patients, clinicians and carers and formed into an inventory which was completed by 200 similar patients. Principal components analysis identified five dimensions: clearer perception of the meaning of life; freedom versus restriction of life; resentment of the illness; contentment with past and present life; past and present social integration. Only the most symptom-oriented scales (freedom, resentment) correlated with the Rotterdam Symptom Checklist. Scale scores showed that younger patients were more resentful of their illness, but also gained a clearer perception of the meaning of life. This questionnaire can evaluate psychological needs of people with incurable cancer which are neglected by existing instruments.

Age Factors↗
PubMed2006

The use of the life course paradigm and life course charts to explore referral for family history of breast cancer.

BACKGROUND: Life course research methodologies are used extensively in historical and social science research. In 1998 the life course paradigm was introduced to provide a way of tracing the interplay of person and setting. The method has had a very limited use in nursing research, but in this study it was utilized as a way of capturing dynamic change by placing the individual within a context of four domains; location in time and place, linked lives, human agency and timing of lives. OBJECTIVE: To describe the paradigm, review its use in healthcare research and provide a specific example of its use in healthcare. DESIGN: This paper discusses a novel method of creating life course charts for a qualitative study exploring the differing experiences of women referred from primary care to specialist services due to a family history of breast cancer. SETTING: A nurse-led breast cancer family history clinic in the UK. PARTICIPANTS: Twenty-two women. METHODS: Life charts were used in conjunction with a grounded theory approach to analyse data collected from semi-structured interviews. FINDINGS: Twenty-two life charts were created and the ability to layer the charts of multiple women to visualise similarities and differences aided the analysis. The life charts were a useful tool in the development of theoretical understandings and the psychosocial process of realisation of risk emerged as central to the initiation of referral. This was often apparent when approaching the age of an affected relative (anticipated onset) or when current circumstances emulate past experience (generational transference). CONCLUSIONS: This approach to charting complex psychological, social and contextual factors throughout the life course was methodologically beneficial and could have a wider utility in nursing and healthcare research. As a research tool it enhanced a holistic approach to patient care issues and was helpful as an aid to understanding health behaviours linked to familial risk.

Adaptation, Psychological↗
PubMed1999

Self-appraisal, life satisfaction, and retrospective life choices across one and three decades.

This research investigated the relationship of a self-appraisal of having lived up to one's intellectual abilities at midlife (average age of 49 years) with life satisfaction and retrospective life choices 1 and 3 decades later among 383 participants in the Terman Study of the Gifted. Study 1 showed that participants who reported living up to their intellectual abilities were higher in satisfaction with occupational success, satisfaction with family life, and joy in living 11 years later. Study 2 showed that participants who reported living up to their abilities were higher in overall life satisfaction and were less likely to report that they would make different life choices in work or family life 3 decades later. In an integrative structural equation model, the relation between the midlife self-appraisal of having lived up to intellectual abilities and overall satisfaction at age 80 was mediated by life satisfaction discrepancy at age 61.

Achievement↗
PubMed2005

Life stress, the "kindling" hypothesis, and the recurrence of depression: considerations from a life stress perspective.

Major depression is frequently characterized by recurrent episodes over the life course. First lifetime episodes of depression, however, are typically more strongly associated with major life stress than are successive recurrences. A key theoretical issue involves how the role of major life stress changes from an initial episode over subsequent recurrences. The primary conceptual framework for research on life stress and recurrence of depression is the "kindling" hypothesis (R. M. Post, 1992). Despite the strengths of the kindling hypothesis, a review of the research literature reveals inconsistencies and confusion about life stress and its implications for the recurrence of depression. Adopting a life stress perspective, the authors introduce 3 major themes that resolve the inconsistencies in the current literature. They integrate these themes and extrapolate the ideas with available data to develop a preliminary framework for evaluating competing explanatory models and to guide research on life stress and the recurrence of depression.

Depression↗
PubMed2002

Quality of life and prevalence of arthritis reported by 5,795 members of the Nordic Psoriasis Associations. Data from the Nordic Quality of Life Study.

Quality of life measures are widely used in dermatology as well as in rheumatology, but there are no large studies taking arthritis into consideration when studying quality of life in psoriasis. The aim of this study was to investigate psoriasis-related quality of life in a large sample of members of the psoriasis associations from the Nordic countries including an arthritis-related evaluation. The prevalence of reported arthritis within the groups was also estimated. An Arthritis Disability Index suitable for parallel use together with Finlay's Psoriasis Disability Index was constructed. A total of 5,795 members and 702 patients seen by Nordic dermatologists rated the severity of their disease and completed the Psoriasis Disability Index formula and a Psoriasis Life Stress Inventory, and if arthritis had been diagnosed, the Arthritis Disability Index formula. Approximately 30% of all psoriatic patients, irrespective of group, received a diagnosis of arthritis either by their dermatologist or a rheumatologist. Members previously hospitalized for their disease had a higher frequency of arthritis (41%) than those without a history of hospitalization (23%). The highest prevalence of arthritis was found in Norway (33.8%). Members with arthritis exhibited greater impairment of psoriasis-related quality of life, longer disease duration, and greater self-reported disease severity for psoriasis. Important predictors for impairment of arthritis-related quality of life were pain, number of affected joints, and restriction of joint mobility. These data show, that the prevalence of arthritis in psoriasis may be significantly higher than the previously accepted average of 7%. The results demonstrate that when studying quality of life in psoriasis, arthritis and arthralgia are important independent factors to be included in the evaluation.

Activities of Daily Living↗
PubMed2001

Negative life events and depressive symptoms in the elderly: a life span perspective.

This study suggests that negative life events may have long-term consequences for people's well-being. A community sample of 194 elderly people was interviewed by means of the Geriatric Depression Scale and the Negative Life Events Questionnaire. Depressed mood at old age was related to the reporting of negative socio-economic circumstances as well as emotional abuse and neglect during childhood, and to the reporting of negative socio-economic circumstances, sexual abuse, emotional abuse and neglect, relational stress and problem behaviour of significant others during (late) adulthood. Depression scores were especially high when subjects reported the experience of many events during adulthood and late adulthood. On top of this, the interaction effect between the number of negative life events experienced in childhood and adulthood indicated that there was a much stronger association between the number of negative life events experienced in adulthood and depressive symptoms in late life, for those who experienced more negative life events in childhood, than for those who did not. It is suggested that incorporating life histories into the diagnostic interview is advisable.

Aged↗
PubMed2001

Predictors of health-related quality of life perspectives, self-esteem, and life satisfactions of older adults following spousal loss: an 18-month follow-up study of widows and widowers.

PURPOSE OF THE STUDY: The overall purpose of the study was to examine the relationship between widowed persons' baseline assessments of self-efficacy beliefs and their ratings of perceived health-related quality of life, life satisfactions, and self-esteem obtained in an 18-month follow-up. DESIGN AND METHOD: At Time 1, a survey of sociodemographics, a multidimensional measure of global self-efficacy, and a domain-specific measure of self-efficacy, having eight subscales of self-efficacy (interpersonal, instrumental, emotional, social support, nutritional, physical, financial, and spiritual) were administered to a group of 231 widows and widowers to obtain baseline assessments of their self-efficacy beliefs. At Time 2, a follow-up of 211 widows and widowers was conducted to obtain their perceptions of health-related quality of life, life satisfactions, and levels of self-esteem 24 months following spousal loss and to assess whether self-efficacy beliefs play a predictive role in widowed individuals' perceptions of their health-related quality of life, life satisfactions, and self-esteem. RESULTS: A series of gender-specific multiple regression analyses models revealed that widows and widowers differ significantly with respect to the relationship between specific domains of self-efficacy and their perceived quality of life in the longer term following spousal loss. IMPLICATIONS: Implications of the findings are discussed for clinicians and health professionals working with bereaved spouses in terms of intervention programs for retraining of self-efficacy.

Aged↗
PubMed2003

Quality of life as medicine. II. A pilot study of a five-day "quality of life and health" cure for patients with alcoholism.

Alcoholism can be understood as a self-treatment for existential pain. A 5-day treatment was designed to relieve this psychological pain and existential anxiety, and thereby diminish the need for self-treatment with alcohol. The basic principle behind the treatment was holistic, restoring the quality of life (QOL) and relationship with self, which according to the life mission theory happens when life-denying views are corrected and inner emotional conflicts are solved. The method in this treatment was a course with teachings in philosophy of life, psychotherapy, and body therapy. The synergy attained was considerable and the outcome demonstrates that in the course of 1 week, people have time to revise essential life-denying views and to integrate important, unfinished life events involving negative feelings. This was demonstrated by an improved QOL and a decrease in their dependency and need for alcohol abuse. In the week before, after the 5-day course, and again after 1 and 3 months, the 16 participants completed the SEQOL questionnaire on QOL and health. This was a pilot study based on a pre-experimental design, without a control group and without clinical control. Common for the group were a low QOL, numerous health problems, and alcohol dependency in spite of treatment with Antabus (disulfiram). The study showed an increase in QOL from 57.6% before the course to 69.4% 3 months after the course, or an improvement in QOL of 11.8%. There was a 24.0% improvement in self-perceived mental health, and satisfaction with health in general was improved by 11.1%. The total sum of health symptoms in the group was reduced from 59% of maximum to 33%. It is concluded that for this small and motivated group with alcohol problems, it was possible to improve QOL and health in only 5 days with a holistic treatment that combined philosophy of life, psychotherapy, and body therapy, but the results are not final. Further research is needed.

Alcoholism↗
PubMed2005

Translating the science of quality of life into practice: What do dermatology life quality index scores mean?

This study's aim was to determine the relationship between Dermatology Life Quality Index (DLQI) scores and a Global Question (GQ) concerning patients' views of the overall impairment of their skin-related quality of life (QoL), and to express this relationship by identifying bands of DLQI scores equivalent to each GQ descriptor. A DLQI questionnaire and the GQ were mailed to 3834 adult general dermatology outpatients. There were 1993 (52%) responses: male 841; female 1152. Mean DLQI score = 4.86 (range 0-30, standard deviation (SD) = 5.83). Mean GQ score = 1.22 (range 0-4, SD = 1.20). The mean, mode, and median of the GQ scores for each DLQI score were used to devise several sets of bands of DLQI scores, and kappa coefficients of agreement calculated. The set proposed for adoption is: DLQI scores 0-1 = no effect on patient's life (GQ = 0, n = 754); DLQI scores 2-5 = small effect on patient's life (GQ = 1, n = 611); DLQI scores 6-10 = moderate effect on patient's life (GQ = 2, n = 327); DLQI scores 11-20 = very large effect on patient's life (GQ = 3, n = 242); DLQI scores 21-30 = extremely large effect on patient's life (GQ = 4, n = 59); kappa coefficient 0.489. Banding of the DLQI will aid the clinical interpretation of an individual's DLQI score and allow DLQI scores to inform clinical decisions.

Adolescent↗
PubMed1998

Measuring quality of life for patients with terminal illness: the Missoula-VITAS quality of life index.

Quality of life (QOL) is an important outcome measure in caring for terminally ill patients. The Missoula-VITAS Quality of Life index (MVQOLI) has been developed to provide a measure of quality of life that is meaningful to both clinicians and patients. Unique features of the instrument include its focus on the terminal phase of life, the item structure and a scoring system that allows the weighting of each dimension of QOL by the respondent, and the subjective wording of the items that allows respondents to interpret the measured elements according to their own experience. The validity and reliability of the patient-reported survey instrument were tested by administering the 25-item questionnaire to 257 patients in 10 community-based hospices. Participants were incurably ill with predicted survival of six months or less. Exclusion criteria included inability to communicate, dementia, or psychological symptoms that might be intensified by completing the index. Reliability and validity of the new index were examined using standard statistical and psychometrical analyses. The MVQOLI demonstrated internal consistency (Cronbach's alpha = 0.77). MVQOLI total scores were correlated with scores on the Multidimensional Quality of Life Scale--Cancer 2 and with patient-reported global QOL ratings. MVQOLI scores did not correlate with observer-rated functional status scores indicating divergent validity. The MVQOLI could be completed by patients of varied educational level, age, functional status, and length of time with a terminal illness. The instrument is designed to contribute to the task of planning care by evaluating patient-identified sources of distress, strength and satisfaction, including issues of life closure. This information contributes to crafting highly specific interventions. Further studies are necessary to determine the usefulness of the instrument in measuring outcomes of end-of-life care in nonhospice settings, and for racial and diagnostic groups under-represented in this sample.

Female↗
PubMed1998

Whose quality of life is it anyway? Some problems with the emerging quality of life consensus.

Two critiques of the emerging consensus in the conceptualization and measurement of quality of life were presented. The first suggests that there are insuperable problems in assessing subjective indicators of quality of life and that this aspect of the quality of life approach should be abandoned. The second critique is that the quality of life approach, which claims to liberate people from a medical model, may paradoxically serve to extend the license of services to exert control over all facets of a person's life. In this view, the quality of life approach should be abandoned altogether. The solutions that follow from these two critiques were critically discussed with the aim of provoking a debate around the quality of life approach.

Humans↗
PubMed1990

[Life style and right to clean air in public places (RCA) (Part 2). The relationship between life style and the aspect of knowledge level of the consciousness towards smoking regulations among employees].

The right to clean air in public places (RCA) is a useful indicator of health consciousness. We surveyed the life style and consciousness towards RCA among employees working at the head office of a major company in Osaka, and examined the relationship between life style and knowledge aspect of RCA, one of the three aspects of consciousness towards RCA. Knowledge on laws concerning smoking regulations in public places was classified into two categories. One was knowledge on laws concerning general matters and the other was knowledge on laws concerning concrete and specific matters. Therefore, there are two kinds of relationship; the relationship between life style and knowledge on laws concerning general matters and the relationship between life style and knowledge on laws concerning concrete matters. These two relationships were examined with statistical procedures. Mean scores of knowledge on laws of subgroups divided by HPI score (POOR, MODERATE and GOOD) within groups divided by age and sex ("M. smoker," "M. nonsmoker" and "F. nonsmoker") were compared by t-test. Life style related to knowledge score was checked by correlation coefficient. The following results were obtained. (1) Relationship between life style and knowledge on laws concerning general matters Knowledge scores and their age-adjusted scores of MODERATE groups were the lowest among the 3 groups ("M. smoker," "M. nonsmoker," "F. nonsmoker"). This set of questions was designed to measure the knowledge level on laws concerning general matters. One would have abundant knowledge if one is health-conscious. In other words, those who do many things beneficial to physical health and have a high HPI have a wealth of knowledge on laws concerning smoking regulations on general matters. In the case of the employees, MODERATE groups were less health-oriented than others ("POOR," "GOOD") within the 3 groups ("M. smoker," "M. nonsmoker," "F. nonsmoker"). (2) Relationship between life style and knowledge on laws concerning concrete matters This set of questions was designed to measure the knowledge on laws concerning concrete and specific matters. To attain high scores, it is necessary to have more smoking experiences in various types of indoor places. POOR group of "M. smoker" and MODERATE groups of "M. nonsmoker" and "F. nonsmoker" had high knowledge scores. They were considered to have greater opportunities to visit public places where smoking is permitted (for example, bars) irrespective of their smoking status.

Adult↗
PubMed2006

An approach to revealing blood fluke life cycles, taxonomy, and diversity: provision of key reference data including DNA sequence from single life cycle stages.

Revealing diversity among extant blood flukes, and the patterns of relationships among them, has been hindered by the difficulty of determining if specimens described from different life cycle stages, hosts, geographic localities, and times represent the same or different species. Persistent collection of all available life cycle stages and provision of exact collection localities, host identification, reference DNA sequences for the parasite, and voucher specimens eventually will provide the framework needed to piece together individual life cycles and facilitate reconciliation with classical taxonomic descriptions, including those based on single life cycle stages. It also provides a means to document unique or rare species that might only ever be recovered from a single life cycle stage. With an emphasis on the value of new information from field collections of any available life cycle stages, here we provide data for several blood fluke cercariae from freshwater snails from Kenya, Uganda, and Australia. Similar data are provided for adult worms of Macrobilharzia macrobilharzia and miracidia of Bivitellobilharzia nairi. Some schistosome and sanguinicolid cercariae that we recovered have peculiar morphological features, and our phylogenetic analyses (18S and 28S rDNA and mtDNA CO1) suggest that 2 of the new schistosome specimens likely represent previously unknown lineages. Our results also provide new insights into 2 of the 4 remaining schistosome genera yet to be extensively characterized with respect to their position in molecular phylogenies, Macrobilharzia and Bivitellobilharzia. The accessibility of each life cycle stage is likely to vary dramatically from one parasite species to the next, and our examples validate the potential usefulness of information gleaned from even one such stage, whatever it might be.

Animals↗