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PubMed1998

Causes of declining life expectancy in Russia.

CONTEXT: Russian life expectancy has fallen sharply in the 1990s, but the impact of the major causes of death on that decline has not been measured. OBJECTIVE: To assess the contribution of selected causes of death to the dramatic decline in life expectancy in Russia in the years following the breakup of the Soviet Union. DESIGN: Mortality and natality data from the vital statistics systems of Russia and the United States. SETTING: Russia, 1990-1994. POPULATION: Entire population of Russia. MAIN OUTCOME VARIABLES: Mortality rates, life expectancy, and contribution to change in life expectancy. METHODS: Application of standard life-table methods to calculate life expectancy by year, and a partitioning method to assess the contribution of specific causes of death and age groups to the overall decline in life expectancy. United States data presented for comparative purposes. RESULTS: Age-adjusted mortality in Russia rose by almost 33% between 1990 and 1994. During that period, life expectancy for Russian men and women declined dramatically from 63.8 and 74.4 years to 57.7 and 71.2 years, respectively, while in the United States, life expectancy increased for both men and women from 71.8 and 78.8 years to 72.4 and 79.0 years, respectively. More than 75% of the decline in life expectancy was due to increased mortality rates for ages 25 to 64 years. Overall, cardiovascular diseases (heart disease and stroke) and injuries accounted for 65% of the decline in life expectancy while infectious diseases, including pneumonia and influenza, accounted for 5.8%, chronic liver diseases and cirrhosis for 2.4%, other alcohol-related causes for 9.6%, and cancer for 0.7%. Increases in cardiovascular mortality accounted for 41.6% of the decline in life expectancy for women and 33.4% for men, while increases in mortality from injuries (eg, falls, occupational injuries, motor vehicle crashes, suicides, and homicides) accounted for 32.8% of the decline in life expectancy for men and 21.8% for women. CONCLUSION: The striking rise in Russian mortality is beyond the peacetime experience of industrialized countries, with a 5-year decline in life expectancy in 4 years' time. Many factors appear to be operating simultaneously, including economic and social instability, high rates of tobacco and alcohol consumption, poor nutrition, depression, and deterioration of the health care system. Problems in data quality and reporting appear unable to account for these findings. These results clearly demonstrate that major declines in health and life expectancy can take place rapidly.

Adolescent↗
PubMed1999

United States life tables, 1997.

The life tables in this report are current life tables for the United States based on age-specific death rates in 1997. Beginning with 1997 mortality data, complete U.S. life tables were constructed using a new methodology that replaces the abridged life table methodology used previously. The methodology is similar to that used in the decennial life tables. Also, life expectancy and other life table values are shown for ages 85 to 100 years for the first time as part of the annual U.S. life tables. Data used to prepare these life tables are 1997 final mortality statistics; July 1, 1997, population estimates; and data from the Medicare program. Presented are complete life tables by age, race, and sex. In 1997 the overall expectation of life at birth was 76.5 years, an increase of 0.4 years compared with life expectancy in 1996. Life expectancy increased from 1996 to 1997 for each of the four race-sex groups for which life expectancy is reported. Life expectancy increased for black males by 1.1 year (from 66.1 to 67.2), for black females by 0.5 year (from 74.2 to 74.7), for white males by 0.4 year (from 73.9 to 74.3), and for white females by 0.2 year (from 79.7 to 79.9).

Adolescent↗
PubMed2001

Nutrition, physical activity, and quality of life in older adults: summary.

If health-related quality of life--and not longevity--is the key goal for health promotion, then it is captured only partly by the existing mortality and morbidity indexes. Researchers now urge that government agencies and health care providers begin collecting quality-of-life data on the populations they serve. Adding life to years, not years to life, is the current agenda for productive and successful aging. Policies and programs on aging are increasingly focused on identifying ways to improve quality of life and health status rather than just extending life span. In the Healthy People 2000 report, the chief goal of health promotion was to increase the span of healthy life. The focus was on mortality and morbidity data and symptom checklists as the principal measures of ill health. In contrast, the new emphasis in the Healthy People 2010 report is on quality of life and overall well-being. Helping people to increase life expectancy and improve their quality of life is the primary goal of the Healthy People 2010 report. The authors of this special issue of the Journals of Gerontology: Biological Sciences and Medical Sciences are united in the belief that optimal nutrition and physical activity make a significant contribution to the overall quality of life at any age and especially for older adults. The key research challenge lies in deciding which aspects of improved fitness, nutrition, and diet contribute the most to quality-of-life measures. We have attempted to provide a comprehensive review of research on exercise, nutrition, diet, and health in elderly adults. Past studies on diet, nutrition, and fitness have largely addressed biomedical outcomes, pointing to substantial benefits in physical functioning, remission of disease symptoms, and improved health. This special issue goes a step further in assessing the effect of improved nutrition and physical activity on the global quality of life and its four principal domains. Although links between diet and exercise and chronic disease risks have been well documented, more needs to be known about motivations for behavioral change and perceived benefits as assessed using quality-of-life measures. No single segment of our society can benefit more from regularly performed exercise and improved diet than elderly adults. These important articles provide a link between diet and exercise and quality-of-life issues, as outlined in the Healthy People 2010 report.

Aged↗
PubMed2001

Quality of life before intensive care unit admission and its influence on resource utilization and mortality rate.

OBJECTIVE: To analyze the quality of life of critically ill patients before their intensive care admission and its relation to age, variables measured in the intensive care unit (ICU; severity of illness, therapeutic effort, resource utilization, and length of stay), and in-hospital mortality rate. DESIGN: Observational prospective multicenter study. SETTING: Eighty-six medical-surgical ICUs in Spain, including coronary patients. PATIENTS: We studied 8,685 patients between 1992 and 1993. Patients <16 yrs old and those dying within the first 6 hrs were excluded. MEASUREMENTS AND MAIN RESULTS: Data collection included age, gender, admission diagnosis, severity level by Acute Physiology and Chronic Health Evaluation (APACHE) III, quality of life survey score, therapeutic activity level by Therapeutic Intervention Scoring System (TISS), and ICU and hospital mortality rate. Pre-ICU quality-of-life score was 3.74 +/- 4.42 points; 33.24% of patients had a normal quality of life (0 points), and numbers of patients declined logarithmically in relationship to increasing quality-of-life scores, with only 189 patients having a score >15 points. Pre-ICU quality-of-life score correlated with age (r =.289, p <.001), with severity level by APACHE III score (r =.217, p <.001), and weakly with TISS (r =.067, p <.001). There was no correlation between quality of life and length of ICU stay. Patients dying in hospital after ICU discharge (n = 429) had worse quality of life (5.88 +/- 5.38 points) than those dying in the ICU (n = 1,453, 4.8 +/- 4.94), who themselves had a worse quality of life than hospital survivors (n = 6,803, 5.05 +/- 5.07; p <.0001 by analysis of variance), with significant differences between all three groups. In the multivariate analysis, pre-ICU quality-of-life was related to age, APACHE III score, and hospital mortality rate but not to TISS or ICU length of stay. Pre-ICU quality of life was introduced as a variable in the APACHE III prediction model and entered the model after acute physiology score, diagnosis, and age and before prior patient location and comorbidities. The area under the receiver operating characteristics curve was 0.834 when quality-of-life was included and 0.83 when not. CONCLUSIONS: In Spain, the quality of life of critically ill patients before their ICU admission is good, and only a small proportion of patients have a low quality of life before admission. Previous quality of life is related to hospital mortality rate but contributes very little to the discriminatory ability of the APACHE III prediction model and has little influence on ICU resource utilization as measured by length of stay and therapeutic activity.

APACHE↗
PubMed1996

Analysis of quality of life in polytraumatized patients two years after discharge from an intensive care unit.

OBJECTIVE: Analysis of quality of life of polytraumatized critical care patients. DESIGN: Prospective study. MATERIAL AND METHODS: Patients admitted in a 2-year period in a traumatologic intensive care unit (ICU) were evaluated. A quality of life questionnaire was completed on admission (N = 351), 1 year and 2 years after discharge from the ICU. The three questionnaires evaluated patients' ability to function and communicate over the previous 2 months. A quality of life score of 0 corresponded to no limitations. Quality of life was also evaluated by the Glasgow Outcome Scale. Information was collected on the severity of illness and the diagnosis prompting ICU admission. RESULTS: The mean quality of life score of survivors worsened from 0.46 +/- 0.11 points on ICU admission to 6.68 +/- 0.41 1 year after discharge, and then improved to 4.86 +/- 0.38 2 years after discharge, although the quality of life score continued to be worse than on admission (p < 0.001). On admission, 93.2% of patients had normal quality of life (0 points), after 1 year 36.5% were normal, and after 2 years 51.6% were normal. Three patients (0.9%) remained in vegetative state. On admission, 96.6% were working, while after 2 years, only 57.5% had returned to employment, although the high levels of unemployment in our country during this study may have been a particular factor in this result. All age groups except pediatric patients showed a worsened quality of life after 2 years, and patients over 60 years had worst scores on admission and after 1 and 2 years. Patients with least severity by Acute Physiology and Chronic Health Evaluation (APACHE) II score (< 10 points) had a better quality of life score after 1 and 2 years. Severity by Injury Severity Score showed patients with > 25 points having the greatest deterioration in quality of life. A multivariate study showed that quality of life after 2 years is influenced by age, severity of injury, and previous quality of life. CONCLUSIONS: Polytraumatized patients admitted into ICU showed a worsening of their quality of life 1 and 2 years after ICU discharge, with an improvement between 1 and 2 years. Quality of life after 2 years is influenced by age, severity of illness, and previous quality of life.

Adolescent↗
PubMed2005

Utilization and outcomes of neonatal cardiac extracorporeal life support: 1996-2000.

OBJECTIVES: Extracorporeal life support for neonatal respiratory failure has decreased, but utilization and outcome of cardiac extracorporeal life support are not well characterized. Among neonates born 1996-2000, our objects were to evaluate changes in utilization and outcome of cardiac extracorporeal life support and characterize correlates of survival. DESIGN: Retrospective analysis of Extracorporeal Life Support Organization Registry data. SETTING: Intensive care units participating in the ELSO registry. PATIENTS: Patients placed on extracorporeal life support for center-specified "cardiac support" at </=30 days of age from 1996 to 2000. Patients with hypoplastic left heart syndrome were also analyzed separately. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Patient characteristics and correlates of survival to discharge or transfer were analyzed by chi-square, Student's t-test, and logistic regression analysis. Neonates placed on cardiac extracorporeal life support increased from 112 in 1996 to 200 in 2000 (total n = 740). Overall survival was 34.2%: 28% for hypoplastic left heart syndrome and 35.4% for nonhypoplastic left heart syndrome. For the overall group, no significant correlations were found between survival and year on extracorporeal life support, multiple runs, or diagnosis of hypoplastic left heart syndrome. Diagnoses of transposition of the great arteries (p = .03) or persistent pulmonary hypertension of the neonate (p = .004) and extracorporeal life support at <3 days (p = .003) were associated with higher survival. Survivors had fewer mean extracorporeal life support hours (125.5 +/- 121.4 vs. 159.0 +/- 127.6, p = .0006). Logistic regression confirmed significant bivariate findings. A total of 118 hypoplastic left heart syndrome patients were reported from 1996 to 2000. Extracorporeal life support at >15 days was associated with improved survival among hypoplastic left heart syndrome patients (p = .03), and survivors had fewer mean extracorporeal life support hours (89.3 +/- 52.3 vs. 147.5 +/- 129.7, p = .015). Logistic regression showed that only greater number of hours on extracorporeal life support was independently associated with nonsurvival. CONCLUSIONS: Neonatal cardiac extracorporeal life support use increased substantially from 1996 to 2000, with survival to discharge or transfer in more than one third of patients. Hypoplastic left heart syndrome was not associated with nonsurvival. Fewer hours on extracorporeal life support, diagnoses of persistent pulmonary hypertension of the neonate and transposition of the great arteries, and extracorporeal life support at <3 days were associated with survival.

Extracorporeal Membrane Oxygenation↗
PubMed2006

Quality of life in palliative care cancer patients: a literature review.

AIMS AND OBJECTIVES: [corrected] This review of the literature intended to get insight into the international standards of quality of life assessment in palliative care, the conceptual and research literature addressing illness related quality of life and an examination of how nurse researchers define and assess this concept in the context of terminally ill cancer patients. Clearly stated goals for measuring quality of life as well as an understanding of the pragmatic and theoretical explanations for current trends in quality of life measurement are fundamental to this focus. BACKGROUND: Most clinicians and researchers agree that the primary goal of palliative care is to optimize the quality of life of patients with advanced incurable diseases through control of physical symptoms and attention to the patient's psychological, social and spiritual needs. Palliative care therefore is the achievement of the best quality of life for patients and their families. Consequently, the outcomes of care should be measured in terms of the extent to which this goal is achieved. Quality of life is difficult to define and measure; it is a multidimensional, dynamic and subjective concept. During the past decade, multidisciplinary research measuring the impact of cancer and its treatment on the quality of people's lives escalated rapidly in international literature but not in the German speaking European countries. This international escalation was accompanied by a proliferation of measurement strategies and tools. Nursing shared this interest and began to generate substantive research of the phenomenon. In the oncology and palliative care nursing societies quality of life and numerous closely related areas of symptom management rank among the highest research priorities. METHOD: This paper examines nursing literature published between 1990 and 2004, retrieved through a computer review of MEDLINE and Cumulative Index of Nursing and Allied Health Literature. The review includes reports that systematically describe or measure the quality of life of people with a terminal cancer in palliative care as a variable of interest. This article also describes conceptual and operational definitions of quality of life and explores the implicit and explicit goals of research. RESULTS: Quality of life is a concept relevant to the discipline of nursing. Nurses, especially oncology and palliative care nurses, actively contributed to the development of the quality of life concept through instrument development and population description. CONCLUSION: Nurses working in German palliative care settings do change the quality of life of patients they care for, but there are no systematic standards of assessing these outcomes. RELEVANCE TO CLINICAL PRACTICE: There are challenges related to measuring quality of life in patient-focused palliative care and research. Systematic quality of life assessment in all palliative care settings will establish quality assurance and the further development of this very young discipline in Germany.

Attitude to Death↗
PubMed2006

A prospective analysis of life events, problem behaviours and depression in adults with intellectual disability.

BACKGROUND: Life events have consistently been found to be associated with behaviour problems and depression among individuals with intellectual disability (ID). However, prior findings have typically been based on correlational or retrospective analyses of case files. The current study attempted to replicate prior findings from life events with concurrent data and extend them to the prospective prediction of behaviour problems and depression. The influence of impact ratings of life events was also explored. METHODS: Seventy-four informants rated 104 adults with ID on measures of life events, behaviour problems and depressive symptoms. Life events were rated as having either a positive, negative or no impact on the life of the individual with ID. Measures were completed twice, at a 4-month interval. RESULTS: Behaviour problems were both correlated with and predicted by frequency counts of life events and life events perceived as negative. However, the predictive ability depended on which measure of problem behaviour was selected. Positive life events were not associated with concurrent behaviour problems. Depressive symptoms were correlated with all life changes, but only predicted by frequency counts of life events and life events perceived as negative. Again, the predictive ability depended on which measure of depression was selected. Findings were corroborated with a group of individuals with clinical diagnoses of major depression. CONCLUSIONS: Frequency counts of all life events and life events perceived as negative play a role in the development of behaviour problems and depressive symptoms among adults with ID. The results have implications for interventions for behaviour problems following a life event, and for reducing depressive symptoms for adults with mild ID.

Adult↗
PubMed1999

Clarification and integration of similar quality of life concepts.

PURPOSE: To identify major problems that obscure understanding of quality of life; to differentiate quality of life from other closely related concepts, and to offer a definition of quality of life. Quality of life is a term frequently used, but seldom defined, in nursing research. Multiple interpretations and measures make evaluating research difficult. The need to clarify concepts, develop nursing theory, and enhance communication is significant. Concept clarification is also essential for research instrument development and evaluation. ORGANIZING CONSTRUCT AND SCOPE: Concept analysis as proposed by Walker and Avant. Preconceived theories were avoided to keep the analysis as unbiased as possible. The analyst considered many descriptions of quality of life, but eventually included only those in the scientific literature. SOURCES: CINAHL, Medline, Psych-Info, ERIC, Social Science Abstracts, and reference lists from published articles in nursing, medicine, psychology, and sociology were used. Twenty-seven theory-based articles and book chapters published since 1989 and a convenience sample of 88 research articles published in 1997 were used. This sample was selected from 16,480 articles published 1993 to 1998. METHODS: Concept clarification comparisons to identify the major attributes of several closely related concepts, including well-being, satisfaction with life, and functional status. Major attributes were validated by a panel of cohorts who met weekly for five consecutive weeks for the purpose of analyzing various concepts. FINDINGS: Quality of life is comprised of subjective indicators such as well-being and satisfaction with life and objective indicators, such as functional status. Continued dialog and research is necessary to distinguish between the concepts of health and quality of life. CONCLUSIONS: A model showing the relationships among quality of life, well-being, functional status, and satisfaction with life is provided and a definition of quality of life is offered. Researchers and authors should include the definition of quality of life used in their work. Instruments should reflect the theoretic definition used. Care should be taken to clarify if functional status, well-being, satisfaction with life are the concepts under consideration as reflecting a part of overall quality of life.

Humans↗
PubMed2001

[Association between life events, subjective health status and health practices in a rural population].

A survey has been conducted on subjective health status, experience of life events in recent 1 year, and health practices in the rural of Kagawa prefecture. The survey was performed from March 1995 to May 1995 with 4,013 participants, aged 40 to less than 80. The proportion of respondents who recognized their physical conditions as good decreased with age. However, the proportion of respondents who recognized their life satisfaction as good increased with age. 'Health-related' life events were the most common experienced life events for both male and female. The proportion of respondents who had life events of type 'family', 'financial', 'at workplace or job', 'in the community', and 'others' decreased with age. Men had higher proportion of 'at workplace or job' life events. The higher proportion of respondents who experienced life events recognized their subjective health status poor. For male, it observed that poor physical health status had significant association with experience of type 'in the community' and 'environmental' life events. Poor mental health status significantly associated with experience of type 'at workplace and job' life events for male, and with 'health-related' and 'family' life events for female. Poor life satisfaction significantly associated with 'at workplace or job' and 'in the community' life events for male, and with 'health related' and 'family' life events. Higher proportion of the respondents who experienced life events and recognized their subjective health status poor had low health practice scores. Logistic regression analysis showed that experience of life events and poor subjective health status had significant association with the poor health practices, especially with 'body weight changed' for both male and female.

Adult↗
PubMed1998

Incorporating individualized quality of life measures in the evaluation of pharmacy services: the IN*COMPASS framework.

Quality of life is a fascinating field to researchers and practitioners alike. To some researchers, quality of life is of interest because it offers untold challenges in constructing instruments and capturing data necessary to answer key questions about health, disease, and treatment. For such researchers, quality of life is about statistical relationships among questions and about using questions to define the physical, social, and emotional domains of health. To other researchers, this field is about finding practical applications in policy and treatment decision making for the information provided by quality of life assessments. To these researchers, the focus of quality of life is on ways to apply knowledge of quality of life differences between groups with and without specific diseases or ways to use knowledge about how treatments affect the quality of life of various patient populations. To practitioners, quality of life is about treatment outcomes that impact individual patients' daily lives. It is the practitioner that Funderburk, Pleil, and Pathak are considering in their paper in this issue of Pharmacy Practice Management Quarterly. These authors give several important messages to practitioners seeking to serve their patients by incorporating quality of life into their practices. The key message in the paper is that to better understand and determine the impact of treatment on a patient's quality of life, it is critical to start with a baseline or reference point relevant to that patient. From that baseline or reference point, treatment decisions can be made and progress, in quality of life terms, can be evaluated. Critical questions in their framework, which is called the IN*COMPASS (Individualized Client Oriented Method for Preferred Alleviation of Sickness States) Approach, are "How are you now?" and "How would you like to be?" The authors do not endorse particular quality of life tools in their approach; rather they prescribe certain critical questions that must be answered if information captured by any quality of life tool is to be useful at the patient level. Readers should not be put off by the fancy acronym used in this paper; nor must readers be keen students of quality of life to appreciate its message. The IN*COMPASS approach is fundamental to good patient care and can be applied by practitioners with any level of understanding of and appreciation for quality of life assessments.

Education, Pharmacy↗
PubMedDate not supplied

[Quality of life and its measurement].

INTRODUCTION: At present quality of life has a significant place within health care and scientific research work. This interest is stimulated by the fact that people want to live, not just to survive. The problem of quality of life in persons whose lives could not be preserved, opens discussions concerning artificial subsistence of life, euthanasia etc. This is not a new topic. What is new is development of official ways to measure quality of life and their routine application. CONCEPT OF QUALITY OF LIFE: In general, quality of life can be defined as the level of well-being. It cannot be identified with health, but probably primarily with ability to conduct an economically and socially productive life. Quality of life refers to physical, psychological and social domains of health, being influenced by one's experience, beliefs, expectations and perceptions. There is no consensus concerning the concept of quality of life and according to the same authors it includes functional ability, level and quality of social interactions, physical welfare, somatic sensations and life satisfaction. Generally speaking concepts include numerous dimensions and possibilities occurring during life, to death itself (Table 1). Although objective dimension of health is important in assessment of patient's health, subjective estimation and expectations make, what is found to be an objective situation, experienced quality of life (Graph. 1). MEASURING QUALITY OF LIFE: The most difficult task is to present various segments of health into quantitative values. All data can be measured at nominal, ordinal, interval or ratio scales. The nominal scale uses numbers and other symbols in classification of characteristics. Categories cannot be classified according to volume and are mutually exclusive. Ordinal scales are used when measuring a limited number of categories classified according to quality. Interval scales measure an unlimited number of categories with equal intervals and they are without a real zero point. Ratio scales have all the characteristics of interval scales, but they have real zero points. CHOICE OF MEASURING INSTRUMENTS: There are different instruments to assess quality of life such as generic instruments, battery scales and modular instruments index methods and instruments. The measuring instruments should be reliable, valid, responsive and sensitive. QUALITY OF LIFE EVALUATION: Three design studies are most frequently used: cross-sectional or nonrandomized longitudinal studies, randomized studies of clinical interventions and cost-effective and cost benefit analyses.

Humans↗
PubMed2001

Women's exposure to early and later life socioeconomic disadvantage and coronary heart disease risk: the Stockholm Female Coronary Risk Study.

BACKGROUND: Measures of low socioeconomic position have been associated with increased risk for coronary heart disease (CHD) among women. A more complete understanding of this association is gained when socioeconomic position is conceptualized from a life course perspective where socioeconomic position is measured both in early and later life. We examined various life course socioeconomic indicators in relation to CHD risk among women. METHODS: The Stockholm Female Coronary Risk Study is a population-based case-control study, in which 292 women with CHD aged < or =65 years and 292 age-matched controls were investigated using a wide range of socioeconomic, behavioural, psychosocial and physiological risk factors. Socioeconomic disadvantage in early life (large family size in childhood, being born last, low education), and in later life (housewife or blue-collar occupation at labour force entry, blue-collar occupation at examination, economic hardships prior to examination) was assessed. RESULTS: Exposure to early (OR = 2.65, 95% CI : 1.12-6.54) or later (OR = 5.38, 95% CI : 2.01-11.43) life socioeconomic disadvantage was associated with increased CHD risk as compared to not being exposed. After simultaneous adjustment for marital status and traditional CHD risk factors, early and later socioeconomic disadvantage, exposure to three instances of socioeconomic disadvantage in early life was associated with an increased CHD risk of 2.48 (95% CI : 0.90-6.83) as compared to not being exposed to any disadvantage. The corresponding adjusted risk associated with exposure to later life disadvantage was 3.22 (95% CI : 1.02-10.53). Further analyses did not show statistical evidence of interaction effects between early and later life exposures (P = 0.12), although being exposed to both resulted in a 4.2-fold (95% CI : 1.4-12.1) increased CHD risk. Exposure to cumulative socioeconomic disadvantage (combining both early and later life), across all stages in the life course showed strong, graded associations with CHD risk after adjusting for traditional CHD risk factors. Stratification of cumulative disadvantage by body height showed that exposure to more than three periods of cumulative socioeconomic disadvantage had a 1.7- (95% CI : 0.9-3.2) and 1.9- (95% CI : 1.0-7.7) fold increased CHD risk for taller and shorter women, respectively. The combination of both short stature and more than two periods of cumulative socioeconomic disadvantage resulted in a 4.4-fold (95% CI : 1.7-9.3) increased CHD risk. CONCLUSIONS: Both early and later exposure to socioeconomic disadvantage were associated with increased CHD risk in women. Later life exposure seems to be more harmful for women's cardiovascular health than early life exposure to socioeconomic disadvantage. However, being exposed to socioeconomic disadvantage in both early and later life magnified the risk for CHD in women. Cumulative exposure to socioeconomic disadvantage resulted in greater likelihood of CHD risk, even among women who were above median height. In terms of better understanding health inequalities among women, measures of socioeconomic disadvantage over the life course are both conceptually and empirically superior to using socioeconomic indicators from one point in time.

Adult↗
PubMed1998

[Daily life patterns associated with 18-months changes of disability among frail elderly living at home].

The purpose of this study was to investigate daily life patterns associated with changes of disability over 18-months among frail elderly living at home. Subjects were 50 frail elderly living at home who were interviewed at baseline, in July-September 1995. By detailed time budgets among them, five life patterns were classified. Lying-rest life pattern, Sitting-rest life pattern, Hobby life pattern, Walking life pattern, and Houseworking life pattern. Activities of daily living (ADL) measured by Extended ADL Index consisted of 8 items of Barthel Index and 4 items of TMIG Index of Competence. Information for follow-up were obtained from home health nurses or mail-questionnaires February-March in 1997. The results were as follows: All samples were able to be followed. Seven people died within the 18 months follow-up. Overall change of score on ADL was not seen between baseline and follow-up study. ADL improvement was seen in 45.0% and 43.7% had declines. Daily life patterns were not correlated with changes in ADL score. However, analysis of decline in ability to perform each activities, relative associations (not statistically significant) were found for changes in function and daily life patterns. Lying-rest life pattern and Sitting-rest life pattern elderly were more likely to decline in ADL than Walking life pattern and HouseworKing life pattern elderly. Hobby life pattern elderly only declined in walking. These findings support previous studies showing that disability of home frail elderly could be improved. Daily life pattern among them would be a helpful predictor of changes in specific physical performance over years.

Activities of Daily Living↗
PubMed2006

Moderate and severe erectile dysfunction equally affects life satisfaction.

PURPOSE: To explore the life satisfaction of patients with erectile dysfunction (ED) and to examine the relation between severity of ED and life satisfaction. MATERIALS AND METHODS: The study sample was recruited from patients who presented in an andrologic outpatient clinic complaining of ED. All patients underwent the basic clinical evaluation and were assessed by the International Index of Erectile Dysfunction (IIEF) and the Life Satisfaction Inventory (LSI). RESULTS: The study included 69 patients with ED (age range 22-71 years, mean 49.5, SD 13.7). The LSI appeared to have satisfactory internal consistency (Cronbach's alpha = 0.82). Men with ED had significantly lower satisfaction with their sexual life (t = -13.756, d.f. = 68, P = 0.000), but also significantly lower total score of satisfaction with their life (t = -2.793, d.f. = 68, P = 0.007) compared with available normative data from healthy population. However, when compared with controls, men with ED showed significantly higher satisfaction scores on their financial status (t = 5.075, d.f. = 68, P = 0.000) and on their leisure time activities (t = 4.029, d.f. = 68, P = 0.000). Regarding ED severity, mild ED affects patients' satisfaction with sexual life less than do moderate and severe ED. Interestingly, no difference was identified between moderate and severe ED groups. CONCLUSIONS: Men who seek help for ED have lower satisfaction with sexual life and lower satisfaction with their overall life compared with healthy people. Severity of ED seems to be an important factor, as men with moderate ED perceive the impact of ED on their life satisfaction equally with those with severe ED. ED patients gain more satisfaction from other domains of their life, provided they adopt coping behaviors that help compensate for their low overall life satisfaction. Furthermore, as ED patients do not differ from healthy people in their expressed subjective rating of quality of life (QoL), life satisfaction may be more sensitive than QoL assessment in the evaluation of the impact of ED on our patients' life.

Adult↗
PubMed2004

Life-lines of Finnish people aged 83-87.

This article presents the characteristics of the life-lines drawn by older Finnish men and women. The study was part of the Evergreen Project, Finland. Seventy-eight persons aged 83-87 participated in an interview, in which they were asked to draw a life-line. The life-line was drawn on a standardized sheet as a continuous line which showed the intensity of positive and negative affects during the course of life. An interview concerning the major life events on the life-line and the most positive and negative life periods was administered after the life-line was drawn. The shape of the life-line was analyzed by calculating the level, trend, and variance, as well as the maximum and minimum points. The content analysis of the life-lines was based on self-reports concerning the major life events and the most positive and negative periods in life. The drawings mostly showed an upward trend. On average, women drew the line on a slightly higher level than men. Interindividual variance was greatest in early childhood and old age and smallest in middle age, whereas intra-individual variance was greatest in early adulthood and smallest in old age. Most of the lowest points were located in childhood and the highest points in the present (old age). The densest period in terms of the location of major life events and their affective meaning was youth and young adulthood (15-30 years). The most frequently expressed contents of the life-line dealt with human relationships and school in women, and work-related issues and war in men.

Aged↗
PubMed2004

Caliber of quality-of-life assessments in congenital heart disease: a plea for more conceptual and methodological rigor.

BACKGROUND: Interest in quality-of-life issues in children, adolescents, and adults with congenital heart disease has increased significantly during the past decades. In general, quality-of-life research is stimulated by an overall interest in outcomes. More specifically, quality-of-life studies add to mortality and morbidity data by taking reported physical, psychological, and social problems into consideration. However, quality of life can be an ambiguous concept that is hindered by methodological weaknesses, a situation that can prevent the drawing of firm conclusions. OBJECTIVE: To appraise the conceptual and methodological rigor of published quality-of-life assessments in patients with congenital heart disease. DESIGN: A review of 70 articles published in the medical literature, using the 10 criteria previously developed by Gill and Feinstein. For each criterion, the number of articles complying with that criterion was counted, and the percentage was calculated. To indicate how well individual articles performed on the respective criteria, a summary score was calculated by summing the number of criteria an article fulfilled and dividing this sum by the number of criteria for which the article was eligible to be evaluated; the resulting value was then multiplied by 100. MAIN OUTCOME MEASURE: Summary scores ranging from 0, for articles complying with none of the criteria, to 100, for articles complying with all of the criteria. RESULTS: We found that quality-of-life assessments in patients with congenital heart disease showed major conceptual and methodological drawbacks (median summary score, 0). Moreover, we found that the term quality of life was often used inappropriately, an observation supported by several articles in which the authors drew conclusions about patients' quality of life, even though quality of life was not specifically measured. CONCLUSIONS: A poor conceptual and methodological basis for quality of life implies that many results from quality-of-life studies performed in patients with congenital heart disease contribute little to the scientific knowledge base of quality of life in this patient population. Future quality-of-life studies need to invest in a rigorous conceptualization, an adequate operational definition, and a sound measurement of quality of life.

Adolescent↗
PubMed2004

Quality of life in patients with osteoporosis.

Complaints regarding, and morbidity of, osteoporosis are caused by fractures which are associated with pain and decrease of physical function, social function, and well-being. These are aspects of quality of life. Health-related quality of life covers physical, mental, and social well-being. Quality of life may be measured for evaluation of treatment effects in clinical trials, for the assessment of the burden of the disease of osteoporosis, and for estimates of the cost-effectiveness of different treatment scenarios in health care policy. Quality of life has been measured in patients with osteoporosis with generic questionnaires such as SF-36 and EQ-5D, which can be used in many diseases, or with one of the six available osteoporotic-specific questionnaires, e.g., Qualeffo-41 or OPAQ. Every questionnaire has to be validated to assess psychometric properties and discrimination power between patients with osteoporosis and control subjects. The value attached to specific health states (utility) can be assessed with some generic instruments or by systematic questioning of the patient, e.g., the time-trade-off method. This results in one value for health status ranging from 0 (death) to 1 (perfect health). Utility values can be used to calculate loss of quality-adjusted life years (QALY). Most data have been obtained in patients with prevalent vertebral fractures. Scores of specific and generic questionnaires showed significant loss of quality of life with prevalent vertebral fractures. In addition, studies with Qualeffo-41 and OPAQ showed a deteriorating quality of life with increasing number of vertebral fractures. Lumbar fractures had more impact on quality of life than thoracic fractures. Incident vertebral fractures were also associated with a decrease of quality of life especially in the physical function domain. This applied to clinical incident vertebral fractures as well as to subclinical fractures to a lesser degree. Loss of quality of life following hip fracture has been documented with generic and osteoporosis-specific questionnaires. A considerable loss was observed in the 1st year with some improvement in the 2nd year, but not to baseline values. Quality of life depended on comorbidity, mobility, activities of daily life (ADL)-independence, and fracture complaints. Utility loss has been observed following hip fracture, especially disabling hip fracture, hip and vertebral fracture combined, or multiple vertebral fractures. Utility following osteoporotic fractures has been valued by patients, the healthy elderly, and panels of experts. The healthy elderly gave the worse quality-of-life scores (lower utility) to various hip fractures than patients with hip fractures themselves. In conclusion, suitable instruments exist for measuring quality of life in patients with osteoporotic fractures. These instruments are useful for clinical trials and for assessment of the burden of disease.

Fractures, Bone↗